CMS leadership declined to publicly address the rule’s status while the review process gets underway.
The opposition cited LPN exclusion, the 24/7 RN requirement, an estimated $6.8 billion annual cost, and a workforce pipeline that cannot support the proposed ratios as major flaws in the rule.
Drama within deluge of CMS staffing mandate comments
Among the 46,000 comments received by federal regulators by the deadline were thousands of coordinated, organization-wide campaigns meant to outpace comments from the rule’s proponents.
Executives told McKnight’s Long-Term Care News the Ensign Group submitted an estimated 1,500 letters from its partners and affiliates. Team members from the Good Samaritan Society shared more than 600, and Tennessee-based Diversicare, more than 500.
— McKnight’s Long-Term Care News, December 7, 2023
CMS leader mum on staffing mandate, delivers ‘back to basics’ message
The director of the nursing homes division at the Centers for Medicare & Medicaid Services made it clear at the start of his policy update session at the LeadingAge annual meeting here that he would not be discussing the controversial staffing rule. At last count, it was approaching 50,000 comments from providers, consumer advocates, union members and others. But the topic received just a few indirect references from CMS’ Evan Shulman.
In preempting any open discussion about the staffing proposal, Shulman acknowledged that CMS was looking forward to reading about “counterproposals.” Sticking with the status quo would not “help anything,” he added.
— McKnight’s Long-Term Care News, November 8, 2023
CMS Flooded With Staggering 40K-Plus Comments on Nursing Home Staffing Mandate
Reviewing the hefty load of comments on the proposal may take as long as a year, according to industry leaders. And encouraged by the size of the comments, advocacy groups are already eyeing the next phase of countering the stipulations contained in the staffing mandate and planning to work with Congress, LeadingAge CEO Katie Smith Sloan said in a meeting with editors from Skilled Nursing News.
If CMS proceeds with this proposed rule, it will severely limit access to care for our nation’s seniors and individuals with disabilities. Without a pipeline of new caregivers and resources to recruit, nursing homes will be forced to downsize in order to meet these requirements or close entirely.
— Skilled Nursing News, November 7, 2023
One last chance to let CMS know how you feel
This most burdensome regulatory proposal in decades has sparked intense industry blowback. In fact, more than 26,000 comments had already been submitted before the final weekend started.
As McKnight’s earlier reported, the Ensign Group has rallied approximately 1,500 submissions from its partners and affiliates. Similarly, Cascadia Healthcare has contributed over 400 comments, and Diversicare has provided more than 500 unique comments. Their proactive involvement underscores the rule’s significance for the industry.
— McKnight’s Long-Term Care News, November 6, 2023
Comments offer nuances that might salvage CMS staffing rule in operators’ eyes
Emboldened by serious operational and financial stakes, many operators and owners have taken a broader view of the comment process and asked mid-level managers, individual administrators and other staff to weigh in on the rule, which was officially proposed Sept. 6.
Our hope is that our collective voice, both as an organization and as an industry, will be heard by policy makers resulting in a more reasonable and nuanced staffing rule.
— McKnight’s Long-Term Care News, November 3, 2023
Former CMS chief Verma: Regulators ‘over their skis’ with staffing mandate
Federal regulators are in over their heads with the proposed first-ever nursing home staffing mandate, the former head of the Centers for Medicare & Medicaid Services said Wednesday.
She added, however, that there appears to be a strong window of opportunity for influencing how the final rule will be shaped and offered advice to providers hoping to make it more favorable.
I think there’s still a lot of room for adjustment, a lot of room for influence about what’s workable and what’s not. There’s a lot of implications for the rest of the industries that help with the ecosystem. I think they’re a little over their skis.
— McKnight’s Long-Term Care News, November 2, 2023
It’s time to dig in and let CMS do the digging out
It’s the nature of this job to cozy up to public documents and mine their contents for previously undiscovered details, provider concerns and critical perspectives.
But nursing home operators, you’ve outdone yourselves this time. You’ve generated so many new public documents that it’s hard to even know where to start to dig.
Could that process take three months, six months, even a year or more? Will the powerful and heavy commentary grind the process to a halt? Could the immense conflict between operators, worker advocates and consumer groups leave CMS leadership flummoxed?
— McKnight’s Long-Term Care News, November 2, 2023
Seema Verma, the former administrator of the Centers for Medicare & Medicaid Services (CMS), isn’t happy with the talk on Capitol Hill around nursing homes, saying that it shows a lack of knowledge on the lawmakers’ part, making it incumbent upon sector leaders to engage with lawmakers directly, even inviting them into facilities.
You have to continue to grow their knowledge. So, maybe you invite them to your nursing home or maybe you go and see them in Washington. But it is a continual process…if you don’t do it, then you’re subject to other special interest groups having more influence than you yourself might have.
— Skilled Nursing News, November 1, 2023
AHA: Nursing Home Staffing Mandate Would Not Align with Modern Clinical Practice, Stifle Innovation
The Centers for Medicare & Medicaid Services (CMS) should not implement the proposed nursing home staffing mandate for numerous reasons, including that “numerical staffing staffing thresholds are not consistent with the modern clinical practice.”
A simple mandate of a base number of RN and NA hours per resident day emphasizes staff roles and responsibilities of yesterday rather than what current and emerging practices may show is most effective and safe for the patient and best aligned with the capabilities of the care team.
— Skilled Nursing News, October 27, 2023
AHA Comments on Long-Term Care Facility Minimum Staffing Proposed Rule
On behalf of our nearly 5,000 member hospitals and health systems who work with long term care facilities to serve hundreds of thousands of patients each year, our professional membership groups and affiliates including the American Organization for Nursing Leadership, and our 2,425 post-acute care members, the American Hospital Association (AHA) appreciates the opportunity to provide comment on the proposed rule regarding minimum staffing standards for long-term care (LTC) facilities.
Instead of being forced by CMS to focus on the question, ‘How do we achieve the minimum staffing threshold,’ nursing homes could instead focus on the far more important questions of ‘What is our ongoing process for safely staffing our facility? How do we respond when we experience staffing shortages or unexpected changes to our patient mix?’
— American Hospital Association, October 26, 2023
SBA Office of Advocacy Comment Letter: Minimum Staffing Requirements for Long-Term Care Facilities
On September 6, 2023, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule entitled, “Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting.” This letter constitutes the Office of Advocacy’s (Advocacy) public comments on the proposed rule.
— U.S. Small Business Administration Office of Advocacy, November 2023
Will there be light at the end of the staffing mandate tunnel?
At the American Health Care Association’s annual convention and expo in Denver this week, there was a mix of resolute defiance in the face of potentially crushing requirements and continued consternation that any federal regulator would have the chutzpah to attempt them in the current environment.
And then there was one tiny glimmer of hope, followed by another.
Word broke widely here Monday that 28 US senators from across party lines (but mostly from rural areas) had written to the Centers for Medicare & Medicaid Services administrator, beseeching her to back down.
— McKnight’s Long-Term Care News, October 5, 2023
Nursing home operators can expect a long comment period once the federal minimum staffing mandate comes out, potentially drawing out into the following year before anything is finalized.
We’re not reacting much to what we don’t know. What we have been focused on is making sure that we continue to be the best employer we can be.
— Skilled Nursing News, July 28, 2023
OMB Still Analyzing Nursing Home Staffing Mandate, with Flurry of Stakeholder Meetings
The Centers for Medicare & Medicaid Services (CMS) transferred the proposal to OMB for review on May 30, federal records show. Association leaders say they are encouraged to see so many stakeholders engaging with OMB as the proposed staffing rule is being reviewed.
Mandating staffing levels is a simplistic, one-size-fits-all approach to the needs of complex and unique nursing home residents and patients. Specifically, staffing ratios are usually informed by older care models and do not consider advanced capabilities in technology or the interprofessional team-care model.
— Skilled Nursing News, July 11, 2023
