Mississippi Today
Lawmakers weigh possible changes to certificate of need law
A new committee convened this week at the Capitol to discuss changes to the state’s law requiring medical facilities to seek state approval before offering new or expanded services.
Health leaders said there is room to strengthen the law with reforms but cautioned against doing away with it entirely.
The law, which requires medical facilities to apply for a โcertificate of need,โ aims to lower costs and increase the accessibility and quality of health care in the state by avoiding duplication of services.
Critics argue that the law stifles competition in the state’s already sparse health care ecosystem and does little to decrease costs. Advocates say it ensures that communities have access to a range of services, not just those that are profitable for providers.ย
Nationwide, the laws have not accomplished much of what they were intended to, like increase quality or reduce costs, State Health Officer Dr. Daniel Edney told committee members on Monday.
But the law has been โextremelyโ successful at preventing health care companies from choosing only to offer only the most profitable services to patients, he said.
โWhen we’re looking at a very fragile health care framework, especially in rural areas of the state, cherry-picking can be disastrous,โ he said. โIt can be catastrophic.โ
When health centers choose to offer only services with a high-profit margin, he explained, it can draw business away from hospitals that provide services at a loss, like inpatient and emergency care. He said this applies in both rural and urban areas.
Rural hospitals in Mississippi are struggling to stay afloat. Over half are at risk of closing, and 64% are operating with losses on services. More than half of Mississippi residents live in a rural area.ย
Richard Roberson, the incoming president and CEO of the Mississippi Hospital Association, said he believes it is unlikely that removing certificate of need requirements will incentivize investment in areas of the state with the highest need for new health care services.
โWhat I suspect is you’re going to see an overproliferation of services in more commercially insured areas,โ he said. โAnd if you’re talking about folks coming in and investing money, that’s where they’re going to put it, where they can make their money back.โ
Gov. Tate Reeves has advocated for abolishing certificate of need laws in the state, arguing that it will allow more competition and innovative health care services to flourish.
Last session, a bill sponsored by Sen. Angela Burks Hill, R-Picayune, sought to repeal the state’s certificate of need law, but it died in committee.ย
Bills seeking to repeal or reform the law have become run-of-the-mill in the statehouse. Last year, over two dozen bills sought to modify the state’s certificate of need law.ย
Legislators in 2016 made several changes to the law, including shortening application review timelines and increasing capital expenditure thresholds.
States were first required to implement certificate of need laws in 1974 in order to receive funding for certain federal programs. Today, 35 states operate certificate of need programs, and 12 have repealed their laws entirely, according to the National Conference of State Legislatures.ย
Laurin St. Pรฉ, CEO of the nonprofit Singing River Health System, said that without the certificate of need law, private equity-backed companies could open health centers near existing hospitals, drawing away patients with insurance.
Hospitals with emergency departments are required to provide emergency care to patients regardless of insurance status under the Emergency Medical Treatment and Labor Act. These hospitals depend on providing services to patients with insurance to offset losses from uncompensated care.
โIf they siphon (insured patients) off, we’re not going to be able to take care of those with the most need,โ he said.
Over 10 percent of Mississippians do not have health insurance, according to data from KFF.ย
Edney said that Medicaid expansion could offset risks associated with repealing the certificate of need law by lowering the rate of people in the state without insurance in response to a question from House Medicaid Chair Missy McGee, R-Hattiesburg.
McGee authored the Medicaid expansion bill that died earlier this year.ย Mississippi remains one of 10 states in the country not to have expanded Medicaid.
โAs we close the coverage gap, that does create more revenue into the system that flows to the hospitals,โ Edney said.
Keith Norman, vice president and chief government affairs officer for Baptist Memorial Health Care, agreed.
โI believe expansion goes hand in hand with this conversation,โ he said.
Though Edney and Roberson cautioned lawmakers of the impacts of repealing certificate of need law, they agreed that reforms could improve the program.
Roberson suggested that allowing hospitals to offer dialysis services without a certificate of need would reduce patient transfers to other hospitals. Many small hospitals do not have their own dialysis centers.
He also proposed allowing hospitals to operate home health services, which would reduce rates of readmission to the hospital. The Centers for Medicare and Medicaid Services penalizes hospitals when readmissions top the national average. Hospitals in the Delta have in the past faced high penalty rates for readmissions.ย
Edney added psychiatric and perinatal care to the list of services he believed should not have to undergo the review process due to the state’s dearth of such care.
The application itself should also be reformed to prevent long, costly appeals, said Edney.
Last year, an applicant vying to provide โmuch-neededโ ambulatory care in the Delta โ a region of the state with limited health care services โ withdrew its application after its certificate of need approval was contested. He said the hospital did not have the resources to sustain a potentially years-long legal struggle.
โWe go through these long battles that are very costly, just to get to the same ruling,โ Edney said.
The State Department of Health approves 95% of certificate of need applications, he said.
Edney also suggested that lawmakers consider more vigorous enforcement of existing certificates of need, noting that some health care facilities do not follow through on the commitments made in their applications.
โWe’re lacking accountability and transparency in the CON world,โ he said.
Rep. Henry Zuber III, R-Ocean Springs, co-chair of the committee, said the group will explore a range of possibilities for certificate of need reform before drafting any legislation. The group will meet again on Sep.10.
โEverything, everything is on the table,โ Zuber said.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
A Mississippi town moves a Confederate monument that became a shrouded eyesore
GRENADA (AP) โ A Mississippi town has taken down a Confederate monument that stood on the courthouse square since 1910 โ a figure that was tightly wrapped in tarps the past four years, symbolizing the community’s enduring division over how to commemorate the past.
Grenada’s first Black mayor in two decades seems determined to follow through on the city’s plans to relocate the monument to other public land. A concrete slab has already been poured behind a fire station about 3.5 miles (5.6 kilometers) from the square.
But a new fight might be developing. A Republican lawmaker from another part of Mississippi wrote to Grenada officials saying she believes the city is violating a state law that restricts the relocation of war memorials or monuments.
The Grenada City Council voted to move the monument in 2020, weeks after police killed George Floyd in Minneapolis. The vote seemed timely: Mississippi legislators had just retired the last state flag in the U.S. that prominently featured the Confederate battle emblem.
The tarps went up soon after the vote, shrouding the Confederate soldier and the pedestal he stood on. But even as people complained about the eyesore, the move was delayed by tight budgets, state bureaucracy or political foot-dragging. Explanations vary, depending on who’s asked.
A new mayor and city council took office in May, prepared to take action. On Sept. 11, with little advance notice, police blocked traffic and a work crew disassembled and removed the 20-foot (6.1-meter) stone structure.
“I’m glad to see it move to a different location,” said Robin Whitfield, an artist with a studio just off Grenada’s historic square. “This represents that something has changed.”
Still, Whitfield, who is white, said she wishes Grenada leaders had invited the community to engage in dialogue about the symbol, to bridge the gap between those who think moving it is erasing history and those who see it as a daily reminder of white supremacy. She was among the few people watching as a crane lifted parts of the monument onto a flatbed truck.
“No one ever talked about it, other than yelling on Facebook,” Whitfield said.
Mayor Charles Latham said the monument has been “quite a divisive figure” in the town of 12,300, where about 57% of residents are Black and 40% are white.
“I understand people had family and stuff to fight and die in that war, and they should be proud of their family,” Latham said. “But you’ve got to understand that there were those who were oppressed by this, by the Confederate flag on there. There’s been a lot of hate and violence perpetrated against people of color, under the color of that flag.”
The city received permission from the Mississippi Department of Archives and History to move the Confederate monument, as required. But Rep. Stacey Hobgood-Wilkes of Picayune said the fire station site is inappropriate.
“We are prepared to pursue such avenues that may be necessary to ensure that the statue is relocated to a more suitable and appropriate location,” she wrote, suggesting a Confederate cemetery closer to the courthouse square as an alternative. She said the Ladies Cemetery Association is willing to deed a parcel to the city to make it happen.
The Confederate monument in Grenada is one of hundreds in the South, most of which were dedicated during the early 20th century when groups such as the United Daughters of the Confederacy sought to shape the historical narrative by valorizing the Lost Cause mythology of the Civil War.
The monuments, many of them outside courthouses, came under fresh scrutiny after an avowed white supremacist who had posed with Confederate flags in photos posted online killed nine Black people inside the historic Emanuel African Methodist Episcopal Church in Charleston, South Carolina, in 2015.
Grenada’s monument includes images of Confederate president Jefferson Davis and a Confederate battle flag. It was engraved with praise for “the noble men who marched neath the flag of the Stars and Bars” and “the noble women of the South,” who “gave their loved ones to our country to conquer or to die for truth and right.”
A half-century after it was dedicated, the monument’s symbolism figured in a voting rights march. When the Rev. Martin Luther King Jr. and other civil rights leaders held a mass rally in downtown Grenada in June 1966, Robert Green of the Southern Christian Leadership Conference scrambled up the pedestal and planted a U.S. flag above the image of Davis.
The cemetery is a spot Latham himself had previously advocated as a new site for the monument, but he said it’s too late to change now, after the city already budgeted $60,000 for the move.
“So, who’s going to pay the city back for the $30,000 we’ve already expended to relocate this?” he said. “You should’ve showed up a year and a half ago, two years ago, before the city gets to this point.”
A few other Confederate monuments in Mississippi have been relocated. In July 2020, a Confederate soldier statue was moved from a prominent spot at the University of Mississippi to a Civil War cemetery in a secluded part of the Oxford campus. In May 2021, a Confederate monument featuring three soldiers was moved from outside the Lowndes County Courthouse in Columbus to another cemetery with Confederate soldiers.
Lori Chavis, a Grenada City Council member, said that since the monument was covered by tarps, “it’s caused nothing but more divide in our city.”
She said she supports relocating the monument but worries about a lawsuit. She acknowledged that people probably didn’t know until recently exactly where it would reappear.
“It’s tucked back in the woods, and it’s not visible from even pulling behind the fire station,” Chavis said. “And I think that’s what got some of the citizens upset.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Crooked Letter Sports Podcast
Podcast: New Orleans sports columnist and author Jeff Duncan joins the podcast to talk about his new Steve Gleason book and the new-look New Orleans Saints.
Jeff Duncan went from the Mississippi Book Festival in Jackson on Saturday to Jerry World in Dallas on Sunday where he watched and wrote about the Saints’ total dismantling of the Dallas Cowboys. We talk about both events and also about what happened in high school and college football last weekend and what’s coming up this weekend.
Stream all episodes here.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1899
Sept. 18, 1899
Scott Joplin, known as โthe King of Ragtime,โ copyrighted the โMaple Leaf Rag,โ which became the first song to sell more than 1 million copies of sheet music. The popularity launched a sensation surrounding ragtime, which has been called America’s โfirst classical music.โย
Born near Texarkana, Texas, Joplin grew up in a musical family. He worked on the railroad with other family members until he was able to earn money as a musician, traveling across the South. He wound up playing at the World’s Fair in Chicago in 1893, where he met fellow musician Otis Saunders, who encouraged him to write down the songs he had been making up to entertain audiences. In all, Joplin wrote dozens of ragtime songs.
After some success, he moved to New York City, hoping he could make a living while stretching the boundaries of music. He wrote a ragtime ballet and two operas, but success in these new forms eluded him. He was buried in a pauper’s grave in New York City in 1917.
More than six decades later, his music was rediscovered, initially by Joshua Rifkin, who recorded Joplin’s songs on a record, and then Gunther Schuller of the New England Conservatory, who performed four of the ragtime songs in concert: โMy faculty, many of whom had never even heard of Joplin, were saying things like, โMy gosh, he writes melodies like Schubert!’โ
Joplin’s music won over even more admirers through the 1973 movie, โThe Sting,โ which won an Oscar for the music. His song, โThe Entertainer,โ reached No. 3 on Billboard and was ranked No. 10 among โSongs of the Centuryโ list by the Recording Industry Association of America. His opera โTreemonishaโ was produced to wide acclaim, and he won a Pulitzer Prize in 1976 for his special contribution to American music.ย
โThe ragtime craze, the faddish thing, will obviously die down, but Joplin will have his position secure in American music history,โ Rifkin said. โHe is a treasurable composer.โ
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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