Proposed changes to required staffing ratios for nursing homes were rejected without prejudice by the Legislative Regulation Review Committee (LRRC) during a December 17 meeting.
The motion, which came after several committee members voiced concerns about the impact the changes could have on pay for nursing home workers and the quality of care nursing homes provide, was unanimously adopted by present members. It was the second time the proposed regulation came before the committee.
The regulation proposed increasing the number of direct care staff for both licensed nurses and nurse’s aides for nursing homes and rest homes with nursing supervision to three hours per day. It also proposed increasing the number of social workers.
A report from the Office of Fiscal Analysis (OFA) estimated the changes would cost the Department of Social Services (DSS) approximately $380,000 annually.
But the first time the proposed regulation came before LRRC, in September 2023, the estimated costs were in the millions, as multiple committee members noted during the recent meeting.
Sen. John Kissel, R-East Granby, noted the committee had previously raised concerns about the fiscal impact. He also noted that while the impact on the Department of Public Health (DPH), responsible for the regulation, was minimal, the impact on DSS was much greater. He said he didn’t think the regulation should be allowed to go through unless its total impact on the budget was addressed.
Committee chair Rep. Lucy Dathan, D-Norwalk, added that she understood there might be foll0w-on costs to the estimated annual $380,000 impact on DSS resulting from Medicaid and needed to understand if DSS would pay increased Medicaid costs.
Nicole Godburn, a fiscal manager for reimbursement and certificate of need at DSS, told committee members that the fiscal impact was likely to be minimal. She said that Medicaid covers an average of 70 percent of revenue for nursing homes in the state. By working with OFA, Godburn said they had identified 4 nursing homes that didn’t meet the proposed changes to staffing requirements for social workers and 24 nursing homes that didn’t meet the requirements for nurses. In total, they estimated implementing the regulations would cost DSS $470,000 but, because of federal Medicaid matching, the state’s share was $235,000.
Dathan noted that, if 28 nursing homes didn’t meet the requirement, the projected annualized cost for one person resulted in an average salary of $16,780, which is below minimum wage.
Godburn said that nursing homes are not necessarily hiring full-time employees, some may be part-time or increased hours for current employees.
Barbara Cass, a senior adviser for long-term care in DPH’s commissioner’s office, also answered questions about the proposed regulations. She noted that DPH has identified few staffing issues that indicate the proposed ratio requirements would impact nursing home’s ability to hire needed staff. Of 161 complaints DPH looked at in the last quarter, Cass said 11 were related to staffing issues and most of these were related to staffing shortages that occurred on a single day.
Sen. Cathy Osten, D-Sprague, also asked a series of questions about the impact the changes would have on nursing homes. Osten questioned whether DSS is required to pay Medicaid reimbursements if they are over projected costs and asked about the relationship between l0wer-ranked nursing homes and funding sources, noting that lower-rated nursing homes tend to have higher rates of patients reliant on Medicaid. She also questioned whether direct care nurses are covered by the changes, expressing concerns that lower-performing nursing homes could receive pushback for asking for reimbursement for using a nurse with a higher-level of licensure in a direct care position.
Godburn stated that DSS shares that concern and had transitioned to an acuity reimbursement system, which adjusts Medicaid rates every quarter and is designed to meet the acuity needs of residents.
The question of whether the incoming Donald Trump administration would affect Medicaid funding the state receives and could have financial ramifications was also discussed.
Rep. Craig Fishbein, R-Wallingford, added that he felt the issue should be dealt with by the full legislature.
Ultimately, the committee voted to reject the proposed regulation without prejudice so, according to Dathan, it could continue discussions and make sure nursing homes are not adversely affected.
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