U.S. Senate Introduces Bill to Enhance Medicaid Funding, Establish Staffing Minimums

Six U.S. senators have introduced the Nursing Home Improvement and Accountability Act of 2021, which would require federal health agencies to closely examine the skilled nursing industry’s staffing requirements, along with bolstered funding to Medicaid.

Sens. Ron Wyden (D-Ore.), Bob Casey (D-Penn.), Richard Blumenthal (D-Conn.), Michael Bennet (D-Colo.), Sheldon Whitehouse (D-R.I.), and Sherrod Brown (D-Ohio) introduced the bill. Staffing improvements are at the core of the legislation, which would allocate $50 million for the U.S. Department of Health & Human Services (HHS) to conduct studies every five years to determine minimum staffing levels and staff-to-resident ratios, beginning in 2022.

Recommended staffing minimums would be reported to Congress within two years of each completed study.

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Senior advocacy groups like the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and non-profit Green House Project applauded federal efforts to overhaul the industry, while adding that more can be done. Mark Parkinson, president and CEO of AHCA/NCAL said in a statement that more changes are needed — funding to match proposed increases to minimum staffing requirements, specifically.

“The proposal to institute permanent minimum staffing requirements without a permanent funding source would be incredibly challenging for long-term care providers,” said Parkinson. “Providers will not be able to meet staffing requirements if we can’t find people to fill the open positions. There must be a comprehensive approach to staffing beyond just numbers.”

The bill incorporates aspects of previous AHCA/NCAL reform proposals, including enhanced Medicaid funding for long-term care providers to support additional staffing for registered nurses (RNs) and infection preventionists, although funds are listed as “temporary” in the legislation; increases are limited to a six-year timeframe.

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The legislation also takes aim at staffing data reports. If enacted, the bill would exclude hours spent on administrative duties from being entered on the U.S. Centers for Medicare & Medicaid Services (CMS) Care Compare website while adding a minimum requirement for hours devoted to infection control services, overseen by an infection preventionist.

Facilities that submit inaccurate data could be fined a max of $10,000, according to the proposed legislation.

AHCA/NCAL said in its statement that the senior advocacy group opposes restrictions on the severe arbitration agreements proposed in the legislation as well, citing it as “quicker and less costly,” with “similar outcomes” compared to litigation.

“An excessive litigation environment, coupled with the existing financial crisis, means thousands of long-term care facilities would be forced to close their doors, in turn, displacing tens of thousands of vulnerable residents and limiting access to critical services for our nation’s seniors,” continued Parkinson.

A $1.3 billion small-home nursing facility demonstration program is included in the legislation, designed to help smaller facilities receive additional funding if they provide private rooms, offer accessible outdoor space for residents, and have “standing resident and family councils,” according to legislation text. If approved, the program would have applications developed by July 2023.

“We are at a critical point for nursing home reform in the United States,” Susan Ryan, senior director of The Green House Project, said in a statement. The organization has advocated for small-home campuses since 2003. “Should this bill become law, the entire Green House Project team stands ready and eager to help any person or organization interested in participating in the program.”

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