While the spotlight on skilled nursing continues to shine bright, an election year has advocacy groups certain that legislative efforts will be pared down to just a couple key pieces Congress aims to tackle this fall.
Policy dedicated to boosting a floundering workforce, expanding telehealth beyond public health emergency (PHE) waivers, and streamlining authorization processes for Medicare Advantage (MA) plans have the best chance to get congressional attention toward the end of this year, according to trade association leaders.
“As we get into the end of the year, it looks like there’s not going to be a lot happening from the perspective of legislation, except for, potentially, a package,” said Clif Porter, senior vice president of government relations at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). “What will be included in that we do not know, there’s a lot of talk about the National Defense Authorization Act potentially being a vehicle for other priorities as well.”
Another continuing resolution in the middle of December will need to be renewed as an additional vehicle for change, Porter said, as AHCA pushes ahead with workforce priorities.
AHCA/NCAL President and CEO Mark Parkinson, along with Porter, met with media during the association’s annual conference in Nashville on Tuesday.
Earlier that day, Advion, formerly the National Association for the Support of Long-Term Care (NASL), outlined key pieces of legislation nursing home operators need to monitor – topics spanned home health, MA plans, telehealth, quality and accountability, along with a differential for therapy assistants.
Advion Executive Vice President Cynthia Morton spoke at the association’s panel on legislative and regulatory highlights for long-term and post-acute care. Lobbyist Michaela Simms, president of Simms Strategies, added insight on the political climate and how the skilled nursing sector fits in.
Workforce policy
AHCA/NCAL President and CEO Mark Parkinson said Congress needs to shift its focus to two areas that can actually help with the staffing crisis – innovation and immigration.
While the Care for Our Seniors Act tackles the innovation focus with incentives like tax credits and scholarship programs offered in other settings, immigration is still “low hanging fruit” Congress isn’t likely to touch.
“Comprehensive immigration reform will be difficult and challenging, and it’s politically divisive. But it is such a layup for the country, for the economy and for the people that live in our buildings,” said Parkinson.
He’s hopeful that after election season is over, there could be some movement on immigration.
“Perhaps people can come together early next year and do what is the obvious thing that needs to be done, which is to let the people that want to come here and do these jobs come here and do them,” added Parkinson.
Porter, on the other hand, said he’s “not optimistic at all” that there’s going to be significant movement on immigration in the near term to increase the nursing home workforce.
Instead, the association needs to do everything it can to impact workforce issues and challenges “bit by bit and byte by byte,” Porter told media.
Porter said he’s excited that the Centers for Medicare & Medicaid Services (CMS) allowed states and facilities to apply for waivers to continue the temporary nurse aide (TNA) program with testing and training barriers. The agency originally intended to sunset the TNA-associated waiver, meaning any TNA hired prior to June 7 would have until Oct. 7 to meet testing requirements.
“The temporary nursing assistant waiver was an essential tool that our facilities use around the country … but it’s not a complete and full solution; our bill is still very important,” said Porter, referring to the Building America’s Health Care Workforce Act.
Another “bite,” Porter mentioned, is the certified nursing assistant (CNA) training expansion, or the Ensuring Seniors’ Access to Quality Care Act (H.R. 8805), which allows nursing centers to expand nursing assistant training themselves.
“It’s not a big tectonic move that we’d love to see with something like immigration, but we think that we can get these two pieces of legislation across the finish line, we know we’re making a dent in some of that [workforce] gap,” added Porter.
Medicare Advantage
Morton said Congress’ strike at Medicare Advantage – the Improving Seniors’ Timely Access to Care Act of 2022 – has significant traction with 327 House sponsors currently.
H.R. 3173 would require MA plans to have electronic prior authorization for members, and provide real-time decisions in response to requests for items and services that are routinely approved.
Plans would also need to publish prior authorization information, including the percentage of requests approved and average response time. Other standards, to be set by CMS, would relate to quality and timeliness of prior authorization determinations.
Morton said it’s very telling that the legislation is supported by the Better Medicare Alliance.
“They’re reading tea leaves,” she said. “They know that even though they have significant support in Congress for Medicare Advantage in general, they do know that the knives are out.”
While Simms agrees that the MA prior authorization bill is likely to get approved by Congress, its $16 billion price tag may be a sticking point in the Senate; that’s especially true for moderate to right wing lawmakers using inflation costs as a talking point, she said.
“[The House] passed it, but they also said they’ve got to figure that piece out before they actually pass it [in the Senate], hopefully by the end of the year … there’s only so much they can do because they have to find offsets,” said Simms.
Compared to MA legislation, the association’s bill for therapy assistant differentials only has 43 cosponsors – it’s a hugely important bill for Advion and its therapy members who face a 15% cut to therapy assistant services in the Physician Fee Schedule (PFS).
Called the SMART Act, or H.R. 5536, the bill delays the cut and excludes services furnished in rural or medically underserved areas that may only have access to a therapy assistant.
“We’re going to need a lot more cosponsors to have this issue get to [congressional] attention,” Morton said, with more than 100 other medical specialties fighting for their own legislative efforts.
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