Bipartisan Legislation Aims to Block CMS Staffing Proposal – Most Recently With Senate Bill

Legislation to block the nursing home minimum staffing proposal gained major traction this week, as a bill introduced on the Senate floor late Tuesday received more bipartisan support.

Sen. Deb Fischer (R-Neb.) led the way with the Protecting Rural Seniors’ Access to Care Act, which aims to stop the Centers for Medicare & Medicaid Services (CMS) from finalizing the minimum staffing proposal – along with requiring that a nursing home workforce advisory panel be created.

The Senate bill is endorsed by more than 90 organizations, according to Fischer’s office. In addition to Senator Fischer, the legislation is cosponsored by U.S. Senators Roger Marshall (R-Kan.), James Lankford (R-Okla.), Jon Tester (D-Mont.), Kyrsten Sinema (I-Ariz.), Joe Manchin (D-W.Va.), Roger Wicker (R-Miss.), Susan Collins (R-Maine), and Angus King (I-Maine).


Rep. Michelle Fischbach (R-Minn.) originally introduced the House bill in October, also garnering a fair amount of bipartisan support.

“Nursing homes across the country face historic staffing shortages, and nowhere are those challenges more real than in rural states like Nebraska,” Fischer said in a statement. “This mandate from the Centers for Medicare and Medicaid Services would force many facilities to reduce their number of patients or even close their doors for good.”

Fischer said her legislation would allow time to find a “fairer solution” that protects rural facilities across Nebraska. Other rural operators have weighed in on how the proposal is particularly difficult for them in terms of finding registered nurses (RNs) for the 24/7 rule, with less populated areas, or “nursing home deserts” expanding.


Nate Schema, president and CEO of the Evangelical Lutheran Good Samaritan Society, said bipartisan support for the bill reinforces that the minimum staffing proposal is “out of touch with reality.”

“It signals a broad recognition among lawmakers that the focus needs to turn to more meaningful solutions – like creating a path for virtual RN coverage in rural nursing homes and bolstering the nursing workforce pipeline,” Schema said in a statement. “We are grateful for Sen. Fischer’s leadership on this issue and look forward to continuing to fight to ensure seniors have access to the high-quality care they need and deserve regardless of their zip code.”

Good Samaritan is one of the largest nonprofit providers of senior care and services in the country, with more than 70% of its residents in rural areas. More than 1,500 positions are open across the operator’s 139 nursing homes — equating to a shortage of nearly 20% of its workforce.

Fewer than 4% of its locations will meet the 24/7 RN rule as proposed.

Nursing home associations including LeadingAge and the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) praised Congressional leaders for prioritizing action to stop the proposal.

“The CMS proposed nursing home staffing requirement is the wrong approach. By prohibiting this unrealistic and unfunded mandate, the Protecting Rural Seniors’ Access to Care Act will help to ensure older adults can get the care and services they need and also fend off more nursing home closures,” said Katie Smith Sloan, president and CEO of LeadingAge.

At the same time, the legislation offers a path to much-needed solutions, Smith Sloan said, by establishing a panel to address the chronic issue of workforce shortages among those in the industry. Panelists would come from both urban and rural communities, according to bill text.

“Sen. Fischer and Rep. Fischbach, and their Congressional colleagues who support these bills recognize that the Biden Administration needs to get this right by addressing the underlying workforce and reimbursement challenges facing long-term care,” said Sloan.

Thoughtful workforce policies are sorely needed instead of an “impossible, one-size-fits-all mandate,” AHCA/NCAL said in a statement. The association looks forward to working with Congress on more productive solutions.

Many of the cosponsors to the Senate bill mentioned access issues as a main reason behind introducing the bill.

“Our long-term care facilities are already facing severe workforce shortage issues, and this federal staffing mandate could force facilities to shut their doors,” Sen. Jon Tester said in a statement. “My bipartisan bill will stop this rule dead in its tracks, and I’m committed to working with my colleagues to address the nursing home workforce so we don’t leave rural seniors in the lurch.”

LeadingAge members and state partners in conjunction with the bill’s introduction are sharing their on-the-ground experiences with members of Congress this month, to really help lawmakers understand the workforce shortages and reimbursement issues operators currently face .

The proposal calls for Medicare- and Medicaid-certified nursing home to provide a minimum of 0.55 hours of care from a RN per resident per day and 2.45 hours of care from a nurse aide per resident per day, with non-rural nursing homes having 3 years and rural nursing homes have 5 years to meet these standards.

An RN to be on-site at facilities around the clock as part of the proposal as well, and care assessment requirements will be tightened.

As proposed, the nursing home space would need to add 16,000 RNs and more than 75,000 nurse aides, according to a statement from LeadingAge. This staffing gap would cost anywhere between $4.2 and $7.1 billion in the first year even as the space continues to grapple with a historic workforce shortage.

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