A new analysis says that Tennessee will be among the states hardest hit by so-called "bad debt" provisions passed in the Middle Class Tax Relief and Job Creation Act of 2012.

The report from Avalere Health states that more than $3 billion will be cut from skilled nursing facility payments and that Tennessee is among the top 10 states that will absorb the bulk of those cuts. For fiscal 2015, the negative impact on Tennessee will be approximately $17.5 million.

Quoted in the report is Alan G. Rosenbloom, president of the Alliance for Quality Nursing Home Care, who notes that “SNFs have no legal recourse to collect 'bad debt' from state Medicaid agencies — and is more accurately described as 'uncollectible debt' as mandated by federal law.”

According to the release, “The Alliance leader pointed out the SNF sector is already slated to absorb another $48 billion in Medicare reductions between FY 2012-21, and that SNFs also remain disproportionately reliant on Medicaid as compared to other providers — with Medicaid paying for 57 percent of patient days.”

The SNF sector is America's second-largest health facility employer.