With Biden Announcement, Nursing Homes Begin Countdown to PHE Expiration on May 11  

In a move long-awaited by skilled nursing providers, President Joe Biden on Monday announced the public health emergency (PHE) will end on May 11 – a month after the current extension expires.

The PHE first was declared in 2020 as Covid-19 was first sweeping across the country and was most recently renewed on Jan. 11, 2023.

Biden’s decision is in tandem with House Republicans calling for an immediate end to the PHE, according to AP News, through a string of resolutions being brought to the floor this week.

Lawmakers and federal entities including the Centers for Medicare & Medicaid Services (CMS) have already ended certain elements of the PHE relevant to skilled nursing, including the temporary nurse aide (TNA) waiver program. CMS backtracked on this sunset somewhat, granting states an opportunity to extend waivers for a limited amount of time.

Another crucial waiver tied to the PHE – suspension of the three-day stay requirement – is set to expire along with the PHE in May.

Suspension of the three-day stay requirement allows Medicare patients to be discharged to a skilled nursing facility without having to stay at a hospital for at least three days.

Without the waiver, patients transferred from a hospital to a SNF in fewer than three days would have incurred out-of-pocket costs. The federal agency initially waived the requirement to free up hospital beds at the onset of the pandemic.

While the PHE may be ending, there is still more work to do to address challenges spurred by the pandemic, Mark Parkinson, president and CEO of the American Health Care Association and National Centers for Assisted Living (AHCA/NCAL) said in a statement.

“Long term care is now facing a historic labor and economic crisis, and we need meaningful, supportive solutions that will help us rebuild,” said Parkinson. “We look forward to working with the Administration and Congress to develop solutions that will invest in our caregivers and protect access to care for vulnerable seniors.”

Leaders in the nursing home sector are somewhat divided about what the fallout from the end of the PHE will be. It could be a milestone that prompts lenders and other capital providers to tighten expectations and move to sell or transition underperforming communities. 

LeadingAge president and CEO Katie Smith Sloan said while the association appreciates the administration giving providers some time to plan, they’re still “severely overstretched and now face a new landscape of funding and rules while simply trying to survive.”

Industry advocates are actively reaching out to CMS, HUD and other agencies to better understand their plans for the end of the PHE while best supporting members, she said.

Mark Lamb, then-chief investment officer at CareTrust REIT (Nasdaq: CTRE), last November said: “I think the end of the public health emergency … will be the end of the line for a lot of operators.”

While the end of the PHE could spur some distressed sales, that depends on where operators stand when that time comes, Rick Matros, CEO of Sabra Health Care REIT (Nasdaq: SBRA), told SNN in late 2022.

Providers now will have a few months to prepare for the end of the PHE, but they almost certainly will still be dealing with intense labor-related headwinds in May. Parkinson cited the “historic labor crisis” in a Nov. 2022 letter urging HHS to extend the PHE.

This is a developing story. Please check back for updates.