PIERRE, S.D. (KELO) — A federal rule to raise staffing requirements would widen the workforce gap that’s already keeping many nursing homes and assisted living centers in South Dakota from accepting more patients, two health care leaders said Monday.
The Legislature’s Study Committee on Sustainable Models for Long Term Care received warnings about the possible impacts from Tammy Hatting, who is chief operating officer for the South Dakota Association of Healthcare Organizations that represents hospitals and various other health care providers, and from Mark Deak (DAY-ak), executive director for the South Dakota Health Care Association that represents long-term care providers, including nursing homes, assisted living centers and congregate living.
Hatting described the Biden administration’s proposed rule for Medicaid- and Medicare-supported facilities as a tornado siren that’s sounding — “We don’t know if it will hit us or not,” she said — while Deak said it would be “a disaster” for South Dakota if the rule takes effect as now written.
Hatting gave lawmakers SDAHO’s analysis. One piece of the Centers for Medicaid and Medicare proposal calls for long-term care facilities to have a registered nurse on site 24/7 to provide care that would take effect two years after the rule is adopted. “Very few of our facilities meet this now,” she said. “And it will cost a fortune.”
Hatting said other parts of the proposal are objectionable, too. She noted that the 478-page report didn’t cover licensed practical nurses, who are widely used in South Dakota. “That will be a big talking point in our letters when we push back,” she said.
Hatting acknowledged that 38 states and the District of Columbia have some sort of minimum staff requirements but the long-term providers in those places can’t hire enough staff to meet them. She said the national cost of the CMS proposal is estimated at $1.5 billion to $6.8 billion, depending on the degree of what’s accepted, but there’s no federal funding attached.
A recent SDAHO survey found 985 openings for registered nurses in South Dakota, more than the 893 who graduated from South Dakota institutions in the past year, and 27% of the new RNs headed to other states, according to Hatting. “The gap is widening,” she said.
The proposed rule was published September 1 and the public comment period closes November 6. After that, the agency can take whatever time it chooses to reach a decision. The rule would take effect 60 days later.
“We want to inundate CMS with the impact this will have on our facilities,” Hatting told lawmakers. She said SDAHO leaders plan to talk Tuesday with South Dakota’s congressional delegation. One possibility is that CMS could withdraw it. “Which is what we’re hoping for,” she said.
The legislators broke into five workgroups Monday — regulatory, innovation, community-based services, workforce, and location/infrastructure — that developed lists of possible actions the committee can recommend.
The panel’s chair, Republican Senator Jean Hunhoff, said the committee will meet again in October. In the meantime, lawmakers along with Legislative Research Council staff and people from the long-term care industry will develop cost estimates for the various potential recommendations. Those dollar amounts will be part of the panel’s considerations next month when the recommendations are made for the 2024 legislative session that opens January 9.
“We’ve got these now. They’re not finalized. We have more work to do,” Hunhoff said.