$11 nursing home fee bill passes Legislature

The OlympianMay 17, 2011 

A fee proposal to spare nursing homes from $38 million-a-year in Medicaid cuts has just passed in the House on a somewhat bipartisan 54-38 vote.

The bill is supported by most of the nursing-home industry and goes to Gov. Chris Gregoire for signing.

Engrossed Substitute Senate Bill 5581 was on a fast track after the Senate voted to approved the $11 per bed fee a week ago. The House Ways and Means Committee followed suit today, sending to a same-day House floor vote.

The final House vote was 54 to 38 and included:

** Seven Republicans from Eastern Washington crossed over to join the Democratic majority in approving the fees, while seven Democrats crossed over against it.

** Crossover Democrats included Reps. Kathy Haigh of Shelton, Chris Hurst of Enumclaw, and Troy Kelley of Lakewood.

** South Sound Republicans voting against it were Reps. Gary Alexander of Thurston County, Bruce Dammeier of Puyallup, Richard DeBolt of Chehalis, J.T. Wilcox of Yelm and Hans Zeiger of Puyallup.


The Washington Health Care Association supported the fee as a way to avert the budget cuts that take effect July 1. The fee provides a net gain of $94 million for nursing facilities, which have seen their rates cut below June 2010 levels.

Go here for our story two months ago about the crisis and why nursing homes are supporting this concept.

House Ways and Means chairman Ross Hunter, D-Medina, said the bill helps reverse cuts that would otherwise be taken – just as cuts are taken in other sectors. But he said this was a chance to do what 44 other states do and he called the impact “overwhelmingly positive to nursing homes in our state.’’

Rep. Eileen Cody, the Seattle Democrat who negotiated the bill with the Senate, said only four of the 220 nursing homes with Medicaid clients in the state would pay more than they are helped. A rival approach offered by Republican Rep. Joel Kretz of Wauconda would have limited the fee to $6 but would have left 33 nursing homes adversely affected by cuts, Cody said.

Republican Rep. Bill Hinkle of Cle Elum his vote in favor was a “leap of faith” that the money would not be swept to other uses by the Legislature as a 2003 bed fee was diverted.

But other Republicans like Rep. Gary Alexander of Thurston County said Kretz approach is more likely to win approval by the federal Centers for Medicare and Medicaid Services. He also said the GOP approach would have left only 15 nursing facilities injured by budget cuts.

As written, the bill avoids taxing most private facilities that do not have patients covered by Medicaid, which is the state-federal shared program for the low income and disabled. The bill exempts about 61 facilities in several categories of care – including beds allocated for federally paid Medicare patients; small facilities of less than 35 beds; hospitals, state, local or tribal run facilities; and others.

Under the bill’s newest form, most nursing homes would see a net gain in proceeds after paying the extra fee, according to this chart provided by committee staff at the hearing. It shows four facilities losing ground – one in Clark, one in Snohomish and two in Whatcom counties.

About 20 Pierce County facilities and six Thurston County facilities would gain. Craig LeVee, owner of the Roo-Lan Healthcare Center in Lacey, strongly supports a fee and says he does not know where he would be able to cut staffing levels further without risk if the fee is not adopted. His facility would receive a net gain of $147,255 rather than a cut of $119,200, according to committee data.

Providence Mother Joseph Care Center, whose parent organization opposes the fee, also would see a net gain of $249,859 based on serving 23,545 Medicaid “bed-days” a year, according to committee data. But Mother Joseph loses a net $294,077 without the fee making up for budget cuts.

“It is a provider tax,” said Vicki Christophersen, lobbyist for Providence Health and Services, in testimony on the bill earlier in the day at Ways and Means. Christophersen said the state should be reducing the number of excess nursing home beds in the system, and she recalled how a $6 bed fee adopted in 2003 was later shifted to other purposes.

“We have been here before and it didn’t work,” she said.

Christophersen also testified to the committee that the federal government and President Obama are talking more and more about eliminating this kind of money match, which could leave the state vulnerable to making the cuts anyway.

Rich Miller, executive director for the Washington Health Care Association and for-profit providers, supported the fee. He said it lets nursing homes receive extra funding from the state, bringing their rates back up to what they received in June 2010.

The House vote was significant and reflects an agreement hammered out with the Senate for the lower fee. Democratic Sen. Karen Keiser of Kent said it is the first time the House has gotten this far on a fee bill that she has pushed for several years.

But it apparently does not produce the kind of revenue windfall the state could shift to other health programs, which elder-care advocates hoped for previously. That was when the fee was $21 and an excess of $15 million a year was expected to be generated for other state needs.

The bill is one of several key pieces needed to pass a budget in the 30-day special session, which is running out of time and ends next Tuesday, May 25.

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