North Dakota
North Dakota long-term care providers call federal rule an 'impossible staffing mandate'
BISMARCK — North Dakota health care providers are scrambling to meet new federal standards set for long-term care facilities. Put in motion by a 2023
executive order,
the series of mandates go into effect Aug. 8 despite nationwide concerns — including a lawsuit filed in June by the American Health Care Association against the Department of Health and Human Services and Centers for Medicare and Medicaid Services.
The rule comes in response to high death rates during the COVID-19 pandemic, citing a Centers for Medicare and Medicaid Services, or CMS,
study
that links fatality rates to high turnover and chronic under-staffing in nursing homes.
Medicare- and Medicaid-certified facilities will be required to have a registered nurse on site 24/7 and increase the number of nurse aids available daily. Rural communities have a year longer to implement the standards than urban communities. Proposed last September and finalized in April, the rule received over 46,000 comments during the 60-day national comment period that closed in November.
“This rule does not only impact nursing facilities, it will impact all sectors of health care and the cost of care in our state,” Nikki Wegner, president of the North Dakota Long Term Care Association, testified in a state Health and Human Services committee meeting on Thursday, July 11.
The association is affiliated with two plaintiffs involved in the CMS lawsuit.
“This, for us and for the rest of the nation, is really an impossible staffing mandate. There are simply not enough RNs to fulfill this requirement. While the intent behind the rule is to improve care quality, it presents really significant challenges,” Wegner said.
Rep. Kathy Frelich, R-Devils Lake, responded to Wegner’s testimony, referencing her professional experience with long-term care as an outreach specialist at the
North Dakota School for the Deaf and Resource Center for Deaf and Hard of Hearing.
“I would say that quality of care generally isn’t related to your RN. It’s usually related to your CNA (Certified Nursing Assistant) on that level. So, I’m concerned that this is just adding a cost,” Frelich said. “Ultimately, that goes back to the residents.”
Long-term care residents pay an average of $403.19 per day — over
$12,000 monthly
— a rate Frelich said would “drastically” increase.
Since the height of the COVID-19 pandemic, the number of nursing homes across the state has been in decline. Six facilities closed in just under three years.
According to the
Bureau of Labor Statistics,
North Dakota would need to add 1,313 nursing home workers to return to pre-pandemic levels.
Data
from the Payroll Based Journal indicates 79% of the state’s facilities would not comply with the registered nurse mandate and only 17% would meet nursing requirements.
The same data shows rural communities in the state would be disproportionately impacted, where 86% wouldn’t meet requirements compared to 65% in urban areas. North Dakota would have to spend a minimum of $4.5 million per year to comply.
Individuals 65 and older make up over 16% of the state population with approximately
8,220 people
receiving care every day, according to the Long Term Care Association.
Some facilities could be considered exempt from the mandates. The
final ruling
states facilities would have to prove the local workforce is 20% or more below the national average and that administrators made “good faith” efforts to hire and retain staff.
Tanya Schnabel, administrator for the Wishek Living Center, said most rural facilities would have to apply for an exemption, including hers. She said the process would add to her already full plate of managing the already “concerning” worker deficit.
“We have housing issues here. So, even if somebody wants to move to town to come work for us, there’s no place for them to live that’s affordable. We wouldn’t be able to do it without contract companies right now, because they’re moving here and giving their time to help care for our residents,” Schnabel told Forum News Service.
“This will just probably be the straw that broke the camel’s back,” she said.
Rep. Kelly Armstrong, R-N.D., and 33 other Republicans cosponsored a joint resolution of congressional disapproval introduced by Rep. Michelle Fischbach, R-Minn., in May. Additionally, Sen. Kevin Cramer, R-N.D., sought to delay the rulings by introducing the VA Report on Proposed CMS Staffing Ratios Act, which would require the Veterans Association to study the risks to elderly veterans posed by the new requirements.
North Dakota’s Long Term Care Association is affiliated with the American Health Care Association and Leading Age. Last May, both entities joined four other plaintiffs in filing a
lawsuit
against the Secretary of the United States Department of Health and Human Services and CMS. According to the filing, CMS exceeded its authority by overriding congressional directives and employing “sweeping” new mandates.
“Hopefully they realize that this will probably kill off some rural facilities. If they close, then people would have to drive to Bismarck or Fargo or Jamestown to see their loved ones. That would be devastating,” Schnabel said.
GRAND FORKS — A North Dakota composer’s dream is turning into a statewide invitation.
Williston-based musician Emily Black-Driscoll was chosen as the North Dakota Music Teachers Association’s commissioned composer for 2026. She’s preparing an original composition that will premiere in August.
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North Dakota
Challengers declare victory after ND Supreme Court rules against Legislature’s attempt to alter term limits
BISMARCK — A constitutional ballot measure to amend the state’s term limits law as proposed by the Legislature will not appear on November’s ballot, the North Dakota Supreme Court ruled Thursday, siding with petitioners who argued the Legislature exceeded its authority and violated the state constitution in proposing the changes.
“The people’s voice was heard,” Grand Forks County Commissioner Terry Bjerke said in reaction to the news.
Bjerke was a member of the sponsoring committee behind the successful 2022 effort to pass a term limits initiative, which amended the state constitution by capping legislative term limits to eight years in the House and eight years in the Senate. The amendment, which became article XV of the state constitution, also included a clause barring the Legislature from making constitutional changes to term limits.
During the 2025 session, however, lawmakers narrowly approved Senate Concurrent Resolution 4008, in which the legislature proposed Constitutional Measure 1, a ballot measure to amend the term limits language to allow legislators to decide in which chamber they want to serve their 16 years, and to repeal the clause limiting the legislative assembly’s authority to propose an amendment to alter or repeal term limits.
Bjerke and former Minot legislator Oley Larsen brought the lawsuit challenging the validity of the Legislature’s action in January, and the state Supreme Court
heard oral arguments in the case
this spring.
“Those term limits may only be altered by a measure proposed by the people rather than the Legislative Assembly. And yet a few years later, the Legislative Assembly is doing what they are prohibited from doing,” attorney Zachary Wallen argued on Bjerke and Larsen’s behalf.
Tanner Ecker / The Bismarck Tribune
The Legislature’s attorneys argued the clause prohibiting legislative proposals to alter the constitutional term limits language “infringes on our republican form of government” by “limiting the people’s ability to vote on amendments proposed by their elected officials.”
Justice Jon Jensen seemed skeptical of that argument during the April 2 hearing, questioning whether a second vote was appropriate.
“The public did speak on this. The public spoke on it when it passed the original constitutional amendment and they said, ‘Legislature, you don’t even get to propose a change.’ They have already spoken on it,” Jensen said. “You want a second shot, or a second bite at the apple, not a first one, a second.”
In Thursday’s ruling, all five justices sided with Bjerke and Larsen.
“We … conclude the Legislative Assembly’s adoption of S.C.R. 4008 violated N.D. Const. art. XV … and declare S.C.R. 4008 and Constitutional Measure 1 void … We enjoin the Secretary of State from placing Constitutional Measure 1 on the November 2026 general election ballot,” the ruling said.
Bjerke thanked the legal team that worked on behalf of their lawsuit, and said he was grateful the court reached the conclusion it did.
“I’m thrilled that what the people voted on and approved has been validated,” Bjerke said.
He added that the Legislature had “multiple opportunities” to address term limits prior to 2022’s initiated measure and chose not to, and gave a nod to the country’s coming milestone and the process by which voters expressed their support for term limits.
“We’ve lasted 250 years,” Bjerke said. “I have two words for those elected leaders who think they aren’t: everyone’s replaceable.”
North Dakota
Fargo woman convicted in North Dakota fraud case now faces charges in Minnesota: A deeper dive
FARGO, N.D. (Valley News Live) – A North Dakota woman who was sentenced to 180 days in jail in Cass County for defrauding healthcare providers and Medicaid programs is now facing additional fraud charges in Minnesota.
Christine Marie Pryor, 55, pleaded guilty in November 2024 to theft by deception involving more than $50,000. She was sentenced to first serve 180 days with a 3-year sentence suspended. She received credit for 44 days already served.
Pryor was ordered to pay $82,584.78 in restitution to Southeast Human Services in Fargo, where she worked between 2018 and 2019.
How the scheme unfolded
According to court documents, Pryor worked at multiple healthcare facilities in North Dakota and Minnesota between 2018 and 2023, using the identities and credentials of three licensed professionals without their knowledge. She submitted fraudulent Capella University diplomas and transcripts to gain employment.
Investigators say Pryor admitted she searched state licensing websites for therapists who shared her first name, then used those therapists’ last names and license numbers when applying for jobs.
At Southeast Human Services, where she worked as a Licensed Addiction Counselor, Pryor earned $55,584.82 while providing therapy services to approximately 150 patients. She also opened her own counseling center, NIAM Brain Injury Center, in Fargo between 2020 and 2021, and worked at The Lotus Center in Moorhead, Minnesota, from 2021 to 2023.
Court documents say the three licensed professionals whose identities were used told investigators they had no knowledge of Pryor’s actions and did not give her permission to use their information.
Two additional charges against Pryor in North Dakota, unauthorized use of personal identifying information, were dismissed on motion of the state.
Additional charges in Minnesota
Pryor is also facing charges in Minnesota. Minnesota Attorney General Keith Ellison announced on Tuesday charges against Pryor in Clay County District Court for six theft offenses and six identity theft offenses related to defrauding Minnesota’s Medicaid program of more than $150,000.
According to the Minnesota complaint, Pryor claimed to provide psychotherapy and alcohol and drug counseling services to Medicaid recipients despite having no license or credentials to do so. Prosecutors allege she used the credentials and identities of three licensed professionals while claiming to provide Medicaid-funded services to 169 clients.
The Minnesota charges were filed as part of National Health Care Fraud Takedown Day, a joint effort involving the Department of Justice and more than 40 state Medicaid Fraud Control Units.
Copyright 2026 KVLY. All rights reserved.
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