Senate committee issues a do‑not‑pass on bill to create regional contracts for ventilator or psychiatric long‑term care; discussion continues on adult‑residence

The Senate Human Services Committee voted 6–0 to recommend a do‑not‑pass on Senate Bill 2360 after expressing concerns about combining ventilator and psychiatric needs into a single contracting scheme and about the feasibility of establishing four regional long‑term care contracts with sufficient workforce and readiness.

SB 2360 would have directed the Department of Health and Human Services to establish four service regions and to contract with a provider in each region to provide long‑term care services to individuals with ventilator or psychiatric needs. The bill also allowed the department to pay for care in an out‑of‑state certified facility if the department was unable to contract with an in‑state provider, and specified that an in‑state facility could receive additional funding equal to the added cost when a patient had been served out of state in the prior year.

Committee members raised multiple concerns. Senators and staff questioned whether combining ventilator care (a medically skilled service) and psychiatric long‑term care in the same contracting framework was workable. Members noted that in some circumstances the state already can authorize higher reimbursement or negotiate an enhanced rate for facilities that incur costs beyond the standard nursing facility rate; Sarah Akers, executive director of the Division of Medical Services, told the committee there is an existing process for facilities to negotiate an individual specific rate when care imposes costs not reflected in the standard rate. Akers also said that some people with ventilators are already served through existing HCBS waiver options and that the department can pay for out‑of‑state care when necessary today.

Committee members also raised workforce and training concerns: ventilator care requires staff with airway and advanced nursing skills, 24/7 coverage and ongoing training to maintain proficiency; committee members questioned whether four regional contracts spread across the state could maintain adequate staffing, especially in rural areas. Several senators observed that the number of patients who require ventilators is relatively small but that maintaining competency across multiple regions would be a continual cost and logistical challenge.

Senator Rohrs moved the do‑not‑pass recommendation; Senator Hogan seconded. Roll call recorded Senators Lee, Weston, Rohrs, Hogan, Van Osteen and Clemens voting Aye on the do‑not‑pass; the motion passed 6–0. Committee members discussed splitting the bill’s issues (for example, addressing ventilator needs separately from psychiatric placement and services) and continuing work on other long‑term care issues.

In the same meeting the department presented a longer discussion about basic care, assisted living and adult residential settings. Department staff recommended considering a streamlined licensure that would combine assisted living, basic care and specialized adult residential care into one HCBS‑focused licensure category, reduce unnecessary institutional licensure requirements, create a pathway for HCBS waiver participation for eligible settings and develop a funding model based on tiers and add‑on payments tied to resident needs. The department noted current risks in program structure and federal funding alignment (for example, how personal care is defined federally versus how the state pays the service in facility settings) and recommended further study and stakeholder engagement. The department’s proposed amendment would base an operating margin on direct services and make technical changes to cost‑report language; the department said no fiscal note was prepared for that amendment because it included an appropriation in the draft.

Why this matters: SB 2360 sought to improve in‑state capacity for patients needing ventilator or psychiatric long‑term care but the committee concluded the bill, as written, raised feasibility and policy concerns. Separating technical solutions for ventilator care, psychiatric residential needs and broader licensure/funding reforms may be necessary to build a workable continuum of care.