The Wyoming Senate Committee of the Whole on Feb. 21 voted to recommend House Bill 289, a bill to repeal the state's certificate-of-need requirement for long-term care facilities, sending the bill forward after debate about competition, Medicaid financing and budget risk.

Sponsor Senator Crump, speaking in favor, said the certificate-of-need requirement prevented new long-term care beds from being built and that repeal would "allow competition within the long term care industry." He argued higher-quality facilities would be rewarded and marginal providers would either improve or be outcompeted. "It's a very simple bill to repeal that certificate of need," Crump said, and recommended approval.

Supporters said repeal could open capacity in areas that cannot currently get additional beds. Opponents warned repeal would shift costs to the state because roughly two-thirds to 70% of nursing home revenue is paid through Medicaid in Wyoming. One senator warned the loss of a private-pay cost-shift could force the state to increase Medicaid reimbursements or otherwise backstop failing facilities, estimating (as a speculative, non-official figure raised in debate) a potential order-of-magnitude impact in the low tens of millions of dollars annually.

Senators also discussed phased effective dates. A standing committee amendment that would have changed the effective date was rejected on the floor; senators later explained the committee originally recommended a delayed date as a compromise with stakeholders but then asked the Committee of the Whole to report the bill without that delayed date.

The Committee of the Whole rose with a favorable recommendation for House Bill 289. The motion that the committee report favorably was made by Senator Olson; the clerk recorded 19 senators rising in support during the voice/standing count that followed.

The debate included repeated caveats from members that the nursing-home market is heavily dependent on public payers and that any expansion of capacity could change payer mixes and reimbursement dynamics. Several senators urged further study of budgetary and regulatory consequences on second and third readings.

If the bill moves forward, sponsors said they expect the Legislature and the Department of Health to monitor the market and any fiscal impacts closely.