Appropriations committee hears request to raise adult residential facility rates, refers bill for further review

Senate Bill 2271, presented to the House Appropriations Committee by Representative Matt Ruby (R–District 40), would reclassify and rebase reimbursement for adult residential facilities—formerly called specialized basic care—and increase the reimbursement rate used to pay those providers. Ruby told the committee the proposal includes a roughly $1.7 million appropriation in the next biennium to adjust rates for that provider group.

The bill matters because adult residential facilities serve people with dementia and those with acquired brain injury who otherwise may qualify for skilled nursing care. Representative Ruby said the current adult residential reimbursement is $29,333 per year while “skilled care is a hundred and 30 5 thousand 6 hundred and 80, 686 a year,” and that raising the adult residential rate is intended to help keep those lower‑acuity options open and reduce bottlenecks at higher‑cost skilled nursing facilities.

Committee members asked technical, budget and capacity questions. Representative Murphy asked whether the $1,709,000 figure was a department administration or rate‑increase number; Ruby said the appropriation is to increase rates to reflect cost of care, and staff said they did not develop the bill and did not supply the funding formula. Representative Murphy and others asked how many residents would be affected; Ruby said there are 224 participants currently in adult residential care. Sarah Aker, executive director of the Division of Medical Services at North Dakota Department of Health and Human Services, told the committee that adult residential memory care is typically separate from nursing facility services, though some providers are co‑located or operated by the same provider.

Department staff and several representatives emphasized statutory distinctions: adult residential services are delivered under an HCBS waiver while basic care (often called personal care under the state plan) uses a different reimbursement construct. Aker said the adult residential service does receive routine inflation adjustments but has not been rebased recently; the bill would rebase the adult residential rate within that payment formula rather than merge it into the basic care formula.

The committee did not vote on the measure. Members asked the committee human resources section to perform a deeper review of the appropriation and rate methodology and to return to the committee as early as Monday for further action.

Outlook: Staff will analyze the bill’s cost model, capacity assumptions and whether the appropriation covers initial rebasing or must be supplemented if enrollment grows.