The Arkansas Legislative Council on Monday authorized the state Department of Human Services to use a total of $245.6 million of federal coronavirus relief funds to assist hospitals and nursing homes with their staffing needs and increased costs amid a surge of coronavirus cases spawned by the delta variant.
In a voice vote with a few audible dissenters, the Legislative Council voted to give the department spending authority to use $129.2 million in federal American Rescue Plan funds to aid hospitals.
The department's request for these funds is aimed at stabilizing the workforce of the hospitals throughout the state, said Human Services Secretary Cindy Gillespie.
"This one is largely aimed at the staffing problem that they are having," she told lawmakers. "This will help them both retain staff and attract staff."
In its request, the Department of Human Services said it asked for $97.3 million to make formula-based payments to hospitals to offset the extraordinary costs related to retaining and acquiring front-line staff.
The department said it developed a formula based on providing an allotment of $9,000 per licensed bed to the Arkansas State Hospital and each acute care hospital, critical access hospital and long-term care hospital -- excluding rehabilitation and psychiatric hospitals -- and a payment based on the Arkansas Department of Health's determination of licensed Medicare beds for each facility as of March 1, 2021. The formula excluded hospitals that do not participate in Medicare or Medicaid.
But, regarding the staff shortage, a handful of lawmakers expressed concern about some hospitals requiring their health care workers to be vaccinated for covid-19 and potentially terminating those who decline to be vaccinated.
"It seems to be that the hospitals that are requiring their staff to be vaccinated that doesn't want to be is counterproductive to the supply-and-demand problem and for us to incentivize that kind of behavior would make it even worse," said Rep. John Payton, R-Wilburn. "So, if we are going to have the taxpayers ponying up the money, then I believe that they should have a seat on the board.
"What can the Department of Health, the state or this body do to get the message to those hospitals that they don't need to be letting Arkansans go and expect Arkansans to bail them out?"
Bo Ryall, president and CEO of the Arkansas Hospital Association, said there are a small number of hospitals that have decided to require their staff to be vaccinated for covid-19.
"That is not the source of the problem," he said. "The problem is the pandemic and all the staffing challenges that surround the pandemic and so all hospitals across the state are seeing these same issues, as are the nursing facilities and other health care facilities. I think this is a problem that is much broader than just that vaccination question."
If lawmakers want to change state law regarding vaccinations, that should be done through legislation and not through this funding request, Ryall said.
Also as part of its request for the $129.2 million, the Department of Human Services asked for $22.2 million to help use of COVIDComm. The Arkansas COVIDComm system was established during the 2020 winter surge to coordinate covid-19 patient transfer in the state.
In order to be eligible for the payment, hospitals must receive patients from other facilities using the COVIDComm system, the Department of Human Services said.
"In addition to the formula payment, an additional $2,500 per licensed bed will be available for distribution to Arkansas State Hospital, acute care, critical access or long-term acute care hospitals that participate as a receiving hospital of covid-19-positive patients in the COVIDComm transfer system as of Aug. 20, 2021," the department said in in its request.
In its request, the Department of Human Services also sought $9.6 million for monoclonal antibody administration.
In addition to the formula payment, an add-on payment of $1,000 per licensed bed will be available for distribution to the Arkansas State Hospital and each acute care, critical access or long-term acute care hospitals that administered monoclonal antibodies in an outpatient setting, including emergency departments, to covid-19 patients through Aug. 20, 2021, according to the department.
NURSING HOME AID
In a voice vote earlier in the meeting, the council voted to give the Department of Human Services spending authority to use $116.4 million in federal American Rescue Plan funds to aid nursing homes.
The department asked for $45.6 million in one-time funding for skilled nursing facilities equivalent to 18 months of Medicaid rate cuts because of total occupancy under 80%, and a portion of the per bed value-associated cuts, in order to help them to continue operations and staffing during the public health emergency.
The covid-19 pandemic has triggered automatic, formula-driven cuts to payments of Medicaid's share of nursing facility fixed property costs, according to the department. The average occupancy for nursing homes is about 60% statewide, with many facilities below 50% or even 40%.
The department also asked for $40 million to establish a fund to cover nursing facilities' unreimbursed costs of biohazard medical waste disposal and covid-19 testing of staff and residents from March 3, 2021, through Feb. 28, 2022.
It also sought $30.8 million to establish a fund so each qualified skilled nursing facility will receive $2,000 per occupied licensed bed to assist them in meeting the continued extraordinary staffing needs during the pandemic.
The staffing issues at the nursing homes "are very, very real," and "that is the short-term impetus behind a lot of this," Gillespie told lawmakers.
"People are tired and worn out, so much of this money will be spent on staffing," she said.
Rachel Bunch, executive director of the Arkansas Health Care Association, said some nursing homes in Arkansas have required covid-19 vaccinations for their employees, but "as of right now the vast majority of long-term care facilities have not mandated vaccine."
"If there are health care workers that want a job that leave their job because of that [vaccine requirement], we can definitely find them another one in Arkansas," she said.
Sen. Terry Rice, R-Waldron, questioned state officials why the state's American Rescue Plan steering committee was made aware of the Department of Human Services' requests for these federal funds only about a hour and a half before Thursday's steering committee meeting. The steering committee, appointed by Gov. Asa Hutchinson, is composed of nine Hutchinson officials and six lawmakers.
"[With] something of this magnitude, that continues to be a problem with the Legislature," Rice said. "Everything is a last-minute emergency and while we want to be help and be as responsible as we can, that is one of the concerns."
Gillespie apologized for the steering committee receiving the requests shortly before Thursday's meeting.
"It is not how we like deal with the Legislature," she said. "We prefer to brief people in advance. It is highly unusual for us to have to move this quickly."
Gillespie said the department had been working with the Arkansas Hospital Association and Arkansas Health Care Association on these requests.
But she said, "The staffing issues became much more problematic much more quickly and we had thought we would have more time, and suddenly it was ... things were really reaching a crisis stage and we needed to do something and we needed to go ahead and move."