NOTE: As provided in LFC policy, this report is
intended only for use by the standing finance committees of the
legislature. The Legislative Finance Committee does not assume
responsibility for the accuracy of the information in this report when used for
other purposes.
The most recent FIR
version (in HTML & Adobe PDF formats) is available on the Legislative
Website. The Adobe PDF version includes
all attachments, whereas the HTML version does not. Previously issued FIRs and attachments may be
obtained from the LFC in
SPONSOR: |
SFC |
DATE TYPED: |
|
HB |
|
||
SHORT TITLE: |
Nursing Home Staffing Needs Pilot Program |
SB |
506/SFCS |
||||
|
ANALYST: |
|
|||||
APPROPRIATION
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
||
FY03 |
FY04 |
FY03 |
FY04 |
|
|
|
|
|
Indeterminate See
Narrative |
|
|
|
|
|
|
|
|
(Parenthesis
( ) Indicate Expenditure Decreases)
REVENUE
Estimated Revenue |
Subsequent Years Impact |
Recurring or
Non-Rec |
Fund Affected |
|
FY03 |
FY04 |
|
|
|
|
|
Indeterminate See
Narrative |
|
|
|
|
|
|
|
(Parenthesis ( ) Indicate Revenue Decreases)
Relates
HB 578
Relates to HJM 25
Responses
Received From
Department
of Health (DOH)
Health
Policy Commission (HPC)
Human
Services Department (HSD)
State
Agency on Aging (SAA)
SUMMARY
Synopsis of Bill
The Senate Finance Committee Substitute
for Senate Bill 506 establishes yearlong acuity-based nursing home staffing
pilot program. DOH must work in conjunction with the State Agency on Aging and
the HSD. The pilot program to determine
appropriate patient-to-staff ratios shall be based on best practices and
include experience in existing nursing homes licensed by DOH. These homes must be operated by:
·
The
state of NM
·
A
nonprofit organization; and
·
A
proprietary organization
A report on the pilot is to be presented to Health and Human
Services Committee and the Legislative Finance Committee at their July 2004
meetings.
Significant
Issues
DOH notes that the pilot proposed in the bill was developed
out of discussions subsequent to the presentation on the HM 90 study. The pilot
is considered as an essential step toward enhancing the current cost
reimbursement process for nursing facilities.
House
Joint Memorial 90 from the 2002 session, and House Joint Memorial 25 (HJM 25)
in the current session, both direct DOH to study the issues around acuity based
staffing in nursing homes. HJM 25
directs DOH to continue their study of the complex issue and report back to the
legislature in the fall of 2003.
The pilot program established by SB 506 substitute will assess nursing home staffing levels from an acuity-based perspective. Acuity-based care is a system of determining the type and frequency of direct care that a patient needs, based on the relative acuity of the patient’s health status. The goal is to match the patient’s specific needs with nursing staff that have the necessary skill and training levels, thus ensuring quality of care.
FISCAL IMPLICATIONS
There
is no appropriation contained in the bill.
State funding could be matched with federal funds on a 3 to 1 ratio.
However, finding the funding to conduct this pilot program may problematic for
DOH. The bill does not address how DOH
will fund the project. For example, DOH will have to use existing funding for
planning, designing, implementing and evaluating this pilot and identify how
much would be passed along to the nursing homes pilot sights to enable them to
increase staffing levels to meet acuity.
A project budget needs to be completed before implementation of the
pilot program.
Human Services Department (HSD) would have to temporarily adjust the rates of the pilot facilities to meet the level of acuity. However, until the study in HJM 90 (last session) and HJM 25 (this session) is completed, HSD points out that the acuity rates would need to be based on some other source such as the Medicare RUGS system of acuity.
DOH need to work very closely with HSD to ensure the funding is set up in such a way to be eligible for Federal Financial Participation “Medicaid Match”.
ADMINISTRATIVE IMPLICATIONS
Reference is made to fiscal implications above on the
funding the project.
DOH, in collaboration with the State Agency on Aging and
HSD, would select pilot programs and project manager/evaluator through a
request for proposal process. The DOH would manage the contract(s) and would
enter into a MOU with HSD/Medical Assistance Division to transfer state funds
for acuity based rate increases for the nursing homes in the pilot.
Nursing roles, now limited to RNs, LPNs and CNAs, might need
to be augmented by other providers like the Certified Medication Aide (CMA) who
would be added into the Nursing Service structure. These changes could lead to
regulatory and licensing impact as well as expanded organizational liability
issues and fears.
OTHER SUBSTANTIVE ISSUES
Currently,
Currently, the
Consumers, family members and direct-care
staff have raised concerns over the quality of care at nursing facilities
citing:
·
Reduced quality of life for the
institutionalized elderly,
·
Increased risk of harm,
·
The inability of facilities to control
organizational costs and
·
Difficulty in recruiting and retaining
competent and compassionate caregivers.
The absence of an objective approach to
quantify appropriate levels of care and appropriate staffing levels, according
to DOH, has led to subjective decision-making processes that emphasize cost
control rather than the quality of care. Acuity-based staffing could make an
important contribution toward overall performance improvements.
According to a study done by the US Department
of Health and Human Service, Bureau of Health Professions “The Health Care
Workforce in Eight States: Education, Practice and Policy” New Mexico
ranked lowest among the 8 states studied in RN’s and LPN’s per 100,000.
A 2001 AARP study reported the
following regarding nursing homes:
·
Currently, nursing
homes are experiencing serious staffing shortages, especially among CNAs.
·
Annual turnover rates
of 100 percent are not uncommon in nursing homes; some homes have seen a 300
percent turnover in aide positions.
·
High turnover rates of nursing
home staff is partly due to more appealing competitive health care profession
opportunities or services, and low pay, limited advancement, poor management-employee
relations, and difficult work.
·
Federal law requires that nursing
facilities maintain a sufficient level of nursing staff to meet resident needs
on a 24-hour basis; however, the law does not define “sufficient.”
BD/njw