Vermont’s nursing home regulations may be headed for an overhaul.
The House has approved bill H.921, which orders an in-depth look at how state officials regulate nursing homes. There’s a particular emphasis on increasing financial transparency and accountability.
The bill also ends the Green Mountain Care Board’s oversight of nursing home ownership changes. There’s broad agreement, even among care board members, that some other entity would be better-suited for that responsibility.
“It didn’t seem that it was really within the realm of expertise, or even appropriate, necessarily, for the Green Mountain Care Board to be dealing with the certificate of need for sales or transfer of ownership of nursing homes,” said Rep. Anne Donahue, R-Northfield.
Last year’s closure of the Brookside Health and Rehabilitation Center in White River Junction spurred talk of changing and/or consolidating the state’s nursing home regulations. The home’s closure came after officials with the federal Centers for Medicare and Medicaid Services said they would stop making payments to the home’s out-of-state owners due to unaddressed health and safety violations.
More broadly, state officials have been discussing industry changes that have made it more difficult to regulate nursing homes.
The state’s Division of Rate Setting — which determines Medicaid payment rates for nursing homes — submitted testimony to the House Health Care Committee in January noting a trend toward “large, out-of-state corporations” buying nursing homes and splitting home operations and real estate into separate limited liability corporations.
Green Mountain Care Board member Jessica Holmes sounded a similar note, telling the committee that for-profit companies are “buying up small mom-and-pop nursing homes, operating them at arm’s length and extracting short-term gains.”
Given that trend, “there is no more important time than the present to shore up Vermont’s regulatory process,” Holmes said.
Rather than imposing new rules and regulatory responsibilities, H.921 sets up an eight-member working group “to examine the oversight of all aspects of nursing home facilities and operators in Vermont,” said Rep. Marianna Gamache, R-Swanton and a member of the Human Services Committee.
The working group must report back to the Legislature by Jan. 15, 2019.
The group includes representation from the Department of Disabilities, Aging and Independent Living and its Division of Licensing and Protection, which is responsible for licensing and oversight of nursing home operations.
The Division of Rate Setting, Office of the Attorney General, long-term care ombudsman and Vermont Health Care Association are also involved in the proposed group, as is a nursing home owner or administrator appointed by the state.
The working group has a long list of duties including identification of procedures “to monitor nursing homes’ ongoing financial stability and to provide for early identification of nursing homes in financial distress.”
The group also must determine the “appropriate regulatory entity or entities and the resources needed to monitor the quality of care and financial stability of nursing homes on an ongoing basis.”
That includes an evaluation of who will oversee changes of ownership, and in what way. The Green Mountain Care Board currently has that job but is looking to change that as part of a larger examination of the board’s certificate of need process.
In January, Holmes told the House Human Services Committee that the care board has no other jurisdiction over nursing home operations or budgets. She also said reviewing nursing homes’ license transfers doesn’t fit with the board’s other duties and responsibilities.
The care board “is not and was never envisioned as a licensing body,” she said.
There have been suggestions that the change-of-ownership review should be shifted to the Department of Disabilities, Aging and Independent Living. Commissioner Monica Caserta Hutt said that may be a possibility, but she cautioned that her department does not currently handle financial reviews.
“It’s not our area of expertise,” Hutt said. “It’s not a capacity we have right now.”
Overall, Hutt said she welcomes the chance to discuss nursing home regulations and how they might be revised, if necessary.
“I think that there is always an opportunity to look at how we do the work that we do, just to make sure we’re guaranteeing quality, health and safety for residents,” she said.
The House on Wednesday gave final approval to H.921 with no debate. The bill now goes to the Senate.
Prior to Wednesday’s vote, the House also endorsed an amendment, offered by Donahue, that extends the Green Mountain Care Board’s oversight of nursing home ownership changes to July 1, 2019.
Donahue said she wanted to ensure that there were no gaps in oversight while the working group and the Legislature work to determine who should regulate those transfers in the future.
