The South Dakota Association of Healthcare Organizations (SDAHO) has joined a lawsuit with 21 LeadingAge state affiliates, membership associations that represent hundreds of not-for-profit aging services providers across the country, in addition to 20 state Attorneys General to overturn the Centers for Medicaid and Medicare Services’ (CMS) staffing mandate.
This lawsuit was initiated by the three Attorneys General from the states of Kansas, South Carolina, and Iowa, and was filed October 8th in the Northern District of Iowa. Multiple other Attorneys General have joined the lawsuit including Alabama, Alaska, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Missouri, Montana, Nebraska, Oklahoma, North Dakota, South Dakota, Utah, Virginia, and West Virginia. While the Attorneys General will focus on the undue burden the mandate will have on state budgets and taxpayers, we, as co-plaintiffs, can express concerns on how the mandate may impact access to care for seniors in our state.
A press release was submitted on October 9, 2024 regarding SDAHO’s involvement in the lawsuit, Kansas v. Becerra, No. 1:24-cv-00110 (N.D. Iowa), which can be viewed here.
There are two primary purposes to our strategy in joining the lawsuit:
- To push back on harmful mandates for our members and nursing homes across the country. To reinforce standing and substantive arguments for the states’ suit and injunction, we completed a “Declarations of Harm” that outlines specifics on how the mandate will harm our members if allowed to take effect.
- To seek to vacate certain of the more onerous requirements in the rule. By joining, we have asked the court to vacate and declare unlawful the (i) staffing requirement, (ii) enhanced facility assessment and (iii) HPRD requirements. This focused approach would provide relief from the most burdensome aspects of the rule.
SDAHO Advocacy in Action
Why Did South Dakota Join the Lawsuit?
SDAHO shares CMS’ goal of ensuring older adults and others have access to high quality skilled nursing care. We have continued to advocate, along with LeadingAge National, that the staffing mandate as written is untenable, given the documented shortage of registered nurses and other nursing professionals in our state and across the country.
As more local LeadingAge State Affiliates joined the lawsuit, it became clear we needed to take advantage of this opportunity to advocate for our members, and for non-member skilled nursing providers. After a vote by the SDAHO Board of Directors, we joined the lawsuit in early September.
Not only does this lawsuit seek to overturn the staffing mandate but also seeks to reserve a claim for preliminary injunction. If the injunction is granted, it could stop some of the more onerous staffing mandate requirements for our members while the lawsuit navigates the court system.
The purpose of our joining the suit includes:
- Despite our best efforts to advocate for changes to the Rule, the staffing mandate provisions contain problematic provisions that ultimately could harm South Dakota residents’ access to skilled nursing care.
- If a preliminary injunction is granted it could be narrowly tailored, and we want to make sure that at the very least, the onerous requirements will be paused for SDAHO members. We continue to advocate that the mandate be paused for all nursing homes, but the likelihood of that outcome is unclear at this time.
- The Rule as written is untenable and unattainable for our members. We estimate the staffing mandate will cost each nursing home in South Dakota, on average, an additional $205,000 each year. Collectively, we anticipate that the rule will cost nursing homes in South Dakota roughly $20 million per year. The Rule contains no additional funding to support nursing homes in addressing these increased costs.
- There are simply not enough registered nurses or nursing assistants to meet this mandate. The cost of implementing the proposed staffing mandate will damage nursing homes. The cost of delivering quality care already far exceeds Medicaid reimbursement, and this unfunded mandate will further jeopardize nonprofit and mission-driven nursing homes’ ability to continue to serve older adults and families—forcing them to consider limiting admissions or even closing.
- Based on recent PBJ data (Payroll Based Journalling data is reported to CMS by every nursing home and is how staffing data is evaluated) we estimate that collectively, nursing homes in South Dakota would need to employ 64 more full-time registered nurses, and 190 full-time nursing assistants to comply with the staffing mandate requirements. Unfortunately, these additional registered nurses and nursing assistants do not exist.
South Dakota Impact:
We estimate the staffing mandate will cost each nursing home in South Dakota, on average, an additional $205,000 each year. Collectively, we anticipate that the rule will cost nursing homes in South Dakota roughly $20 million per year. The Rule contains no additional funding to support nursing homes in addressing these increased costs.
Based on recent PBJ data (Payroll Based Journaling data is reported to CMS by every nursing home and is how staffing data is evaluated) we estimate that collectively, nursing homes in South Dakota would need to employ 64 more full-time registered nurses, and 190 full-time nursing assistants to comply with the staffing mandate requirements. Unfortunately, these additional registered nurses and nursing assistants do not exist.
