Maui News

Reps. Tokuda, Peltola, Case push to increase medicare payments for nursing facilities

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The Equitable Payments for Nursing Facilities Act of 2023 would authorize a cost-of-living adjustment to the Medicare payment formula for skilled nursing facilities in Hawaiʻi and Alaska. (file photo)

Rep. Jill Tokuda (HI-02) along with Reps. Mary Sattler Peltola (AK-At Large) and Ed Case (HI-02) introduced legislation aimed at ensuring that skilled nursing facilities in Hawaiʻi and Alaska receive fair reimbursements for the services they provide.

The Equitable Payments for Nursing Facilities Act of 2023 would authorize a cost-of-living adjustment to the Medicare payment formula for skilled nursing facilities in Hawaiʻi and Alaska to account for the significantly higher cost to provide care in these areas.  

Under current law, the Centers for Medicare and Medicaid Services has the authority to provide adjustments to payment amounts in consideration of the unique circumstances of hospitals located in Hawaiʻi and Alaska — but this authority only applies to hospitals and inpatient psychiatric facilities, not skilled nursing facilities. 


“Skilled nursing facilities are a critical part of Hawaiʻi’s health care system and especially important in our rural communities,” said Rep. Jill Tokuda. “They provide hospitalized patients with continued care following an accident, severe illness, or surgery. In addition to helping them regain their ability to do daily activities and tasks, our skilled nursing facilities are a life saver for families and caregivers that want to be sure their loved ones have a safe place to recover and heal.” 

“That is why we must make sure our skilled nursing facilities are adequately compensated, especially in high cost-of-living states like Hawaiʻi, to ensure access to high-quality care and the best health outcomes for patients,”  Rep. Tokuda said. “My bill represents an important step in making that goal a reality.”

Rep. Mary Peltola said, “Alaska and Hawaiʻi have many wonderful things in common, but we also face some similar challenges. One challenger of our remote locations and dispersed populations is the high cost of living and delivering health care services. Skilled nursing facilities are an important part of our health care systems, providing a safe and stable environment for patients to recover following intensive medical treatment.”


“We must provide appropriate compensation for these facilities and skilled health care workers that take care of our loved ones,” Peltola said. “That’s why I’m proud to support this bill.”

Rep. Ed Case said, “For years, long-term care operations including skilled nursing facilities have struggled with staff shortages, low pay and the lack of patient beds across the country including Hawai‘i. With the growing population of seniors in our islands, referred to as ‘Silver Tsunami’, this bill calls for adjustments to Medicare payment rates to relieve the financial strain of these facilities, and ensure that beds will be available for our kūpuna on the waiting list for continuous health care in their golden years.”

“This legislation, if passed, will make payments to Hawaiʻi nursing facilities more equitable given the high cost of providing care in Hawaiʻi,” said Hilton Raethel, President and CEO of Healthcare Association of Hawai‘i. “Skilled nursing facilities continue to provide care to an increasingly vulnerable and medically complex population, but struggle with rates that fail to take into account the costs of living and doing business in Hawaiʻi. Hawaiʻi’s population is aging at a higher rate than that of the continental United States and the need for skilled nursing care is increasing.”


“Skilled nursing facilities also face challenges with workforce retention and recruitment as they struggle to compete for workers with acute care facilities in a sector that has been adversely impacted by the COVID-19 pandemic,” Raethel added.

If enacted, the Equitable Payments for Nursing Facilities Act would provide the Secretary of the US Department of Health and Human Services the authority to make adjustments to Medicare payment rates for Skilled Nursing Facilities in Hawaiʻi or Alaska. 

Companion legislation has been introduced in the Senate by Brian Schatz (D-HI), Lisa Murkowski (R-AK), Mazie Hirono (D-HI) and Dan Sullivan (R-AK). 


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