[A] new law will change the way Vermont officials scrutinize nursing home ownership changes.
The governor has signed H.921, which seeks to improve the state’s oversight of nursing homes by creating an eight-member group to study the issue.
But the statute also has more-immediate impact: As of July 1, oversight of nursing home transfers will switch from the Green Mountain Care Board to the Agency of Human Services.
Officials with both entities support the change, saying the care board is ill-suited to regulate the increasingly complex world of nursing home ownership. Human Services Secretary Al Gobeille is pledging to develop “a very thorough, very credible review process” for when his agency takes over.
“I completely agree with the Green Mountain Care Board’s assessment that this is not the work for them,” Gobeille said.
The state’s oversight of nursing home ownership came under scrutiny last year when the 67-bed Brookside Health and Rehabilitation Center in White River Junction closed because of unaddressed health and safety violations.
That incident aside, state officials also have been engaged in a more general discussion of changes in the nursing home industry. Those changes include a trend toward large, out-of-state companies buying nursing homes, then breaking up home operations and real estate into separate corporations.
Green Mountain Care Board member Jessica Holmes told the House Human Services Committee earlier this year that such companies are “buying up small mom-and-pop nursing homes, operating them at arm’s length and extracting short-term gains.”
Legislators subsequently introduced H.921, now dubbed Act 125 after the governor’s approval.
The act’s main feature is the Nursing Home Oversight Working Group, which is supposed to “examine the oversight of nursing homes in Vermont, including financial stability and licensing criteria, in order to ensure the provision of high-quality services and a safe and stable environment for nursing home residents.”
The group must submit a report to the Legislature by Jan. 15, 2019.
The working group will look at a wide variety of issues, including the information currently reported by nursing homes and “what types of additional financial data may be necessary to evaluate nursing homes’ ongoing financial stability.”
The group also will discuss the state’s current process for regulating nursing home sales and how those sales “should be addressed in the future, by whom and as part of what process.”
The new statute answers that question, at least for the short term, by placing the Agency of Human Services in charge of nursing home transfers when the new fiscal year begins on July 1.
The change applies retroactively to any unresolved nursing home transfer request pending before the Green Mountain Care Board. Those applicants can switch to a Human Services Agency review if they so choose.
Gobeille said he’s confident that his agency will be ready to assume that responsibility this summer. Officials already have begun to lay groundwork for the change, he said.
“I can’t say we don’t have the talent here at (the agency) to rise to the challenge. We do,” Gobeille said. “It’s just something we have to work through, because it’s important.”
Though the statute says Human Services is assuming oversight of nursing home sales on an “interim” basis, Gobeille said he believes his agency will take that responsibility for the long term. It makes sense, he said, given that the agency already regulates nursing homes’ operations and Medicaid rates.
Green Mountain Care Board officials “just don’t know these entities the way the people that work with them every day do,” Gobeille said.
Gobeille has first-hand knowledge of the situation, since he formerly chaired the care board. And he’ll get no argument from current care board leaders.
Reviewing nursing home transfers “was hard for us, because we just had a one-point-in-time glimpse,” said Kevin Mullin, Green Mountain Care Board chairman. “But we didn’t have oversight of nursing homes going forward.”
Mullin said there aren’t many nursing home sale proposals, so the change is not intended to free up care board resources. Rather, he argues that shifting responsibilities to the Human Services Agency is “the right thing” because “we weren’t adding value to the process.”
The agency’s review process for nursing home transfers is expected to be faster and less expensive than the care board’s. Gobeille said it also will be “more informed” given his agency’s extensive dealings with nursing homes.
Mullin said that change is important for Vermonters.
“This is a segment of the population that is the most vulnerable, and we have to do a better job of making sure they get the best care possible,” he said.
CORRECTION: A previous version of this article misstated the committee that Jessica Holmes was quoted speaking to. It was the House Human Services Committee.
