Illinois Gov. J.B. Pritzker earlier this month signed an omnibus health care bill with some good news for nursing homes in the state, delaying fines tied to the state’s minimum staffing requirement for two-and-a-half more years.
Pritzker’s decision gives those in the sector a glimpse into how a federal staffing mandate mightbe received and potentially mitigated, given the ongoing staffing crisis. A federal staffing mandate is due to be revealed this spring, based off of a study completed by the Centers for Medicare & Medicaid Services (CMS).
Monetary penalties can’t be imposed earlier than July 1, 2025, according to the omnibus bill which included updates to the state’s Nursing Home Care Act. Fines would be based on data for the quarter beginning Jan. 1, 2025 through March 31, 2025.
“The 2019 negotiation which led to the imposition of these staffing based fines didn’t have the benefit of the knowledge of what the past three years have done to the sector,” Matt Hartman, executive director of the Illinois Health Care Association, said in an emailed statement to Skilled Nursing News. “The fines would take money away from care, further undermine efforts at bolstering staff, and lead to additional access to care concerns through more restricted admissions and closures of centers.”
If a facility is found to be out of compliance prior to the revised implementation date of Jan. 1 2025 for staffing minimums, the facility will need to provide a “sufficiently detailed correction plan” that outlines proposed and completed actions to meet staffing requirements, including hiring action.
The reform initiative requires minimum staffing ratios of 3.8 hours per resident per day, and 2.5 hours per day for residents needing intermediate care.
Staff included in ratio calculation are registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs), among other rehabilitation titles and nursing directors.
“Fining organizations that legitimately are unable to hire enough qualified workers to fill open positions is not going to lead to meaningful quality improvements and outcomes,” Angela Schnepf, president and CEO of LeadingAge Illinois, said in a statement. “It is simply going to speed up the closure of nursing homes that are still trying to recover from the pandemic.”
Operators need proper investments in workforce development programs instead of fines, Schnepf said, adding that such penalties will only further damage a system of care that is already struggling.
“Consumers and families will be harmed by the reduction of nursing homes in their community and in the state of Illinois,” she said.
The updates come after 74 nursing homes in the state were fined up to $50,000 each for violations to the Nursing Home Care Act during the first quarter of 2022, according to the state Department of Public Health (IDPH) quarterly report published last summer.
The first penalty is 125% of the cost of wages and benefits for the missing staff hours, according to the bill. Penalties will increase to 150% for the second offense and 200% for the third and all subsequent offenses.
Meanwhile, nursing homes have lost 210,000 from February 2020 to December 2022 on a national level – current workforce levels haven’t been this bad since 1994, according to data published by the Bureau of Labor Statistics and aggregated by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).
“We still believe that centers must be held accountable to staffing to their resident’s needs, and that any who would intentionally not staff appropriately should be appropriately penalized,” noted Hartman. “However, when our centers are facing the worst crisis they have ever seen in regards to staffing, now is not the time to pull critically needed funding away from where it is needed most.”
There seems to be some wiggle room for operators in Illinois, as the IDPH can make adjustments to penalties if providers fail to meet staffing requirements by a certain percentage. But, the provision can’t be applied more than six times in a quarter, according to the revised bill.
“The penalty may not be waived, but the Department shall have the discretion to determine the gravity of the violation in situations where there is no more than a 10% deviation from the staffing requirements and make appropriate adjustments to the penalty,” state legislators wrote. “The Department is granted discretion to waive the penalty when unforeseen circumstances have occurred that resulted in call-offs of scheduled staff.”
Illinois operators can appeal penalties, the state said. Notices of noncompliance issued during the revised implementation period, however, can’t be appealed.
New York operators also met with a staffing mandate are seeing similar concessions from state officials. Waivers are being developed to prevent fines if operators prove they are making a good faith effort to recruit workers and advertise bonuses. Earmarked funds to support staffing minimums are in the wings too, but haven’t been released, according to NY senior services organizations.
In comparison, Pritzker last year greenlit a $700 million Medicaid boost to help operators meet higher staffing levels. There are strings attached, however, and nursing homes must meet at least 70% of federal staffing guidelines in order to qualify, with 40% of that going to direct care workers. Star ratings are also taken into consideration when the concession is granted.
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