Leading Age, a community of nonprofit aging service providers, including long-term care organizations and hospices, is seeking congressional action before the swearing in of the incoming 119th Congress (on January 3, 2025), specifically pertaining to year-end legislative and funding priorities. Among the actions sought by Leading Age are several that affect long-term care facilities and Medicaid/Medicare programs, including:
In its letter addressed to congressional leaders, Leading Age asks congress to halt implementation of the Centers for Medicare and Medicaid Services’ (CMS) final rule on nursing home staffing standards (implemented on April 22, 2024 – see link to CMS Fact sheet on such here. Under the CMS nursing home staffing standards, CMS requires all nursing homes that receive federal funding to provide a minimum of 3.48 hours of total direct nursing care to residents, of which .55 hours must be provided by a Registered Nurse and 2.45 hours to be provided by nurse aids. Additionally, CMS requires an RN to be onsite 24 hours a day/seven days a week and stipulates that such RN must be available to provide direct resident care (the 24/7 RN can be the Director of Nursing, however, this person must be available to provide direct resident care).
Leading Age states the CMS staffing requirements are “impossible” to implement as a result of “chronic reimbursement challenges and workforce shortages plaguing the health and long-term care sectors”.
Leading age notes to congressional leaders that while it supports the highest care standards for nursing home residents, federal action must prioritize workforce investments to train RNs and nurse aides in order to be realistic.
Along these lines, Leading Age additionally asks congress to prioritize passing of the Ensuring Seniors’ Access to Quality Care Act (H.R. 8244/S. 1749). This legislation would help alleviate prohibitions on nursing homes from implementing nurse aide training programs when the nursing home is the subject of civil monetary penalties, as long as the nursing home addresses the penalties and has not been found to have deficiencies related to quality of care.
- Address Workforce Challenges through Visas
Leading Age further addresses the workforce crisis nursing homes face, highlighting to congress that it is estimated that 610,388 RNs have indicated plans to leave the professional by 2027. Leading Age asks that congress pass Healthcare Workforce Resilience Act (H.R. 6205/S.3211) . This bill would allocate 40,000 unused visas to fill gaps in the healthcare sector, including 15,000 visas for foreign-born physicians and 25,000 visas for foreign-born nurses.
- Changes to Medicaid Waiver Program
Leading Age asks that congress include the Ensuring Access to Medicaid Buy-in Programs Act (H.R. 8107) in any year-end package. Under this bill, 5 states would implement a test program removing the requirements that 1915(c) waivers would only be available to individuals who meet a nursing home level of care and would allow home and community-based services (HCBS) to be offered to other, to be determined, needs-based criteria and would lift the age limit on the Medicaid buy-in program. These changes would increase access to Medicaid HCBS programs.
As President-elect Trump prepares to take office on January 20, 2025, many expect that changes to the CMS staffing rule will be forthcoming. For example, Fred Bentley, managing director for Medicare innovation at ATI Advisory, states the CMS staffing mandates are “dead on arrival”. However, challenges pertaining to workforce and immigration reforms to address shortcuts in staffing may persist under President-elect Trump’s next administration. Bentley also notes that tougher rules for Medicare Advantage plans, which have increasingly denied access to post-acute care, will be rolled back.
We can anticipate actions affecting long-term care providers will be forthcoming in the coming months. We will continue to monitor and highlight noteworthy action by the federal government affecting long-term care providers.
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