Committee hears updates to ND geropsychiatric facility law; supporters say changes align process, advocates urge community services

Chairman Ruby opened a hearing on Senate Bill 20‑81, which would amend North Dakota Century Code Chapter 50‑24.4‑29 to update admission and service rules for geropsychiatric facilities in skilled nursing homes.

Pam Sagness, Executive Director of Behavioral Health at the Department of Health and Human Services, said the bill removes a statutory requirement that the North Dakota State Hospital always perform an admission evaluation for patients heading to gero‑psychiatric units. “By removing this language, it allows the avoidance of unnecessary evaluations by the North Dakota State Hospital,” Sagness said, adding that the change lets a qualified provider’s assessment permit direct transfer and prioritizes state hospital referrals when openings exist.

Sagness said the department also asked to remove language that barred the state hospital from offering general psychiatric services through a unit established for those services, explaining the change would let the state respond if private‑sector capacity is lacking. She noted demographic trends — “in 2024, 15.86 percent of North Dakotans were age 65 and older” — and said the department is working with the Long Term Care Association to clarify admission criteria.

Nikki Wagner, president of the North Dakota Long Term Care Association, testified in support and described the bill as modernizing outdated language and clarifying that patients do not need to be admitted to the state hospital before consideration for a gero‑psychiatric nursing unit. Wagner said these units require both skilled nursing and psychiatric services and that existing payment systems are essentially the same for those patients.

Pam Sagness and other witnesses said the need for gero‑psychiatric capacity is high and that recruiting qualified providers and arranging psychiatric consultation and training are major implementation tasks.

Denise Harvey, director of program services for general psychiatric services, representing Protection & Advocacy (P&A), testified in opposition to aspects of the bill. Harvey urged that individuals and families be consulted about the full continuum of care before nursing home placement and said some people eligible for gero‑psychiatric units have successfully received home‑ and community‑based services (HCBS). P&A recommended strengthening community alternatives and argued the bill’s language could increase reliance on institutional care; the group suggested adding a moratorium limiting the number of gero‑psychiatric units.

Committee members pressed for clarifications. Representative Rohrer asked whether removing the bar on the state hospital offering general psychiatric services would allow the hospital to compete with private providers; Sagness said the change would only allow the state to fill gaps — for example, when individuals with certain criminal‑justice histories cannot find a skilled nursing placement. On age criteria, Sagness said the working group is evaluating whether language should reflect that some people under 65 (even in their 30s or 40s) may need gero‑psychiatric services.

No formal committee action was taken during the hearing.