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MORE THAN 130 NURSING HOMES SUE TO BLOCK NY LAW CAPPING PROFITS


IT'S THE LATEST IN A SERIES OF COURT CASES THAT GROUPS REPRESENTING HOSPITAL
ASSOCIATIONS AND NURSING HOME FACILITIES HAVE FILED AGAINST THE STATE

Raga Justin
April 14, 2023


Members of the 1199SEIU rally in Albany on April 12, 2023. The union has backed
a Department of Health law that would require nursing home operators to abide by
a set of strict spending requirements; nursing homes recently called the measure
unconstitutional in a lawsuit filed last week.

Lori Van Buren/Times Union

ALBANY — More than 130 nursing homes are suing the state alleging that a
requirement to designate 70 percent of their profits for care of residents
represents “the most serious regulatory threat” facing the industry.



The controversy centers around a 2021 law included in that year’s budget that
required residential health care facilities to spend a minimum of 70 percent of
their total operating revenue on direct care for their residents, including at
least 40 percent of their revenue for resident-facing staff. The law was set to
go into effect in January 2022, but was delayed by a series of executive orders
and other regulatory holdups. 

The lawsuit, filed late last week in state Supreme Court in Albany, names state
Department of Health Commissioner James McDonald and Budget Director Robert
Megna as defendants. It's the latest in a series of court actions that groups
representing hospital associations and nursing home facilities have taken in
recent years seeking to overturn the law.

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Nursing home operators contend that what they contend is an “arbitrary,
capricious, and extremely damaging” statute poses grave risks to the industry
and to the quality of care for residents. The measure had been crafted by the
Legislature in response to pandemic-related concerns over how nursing homes were
spending their money as public outrage over the conditions in those facilities
began to escalate.



They have also criticized a provision that would require nursing homes that have
profits over a 5 percent cap to turn those funds over to a state-managed fund,
which would then disburse money as a reward to facilities that have met certain
standards for high-quality care. Nursing homes would also face monetary
penalties for failing to meet the 70/40 allocation rule.

In effect, the law forces nursing homes to turn over private and federal
Medicare dollars to fund the state’s Medicaid program, the lawsuit alleges. A
previous federal lawsuit filed in U.S. District Court in Albany in 2021, right
before the law was originally set to go into effect, called the measure an
unconstitutional takeover of private property for public programs.

Groups who support the law have argued that it was intended to ensure
accountability in how nursing homes spend Medicaid funds, ensuring that most of
the funds received are spent on caring for residents — not administrative costs.
Studies cited by the 1199SEIU union representing nursing home care workers have
shown that under the law, an extra $510 million of funding would have gone to
resident care based on cost reports from 2019.

James Clyne, the president of LeadingAge New York — a group that filed a similar
state lawsuit last May that was later dismissed — said that while the nursing
home industry can comply with the rule, facilities want to ban the section of
the law that demands funds over the 5 percent cap be turned over to the state. 



“The problem with the state is they're telling us what we have to do with other
people's money,” Clyne said. “They're not a party to the contract that we have
with either Medicare or with people who are private payers.”

Clyne also criticized a separate provision in the law that facilities have also
balked at, which establishes minimum staffing standards of at least 3.5 hours of
daily nursing care for each resident. 

He said that some types of residential care facilities have different needs,
providing the example of a dementia unit versus a pediatric facility for
children with greater medical requirements. In the former, residents may need
less clinical care but more recreational activities, rendering the 3.5-hour
standard ineffective. 

“One size does not fit all for every nursing home,” Clyne said, calling the law
“fundamentally flawed.”


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But proponents and unions who back the policy have said the underlying premise
behind the law is meant to provide guardrails for how nursing home operators
allocate funds they already have, not unfairly penalize facilities. 

“All the law requires them to do is to sort of shift their priorities,” said
Dennis Short, a policy analyst with 1199SEIU. “If they're not meeting the
standard, the easiest way to do so is to hire additional staff and spend more
money on supplies, increase wages or benefits.”

“If the money is intended to go to resident care, is it permissible to to use
taxpayer dollars to enrich owners?” Short added.

The majority of facilities already meet the standard, Short said. The law is in
effect, although no penalties have been assessed since nursing homes have not
released updated cost reports, Short said.



If the lawsuit is successful, no penalties would be assessed. 

The lawsuit, which claims the law violates several protections under the U.S.
Constitution, including the Contracts Clause and Supremacy Clause, is seeking an
injunction that would bar the state Department of Health from enforcing any
penalties either in the future or retroactively.







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Written By
Raga Justin
Reach Raga on

Raga Justin is a second-year Hearst fellow covering state politics for the Times
Union. She spent her first year covering Darien, Connecticut, as part of the
Hearst Connecticut Media Group. She is from Texarkana, Texas, and previously
worked for the Dallas Morning News in Washington, D.C., the Houston Chronicle
and the Texas Tribune. Raga graduated in 2021 from the University of Texas at
Austin, majoring in journalism.

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