[{"_1":2,"_100":-5,"_101":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6125937,"mediaKeyId","2674136-209a87d52f2338731c6423ea909a41b6","parentId",2674136,"title","Lawmakers hear bill to rebase payments for adult residential care for dementia and brain injury","audioSeconds",624,"startMs",2436000,"endMs",3060000,"viewUrl","/Search/View?dp=1&key=2674136-209a87d52f2338731c6423ea909a41b6&start=2436&end=3060","thumbnailUrl","https://assets.pipeline.soar.com/2674136-209a87d52f2338731c6423ea909a41b6/thumbnail_2436000.jpg","articleUrl","/articles/6125937/North-Dakota/Lawmakers-hear-bill-to-rebase-payments-for-adult-residential-care-for-dementia-and-brain-injury","mediaUrl","https://secure.pipeline.soar.com/6125937-c0b622af649b8df09e6a6bcfb3c54986/orig.mp4?Expires=1770447747&Signature=LYpOWI2nYB5449kGqZ0jUIlViF~6z5EmPYOaVThIW9N6XLkhObD~xqWug~PC0RUQUQ89BuPoKR3Ed3XCpNeQXnjGWzKAWA4DWzRK6SbIpQWgjpGKtyL8QoR3mKVUMTy9IJLrq-hKgcJEgoFMmgDspdydu5e9kwq3QzjA53uYJEj~NSyT~xYvrPERHhrZHSxIvAFF4bbOvsAfIudaQxh0hBQR3ESWgzhBnWzLkXQ01kfhqzw62dj3Wt4OoBT83y0pybu41cm7LUvEfVBLtPPzwkUotTl9D~dFWVhvmTkSzV1tBh6pJmPLkiDYrfF7gq~UTYcLwjjrzyvYXSszuFPYBQ__&Key-Pair-Id=KUT5TJCACFTXG","author","North Dakota State Legislature","date","2025-03-18T00:00:00Z","article","The House Human Services Committee received testimony on Senate Bill 2271, a proposal that would require the Department of Health and Human Services (DHHS) to collect cost reports from adult residential care facilities and rebase Medicaid payment rates to reflect providers’ actual costs.

Why it matters: Providers and the bill sponsor said adult residential facilities — licensed as basic care and serving people with dementia and acquired brain injury — are a lower-cost alternative to nursing homes but are reimbursed at rates that do not cover current operating costs. Supporters told lawmakers the shortfall forces facilities to raise private-pay rates or discharge Medicaid residents to higher-cost nursing homes.

Senator Sean Cleary, sponsor of the bill, told the committee adult residential facilities are a cost‑effective option compared with skilled nursing but that state reimbursement “doesn’t actually reflect the cost associated with providing the care.” Cleary said the Long Term Care Association’s data show an average cost of about $203 per resident per day versus average state reimbursement near $162 per day. He said the bill would require facilities to submit cost reports by Oct. 31, with recalculation of rates effective Jan. 1, 2026, and another round of rebasing to begin July 1, 2027.

Provider testimony: Nikki Wagner, president of the North Dakota Long Term Care Association, said the facilities have existed for decades but were not always recognized in state code, which contributed to funding gaps. Wagner cited department data showing an average operating cost around $212 per day and an average paid rate near $166 — a roughly $46 per-resident daily shortfall. She said the shortfall is driven largely by staffing and regulatory costs and that rebasing would stabilize providers who deliver 24‑hour specialized memory-care services.

Lana Sharvitt, administrator of Maple View Memory Care Community in Bismarck, described local experience: Maple View operates several facilities with Medicaid and private-pay residents and she said the share of Medicaid residents has grown, creating situations where residents “spend down” and become unable to pay room-and-board fees. Sharvitt said keeping residents in adult residential care can be substantially less expensive for Medicaid than placement in skilled nursing; she cited a 2024 average skilled nursing rate of $403.19 per day.

Fiscal estimate and scope: Senator Cleary told lawmakers the bill would affect roughly 16 facilities and estimated an initial cost of about $1.7 million general fund and $1.7 million federal funds to align reimbursements with reported costs. Witnesses said a rebasing in 2019 had been helpful and argued for another rebasing to reflect rising costs.

What the bill would do: The measure would define adult residential facility language in statute, require cost reporting and instruct DHHS to recalculate provider rates based on submitted costs with phased implementation through 2027. Supporters said this would reduce pressure to shift costs to private-pay residents and help facilities recruit and retain staff.

Next steps: The committee closed the hearing on Senate Bill 2271; no committee vote was recorded in the hearing transcript.

Speakers quoted or referenced in this article: Senator Sean Cleary, Nikki Wagner (North Dakota Long Term Care Association), Lana Sharvitt (Maple View Memory Care Community), Chairman Ruby.

Clarifying details: {\"facilities_count\":\"~16 facilities (sponsor estimate)\",\"estimated_budgetary_impact\":\"$1.7M general fund and $1.7M federal funds (sponsor estimate)\",\"average_cost_per_day_provider_data\":\"$203 per resident per day (Long Term Care Association cited)\",\"department_cost_comparison\":\"$212 per day (department slide) vs average paid rate $166 per day (department slide), ≈$46/day shortfall\",\"skilled_nursing_avg_2024\":\"$403.19 per day (testimony)\"}

Proper names: North Dakota Long Term Care Association; Maple View Memory Care Community; Department of Health and Human Services (DHHS).

Community relevance: Statewide but concentrated on facilities and families that care for residents with dementia or acquired brain injury; fiscal impact on Medicaid and private-pay residents.","mediaType","Video","parentTitle","House Human Services Tuesday, Mar 18, 2025 8:57 AM - 11:46 AM","oneSentenceSummary","The House Human Services Committee received testimony on Senate Bill 2271, which would require cost reporting and rate rebasing for adult residential facilities that serve people with dementia and acquired brain injury.","taxTitle","Human Services, House of Representatives, Legislative, North Dakota","taxId",28893,"location","North Dakota","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6125942,"Committee hears bill to fund 988 crisis hotline as lawmakers weigh phone-fee option",1394,360000,1754000,"/Search/View?dp=1&key=2674136-209a87d52f2338731c6423ea909a41b6&start=360&end=1754","https://assets.pipeline.soar.com/2674136-209a87d52f2338731c6423ea909a41b6/thumbnail_360000.jpg","/articles/6125942/North-Dakota/Committee-hears-bill-to-fund-988-crisis-hotline-as-lawmakers-weigh-phone-fee-option","https://secure.pipeline.soar.com/6125942-614ccef29761e9d45a158384cebd34da/orig.mp4?Expires=1770447746&Signature=jrrFgXd7xf0tC2ISa24MQyx9~SW7G23Rx4U65JyEPmyDQlftT1vjlaa3a9FaPyyua6FrRLAi2hACS~Oqub2KmG754htWFSAvqUCAn9wkYhzXZ65mRcECXPVXebZbBA1D1sbj2Y-R-YCc9HOmGX2Nk7TxOs4Wcd7LE2I4ciftgKHXrlZO3~HRtaj7J2ROBxjjMBDNMURczTHldq0TuCVZWwcokGIE93vvkCNRzsU8aP91UesZ2km8MDD5nBo5yKRl2CjAgupRylBolqDkJABq20rhUSr8G8WVZVRp9NRDJrMhgvUtMMt-zi0Y251dsdpWVhQ8HIULXxI2bTRZdntRaA__&Key-Pair-Id=KUT5TJCACFTXG","The House Human Services Committee heard testimony on Senate Bill 2200, which would create a 988 crisis hotline program and a 988 crisis stabilization fund, at a committee hearing. Senator Kathy Hogan, sponsor of the bill, told the committee that federal designation of the 988 dialing code in February 2020 brought new standards and requirements but not ongoing funding.

Why it matters: Advocates and the bill sponsor said 988 is a central part of crisis response that connects people in acute behavioral-health emergencies to trained staff and mobile crisis resources. Supporters told the committee that without a stable funding source the answering point and the broader crisis continuum risk understaffing and service gaps that can leave callers without timely help.

Senator Kathy Hogan, who represents District 21, said many states are using a small phone surcharge to pay for 988 services and that North Dakota’s bill began as a similar fee proposal. “With this new federal designation and standards came many new requirements and regretfully no funding,” Hogan said. She told lawmakers the bill’s original phone-fee option was removed in committee, and the current proposal would fund the 988 answering point, First Link, through a direct appropriation in the Department of Health and Human Services (DHHS) budget. The House appropriations recommendation lowered an original $700,000 allocation to $500,000.

Advocates urged more investment than the current appropriation. Madison Hansen, policy advocate for the National Alliance on Mental Illness (NAMI), called the fund “a lifeline” and said 988 must be backed by trained staff, mobile crisis teams and stabilization units. “A number alone cannot do the work,” Hansen told the committee.

Testimony and details: Hogan said First Link — the statewide answering point that handles 988 calls, texts and chats — responded to more than 14,000 suicide-related contacts in 2024. Committee and sponsor testimony said roughly 90 percent of the costs of answering services go to staffing; Hogan said First Link currently pays many bachelor-level staff less than $20 an hour and faces high turnover. Witnesses described First Link as the central triage and coordination point that maintains a statewide provider registry and bed-management contacts for emergency responders.

Committee members asked about operational details. Representative Hawley asked whether calls are answered in the United States and whether automated systems or AI could be used; Hogan and witnesses said the system is primarily local, staffed by trained, bachelor-level responders and uses a national backup only when local capacity is exceeded. Representative Dobrevitch asked whether the $200,000 reduction from $700,000 to $500,000 would materially harm First Link’s ability to meet demand; Hogan replied the provider would “still struggle” even with $700,000 and that staffing and turnover are core problems.

Funding options discussed: Senators and members debated the longer-term funding approach. Hogan and others said many states have adopted small per-line surcharges similar to 9-1-1 fees. One estimate cited in committee testimony suggested a 30-cent-per-line fee would generate roughly $4.4 million annually; sponsors discussed alternatives such as a 15- or 20-cent surcharge to reduce the revenue target while creating a more stable, permanent funding stream than periodic appropriations.

What the bill would and would not do: The draft bill would create a 988 crisis program and stabilization fund and includes reporting and appropriation language. Committee discussion focused on whether to pursue a permanent fee model or rely on appropriations; no vote on final passage was recorded at the hearing.

Next steps: The committee closed the hearing on Senate Bill 2200 and moved to other items on the calendar. Supporters urged members to review written testimony from First Link and other providers submitted for the record.

Speakers quoted or referenced in this article: Senator Kathy Hogan, sponsor; Madison Hansen, policy advocate, National Alliance on Mental Illness (NAMI); Chairman Ruby, House Human Services Committee; Representative Hawley; Representative Dobrevitch.

Clarifying details: {\"requested_appropriation_initial\":\"$700,000 (committee request)\",\"appropriation_after_action\":\"$500,000 (appropriations recommendation)\",\"FirstLink_2024_calls\":\">14,000 suicide-related calls/texts (reported)\",\"staffing_share\":\"~90% of operating costs are staffing (testimony)\",\"current_staff_pay\":\"less than $20/hour for many bachelor-level staff (testimony)\",\"phone_fee_estimate\":\"30¢/line estimated to raise ≈$4.4M/year (committee estimate)\"}

Proper names: First Link; Department of Health and Human Services (DHHS); National Alliance on Mental Illness (NAMI).

Community relevance: Statewide; affects callers in urban and rural areas, law enforcement and emergency medical services who receive referrals from 988.","The House Human Services Committee heard testimony on Senate Bill 2200, which would create a 988 crisis hotline program and a 988 crisis stabilization fund.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6125932,"Panel divided over bill to let Life Skills Transition Center temporarily serve non‑DD youth in crisis",3698,3809000,7507000,"/Search/View?dp=1&key=2674136-209a87d52f2338731c6423ea909a41b6&start=3809&end=7507","https://assets.pipeline.soar.com/2674136-209a87d52f2338731c6423ea909a41b6/thumbnail_3809000.jpg","/articles/6125932/North-Dakota/Panel-divided-over-bill-to-let-Life-Skills-Transition-Center-temporarily-serve-nonDD-youth-in-crisis","https://secure.pipeline.soar.com/6125932-da3ee30e80808548b49931a5dc16127a/orig.mp4?Expires=1770447746&Signature=kzbFSRABO3ObtP-yoLD3-AIrbCwH7Tdxh0lIP~ead4X3EWS~HMCfeae~tn991yQh-9zXlk6qE-hJicJKiS143e3paI54GeWoCG73Wg6nBEUW5T5L2Fw7Q5e6xHF6JgUfXNiOLElhOmldxDIlKOFicTqKz3AxlvkiMGNj4FFKPYtSMlecNv9Th--R--NEDtow3GLPV5QwSx093gZwfjFF1OSQPAo~pqFDMWKiTnSLzSZScaCA6k3FTtv~w51Eto0vqk2J~acuTo3NFxPS-Y9dB4qfQXj5xLp3Fd0p7BRGY111S2guaxGxT9komn2g2uqTl3p5qFOQBf8fOEGSFN-niQ__&Key-Pair-Id=KUT5TJCACFTXG","The House Human Services Committee heard Senate Bill 2112, a proposal to permit the Life Skills and Transition Center (LSTC) in Grafton to admit “noneligible” minors — that is, minor residents who do not meet eligibility for developmental disability (DD) services — for short-term crisis stabilization. The bill would add a noneligible definition to statute, allow stays of up to 90 days with a possible 90‑day extension, require the DHHS commissioner and LSTC superintendent to concur on any admission of a noneligible youth, and impose a sunset on the authority on June 30, 2027, plus semiannual reports to legislative management.

Why it matters: Supporters told the committee that human service zones face recurring placement crises in which children with complex, multilayered needs have no appropriate community placements, sometimes remaining in zone offices, hotels or other temporary settings. Proponents argued LSTC is a state-operated safety-net resource that can provide short-term stabilization and multidisciplinary planning, allowing zones time to secure longer-term placements or community supports.

Supporters’ testimony: Jessica Thomason, executive director for the Human Services Division at DHHS, said the measure targets a small number of youth with very complex behavioral, developmental or psychiatric needs who lack other suitable placements and for whom short-term, structured stabilization could prevent deeper system involvement or out-of-state placement. Kelsey Bless (DHHS Children and Family Services) and human service zone directors including Kim Jacobson described episodes where children have stayed in zone offices for extended periods because no licensed provider would accept them.

Heather Jenkins, superintendent at LSTC, described the center’s youth transition program, its 12‑person home‑like residences and the multidisciplinary approach LSTC uses to prepare youth for reintegration. Jenkins said LSTC has returned youth to communities after stabilization and that the program’s goal is temporary crisis care and transition planning, not long-term placement.

Opponents’ testimony: Mental-health advocates and disability organizations strongly objected. Carlotta McClary of Mental Health America and the North Dakota Federation of Families said the state should invest in community-based crisis beds, partial hospitalization and psychiatric residential treatment (PRTF) capacity rather than broaden LSTC’s mission. Veronica Zietz of the Protection and Advocacy Project and Kirsten Dvorak of The Arc of North Dakota said LSTC exists under state law and the constitution to serve residents with developmental disabilities and that allowing non‑DD admissions risks denying beds to DD residents and commingling populations with different needs and vulnerabilities.

Providers’ concerns: The North Dakota Association of Community Providers cautioned that LSTC and other DD services already face staffing shortages and that expanding the center’s eligible population could strain capacity and undermine care for eligible residents. Several witnesses urged stronger community services, expanded treatment foster care and host‑home pilots as alternatives.

Policy details and safeguards: The bill as engrossed requires concurrence from both the DHHS commissioner and the LSTC superintendent before a noneligible admission; it limits stays, includes a sunset date and mandates regular reporting to legislative management on utilization, barriers to community placement and steps DHHS is taking to expand community services. DHHS officials testified they are piloting host‑home models and pursuing system-of-care grants to expand community-based crisis resources.

Next steps: The hearing produced extensive, divided testimony but no committee vote in the published transcript. Proponents asked for the temporary authority so the state can address immediate placement crises while pursuing longer-term community solutions; opponents urged caution, additional safeguards and a focus on expanding community-based services and PRTF capacity.

Speakers quoted or referenced in this article: Jessica Thomason (DHHS Human Services Division), Kelsey Bless (DHHS Licensing Unit), Heather Jenkins (superintendent, LSTC), Kim Jacobson (Agassiz Valley Human Service Zone), Carlotta McClary (Mental Health America of North Dakota), Veronica Zietz (Protection and Advocacy Project), Kirsten Dvorak (The Arc of North Dakota), Angela Denias (North Dakota Association of Community Providers), Chairman Ruby.

Clarifying details: {\"definition_noneligible\":\"Minor who is a legal resident of the state and has not been deemed eligible by the department for Developmental Disability Services (bill text)\",\"maximum_length_of_stay\":\"90 days, with an additional 90 day extension possible (bill text)\",\"reporting_requirement\":\"DHHS to report to legislative management every 6 months on utilization, barriers, and strategies\",\"sunset\":\"June 30, 2027 (bill text)\"}

Proper names: Life Skills and Transition Center (LSTC); Department of Health and Human Services (DHHS); Ruth Myers Adolescent Center; Human Service Zones; Nexus Path Family Healing; Agassiz Valley Human Service Zone.

Community relevance: Affects child-welfare placements across human service zones; touches juvenile court proceedings, child welfare and behavioral-health systems.","Senate Bill 2112 would allow the state-run Life Skills and Transition Center (LSTC) to admit minors who are not eligible for developmental disability (DD) services for short-term crisis stabilization. Proponents said the change fills urgent placement gaps; opponents said it could divert beds and staff from DD residents and urged expansion of in‑","actionData","errors"]

Article not found

Lawmakers hear bill to rebase payments for adult residential care for dementia and brain injury

Committee hears bill to fund 988 crisis hotline as lawmakers weigh phone-fee option

Panel divided over bill to let Life Skills Transition Center temporarily serve non‑DD youth in crisis