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.
Greg Power, fisheries division chief with the North Dakota Game and Fish Department, shares information about the new 2026-2028 Fishing Guide and a few new regulations starting April 1, 2026.
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SIOUX FALLS — Ali Stephens had 17 points and 13 rebounds and 8th-seeded Omaha defeated 9th-seeded North Dakota 49-39 in the first round of the Summit League women’s tournament.
The Fighting Hawks had a tough time putting the ball in the hoop all night long, scoring just three points in the first quarter and having only marginally better luck from there.
UND (7-24) shot just 23.5 percent from the floor (12-for-51) and made 1-of-20 shots from outside the arc. Walker Demers and Mackenzie Hughes had 10 points each to lead the Hawks, with Demers adding eight rebounds.
Matt Zimmer/Sioux Falls Live
Regan Juenemann had 10 points and five rebounds for the Mavericks while Avril Smith had seven points and 16 rebounds and Sarai Estupinan eight points, five assists and three rebounds. Omaha (6-26) shot the ball slightly better than the Hawks, going 16-of-53 from the field (30 percent) and 8-of-23 (35 percent) on 3-pointers.
With the win, the Mavs earn a date with top-seed North Dakota State on Thursday at 2:30 p.m.
The Bison won both regular season matchups by more than 50 points.
Matt Zimmer/Sioux Falls Live
Oral Roberts 84, Kansas City 62 — Don’t look now but the team that started the conference season 0-10 and at one point lost 15 of 16 games might be the hottest in the Summit League.
Oral Roberts picked up their fourth straight victory on Wednesday night in the conference tournament opener, routing Kansas City at the Premier Center in the 8/9 “play-in” game.
Ty Harper had 22 points to lead the Golden Eagles (10-22), who took a 44-21 lead by halftime and never looked back. ORU shot 50 percent from the floor and made 13-of-27 3-pointers while the Kangaroos shot just 34 percent and made 6-of-24 from deep. Martins Kilups had 17 points for the Eagles and Connor Dow added 14.
Jayson Petty had 14 points to lead the Kagaroos, who finish the season 4-27. It was their final game under coach Marvin Menzies, whom the school announced earlier this season would not return next year.
With the win ORU advances to face top-seed North Dakota State on Thursday at 6 p.m.
The Golden Eagles lost to NDSU 86-58 in Tulsa on Jan. 24 but they took the Bison to overtime in Fargo on Jan. 3 in a 79-77 loss.
Matt Zimmer is a Sioux Falls native and longtime sports writer. He graduated from Washington High School where he played football, legion baseball and developed his lifelong love of the Minnesota Twins and Vikings. After graduating from St. Cloud State University, he returned to Sioux Falls, and began a long career in amateur baseball and sports reporting. Email Matt at mzimmer@siouxfallslive.com.
North Dakota
The North Dakota Attorney General issued an opinion to the ND State Auditor – North Dakota Attorney General
04 Mar The North Dakota Attorney General issued an opinion to the ND State Auditor
in Opinions
March 4, 2026
Media Contact: Suzie Weigel, 701.328.2210
BISMARCK, ND – It is the opinion that federal law does not prevent the state from auditing P&A and even though P&A possesses confidential records, N.D.C.C. § 54-10-22.1 and 42 C.F.R. § 51.45(c) authorize the state auditor and the employees of the auditor’s office, to review the records without detriment to P &A.
Also, whether Rule 1.6 of the North Dakota Rules of Professional Conduct for licensed attorneys prohibits P&A from disclosing to the State Auditor the contents of a client file for the purpose of conducting a non-financial performance audit under N.D.C.C. ch. 54-10 when the requested file includes information about individuals and businesses in the private sector who chose to contact P &A.
This issue was already addressed in a 1995 opinion of this office regarding P&A. The 1995 opinion highlighted that P&A has authority to contract with private attorneys to represent private individuals. 17 During that performance audit, auditors asked to see billings from the contracted attorneys. 18 P&A redacted the names of the individuals represented by the contract attorneys under the rules for attorney-client privilege or attorney-client confidentiality. 19 The names of individuals seeking services of P&A are protected under N.D.C.C. § 25-01.3. The opinion stated:
Thus, P&A’s records which indicate to whom its services were provided are available to the State Auditor for performance audit purposes. The State Auditor has
been given access by P&A to its records other than the attorney’s billings. Therefore, the State Auditor already has access to the names of the persons to whom P&A
provides services. State law requires that the State Auditor and his employees must keep such information confidential.
Here, P&A has not identified a specific record. Given that, I rely on the past opinions declaring that records made confidential by N.D.C.C. § 25-01.3-10 are available under N.D.C.C. § 54-10-22 to the State Auditor and the Auditor’s employees for audit purposes.
Link to opinion 2026-L-01
###
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