KDADS outlines staffing, training shortfalls as survey workload grows

Lacey Hunter, commissioner of survey certification and credentialing for the Kansas Department for Aging and Disability Services, told the Special Committee on State Employee Compensation that the state is behind federal survey requirements because of staff shortages and the length of training required to certify new surveyors. Hunter said Kansas currently certifies about 303 federally certified nursing facilities and about 525 state-licensed-only adult care homes, and that federal rules call for a recertification survey “no greater than every 15.9” months. “We are currently as a state sitting at an average of 19.9,” Hunter said.

Hunter outlined the surveyor training pipeline: state onboarding plus approximately 1,500 pages of federal reading and a sequence of online tests and observation surveys. She said most recruits take about six months from hire to independent surveyor. “Most of our staff are getting all this done, getting all their tests passed in about six months from the date of hire,” Hunter said, adding that the Centers for Medicare and Medicaid Services (CMS) expects a shorter ramp-up.

To address vacancies, Hunter described a recent regrade and salary negotiation with the Department of Administration. The licensure unit’s approved headcount was reduced from about 51.5 positions to a smaller number; Hunter said 28 of the original 51.5 positions were vacant earlier and the department eliminated 15 positions in the reclassification, leaving 13 vacancies at the higher starting salary. Hunter said the new salary framework allows non-RN hires to be offered a starting pay about $60,000 and registered nurses about $67,000, with a roughly $2,000 training completion bonus (raising those levels to $62,000 and $69,000 after passing required training).

Hunter said CMS permits states to use a broader pool of professionals as surveyors—social workers, dietitians, sanitarians and others commonly called “generalists” in other states—but Kansas has been cautious. She said a key barrier is the difference between exempt and nonexempt pay status: many potential non-RN hires would be nonexempt and eligible for overtime, while RNs in Kansas are currently treated as exempt salaried employees. Hunter explained that overtime exposure would substantially increase budget needs and complicate team dynamics on multi-day surveys: “It is often not right next door…when we are looking at staff who are not exempt and held to 40 hours a week or we’re paying overtime…that part will make a little more sense in my next presentation actually.”

Committee members asked about alternatives Hunter said the agency is pursuing: targeted recruitment at career fairs, state fleet vehicles for surveyors, and revised pay offers intended to make state jobs more competitive with local employers. Hunter and other KDADS staff said they are also discussing flexibility about who may serve on survey teams, but emphasized any change requires coordination with the Department of Administration and attention to state pay rules and federal CMS requirements.

Hunter framed the problem as operational and legal: surveyors must be experienced and trained, the federal standard for the recertification frequency is fixed, and CMS has minimum expectations for who may act as a surveyor and how long training should take. She recommended a combination of strategies—higher starting pay, more recruitment, and careful consideration of generalist hires—to decrease Kansas’ average recertification interval toward the 15.9-month target.

Ending: KDADS officials said they will return to the committee with updated vacancy and hiring outcomes and asked for legislative flexibility where state rules constrain recruitment options.