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Rules review takes on nursing facility administration challenges

Not many elderly people get long-term care insurance. It's expensive and many hope their kids will look after them instead.

Rural nursing homes are the subject of sustainability questions across the nation – and South Dakota is no different. During this summer’s rules review discussions, finance practices are a focus.

The interim rules review committee is busy in the legislative offseason, and administrative issues for nursing facilities were on the docket in Tuesday's meeting.

Jeremy Lippert is the Department of Social Services legal services director. He summarized the proposed changes.

“These rule changes will transition nursing home rate methodology from the resource utilization group currently used – transition that to the patient-driven payment model case mix system," Lippert said. "Nursing facility rates will be rebased using current cost data, and CMS has indicated it will end support for the prior methodology later this year which is driving this change.”

Other changes in the package would remove outdated provisions, update reimbursement practices for Medicaid providers, and adjust inflation calculations for nursing facilities.

However, the DSS is not in control beyond this rules-writing process.

“These rules fall under the Department of Social Services, the working relationship and program implementation and consequently the rate-setting methodology being addressed here this morning is actually carried out by the Department of Human Services," Lippert said. "This is due to an executive reorganization that occurred in 2017. Therefore, the agencies worked closely together on these rules.”

The package drew little discussion from the board. Sen. Jean Hunhoff said she has been following this proposal closely.

“I understand what they were trying to do, I’ve been involved with that work group, and I feel comfortable in addressing what the industry has been saying," Hunhoff said. "Again, we’re going from a case mix to a per-day, per-patient, what their needs are – and really it’s the same thing just in a different format.”

The package passed unanimously, completing the rules process.

C.J. Keene is a Rapid City-based journalist covering the legal system, education, and culture