Assisted Living Funding Still Lags
While we are pleased that the Legislature appropriated $47.8 million to improve assisted living Medicaid funding, we are unclear why legislative budget leaders failed to fund assisted living at a reasonable level. Budget conferees opted to fund overall Medicaid rates at 68 percent of the methodology, as opposed to the House budget level of funding of 74 percent of the methodology, which is equitable with adult family home funding.
Here is a synopsis of the funding for assisted living:
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Assisted Living Medicaid Rates Rebase: The new Medicaid payment methodology for assisted living requires annual rebasing. The supplemental proposal includes $13.3 million for this purpose.
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Assisted Living Medicaid Rates Increase: The final supplemental proposal will fund the assisted living Medicaid payment methodology at 68 percent. Our work will be to influence the development of the DSHS decision package for assisted living for the 2023‑25 operating budget plan. Click here for rates projections for rates starting July 1, 2022.
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Specialized Dementia Care Rates Increase: The conference budget will increase the daily weighted average for specialized dementia care rates by just over $16/per resident day.
Skilled Nursing Facility Funding Mirrors House Proposal
The final conference budget proposal largely mirrored the House plan. For skilled nursing facilities, the 2022 supplemental proposal:
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Affirms the July 1, 2022, rebase to 2020 costs. The $124.4 million appropriation Includes the rebase, raises the direct care median from 100 to 105, and raises the direct care growth lid to 130 percent.
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Lowers the SNF occupancy penalty to 75 percent for FY 23. The current occupancy penalty is 90 percent. Stakeholders successfully argued that penalties should be reduced to address occupancy problems that are not in a providers’ control.
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Skilled Nursing Facility Wage Equity Proposal: $48.6 million total funds are provided to increase worker wages for certain low-wage job categories by up to $4 per hour. The direct care median is set at 111 percent, and the indirect care median to 92 percent. The direct care lid is increased to 165 percent. A verification process will be used to ensure that providers utilize the funding as intended. WHCA will be engaged in work on developing the verification standard.
- All of these measures together move the budget dial from the current level of $259.84 to $319.82
COVID Funding
Emergency COVID Funding Add-Ons: Assisted living COVID add-ons of $4.79 and SNF COVID add-ons of $8.33 per resident day are continued. Those rates remain at current levels through June 30, 2022. Beginning July 1, 2022, rates are reduced by 20 percent every 6 months and are fully phased out by FY25.
COVID Rapid Response Teams: DSHS is allocated $26 million and broad authority for rapid response staffing teams through June 30, 2022.
Hospital Incentive Payments: $21 million is provided to extend COVID-19 incentive payments for SNFs to admit hard-to-place hospital residents through June 30, 2022.
LTC Workforce
Five years ago, we commenced work with the Nursing Care Quality Assurance Commission related to the LTC workforce and the need to address ongoing shortages and barriers for workers interested in this sector. The preliminary work is beginning to bear fruit in the supplemental budget plan. The conference proposal includes funding to:
- Streamline CNA testing and training.
- Expand the LPN workforce with apprenticeship programs.
- Implement a LTC transition project designed to strengthen nurse leadership in long term care.
Training and Licensing Backlogs: Funds are also provided for criminal history background check backlogs and licensing delays.
Nursing Student Supervision: The Nursing Commission is also allocated $6 million in grant funding and is provided authority to manage a grant process to incentivize nurses to supervise nursing students in health care settings.
Timely Licensing: The Department of Health has been provided additional resources to ensure timely licensing activities. (Please keep us apprised if you are dealing with longer than normal wait times for your licensed health care professionals.)
Policy Round Up
HB 1124 – Delegation of Blood Glucose Monitoring
This legislation will permit registered nurses to delegate blood glucose monitoring, regardless of care setting. The Nursing Care Quality Assurance Commission is charged with determining training and supervision standards.
HB 1837 – Regulation of Ergonomics in the Workplace
This highly controversial legislation would have permitted the Department of Labor and Industries to promulgate ergonomics standards in Washington workplaces. The general public rejected this idea nearly 20 years ago with an initiative that repealed original workplace regulations. WHCA’s workers compensation third party administrator ERNwest developed a 300-page manual to help providers comply with the original rule. The measure narrowly passed the House after a 9-hour floor fight. With over 40 amendments that would have to be considered during the floor debate, the measure failed to be scheduled for floor action.
This was another highly contentious measure. WHCA’s opposition to the legislation, which would have established nurse staffing ratios, was predicated on the inability of long term care providers to compete with hospitals for nurses and certified nursing assistants currently, let alone with the adoption of staffing ratios.
HB 1732 – 18-Month Delay of the LTC Trust Program
Collection of worker premiums for the WA Cares Program, the nation’s first worker-funded long term care benefit, has been delayed by 18 months.
HB 1646 – Extending the Dementia Action Collaborative
The Dementia Action Collaborative is established to assess the current and future impact of Alzheimer's disease and other dementias on Washington residents. Specifically, it must examine progress in implementing the Washington State Alzheimer's Plan adopted in 2016, assess available services and resources for persons with Alzheimer's disease and other dementias and their families and caregivers, examine strategies to rectify disparate effects of Alzheimer's disease and other dementias on people of color, and develop a strategy for a state response to this public health crisis.
Thank You to Our Members
Your work to drive thousands of email messages and telephone calls to your local legislators has been critically important to this work. We appreciate your efforts and look forward to our continued work to ensure the Legislature understands your work on behalf of Washington State nursing facility and assisted living residents, workers, and their families.
