Head of Nursing Home Group Says Minimum Staffing Law May Trigger $60M in Penalties
GoLocalProv News Team
Head of Nursing Home Group Says Minimum Staffing Law May Trigger $60M in Penalties
“Rhode Island law states nursing facility residents are to receive an average of 3.58 hours of direct care per day (2.44 hours of which must be provided by CNAs) in the first year (2022) then 3.81 and 2.60 respectively from year 2 (2023) forward which gives Rhode Island the highest staff-to-patient ratio in the country. RIHCA’s concern was that this would not be attainable and would cripple nursing facilities and severely impact access to nursing facility care. This concern has been greatly exacerbated by the pandemic,” said Gage.
In May of 2022, Gage made similar claims of economic catastrophe for the industry.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTAs GoLocal reported, an analysis conducted by Clifton Larson Allen LLC (CLA), a national accounting and consulting firm, revealed that 95% of Rhode Island’s nursing homes were losing money, and 87% were deemed at “Financial Risk” - at high risk of closure with operating losses at -7.5% or worse.
“Rhode Island nursing homes have been hit by the perfect storm," said Gage in May of 2022.
Lack of Workers, Insufficient Reimbursement
According to RIHCA, the staffing law was implemented amid a deep and worsening workforce crisis, a direct result of the global Covid-19 pandemic.
The Federal Bureau of Labor Statistics shows that since the start of the pandemic, RI’s nursing facility workforce has decreased from 9,940 (12/31/19) to 7,963 (6/30/22) – a 20% decrease.
There is not sufficient reimbursement from RI Medicaid to comply, and there are simply not enough workers available to meet the mandated staffing metrics, says RIHCA.
RIDOH Fines Waived
In letters released by the Rhode Island Department of Health (RIDOH) to nursing facilities in the state last Monday, February 6, 2023, 70% of facilities were found to be out of compliance in Quarter 2 of 2022 (April through June).
Fines for that quarter alone would have totaled more than $11.4 million.
While RIHCA says it is grateful that fines and penalties were waived for Q1 and Q2 2022, the law, currently in full effect as on July 1, 2022, means that fines for Quarter 3 of 2022 are expected to be issued by RIDOH sometime in late February 2023.
"Based on RIHCA’s analysis of the first three quarters of 2022, we estimate that, had the law been fully implemented on January 1, 2022, as passed, RI nursing facilities would have been fined more than $40 million. Nearly two-thirds of facilities in the state were unable to comply in each of the first three quarters of 2022 and, in addition to fines, they would now be facing mandatory admissions freezes or be forced to return all Medicaid payments retroactive to January 1, 2020. In short, more than 60% of RI nursing facilities would be forced to go bankrupt or to close," wrote Gage.
Call for Delay in Minimum Staffing Law Enforcement
RIHCA is advocating for a further delay in the full implementation of the minimum staffing law, with fines and penalties waived through at least December 31, 2024.
"We are also asking for meaningful changes to the existing statute to include proper funding (as this is an unfunded mandate), a broader definition of Direct Care Workers, a restructuring of the methodology of determining fines, and giving RIDOH discretion when determining non-compliance – with the ability to consider factors such as workforce shortages, demonstrated recruitment efforts, patient acuity and quality of resident care, etc," adds the organization.
"Without meaningful action by the General Assembly, it is estimated that RI nursing facilities would be fined $60 million in the first full year of the implementation of the mandate. How would hospitals handle the inability to transition patients to nursing facilities for care post-hospitalization? How many more facilities will close? Who will care for RI’s frailest elders?" claims Gage.