Supplemental Nursing Services Agencies 2003: A Report to the Minnesota Legislature

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4-68 Supplemental Nursng Servces Agences 23: A Report to the Mnnesota Legslature

For more nformaton, contact: Mnnesota Department ofhuman Servces Nursng Faclty Rates and Polcy Dvson 444 Lafayette Road 81. Paul, Mnnesota 55155 (651) 297-3583 Ths nfonnaton s avalable n other fonns to people wth dsabltes by callng 651-296-2544 (voce), toll free at 1-8-333-5433, or 1-8-627-3529 (TTY). Prnted wth a mnmum of1 percentpost-consumer materal. Please recycle.

Supplemental Nursng Servces Agences 23 A Report to the Mnnesota Legslature Mnnesota Department ofhuman Servces Contnung Care Admnstraton January, 24 Prepared by the Department ofhuman Servces Nursng Faclty Rates and Polcy Dvson 444 Lafayette Road North St. Paul, MN 55155-3836 (651) 297-3583

. NTRODUCTON Mnnesota Statutes, Chapter 256B.39, requres the Commssoner ofthe Department of Human Servces (DHS) to report annually to the legslature on the use ofsupplemental nursng servces, ncludng the number ofhours worked by supplemental nursng servces agency (SNSA) personnel and payments to supplemental nursng servces agences. For a background descrpton ofthe SNSA law, ts hstory, ntent and provsons, please see Supplemental Nursng Servces: A Report to the Mnnesota Legslature publshed on Aprl 16,23. Table 1 provdes nformaton on allowable maxmum charges by SNSAs effectve 711/3 and Table 2 lsts the countes n each geographc group.. Data Avalable Data s provded for the nne year perod from thru 22, the latest year for whch ths data s avalable. Showng for each of the three geographc areas, three postons are consdered-rn, LPN and CNA. Data for all years shown s for the 12-month perod endng on 9/3 ofthat year, and fled wth DHS by 12/31. ncludng a year-by-year comparson ofsnsa data s not possble for all facltes. Under Mnnesota Statutes 256B.434 (commonly known as the APS statute), nursng facltes have been allowed to remove themselves from the Rule 5 method of rate settng snce 1996. Before then, Rule 5 was the mechansm by whch nursng faclty rates were set and they were based on hstorcal costs. When a faclty moves to APS, t fles a "data collecton report" rather than a Rule 5 costreport. The data collecton report does not requre a faclty to report costs, only selected statstcal data. Wthout the cost data, a trend analyss of all nursng faclty expenses related to SNSA's cannot be produced. Startng n 21 the data collecton report dd nclude dollar amounts for some postons. Therefore, the data for the years 1995 to 2 s ncomplete. However, whle the number of facltes upon whch ths data s based vares from year to year, we have no reason to beleve that ths varaton n the number of facltes ntroduces any sgnfcant bas to the overall trends that emerge. The number of facltes reportng s shown n Table 3. The total statewde facltes n 22 s fewer than the number offacltes n the state because Rule 5 hosptal attached facltes are not requred to provde ths data.. Enforcement Actvtes Actvtes to enforce the SNSA law by MDH have been mnmal due to staff and budget lmtatons. There have been sx ste vsts and and only one agency was found to be out of complance. That nstance oflack ofcomplance has been corrected. No volaton ofrates was found. Page 1

V. Number of SNSA Agences MDH has been regsterng SNSAs snce 1/2/2. Snce ths date 33 agences have stopped regsterng and 5 new agences have been added to the regstery. MDH lsted about 4 of these agences before 1/2/2. Some never regstered on 1'2/2, perhaps becasue ofthe $891 regsteraton fee and other requrements ofthe law. The agences lsted by MDH are not necessarly all SNSAs. t ncludes some other agences that are requred to do crmnal background studes. V. Comparng SNSA Costs per Hour wth Employee Costs per Hour Trend data for the cost per hour of SNSA workers and nursng home employees s provded n Table 4. For all three nursng categores and n all three geographc groups, wth one small excepton, the average hourly cost for SNSAs went down n 22, as compared wth 21. Only the rural (group one) RN average cost per hour ncreased, and only by $.1 per hour. The largest percent decrease was 43.4% for RNs n sem-rural (group two) facltes. Statewde SNSA RN costs went down by $6.96 per hour, 16%; LPN costs by $6.37, 18.2%; and CNA costs, by $3.64, 16.9%. The average hourly cost for 22, for each dscplne, n each geographc group exceeded the maxmum charge level establshed on 7/1/2. Ths may be explaned by several factors: Only three months ofthe reportng year data was subject to the 7/1/2 maxmum charges and the earler maxmum charges only went nto effect on 4/9/2 when new legslaton resulted n the droppng of a lawsut and the lftng of a temporary restranng order prohbtng mplementaton ofthe orgnal 21 legslaton. n other words, half the year was not subject to the statutory lmts. The average hourly cost would be nfluenced by hgher maxmum charges allowed on recognzed holdays. t should be noted thatthe weghted average wage rates used n Table 1 for determnng the allowable maxmum charges dffer from costs per hour for employees shown n Table 4. Ths s because the fgures n Table 1 are adjusted upward to allow for the cost ofpayroll taxes. Also note that SNSA costs may exceed the target for 22 because the charge lmts were n force for only halfthe year. Page 2

V. SNSA Hours Trend data for SNSA hours s provded n Table 5. SNSA usage per 1, total hours decreased markedly n 22 n all geographc groups for all three postons reported except for RNs n sem-rural (group two) facltes whch ncreased to 1,353 SNSA hours per 1, total hours. Ths followed marked ncreases n all geographc groups for all three postons n the pror year. Statewde the rato of all SNSA hours per 1, total hours decreased from 3,99 to 2,35, a reducton of48%. V. SNSA Costs Trend data for SNSA costs s provded n Table 6. As wth cost per hour and hours worked, we see sharp declnes n 22 to total SNSA costs. Total spendng by Mnnesota nursng facltes n the year that ended 9/312 was down $21 mllon (5%) when compared wth the prevous year. Ths was a result ofa declne n SNSA cost per hour by 17% and of a declne n total SNSA hours by 48%. By geographc group total savngs n 22, as compared to 21, were $1.37 mllon n rural (group one) facltes, $4.48 mllon n sem-rural (group two) facltes and $16.2 mllon n metro (group three) facltes. By dscplne the total savngs were $1.56 mllon for RNs, $8 mllon for LPNs and $11.46 mllon for CNAs. V. Conclusons We theorze that the dramatc reducton n spendng by nursng facltes s a result oftwo factors, the SNSA law and the economy. We may be able to see the relatve strength ofthese factors when the economc recovery s more complete and unemployment goes down. As of ths wrtng, no evdence has appeared suggestng adverse outcomes for resdents resultng from the movement away from use ofsnsas. Page 3

.Weghted Average l Wage Rates n Mnnesota Nursng Facltes Sorted by Rule 5 Geographc Groups Annual ncrease Effectve July 1, 23 Weghted Average Wage and Payroll Tax Rates Table 1 Employee Group Group One Group Two Group Three Class (76 facltes) (168 facltes) (161 facltes) Regstered Nurse $24.8 $24.11 $27.52 LPN $17.25 $17.88 $21.8 Nursng Ades (CNA) $11.89 $12.58 $15.4 Traned Medcaton Ade $12.75 $13.47 $16.53 (TMA) Allowable Maxmum Supplemental Nursng Servce Charge (15%) Employee Group Group One Group Two Group Three Class (76 facltes) (168 facltes) (161 facltes) Regstered Nurse $36.12 $36.17 $41.28 LPN $25.88 $26.82 $32.7 Nursng Ades (CNA) $17.84 $18.87 $22.56 Traned Medcaton Ade $19.13 $2.21 $24.8 (TMA) 1 Weghted by the number of employees n each job classfcaton. Page 4

Table 1 (contnued) Weghted Average Holday2 Wage Rates n Mnnesota Nursng Facltes Sorted by Rule 5 Geographc Groups Annual ncrease Effectve July 1, 23 Weghted Average Wage and Payroll Tax Rates Employee Group Group One Group Two Group Three Class (76 facltes) (168 facltes) (161 facltes) Regstered Nurse $39.73 $42.92 $51.19 LPN $27.95 $31.47 $4.77 Nursng Ades (CNA) $19.5 $21.89 $28.28 Traned Medcaton Ade $21.8 $23.57 $31.74 (TMA) Allowable Maxmum Supplemental Nursng Servce Holday Charge (15%) Employee Group Group One Group Two Group Three Class (76 facltes) (168 facltes) (161 facltes) Regstered Nurse $59.6 $64.38 $76.79 LPN $41.93 $47.21 $61.16 Nursng Ades (CNA) $29.25 $32.84 $42.42 Traned Medcaton Ade $32.7 $35.36 $47.61 (TMA) The countes n each ofthe three geographc groups s the same as the non-holday pay scale. 2 Days to whch these rates apply are based on when the nursng faclty pays hgher rates to ts employees for workng recognzed holdays. Page 5

Table 2 Geographc group one s the rural group consstng ofbeltram, Bg Stone, Cass, Chppewa, Clearwater, Cottonwood, Crow Wng, Hubbard, Jackson, Kandyoh, Lac Qu Parle, Lake ofthe Woods, Lncoln, Lyon, Mahnomen, Meeker, Morrson, Murray, Nobles, Ppestone, Redwood, Renvlle, Rock, Swft, Todd, Yellow Medcne, and Wadena countes. Geographc group two s the sem-rural group consstng ofbecker, Benton, Blue Earth, Brown, Chsago, Clay, Dodge, Douglas, Farbault, Fllmore, Freeborn, Goodhue, Grant, Houston, sant, Kanabec, Kttson, LeSueur, McLeod, Marshall, Martn, Mlle Lacs, Mower, Ncollet, Norman, Olmsted, Otter Tal, Pennngton, Pne, Polk, Pope, Red Lake, Rce, Roseau, Sherburne, Sbley, Stearns, Steele, Stevens, Traverse, Wabasha, Waseca, Watonwan, Wlkn, Wnona, and Wrght countes. Geographc group three s the metro group consstng ofatkn, Anoka, Carlton, Carver, Cook, Dakota, Hennepn, tasca, Koochchng, Lake, Ramsey, Sant Lous, Scott, and Washngton countes. Page 6

Number of Facltes Reportng Table 3 1995 1996 1997 1998 1999 2 21 22 Rural (group one) Facltes 58 56 51 43 23 17 14 69 76 Sem-rural (group two) Facltes 138 129 11 83 55 47 42 14 154 Metro (group three) Facltes 159 138 111 94 42 34 3 142 154 All Facltes (statewde) 355 323 263 22 12 98 86 351 384 Page 7

SNSA and Employee Cost per Hour Comparson Table 4 Rural (group one) Facltes $45. $4 --. $35 J: $3 a; $25 Co. $2 - - ) $15 U Z $1 c:: $5 $ 1995 1996 1997! 1998 1999 2 21 22 -+-SNSA 4 37.33 37.86 39.5 39.6 1--Employee 15.2 15.68 16.5 16.86 16.68 17.49 16.52 2.92 21.14! SNSA% change from pror year -6.7% 4.3%.3% $35. $3. J:. $25 Gl Co $2. ) $15 U Z 'L. oj $1 $5 $ -+-SNSA 1 Employee $1.25 $1.71 1995 1996 $1.88 ----. -._-,, 1997 1998 1999 2 21 22 $29.85 $3.72! $26.89!, $11.24 $11.36 $12.91 $13.88 $14.29 $15.2 SNSA% change from pror year 2.9% -12.5%. $3 $25. J:. $2 Gl / Co V $15 U $1 «z - - U $5 ---- -..- $!, 1995 1996 1997 1998 1999, 2 21 22 -+-SNSA $15.25 $2.65 $12.13 $18.36 $23.93 $22.68 $18.78 1 Employee $7.12 $7.33 $7.61 $7.62 $8.1 $8.83 $9.39 $1.19 $1.46 SNSA% change from pror year 35.4% -41.3% 51.4% -5.2% -17.2% Page 8

SNSA and Employee Cost per Hour Comparson Table 4 (contnued) Sem-rural (group two) Facltes $6 ::l $5 J: $4 Cll Co. $3 Ul U $2 Z :: $1 / ---- ----.---.- $ 1995' 1996 1997 1998 1999 2 21! SNSA $22.19 $2.44 $26.93 $29.88 $4.4 $35.68 $49.19 $49.91 1 Employee $15.2 $15.68 $16.5 $16.86! 22 $28.24 $16.68 $17.49 $16.52 $2.92 $21.14 SNSA%change from pror year -7.9% 31.8% 11.% 34.% -1.9% 37.9% 1.5% -43.4% $4 ::l $35 J: $3 Cll $25 Co. $2 Ul U $15 Z $1 Q. oj $5 $ --- 1995 1996 1997 1998 1999 2 21 22 : SNSA $25.18: $24.3 $26.68 $25.7 $3.6' $31.92 c- --=---E"'m.:.:p"-O'--Y-ee-+----=$'1=-.2"'5=- -1----=$=-1=-.=-71,---'----=$=-1-=-.-=-88=--':-$=-1=-1-cc.24-,----'----$11:$12:91 1, $3.7 - $18- $35.77 $2.27 $14.29' : $15.2 SNSA% change from pror year -4.6% 11.% -6.% 22.1% 4.3% -3.8% 16.5% -43.3% $25 ::l $2 ::r: -------- $15 ""'" Co Q) rn $1 - U <t $5 - Z (,) $, 1995! 1996 1997 1998 1999 2 21 22 SNSA 16.56 15.99 19.44 18.15 22.69 23.13 21.39 22.62 13.43!-- Employee 7.12 7.33 7.61 7.62 SNSA% change from pror year -3.4% 21.6% 8.1 8.83 9.39 1.19 1.46-6.6% 25.% 1.9% -7.5% 5.8% -4.6% Page 9

SNSA and Employee Cost per Hour Comparson Table 4 (contnued). Metro (group three) Facltes. $5. -----.._.- : $4. c :J:. $3. Ql. c. --.- ----------- - V C $2. U - Z :: $1. $. 1995 1996 1997 1998 1999 2 21 22 1 1 1 SNSA $3.9 $29.45 $35.61 $28.93 $34.21 $36.41 T $43.2 $42.82 $4.85! Employee $16.8 1 $16.7 1 $16.48 $17.34! $17.72 $19.12 $2.77 $23.33 $24.48 SNSA% change from pror year -4.7% 2.9% -18.8% 18.3% 6.4% 18.6% -.9% -4.6% $4 $35 :; C $3 J:. $25 G> -- c. $2 c $15 -- U --- ------ Z $1 a. oj $5 --------_._ - --- - _. -----. - $! 1995 1996 1997 1998 1999! 2 21 22 SNSA $23.34! $21.78 $25.46 $25.93 $26.38 $26.71! $32.85 $34.93 $31.12!-D- Employee $12.86 $13.3 $13.5 $13.82 $13.5 $15.6 $16.17 $18.28 $16.1 1 1 1 SNSA% change from pror year -6.7% 16.9% 1.8% 1.7% 1.3% 23.% 6.3% -1.9% - $25.. ::l $2 :::. ----- Ql $15 Co. -. V $1 U - «Z $5 U $ 1995 1996 1997 1998 1999 2 21 22 1 SNSA $13.95 $14.79 $13.55 $17.21 $16.96 $18.97 $22.57 1 Employee $9.29 $9.59 $9.92 SNSA% change from pror year 6.% -8.4% $1.11 $1.7 $1.88! $11.56 $2.92 $21.87 $12.84 $13.47 27.% -1.5% 11.9% 19.% -7.3% 4.5% Page 1

SNSA and Employee Cost per Hour Comparson Table 4 (contnued) All Facltes (statewde) $5. :l $4. :: :u $3. c. U $2. (,) Z $1. c:: ------- -. -----. ---- -- ---. - $. SNSA Employee SNSA% change from pror year 1995 1996 1999 21 22 $3.38 $28.8 $34.55 $43.57 $36.61 $16.18 $16.27 $15.98 $22.3 $22.92-7.6% 23.1% -15.8% 27.2% -2.6% 22.6% -1.4% -16.% -- $4. ---- $35. :l $3. ::t: Q) $25. c.. $2. V $15. --ll ;j- - : L () l!l Ell l! Z $1. Do oj $5. $. SNSA! $23.39 Employee $11.69 1995 1996 1997 1998 1999 T 2 21 22 $21.87 $25.46 $25.89 $27.38 1! $28.99 $32.33 $34.97 $28.6 $11.93 $12.13 $12.47 $12.43 $13.72 T $14.53 $16.33 $15.71 SNSA% change from pror year -6.5% 16.4% 1.7% 5.8% 5.9% 11.5% 8.2% -18.2% $25. :l $2. ::t: C> $15. Co V $1. () - «$5. Z () $. SNSA $14.14 1 Employee $8.35 1995 $14.94 $8.54 1996 1997 1998 1999 2 21 22! $13.8_8_.:._$".1_7._39.--,-_$.:,.1_9_.7_1_L$21.5 _,_322 s._!_178. $8.81 $9.1 $9.3 $9.77 $1.47 $11.66 $12.7 - SNSA% change from pror year 5.6% -7.1% 25.3% 13.3% 6.8% 5.2% -2.9% -16.9% Page 11

SNSA Hours Compared to Total Hours Rural (group one) Facltes Table 5 SNSA RN Hours/1, Total Hours 1':::j 1 ' L- 1995 1996 1997 1998 1999! 2 21 22 --RN 59 949 41 SNSA RN Hours Total RN Hours 5 472,371 6 2.% 45,496 o -1.% 46,413 o 32,778 o 143,796 o 95,179 52 6,214 1137.8% 85,42 654,479 2,822-54.6% 687,492 SNSA LPN Hours/1, Total Hours 1,5. 1,:::,--. --TZ_S => o1'-_1-,.-_1--,-----,----',-----,-==;=-------,.-----.,-- 1995 1996 1997 1998 1999 2 21 22 LPN 1 177 1,93 SNSA LPN Hours Total LPN Hours 1,41,61 1,42,687 o 967,122 o 351 13,542 4,493 3758.1 % -66.8% 773,154 348,186 244,3 198,12 1,239,377 1,354,49 SNSA CNA Hours/1,OOO Total Hours 2,./ 1995 1996 1997 1998 1999 2! 21 22 1, --CNA! 119 66 5 18 1 1,472 414 SNSA CNA Hours 4,342 2,295 1,449 4,215 6 55,437 16,895-47.1% -36.9% 19.9% -1.% 92295.% -69.5% Total CNA Hours 3,637,57 3,468,56 2,924,785 2,343,81 1,97,36 684,962 582,76 3,766,12 4,78,516 SNSA Hours/1,OOO Total Hours r------=:;r--1 SNSA RN, LPN, CNA Hours 4,347 2,31 1,449 4,215 913 75,193 24,21-47.1% -37.% 19.9% 8135.8% -67.8% Total RN, LPN, CNA Hours 5,151,29 4,961,743 4,298,32 3,437,742 1,589,18 1,24,144 865,589 5,673,5 6,124,991 Page 12

SNSA Hours Compared to Total Hours Sem-rural (group two) Facltes Table 5 (contnued) SNSA RN Hours/1, Total Hours :::::: -. s:;;/ 5 ---------:;:::::::::::==--====--"":::.-------"';?'"=7""'"------- _.==.=:,._-:-_,._--_.,_----.:.----,_-----.J o 1995 2 21 22 RN 178 188 352 777 1,353 SNSA RN Hours 2,531 2,685 3,437 4,318 4,879 5,48 1,428 12,85 22,795 6.1% 28.% 25.6% 13.% 12,3% -73.9% 799.9% 77.4% Total RN Hours 1,423,417 1,427,491 1,12,353 943,568 646,27 493,741 45,963 1,654,596 1,684,549 SNSA LPN Hours/1, Total Hours ' L. 2, o 2 21 LPN 98 645 2,974 / SNSA LPN Hours 2,981 3,975 273 2,592 11,152 8,96 6,5 93,17 87,78 33.3% -93.1% 849.5% 33,2% -2.1% -32.1 'O 1439.% -5.7% Total LPN Hours 3,48,373 2,947,579 2,263,962 1,866,278 1,246,535 1,71,687 938,478 3,131,153 3,411,514 SNSA CNA Hours/1, Total Hours Z s:;::: 7 1995 1996 2 21 22 55 192 6 2,753 1,875 SNSA CNA Hours Total CNA Hours 38,667 1,43,87 51,61 32.1% 9,289,36 12,569-75.4% 6,54,89 29,145 71,91 33,933 15,33 131.9% 146.7% -52.8% -55.7% 5,397,39 3,691,218 3,66,63 2,54,53 238,822 1488.7% 8,673,82 183,863 9,84,269 SNSA Hours/1, Total Hours 34 1995 422 + /.-.-J. -- --=:::::::7 '! 2 21 2 -- 585 2,562 SNSA RN, LPN, CNA Hours 44,179 57,721 16,279 36,55 87,941 48,319 22,511 344,779 2S4 438 32.1% -75.4% 131.9% 146.7% -52.8% -55.7% 1488.7%.: 1 OtJ u Total RN, LPN, CNA Hours 14,515,66 13,664,376 9,97,124 8,27,236 5,583,96 4,631,491 3,848,971 13.459.569 '4 «322 Page 13

SNSA Hours Compared to Total Hours Metro (group three) Facltes Table 5 (contnued) SNSA RN Hours/1, Total Hours 3, -- 2, / ----- 1,. --RN 1,52 439 984 1,24 795 1,156 1,141 2,688 1,565 o! 1995 1996 1997 1998 1999! 2! 21, 22 SNSA RN Hours 4,6 14,924 24,799 23,264 5,321 5,38 4,113 74,453 43,9-62.7% 66.2% -6.2% -77.1% -.2% -22.5% 171.2% -42.2% Total RN Hours 3,88,834 3,399,55 2,52,526 1,931,957 669;199 458,976 36,62 2,769,966 2,747,573 SNSA LPN Hours/1, Total Hours 15, 1, 5, / 1995 1996 1997 1998 1999 2 21 22 1,728 2,586 4,178 1,78 3,524 1,581 5,437 --LPN 2,592 2,726 SNSA LPN Hours 16,755 Total LPN Hours 4,118,57 92,523 44,827 53,16 36,1 11,487 2,719 439,251 293,223-13.3% -51.6% 18.3% -31.9% -68,2% 8.4% 22.% -33.2% 3,393,971 2,593,473 2,5,154 864,69 672,627 587,976 4,151,485 5,392,654 SNSA CNA Hours/1, Total Hours 5, 4, A 3, /' ""'- /' --- -- 2, ""- 1, 1995 1996 1997 1998 1999 2 : 21 22 --CNA 3,333 2,287 1,732 3.559 2,165 2,967 1,633 4,588 1.556 : ; SNSA CNA Hours 517,781 442,66 22,745 151,989 78,75 34,14 26,358 571,479 199.64-14.5% -54,2% -25,% -48.6% -56.4% -22.5% 268.1 % -65.1% Total CNA Hours 15,536,725 12,437.68 8,866,649 7,2,32 2,631,643 1,963,422 1,614,247 12,455,191 12,827,827 SNSA Hours/1, Total Hours 6, - 4. 2. - ---. / --- 1995 1996 1997 1998 1999 2 21 2e: --SNSA 2,832 2,86 1.948 2,75 2,869 1,642 1,997 5,6 :.55:. ------- -._._-- SNSA RN, LPN, CNA Hours 664.596 55,53 272,371 228,269 119,496 5,89 51,19 1,85,183 53:' e36-17,2% -5.5% -16.2% -47,7% -57,5%.7% 219.9% -5() 6{ v Total RN, LPN, CNA Hours 23,464,66 19,23,544 13,98,648 11,2,413 4,164,911 3,95,25 2,562,843 19,376.642 2C ff6e :':'4 Page 14

SNSA Hours Compared to Total Hours All Facltes (statewde) Table 5 (contnued) ::::j SNSA RN Hours/1,OOO Total Hours 1,:::._. +-._-;-_. ----;. --,,----------r--- -, -z-. -;--L------.-. :;=j --,--3 -.J 1== 71 1.34 SNSA RN Hours 42,596 17,615 28,236 27,582 1,2 1,788 6,43 93,517 68,626 58.6% 6.3% 2.3% -63.% 5.8% -44.% 1447.5% 26.6% Total RN Hours 5,74,622 5,277,492 4,29,292 3,196,33 1,459,22 1,47,896 851,625 5,79,41 5,119,614 SNSA LPN Hours/1,OOO Total Hours -.---- /z":s::g SNSA LPN Hours 19,736 96,498 45,1 55,68 47,252 2,393 27,12 545,9 385,496 12.1% -53.3% 23.3% 15.% -56.8% 33.% 1912.9% -29.4% Total LPN Hours 8,28,481 7,384,237 5,824,557 4,689,586 2,458,79 1,988,317 1,724,925 8,535,557 1.163,151 SNSA CNA Hours/1,OOO Total Hours 4, 3, A 2, / / ". 1, - ---- --- ------ 1995 1996 1997 1998 1999 2 21, 21 CNA 1,919 1,968 1,182 1.256 2,21 1.189 882 3,478 r- 1,499 1 SNSA CNA Hours 56,79 495,962 216,763 185,349 149,985 67,947 41,451 865,738 4,362 11.6% 56.3% -14.5% 19,1% -54.7% 39.% 1988.6% 53.8% Total CNA Hours 29,217.652 25,194,934 18.332,243 14.761,52 7,419.897 5,714,447 4,7,853 24,895,113 26.71,612 SNSA Hours/1,OOO Total Hours 7Z:--S:: 2 21 1,25 3.99 SNSA RN, LPN, CNA Hours 713,122 61,75 29,99 268,539 27,437 99,128 74,614 1,55,155 854,484-14.5% -52.4% -7.4% -22.8% -52.2% 24,7% 1917.3% 43.2% Total RN, LPN, CNA Hours 43,13,755 37,856,663 28,186,92 22,647,391 11,337,889 8,75,66 7,277,43 38,59,711 41,993,377 Page 15

Actual Costs of Supplemental Nursng Servces Rural (group one) Facltes Table 6 SNSA RN Costs 3,j 2, A 1, --,,<.Z S -'<-----1 1 SNSA Costs o _---. ----_,--_ --.,- --- ------ --===7:=-,----.,-----l 1996 1998 1999 24 12.% -224-1.% o o o o 19,6 226,436 1191.4% -133,71-54.5% SNSA LPN Costs 5,1 4,. 3, 2, ----------------------------+------ 1, '-----------------------------r---------=o \-1-1. :.94---;------;------,-------,------:-------'---,-----;------ SNSA Costs o o o o o 1,477 45.534 387.7% -295.194-71.% SNSA CNA Costs 1999 o -18,83-28.4% -29,814-62.9% 59,799 34.1% -77,381-1.% o 1,436 1,255,642 8744.3% -939.78-74.8% Group One SNSA Costs 2,5, 2,, 1,5. 1,, 5, / / 1995 1996 1997 1 1998! 1999 2 21 22 ; 47,62 17,582 77,381! 3,919 1 SNSA Costs 66,399 / A 1,918,531 "'" 549,928 -- -18,779-28.3% -3,38-63.1% 59,799.34.1% -77,381-1.% o 3,919 1,887,612-1,368,63 615.% -71.3% Page 16

Actual Costs of Supplemental Nursng Servces Sem-rural (group two) Facltes Table 6 (contnued) SNSA RN Costs 8,,-------------------------------------, 6, -1-----------------------------/-===- l " 4, t---------------------------------,-'------------ 2,OOOt=;;;=;=:=:==:::?-/:=::=:J o Ị -+-SNSA Costs 56,153 1995 1996 1997 1998 1999 2 21 22 54,877 92,547 129,29 195,36 195,545 7,243 641,369 643,682-1.276 37,67 36,482 66,331 185-125.32 571,126 2.313-2.3% 68.6% 39.4% 51.4%.1% -64.1% 813.1%.4% SNSA LPN Costs 4,, 3,, 2,, / 1,, 1995 1996 1997 1998 1999 2 21 22 -+-SNSA Costs 75,63 95,537 7,283 64,986 341,222 284,248 \ / /. 185,729 3,33,874! 1,778,99. 2,474 27.3% -88,254-92.4% 57,73 792.3% 276,236 425.1% -56,974-16.7% -98,519 3,145,145-1,551,965-34.7% 1693.4% -46.6% SNSA CNA Costs 6,, 5,, 4,, / 3,, / '" '" 2,, / -. 1,, ----- -+-SNSA Costs 64,334 - / ------ 1995 1996! 1997 1998 1999 2 21 22 816,716 244,371 528,9 1,631,322 : 784,98 321,53 ; 5,43,23 2,469,613 176,382 27.5% -572,345-7.1% 284,529 116.4% 1,12,422-846,342 28.4% -51.9% -463,477-59.% 5,81,7-2,933,59 158.6% -54.3% Group Two SNSA Costs 1,, 8,, 6,, / - 4,, / 2,,. / -. -+-SNSA Costs 771,55 1995 1996 1997 1998 1999 2 21! 22 967,13 344,21 722,915 2,167,94 1,264,773 577,475 9,375,446 4,892,24 195,58 25.3% -622,929-64.4% 378,714 11.% 1,444,989-93,131 199.9% -41.7% -687,298-54.3% 8,797,971-4,483,242 1523.5% -47.8% Page 17

Actual Costs of Supplemental Nursng Servces Metro (group three) Facltes Table 6 (contnued) 4,, 3,. 2,, 1,, o ---------- SNSA RN Costs / / / 1995 1996 1997 1998 1999 2 21 22 -.-SNSACosts! 1,237,83 673.13 182,35 193,265 177.692 3,187.867 1,757.1-798,266-64.5% 443,577 1.9% -21,11-23.8% -49,978-73.% 11,23 6.2% -15,573-8.1%. 3,1,175-1,43,857 1694.% -44.9% '"OO" 15,, 1,, SNSA LPN Costs 5,, o!-.-snsa Costs! 2,491.898-476,615-19.1% -874,123-43.4% 233,368 2.5% -422,82-3.7% -645,6-67.8% 373,769 121.8% 14,661,93-6,218,852 2154.2% -4.5% SNSA CNA Costs 15,, 1,, A 5,, /.!-.-SNSA Costs 7,224,375 6,546,71 2,746,7 2,616,16 1,324,37 645,274 594,899 1995 1996 1997 1998 1999 2 21 / 22 11.955,19 4,365,462-678,34-9.4% -3,799,371-58.% -13,594-1,291,799-679,33-4.8% -49.4% -51.3% -5,375-7.8% 11,36,295-7,589,732 199.6% -63.5% Group Three SNSA Costs 4,. 3,, 2,, / / "-. 1,, ---- / 1995 1996 1997 1998 1999 2 21 22 1-.-SNSA Costs 1.954,7 9,,891 4,77.974 4,663,647 2,458,788 1,145,385 1,453.26 3,485,57 15.246,13-1,953,185-4,229,917-17.8% -47.% -17,327-2,24,859-1,313,43 37.821-2.2% -47.3% -53.4% 26.9% 29,32,373-15,239.441 1997.8% -5.% Page 18

Actual Costs of Supplemental Nursng Servces All Facltes (statewde) Table 6 (contnued) SNSA RN Costs 5,,1. /s 3,. 7 ""::; 2,, ---------------------------/7L-------- 1,, --"' ::::".-. """"'=---:---===-'.-===;-=-----------7-/--------- o.---.:::!:::----;--.:.--===::!:====::::::!.===.-.,._---,.----!! 1995 1997 1998 1999 2 SNSAcosts! 1,294,156 494,638 82,42 377,395 388,81 266,941! SNSA Costs : 2,, 15,, 1,, 5,, --- / A / / "'., 1995! 1996 1997 1998 1999 2 21 22, SNSA Costs 7,93,98 7,41,183 3,8,653 3,222,387 2,955,629 1.32J 917,838 18.615,47 7,152.445 --- -52,725-6.6% -4,41,53-59.4% 213,734 7.1% -266,758-1,525,375-512,416 17.697,637-11.463.3-8.3% -51.6% -35.8% 1928.2% -61.6% Statewde SNSA Costs 5,, 4,,. 3,, / 2,, / 1,, /./ 1995 1996 1997 1998 1999 2 21 2:: --SNSA Costs 11,792,2 1,15,64 5,132,757 5,463,943 4,626,692 2,41,158 2,61,6 41,779,55 2C 688 :,! ---- -1,776,384-4,882,884-15.1% -48.8% 331,186 6.5% -837,251-2,216,534-348,558 39.717.956-2.41.:H, -15.3% -47.9% -14.5% 1926.6% -5 <"" Page 19