PIERRE, S.D. — With yet another nursing home closing later this summer, making the seventh statewide in three years, legislators are lifting some departmental rules on redistributing nursing home beds with the hope of helping South Dakota's nursing home crisis.
The Legislature's Interim Rules Review Committee on Monday, July 8, approved rule changes for the Department of Health's process for redistributing nursing home beds in the state. Previously, in order for a facility to obtain additional beds, it had to submit things like community support letters and audits in order to make their case to the DOH.
DOH Deputy Secretary Tom Martinez told the legislators Monday that the process "seemed to work very well" since it was put in place in 2012, but has recently created complications and confusion amidst the industry's ongoing struggles in the state. Now, he said the department is sitting on a pool of 400 open beds which are yet to be redistributed.
He said the department through the rule changes hopes to streamline the process for homes in order to get those beds back into use.
Legislators agreed, voting unanimously in favor of the rule changes. Sen. Lance Russell, R-Hot Springs, called the old rules "arbitrary," and pointed a finger at the executive branch for rule-making that he said "hastens the closure of numerous facilities across the state."
"We (the Legislature) allow this to go on because we aren’t willing to look at things in a serious fashion. We're so interested in turning over this type of authority to the executive branch so we don't have to make a decision and we create a crisis situation," Russell said. "All of a sudden, it becomes an emergency that we have to allocate an exorbitant amount of money to solve."
That emergency is widespread nursing home closures throughout the state within just a few years, which South Dakota Health Care Association Director Mark Deak said has been due to the state's under-reimbursement for Medicaid patients. Homes lose money everyday on Medicaid patients, and ones with high Medicaid patient populations are run into the red, forced to shut their doors.
Deak said more than half of South Dakota's nursing home patients are covered by Medicaid, and statewide, unreimbursed care costs facilities more than $48 million every year. And in addition to forcing homes' doors shut, Deak said the disparity "fuels staffing challenges, including difficulty hiring caregivers and high turnover among nursing center staff.”
During the 2019 legislative session, legislators approved a budget which increased Medicaid reimbursement by 10%, which made for a substantial one-year budget increase. But even after the increase, Deak said nursing homes continue to lose on average $42 per day per Medicaid patient in their care.
In addition to the ongoing budget increase, the Legislature appropriated Republican Gov. Kristi Noem's proposal of $5 million in one-time funds to partner providers to identify potential alternative care options.