Budget
Earlier this week, on Monday, the Senate Ways & Means and House Appropriations Committees held respective public hearings on the budget proposals. Then on Wednesday, both Committees held executive hearings and introduced amendments to their budgets. One key amendment we pushed was to increase funding for Adult Day programs. This amendment passed and is now included in the Senate budget proposal. Both chambers will now hold a floor vote on their respective budgets, likely later today. Once this is completed, they will then move into conference and begin negotiations to reconcile the differences between the two budgets so that the compromise budget can then be acted upon in a final vote by both chambers.
Thank you to everyone that has submitted a message to their legislators. Your advocacy is the most impactful step you can take in the legislative process. If you have not taken the opportunity to reach out to your legislators, we have set up advocacy campaigns to assist you in doing so now. We need the Senate to match the higher funding levels of the House and we are also thanking the House for their historic investments in long-term care so that they realize how important their budget is in supporting assisted living and skilled nursing facilities throughout the state. This is especially important as they head into negotiations with the Senate where the House needs to stand strong and force the Senate to move to its position.
Senate Budget
While we appreciate the work that has gone into the Senate budget and the increased funding, it is deficient in several key areas. Below is a summary:
SNF:
Reduce Occupancy Penalty: The Senate has included a reduction to the occupancy penalty used to calculate the indirect care median from 90% to 80% for one year, effective July 1, 2022. This falls short of the relief we have sought, which would decrease the occupancy threshold to 70%, recognizing that COVID had significantly impacted admissions through local health jurisdictions holds or loss of staff. Lowering the occupancy threshold to 80% equates to an increase of nearly $5 to the indirect care rate component. GF-S $8.3 million, Total Funds $16.5 million.
The Senate has not included any funding to increase wages for certain staff in SNFs. The failure to address needed wage relief to hire and retain frontline staff must be corrected in the Senate budget and match what the House has provided.
AL:
Assisted Living Facility Rates: The Senate has increased funding for assisted living to 68% of the model. While this gives a small increase, it falls far short of what is needed. We have been advocating for the funding to be set at 77% of the model and will continue to advocate for this. GF-S $12.6 million, Total $26.8 million
COVID rate add-ons: The Senate removes COVID rate add-ons for some provider types, including SNF and AL. Their explanation is that the base rates, following rebasing and funding through the methodology, will surpass the add-on amount and, therefore, the add-ons are no longer necessary. The Senate must again adopt the House position on retaining COVID add-ons even if they are gradually decreased over time. GF-S $83.5 million, Total $184.5 million
NEW - Adult Day:
The Senate Ways & Means Committee added an amendment that increases the Adult Day rate by the amount of the COVID add-on ($11.08), essentially making the add-on permanent. Thank you to everyone who reached out to the committee chairs and their own legislators! GF-S $273,000, Total $620,000
House Budget
The House budget is more comprehensive and includes many of the funding asks we have pushed. We believe the House has made some historic investments that were long overdue. The following summarizes the House budget.
SNF:
Reduce Occupancy Penalty: The House has included a reduced occupancy penalty of 70% when setting the indirect care rate component. This is the position that we alone pushed and was also included in the Governor’s budget. An occupancy penalty lowered from 90% to 70% results in an increase of nearly $10 to the indirect care rate component. GF-S $16.8 Total Funds $33.6 million
Nursing Home Rate Increase: The House has included funding for SNFs to raise wages to low-wage workers in certain job categories. This is accomplished by raising the direct care and indirect care medians from 105% to 111% for direct care and from 90% to 92% for indirect care. The direct care growth cap is also raised from 130% to 165%. The House directs DSHS to work with stakeholders to develop a verification process to demonstrate how providers have used this increased funding (difference between funding at 105% of direct care median and funding at 111% and difference between 90% and 92%) to increase wages. Wage increases provided as of January 1, 2022, and forward will be included in the verification process. There will be a mechanism created for the state to recover any funds that were not spent in accordance with the verification process. The House budget states that it is their intent for this funding to be continued forward into the next fiscal biennium. GF-S $24.28 million Total Funds $48.5 million
AL:
Assisted Living Facility Rates: The House has increased funding for assisted living to 74% of the model and specifically calls out SDC contracts being included in this funding. GF-S $28.5 million Total Funds $59.8 million
The House has included funding for the COVID add-ons, and it is not dependent on a comparison to the base rates following rebasing and new methodology funding. COVID add-ons continue and are gradually decreased by 20% every two quarters. The amounts listed here are for all provider types that are receiving COVID add-ons. GF-S $130.3 million, Total Funds $273.8 million
Also included in the House budget is one-time funding to continue the Rapid Response Teams. GF-S $17.9 million, Total $35.9 million
Other Items
CCRCs ~ Both the Senate and House budgets include one-time funding for the Office of the Insurance Commissioner to assess federal and state laws and regulations and provide recommendations on creating a legal framework with which CCRCs may achieve heightened consumer protections through shared state agency regulatory oversight by the office of the insurance commissioner. The report is due to the legislature no later than December 1, 2022. GF-S $250,000
Staffing Agencies ~ Despite heavy advocacy from multiple stakeholders, no language was included in either budget to study nurse agency staffing practices and fees.
Bills to monitor impacting LTC
Support
HB 1124 - Concerning nurse delegation of glucose monitoring, glucose testing, and insulin injections. This bill is waiting to be pulled to the Senate floor for a vote.
HB 1877 - Addressing expired certifications for certain health professions. This bill did not make it out of the Senate Health & Long Term Care Committee by yesterday’s cutoff and is now considered dead.
Oppose/ Concerns
HB 1868- Improving worker safety and patient care in health care facilities by addressing staffing needs, overtime, meal and rest breaks, and enforcement. This bill was passed out of the Senate Committee on Labor, Commerce & Tribal Affairs yesterday with some amendments to the staffing committee requirements. The bill still includes strict staffing ratios for nurses. It has been scheduled for a hearing in the Senate Ways & Means Committee tomorrow and up for executive action Monday morning.
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