Bipartisan lawmakers tell HHS to reconsider nursing home staffing mandate

Photo: David Sacks/Getty Images

Ninety-one bipartisan members of Congress have joined in objecting to a Centers for Medicare and Medicaid Services proposed rule for minimum staffing levels at nursing homes.

U.S. Rep. Greg Pence, R-Ind. and others, including Reps. Brett Guthrie, R-Ky., Vern Buchanan, R-Fla., Michelle Fischbach, R-Minn., Jared Golden, D-Maine and Chris Pappas, D-N.H., sent a letter to the Department of Health and Human Services Secretary Xavier Becerra saying the requirements would inevitably result in limited access to care for seniors, increases in the Medicaid budget and widespread nursing home closures. 

"At a time when nursing homes are already experiencing healthcare worker shortages and financial hardships, CMS and the Biden Administration should not be implementing a regulation that would only exacerbate this issue," Pence said in the letter. 

The regulation would result in a reduction of long-term care options, especially in rural communities, they said. 

Guthrie suggested his bipartisan Building America's Health Care Workforce Act would bolster the workforce by extending a pathway for temporary nurse aides to become Certified Nursing Assistants.

The American Health Care Association, National Rural Health Association, National Association of State Veterans Homes, Lutheran Services in America, Council for Health and Human Services Ministries, and LeadingAge are supportive of the letter, according to Pence's office.

WHY THIS MATTERS

CMS issued the proposed rule on September 1 as a response to President Biden's 2022 State of the Union Address calling for Medicare to set higher standards for nursing homes.

A final rule is due out any time after the comment period closes on Monday, November 6.

The proposal has received pushback from long-term care facilities and others as all providers grapple with staffing shortages.

The American Hospital Association said if implemented, the rule would exacerbate current delays in moving patients from hospitals to nursing homes due to capacity issues. This could become especially dire in rural and underserved communities, the AHA said.

Under the CMS proposal, nursing homes participating in Medicare and Medicaid would need to provide residents with a minimum of 0.55 hours of care from a registered nurse per resident per day, and 2.45 hours of care from a nurse aide per resident per day.

CMS estimates that about 75% of nursing homes would be required to bolster their staffing levels to comply with the regulations.

The Bureau of Labor Statistics reported there are roughly 235,900 fewer healthcare staff working in nursing homes and other long-term care facilities compared to March of 2020, according to information posted by Pappas. Under the rule, nursing homes would need to hire nearly 13,000 registered nurses and 76,000 nursing assistants, costing billions to implement. 

Noncompliance with CMS' proposed minimum staffing requirements would lead to citations for noncompliance with Medicare Conditions of Participation, potentially resulting in a variety of enforcement actions, including imposition of Civil Monetary Penalties, denial of payments for new admissions, and even termination from the Medicare program, Pappas said.

THE LARGER TREND

Nursing homes came under scrutiny during the height of the pandemic when infections of residents represented an estimated 8% of COVID-19 cases nationwide. As of February 2022, 200,000 nursing home residents had died from COVID-19, according to KFF. 

Kaiser Health News reported around the time of the September 1 proposed rule that CMS's own study, released in June, said no single staffing level would guarantee quality care.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org