News Digest: Legislative branch questions proposed executive rule
Federal legislators in Congress vocally responded to CMS’ proposed rule. While CMS considers public comments and works on the Final Rule in 2024, the congressional push back can also provide clues to how Congress may intervene legislatively with Minimum Staffing requirements. Whether congressional warnings influence the rule making process – or simply foreshadow future lawmaking to override CMS – remains to be seen.
These lawmakers should be more careful about what they ask for
The ongoing debate about staffing requirements in nursing homes took an even more bizarre twist on Thursday.
That’s when 103 House members, led by Lloyd Doggett (D-TX) and Jan Schakowsky (D-IL) decided not to leave bad enough alone. Instead, they called for a 40% increase in the mandated number of nurse hours per patient day.
Yes, that is on top of staffing increases CMS has already proposed.
I’m not saying that even what CMS is calling for is impossible. But that alone would likely require an infusion of at least $6 billion in taxpayer support. Does anyone believe that is going to happen any time soon?
O’Connor, John. “These Lawmakers Should Be More Careful About What They Ask For.” McKnight’s Long-Term Care News, 10 Nov. 2023, www.mcknights.com/daily-editors-notes/these-lawmakers-should-be-more-careful-about-what-they-ask-for.
15 Republican Governors Pen Letter Opposing Staffing Mandate for Nursing Homes
Fifteen Republican governors, led by Jim Pillen of Nebraska and Kim Reynolds of Iowa, are amplifying their disapproval of the proposed nursing home staffing mandate inn a letter addressed to President Joe Biden on Wednesday.
The governors emphasized their own efforts to guarantee that facilities are adequately staffed for resident care, adding that the staffing mandate undercuts those and ignores regional variations of the labor shortage.
The governors argued that the rule would disproportionately affect rural communities, exacerbate the ongoing workforce crisis in the country, which has not fully recovered from the impact of Covid-19, and diminish access to care for some of the most vulnerable citizens.
Grebbin, Shelby. “15 Republican Governors Pen Letter Opposing Staffing Mandate for Nursing Homes.” Skilled Nursing News, 2 Nov. 2023, skillednursingnews.com/2023/11/fifteen-republican-governors-pen-letter-opposing-staffing-mandate-for-nursing-homes.
‘Shocking’ Assumptions on Labor: Lawmakers Urge CMS to Withdraw Staffing Mandate
More lawmakers are calling upon the Biden administration to kill the proposed minimum staffing rule in a letter sent Tuesday to federal agencies.
Members of Congress expressed concern over lack of workers and what they noted was an “unfunded mandate” with a high price tag of $40.6 billion, arguing that if implemented, it could force many nursing homes to close, threatening resident access to direct care services.
“It is … shocking to see the Administration assume that an available, trained workforce is sitting on the sidelines – ready to immediately fill these gaps within the next three to five years,” the lawmakers wrote in the letter addressed to Health and Human Services (HHS) secretary Xavier Becerra and the Centers for Medicare & Medicaid Services (CMS) administrator Chiquita Brooks-LaSure.
Siddiqi, Zahida. “‘Shocking’ Assumptions on Labor: Lawmakers Urge CMS to Withdraw Staffing Mandate.” Skilled Nursing News, 2 Nov. 2023, skillednursingnews.com/2023/11/shocking-assumptions-on-labor-lawmakers-urge-cms-to-withdraw-staffing-mandate.
Crapo, Smith, McMorris Rodgers Press Biden Administration to Withdraw Unworkable, Unrealistic Federal Nurse Staffing Mandate
The Biden Administration recently proposed a one-size-fits-all federal nurse staffing mandate, despite overwhelming evidence that such a policy would be virtually impossible for the nation’s nursing homes to meet.
In a letter to U.S. Health and Human Services (HHS) Secretary Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Brooks-LaSure, U.S. Senate Finance Committee Ranking Member Mike Crapo (R-Idaho), along with U.S. House Ways and Means Committee Chair Jason Smith (R-Missouri) and U.S. House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-Washington), call on the Administration to immediately withdraw the proposed rule and provide justification for its $40.6 billion unfunded mandate that could force many nursing homes to close, threatening resident access to direct care services.
Crapo, Smith, McMorris Rodgers Press Biden Administration to Withdraw Unworkable, Unrealistic Federal Nurse Staffing Mandate. 31 Oct. 2023, www.finance.senate.gov/ranking-members-news/crapo-smith-mcmorris-rodgers-press-biden-administration-to-withdraw-unworkable-unrealistic-federal-nurse-staffing-mandate.
What They Are Saying: Diverse Voices Urge Biden Administration To Reconsider Nursing Home Staffing Mandate
Members of Congress On Both Sides Of The Aisle & Long Term Care Advocates Reinforce Negative Consequences of the Proposed Rule
This week, the U.S. House Committee on Energy and Commerce Subcommittee on Health held a hearing titled, “Supporting Access to Long-Term Services and Supports: An Examination of the Impacts of Proposed Regulations on Workforce and Access to Care.” Members of the committee and witnesses during the hearing joined a growing list of voices who are urging the Biden Administration to reconsider its proposed federal staffing mandate for nursing homes.
There is growing consensus that the one-size-fits-all requirement will be impossible for nursing homes to meet, driving facilities to limit their admissions or close down, which will only limit access to care.
See what Members of Congress and long term care advocates are saying about the proposed mandate:
What They Are Saying: Diverse Voices Urge Biden Administration to Reconsider Nursing Home Staffing Mandate. www.ahcancal.org/News-and-Communications/Press-Releases/Pages/What-They-Are-Saying-Diverse-Voices-Urge-Biden-Administration-To-Reconsider-Nursing-Home-Staffing-Mandate.aspx.
GOP defends providers, who decry ‘terrifying and heartbreaking’ staffing mandate scenarios
House Republicans Wednesday took aim at the Biden administration’s proposed federal staffing rule, saying it would threaten access to and disrupt care in nursing homes.
The criticism was echoed by several witnesses representing a range of long-term care perspectives during a hearing on two proposed regulations and their impacts on workforce and access to long-term care services and supports.
Republicans also objected to a proposed home- and community-based services rule that would force 80% of payments to be spent on direct care, a change that could devastate state Medicaid systems that also would be tasked with paying skilled nursing providers for increased staffing.
“While well-intentioned, these rules are misguided and will ultimately threaten to undermine access to vital services that our most vulnerable rely upon,” said Rep. Brett Guthrie (R-KY), chair of the House Committee on Energy and Commerce Subcommittee on Health. “We’re at a critical juncture for our long-term care system. Since the start of the pandemic, we’ve lost hundreds of thousands of workers from nursing homes, as well as home- and community-based services, while more Americans continue to age and need more long-term care.
Marselas, Kimberly. “GOP Defends Providers, Who Decry ‘Terrifying and Heartbreaking’ Staffing Mandate Scenarios.” McKnight’s Long-Term Care News, 26 Oct. 2023, www.mcknights.com/news/gop-defends-providers-who-decry-terrifying-and-heartbreaking-staffing-mandate-scenarios.
House Lawmakers, Providers Clash Over Nursing Home Staffing Mandate in Hearing
Amid the House of Representatives electing a speaker after a period of chaos, federal lawmakers on Wednesday also engaged in discussion of the proposed federal nursing home minimum staffing mandate.
In a subcommittee hearing of the House Energy & Commerce Committee, critics contended that the minimum staffing rule would place an excessive burden on facilities, especially those located in rural areas with staffing shortages.
Among the lawmakers, Energy and Commerce Health Subcommittee Chair Brett Guthrie (R-KY) was among the critics of the policies under consideration, including the long-term care staffing rule.
“While well-intentioned, these rules are misguided and will ultimately threaten to undermine access to vital services that our most vulnerable rely upon,” he said in his opening remarks.
Grebbin, Shelby. “House Lawmakers, Providers Clash Over Nursing Home Staffing Mandate in Hearing.” Skilled Nursing News, 26 Oct. 2023, skillednursingnews.com/2023/10/house-lawmakers-providers-clash-over-nursing-home-staffing-mandate-in-hearing.
Bipartisan group of lawmakers push back on proposed nursing home rules
U.S. Rep. Greg Pence and other bipartisan leaders are expressing concerns about a proposed rule that sets minimum nursing requirements and standards for nursing homes throughout the country.
The proposed rule from the Centers for Medicare and Medicaid Services (CMS), issued on Sept. 1 under the directive of the Biden White House, seeks to set forth staffing requirements and other standards for nursing homes.
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In a joint letter addressed to the Department of Health and Human Services on Monday, Pence, R-Ind., and fellow Reps. Brett Guthrie, R-Ky., Vern Buchanan, R-Fla., Michelle Fischbach, R-Minn., Jared Golden, D-Maine, and Chris Pappas, D-N.H., conveyed apprehensions that the requirements might result in limited access to senior care for facilities that are already struggling.
Feindt, Casey. “Bipartisan Group of Lawmakers Push Back on Proposed Nursing Home Rules – UPI.com.” UPI, 23 Oct. 2023, www.upi.com/Top_News/US/2023/10/23/Congressman-Greg-Pence-letter-Medicare-Medicaid-Services-staffing-requirements/4391698094740.
Nearly 100 House Members Ratchet Up Pressure on CMS to Scrap Nursing Home Staffing Mandate
Nearly 100 members of the U.S. House of Representatives are urging the Centers for Medicare & Medicaid Services (CMS) to reconsider the proposed federal nursing home staffing mandate.
The lawmakers on Friday sent a letter to CMS describing their concerns with the mandate.
“Finalizing this proposal would result in limited access to care for seniors, mandatory increases in state Medicaid budgets, and could most consequentially lead to widespread nursing home closures,” they wrote.
Among numerous objections they raised, the representatives stated that the mandate’s requirement for 24/7 registered nurse staffing “disregards existing Medicare and Medicaid statutes.”
Mullaney, Tim. “Nearly 100 House Members Ratchet up Pressure on CMS to Scrap Nursing Home Staffing Mandate.” Skilled Nursing News, 20 Oct. 2023, skillednursingnews.com/2023/10/letter-from-nearly-100-house-members-ratchets-up-pressure-on-cms-to-scrap-nursing-home-staffing-mandate.
Senators warn of ‘unintended consequences,’ closed VA nursing homes if staffing mandate is enacted
A pair of US Senators have asked the Centers for Medicare & Medicaid Services to stop the proposed federal staffing rule for nursing homes, saying that “unintended consequences” of the mandate could force the closure of veterans’ facilities.
US Sens. Kevin Cramer (R-ND) and Angus King, pictured, (I-ME) voiced their concerns in a letter sent Thursday to CMS Administrator Chiquita Brooks-LaSure. The two senators sit on the Senate Veterans Affairs Committee and represent states with significant rural areas.
“Our entire healthcare system is currently grappling with a severe shortage of qualified nurses and caregivers,” the letter states. “We recognize the importance of high-quality service, but as drafted and without revisions, this proposal may have unintended consequences that will close nursing homes.”
Towhey, Jessica R. “Senators Warn of ‘Unintended Consequences,’ Closed VA Nursing Homes if Staffing Mandate Is Enacted.” McKnight’s Long-Term Care News, 20 Oct. 2023, www.mcknights.com/news/senators-warn-of-unintended-consequences-closed-va-nursing-homes-if-staffing-mandate-is-enacted.
US Senators Put More Pressure on CMS to Halt Nursing Home Staffing Mandate
The proposed federal staffing mandate for nursing homes is drawing more opposition on Capitol Hill.
U.S. Senators Kevin Cramer (R-ND) and Angus King (I-Maine), both members of the Senate Veterans Affairs Committee (SVAC) sent an opposition letter on Oct. 19 to the Centers for Medicare and Medicaid Services (CMS), expressing concerns that the mandate may adversely affect veterans’ access to essential care services.
In their appeal, the senators called for a more flexible and collaborative approach between CMS and Congress, emphasizing the critical role of these facilities in supporting retired veterans, whose demand for care is projected to increase.
Grebbin, Shelby. “US Senators Put More Pressure on CMS to Halt Nursing Home Staffing Mandate.” Skilled Nursing News, 19 Oct. 2023, skillednursingnews.com/2023/10/us-senators-put-more-pressure-on-cms-to-halt-nursing-home-staffing-mandate.
What They Are Saying: Nursing Home Staffing Mandate is a ‘Disaster’, ‘Insanity’, ‘Catastrophic’
Members Of Congress, Medicare Policy Experts, And Local Nursing Home Advocates Say Biden Administration’s Staffing Mandate Will Limit Access To Care For Vulnerable Residents
The consensus is clear: the Biden Administration’s proposed federal staffing mandate will be impossible for the nation’s nursing homes to meet, limiting access to care for our seniors. The U.S. Centers for Medicare and Medicaid Services (CMS) released the one-size-fits-all mandate earlier this year, despite its own study finding no level of staffing guarantees quality of care.
A recent analysis estimates that the staffing requirement would cost nursing homes approximately $6.8 billion per year to hire an estimated 102,154 additional full-time employees, jeopardizing access to care for nearly 300,000 residents.
What They Are Saying: Nursing Home Staffing Mandate Is a ‘Disaster’, ‘Insanity’, ‘Catastrophic.’ www.ahcancal.org/News-and-Communications/Press-Releases/Pages/What-They-Are-Saying-Nursing-Home-Staffing-Mandate-is-a-%E2%80%98Disaster%E2%80%99,-%E2%80%98Insanity%E2%80%99,-%E2%80%98Catastrophic%E2%80%99.aspx.
MedPAC members rip ‘brute force test’ of staffing mandate, ponder consequences and possible gaming
A key Congressional advisory panel expressed deep skepticism Thursday over the proposed federal nursing home staffing mandate and whether it would address ongoing quality concerns in the post-acute care sector.
Members of the Medicare Payment Advisory Commission questioned the goal of the regulations and how they would work to drive quality, with some going so far as calling for a separate funding mechanism to support the sector’s hiring of round-the-clock registered nurses.
The feedback came as commissioners reviewed a new staffing data analysis by MedPAC staff. They asked for more details on metrics that could help clarify whether the rule might help or hurt patients.
Marselas, Kimberly. “MedPAC Members Rip ‘Brute Force Test’ of Staffing Mandate, Ponder Consequences and Possible Gaming.” McKnight’s Long-Term Care News, 6 Oct. 2023, www.mcknights.com/news/medpac-members-rip-brute-force-test-of-staffing-mandate-ponder-consequences-and-possible-gaming.
Nursing Home Leaders Support House Bill To Defeat CMS’ ‘Cookie-Cutter’ Minimum Staffing Proposal
A Congressional bill that aims to defeat the Biden Administration’s minimum staffing proposal began making rounds last week, and nursing home executives, including clinical team members attending the industry’s largest annual gathering in Denver, hailed it as a welcome development.
If passed, the bill could keep the Centers for Medicare & Medicaid Services (CMS) from implementing the proposed rule.
“It has never been proven that cookie-cutter approaches help seniors. A blanket mandate has usually not worked so I’m very skeptical of the staffing mandate, personally,” Dr. Arif Nazir, who serves as chief medical officer for the physician group Abode Care Partners, told Skilled Nursing News.
Siddiqi, Zahida. “Nursing Home Leaders Support House Bill to Defeat CMS’ ‘Cookie-Cutter’ Minimum Staffing Proposal.” Skilled Nursing News, 4 Oct. 2023, skillednursingnews.com/2023/10/nursing-home-leaders-support-house-bill-to-defeat-cms-cookie-cutter-minimum-staffing-proposal.
Bill would block federal nursing home staffing mandate
A Minnesota Congresswoman has introduced legislation that could stop the Centers for Medicare & Medicaid Services from implementing its proposed nursing home staffing requirements.
Protecting Rural Seniors Access to Care Act, H.R. 5796, would prohibit federal officials from finalizing the draft rule introduced on Sept. 1 and convene a nursing home workforce advisory panel instead.
“I am deeply disappointed CMS continued to move forward with this rule given the public knows their reservations regarding its efficacy,” Rep. Michelle Fischbach (R-MN) said in a press release publicizing the bill’s Sept. 29 introduction.
Marselas, Kimberly. “Bill Would Block Federal Nursing Home Staffing Mandate.” McKnight’s Long-Term Care News, 4 Oct. 2023, www.mcknights.com/news/bill-would-block-federal-nursing-home-staffing-mandate.
28 Senators Push CMS to Scrap Nursing Home Staffing Mandate
In a bipartisan effort, U.S. Senators Jon Tester (D-MT) and James Lankford (R-OK), along with 26 other senators, penned a letter to Chiquita Brooks-LaSure, Administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), urging the Biden Administration to reconsider the proposed federal staffing mandate.
The senators expressed their collective concern that, amid an unprecedented workforce crisis, the proposed federal mandate may exacerbate the challenges faced by long-term care facilities.
Grebbin, Shelby. “28 Senators Push CMS to Scrap Nursing Home Staffing Mandate.” Skilled Nursing News, 3 Oct. 2023, skillednursingnews.com/2023/10/28-senators-push-cms-to-scrap-nursing-home-staffing-mandate.
Letter from 28 Senators to CMS Regarding Nursing Home Proposed Rule
Dear Administrator Brooks-LaSure:
We write to express concerns regarding the Centers for Medicare and Medicaid Services’ (CMS) recent proposed rule establishing staffing mandates for nursing homes. In many parts of the country, America’s long-term care facilities are facing severe workforce shortage issues that are harming access to critical care for our nation’s seniors. With this in mind, we are deeply concerned that now is the worst possible time for the United States to establish the nation’s first federal staffing mandate for long-term care facilities. We believe the rule as proposed is overly burdensome and will result in additional closures and decreased access to care. We urge you to rescind CMS’ proposed rule and instead commit to working with Congress on the large number of alternate approaches to ensure the quality and safety of care in skilled nursing facilities.
We understand the importance of ensuring beneficiaries of federal health care programs have access to safe and high-quality nursing care. In fact, we share your intended goal of improving the quality of care for seniors and ensuring resident safety. However, a one-size-fitsall staffing mandate significantly undermines access to care for patients, particularly in rural communities. Instead, CMS should work with Congress and stakeholders on policy alternatives that address the severe workforce challenges in our states’ underserved areas.
What They Are Saying: Health Care Experts, Lawmakers Express Serious Concerns Over Biden Administration’s Proposed Staffing Mandate For Nursing Homes
Last week, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule, Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. The rule comes after a recent CMS study found that no single staffing level would guarantee quality care.
Voices from across the nation, including health care experts and lawmakers are calling the federal staffing requirement for nursing homes impossible to meet and warn that a blanket mandate is the wrong approach. See what they had to say:
What They Are Saying: Health Care Experts, Lawmakers Express Serious Concerns Over Biden Administration’s Proposed Staffing Mandate for Nursing Homes. www.ahcancal.org/News-and-Communications/Press-Releases/Pages/What-They-Are-Saying-Health-Care-Experts,-Lawmakers-Express-Serious-Concerns-Over-Biden-Administration%E2%80%99s-Proposed-Staffing-.aspx.
