South Dakota Association of Healthcare Organizations COO Tammy Hatting, along with Director of Advocacy and Reimbursement Jacob Parsons, presented to the Joint Appropriations Committee, Tuesday May 21, 2024. The meeting took place at the state Capitol in Pierre, with Hatting and Parson’s focusing their presentation on the impact the Center’s for Medicare and Medicaid Services (CMS) finalized staffing mandate will have on nursing homes.
Hatting shared with lawmakers, “the new requirements pose a serious threat to nursing homes nationwide.”
The new rule requires nursing homes to complete a comprehensive facility assessment by August 8, 2024. Once the final rule is fully implemented, nursing homes are required to provide 3.48 total nurse staff hours per resident day, on site RN coverage 24/7, and possibly higher ratios, depending on resident acuity.
One of many concerns for Hatting includes the CMS decision to follow the Office of Management and Budget (OMB) definition of rural vs. urban, rather than the Health Resources and Services Administration (HRSA) definition. “Many of our smaller communities across the state are considered urban as defined in the new rule. We are seeking clarification on the OMB definition and working to raise the population threshold to redefine what qualifies as an urban area. The way it is defined now would mean a town like Canton or Canistota could be considered urban, so we will continue to work on changing that definition”.
Hatting says, “I feel it is very important to get all our state lawmakers up to speed on this new federal rule because the clock is ticking and if the deadlines are not met, nursing homes could face serious monetary penalties. Deadlines for implementation are set based on whether a facility is considered urban or rural. May 10, 2026, is the deadline for urban facilities and May 10, 2027, for rural facilities to meet the 24/7 RN requirement.” In addition to the 24/7 RN requirement, the final rule also requires rural facilities to have at least 0.55 of the 3.48 hours of daily care per resident coming from a registered nurse. 2.45 hours must come from a certified nurse assistant. Hatting shared with lawmakers; these requirements create an imminent staffing crisis concern. “South Dakota has over 1,200 nursing jobs that need to be filled today, and estimates show that 15% of nurses will be retiring in the next five years. RN’s and CNAs are hard positions to fill, especially after the pandemic.”
Congress currently has several bills that have been introduced, that range from stopping the rule to providing grant funding to help states address the workforce crisis. SDAHO along with several stakeholder groups are working with South Dakota’s congressional delegation to take action and ask the Centers for Medicare and Medicaid Services (CMS) to pull back the new federal rule and come to the table with key stakeholders to develop a comprehensive plan for improving quality of care in our nursing homes.
Hatting shared with lawmakers, “The part where you come in is with the impact of the total cost to South Dakota and our providers, so I think it is important you are aware of the financial pressure to come. Nationally CMS has calculated the total cost of the final rule being $43 billion over 10 years, that is $4.3 billion dollars per year to meet this mandate. In the final rule, CMS stated their expectations for the cost to be shared, 67% by Medicaid, 11% by Medicare and 22% by other. This is an unfunded mandate being placed on the state and nursing homes at no fault of their own”.
In addition, the estimated additional yearly cost to meet the proposed staffing regulation in South Dakota is $18,677,719.00, which is roughly $190,489 per nursing home.
State lawmakers applauded SDAHO for their presentation, Senator Jim Bolin of Canton commenting, “This is a really big deal, and I don’t know if anyone from the press is listening but this is a big story that could have a huge impact on South Dakota and I would urge them to dig into this, as this is a very big thing especially as we are a state with an aging population. This is very important.”
Lead Co-Chair, Rep. Micheal Derby also shared the importance of the issue and it being worthy of keeping on the agenda for the next meeting.
To view the presentation presented by SDAHO at the May 21, 2024, JCA meeting – click here.
To listen to the full presentation, provided by SDPB, Click Here.
