Appropriations subcommittee directs DHHS to develop nursing-facility payment-withhold, delays implementation until 2027

The Senate Appropriations — Human Resources Division agreed to include an amendment directing the Department of Health and Human Services (DHHS) to work with the North Dakota Long Term Care Association to develop a payment-withhold structure for value‑based payments to nursing facilities, and to delay implementing any withhold until July 1, 2027.

Senator Davidson offered the language (the “Davidson amendment”) stating that DHHS shall collaborate with the association during the 2025‑26 interim to develop a payment-withhold structure for a value‑based care incentive program and shall not implement any withhold before July 1, 2027. "So that gives them two years to work through that process without having a withhold program," Davidson said when presenting the amendment.

Committee members said the amendment is intended to preserve the current payment system for the next two years while directing DHHS and industry stakeholders to design a new structure. "Everything will be business as usual until July of '27," Senator Mather said, noting the language creates a moratorium that gives the department time to negotiate program details and report back in the next session.

Some senators expressed concern about delaying or altering the department's plan. A committee member estimated that removing the department's proposed change now would cost about $4 million to the budget by preserving the status quo; the member said that number represents money the department would have had for the next biennium if a new system were implemented. "I would see all three of the potential amendments as delaying what the department wanted to do so that this would cost about $4,000,000," the senator said.

Committee members also discussed the practical stakes for individual providers. One senator noted he had heard there were three facilities at risk of closure if payment changes occur; another committee member urged that the moratorium be used to strengthen relationships between the department and providers rather than to serve as an operational mandate.

After discussion and comparing competing amendment language offered in the room, the subcommittee agreed to include the Davidson amendment on Section 41. Members described the outcome as a direction to DHHS and the Long Term Care Association to collaborate, not as immediate implementation of any withhold.

The decision leaves operational details and any final law changes to future legislative action; senators noted the legislature can revisit payment policy in the 2027 session if the department or providers request changes.

Ending: The subcommittee recorded the inclusion of the amendment into the draft bill and directed staff to reflect the change in the long sheet and in the bill text for further consideration in the full committee and subsequent conference work.