Nursing home fee faces uphill battle

Jan. 23--What the nursing home industry in North Dakota called a last resort to stay in the black may face a bleak future in the Legislature, according to Rep. Chet Pollert, R-Carrington.

House Bill 1130 would place a 5 percent fee on skilled nursing home care. The funds would earn a 50 percent match from

Pollert is chairman of the House Appropriations -- Human Resources Committee. That committee met in a joint session with the House Human Services Policy Committee to hear a presentation on the bill last week. No action was taken.

The 5 percent fee is based on charges the nursing home makes for the care it provides. It would be considered another expense the federal government before being spent on long-term care for North Dakota residents.

"It's not very popular from what I'm hearing in the hallways," Pollert said. "We have to figure some way (to restore funding), long-term care got hit hard with the allotments, but this bill needs changes. For one thing the penalty should not be so tough."

and passed on to anyone paying for skilled nursing home care. It does not apply to basic care facilities.

Tim Burchill, administrator at Ave Maria Village in Jamestown, said the 5 percent fee would be felt by the roughly 38 percent of nursing home residents who are responsible for paying their own nursing home costs in North Dakota. The 51 percent of patients who receive benefits from Medicaid would not see an increased cost. Roughly 11 percent of nursing home residents are there for rehabilitation or other services that may be covered by medical insurance or other agencies.

Medicaid patients in nursing homes pay all of their Social Security or retirement income to the nursing home and Medicaid then covers any remaining costs.

The benefit to the longterm care industry comes in the federal matching dollars available to the state because of the larger budget for long-term care.

"This could generate $20 million to $30 million in additional federal funds," said Shelly Peterson, president of the North Dakota Long Term Care Association. "The public will support the legislation if they see this as the only choice."

The extra federal money would allow North Dakota to reimburse nursing homes at a rate that covers their expenses, Peterson said.

Burchill said the bill is a last resort method of generating full funding for long-term care facilities in North Dakota.

"This not the preferred way of funding longterm care," he said, "but it is a kind of double your money kind of thing."

Peterson referred to the bill as "the best possible choice given the circumstances."

The bill was initially proposed by the Long Term Care Association as one way to generate enough state money to garner the necessary federal matching dollars, Peterson said. The association has included a clause in the bill that ends the fee after two years.

Pollert said the bill faces some challenges within the House of Representatives. The bill is seen as a tax on the elderly which is unpopular, and the funds generated by the tax would be used to pay some expenses related to long-term care but not directly to nursing homes. The fee's benefit comes in the additional federal funds it earns that can be used for long-term care.

The amount of the fee could be changed if the spending from the program is limited to only direct payments to nursing homes, Pollert said.

Pollert said the longterm care payment plan is complicated but understood well by the nursing home managers. Charging facilities a fee that earns a federal match before it is used as part of the payments to the same facilities could make the process more complicated.

"It is a different way of doing business," Pollert said.

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