AHCA’s Clif Porter: Nursing Home Staffing Proposal May Be Finalized in Summer, Felt Like an Unpleasant ‘Bucket of Cold Water’

CMS isn’t expected to finalize the minimum staffing proposal until the summer at the earliest, with the agency having to wade through more than 40,000 comments before moving forward with the rule.

The voices of skilled nursing providers, along with coalition partners like the American Hospital Association, will hopefully have been heard by CMS and the agency will moderate the proposal to something more manageable, according to Clifton Porter, senior VP of Government Relations at the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).

Porter spoke about the staffing proposal, among other skilled nursing topics, on VIUM’s Versed podcast.


“From there, the rule will be finalized and we’re hopeful that our voices have been heard and that it will be moderated,” said Porter. “We’ve had a tremendous amount of Congressional support.”

The association’s goal this year is to push legislation and continue to put pressure on the administration to moderate the proposal in a manner that will make it practical and implementable, he said.

3-Day Stay updates


AHCA/NCAL is also pushing again to eliminate the 3-Day Hospital Stay rule for nursing homes, specifically siding with legislation that would count observation stays toward the rule that the Improving Access to Medicare Coverage Act of 2023 reintroduced in August.

The association was able to do some analysis, and has data on what the process looks like without a 3-Day Stay. There was also a regulatory announcement around observation stays, involving a new appeal process that will help consumers appeal these decisions concerning the type of stay.

“One thing that was constantly a concern in the [Congressional Budget Office, CBO] scoring process was abuse, right? People were going to abuse the 3-Day Stay and run it up,” said Porter. “Well, that didn’t happen during Covid. Not at all. It didn’t happen at all. Frankly, it was used very sparingly. So I think, again, in practice, it just makes all the sense in the world to get rid of this.”

There’s a huge disconnect between the reality of the market place and calculations on projections on the financial fallout from the 3-Day Stay rule , he noted.

Huge disconnect

Looking ahead, Porter said the administration needs to work with the skilled nursing sector in anticipation of the “continued explosion of the 85-plus population,” to address the shortage of skilled nursing beds in the future to fulfill the demand, especially as occupancy faces pressure from a shortage of workers. The government can help resolve staffing issues with the help of better policies on regulation, immigration and education, and involving technical schools and improving training programs.

This, Porter said, is on top of recognizing that there is a structural deficit of clinicians across the country and across care settings, and that the SNF sector workforce is still on the mend after the pandemic.

“The Biden administration makes this (staffing) proposal, for me, a big bucket of cold water thrown right on our faces as we are still in the process of recovery,” said Porter. “In this business, we used to always joke and say that memories are short, and memories are really short when it comes to policymakers in DC.”

In terms of immigration, Porter says it’s not the only answer but it’s part of the answer to the industry’s workforce shortage. The country’s immigration system right now is overly influenced by politics and not based on what our economy needs, he noted.

Common sense approaches, as Porter puts it, should include bringing in registered nurses in particular, in key clinical categories. It’s a process similar to what is allowed for PhD engineers for software.

“It has to be like a big new deal kind of approach. Regulatory relief is a big solution,” said Porter.

Other pieces of legislation AHCA is involved in would allow the industry to better train and develop certified nursing aide (CNA) programs in markets where they’re needed, while also alleviating paperwork burdens from nurses.

Better funding for nursing schools will help the staffing pipeline too, he said.

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