ICYMI: State Staffing Mandates Impossible To Meet As Governors Pause Penalties, Underscoring Impracticality Of Federal Rule

Advocacy; Legislative; Regulations
In case you missed it, Modern Healthcare reports three states with state staffing requirements – Illinois, Rhode Island and New York – have paused penalties for facilities not being able to meet the mandate for fear of reduced access to care. The article states:

“Illinois, Rhode Island and New York paused penalties for nursing homes that violate state staffing mandates as the governors feared the cost of compliance could force nursing homes to limit patient access or close their doors. Their experiences point to problems [Centers for Medicare and Medicaid Services (CMS)] could encounter carrying out a federal staffing mandate, but the agency is adamant its final rule will be workable for nursing homes.

“The White House Office of Management and Budget began reviewing the final rule March 1. But an industry trade group said the mandate is not feasible when nursing homes need more than 130,000 workers to return to pre-pandemic workforce levels."

John Gage, president and CEO of the Rhode Island Health Care Association, said of his state's staffing requirement:

“While well intentioned, Rhode Island's unfunded staffing mandate has many unintended and grave consequences. Eighty-six percent of facilities in Rhode Island are unable to comply, and those that do are suffering major financial losses. Six facilities in our state have already closed because of chronic Medicaid underfunding. Governor McKee stayed the fines through Executive Orders, but more needs to be done to support the profession."

Matt Hartman, president and CEO of the Illinois Health Care Association (IHCA), shared his state's experience:

“The ongoing shortage of staff and failure to provide solutions aimed towards the creation of new staff, have led to a severe concern about access to care . Illinois' delay in assessing the fines was made in recognition of this. Without that decision, access to care would have continued to shrink, with many providers closing their doors. These concerns are directly translatable to the proposed CMS staffing rule, which is equally arbitrary and fails to recognize resident need and the larger concerns around the nursing shortage."

​Stephen B. Hanse, president and CEO of New York State Health Facilities Association, noted:

“New York turned a blind eye to our state's caregiver shortage and implemented a 3.5 nurse staffing mandate for nursing homes in 2022. Approximately 475 of the state's 610 nursing homes were unable to meet the mandate despite the efforts providers employed to recruit new staff. It is critical that policymakers work in partnership with providers and labor to solve the long term care staffing crisis and increase Medicaid funding to nursing homes so providers can compete in the labor market."

CMS is expected to soon finalize the federal staffing rule, despite 94 percent of facilities currently not meeting at least one of the three requirements. A nursing home that cannot meet the requirements will face the risk of being cited, fined or even worse, removed from the Medicare and Medicaid programs.

Further, the rule fails to consider the state of the nursing home sector. The American Health Care Association's (AHCA) recent State of the Sector Report found 99 percent of nursing homes currently have open jobs, including 89 percent who are actively hiring for registered nurse (RN) positions. Ninety-four percent of facilities actually say it is difficult to recruit new staff, despite unrelenting efforts to increase wages and enhance the workplace. Fines take finite resources away from nursing homes that could be used to further invest in recruiting and retaining staff.

Last Week's Senate Finance Hearing

During a recent U.S. Senate Committee on Finance hearing, U.S. Senators James Lankford (R-OK) and John Barrasso (R-WY) questioned U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra over the proposed staffing requirement.

Senator Lankford challenged Secretary Becerra to reconsider the rule:

“HHS is creating a rule that's going to cause the closure of a lot of our rural nursing homes. I understand the good intent that's here, but what this is going to cause is dramatic rise in prices and a difficulty of getting RNs into those different locations. I would just encourage you to reconsider that rule."

Senator Barrasso raised concerns that facilities will not be able to meet the one-size-fits-all mandate:

"Only one in five nursing homes can meet the proposed requirements. Even those trying to hire people can't find people to fulfill it. So, four out of five nursing homes are going to be out of compliance with administration rules. And apparently what you're saying is that all of the nursing home, these other nursing homes are right now incompetent to provide care and I think they're still providing pretty good care today."

​While critics argue that the proposed rule offers exemptions and waivers for nursing homes that are unable to comply with the new requirements, the reality is that few facilities will be able to qualify for these exemptions. For example, the 24/7 RN waiver is impossible for urban facilities to attain, which is about 80 percent of all facilities. Additionally, the criteria for these exemptions is extensive and the process is cumbersome, requiring additional administrative work among already strained facilities. Without a viable path for facilities that are making good-faith efforts to receive an exemption, many nursing homes will be forced to downsize or close their doors for good.

Read the full Modern Healthcare story HERE.

See AHCA's State of the Sector Report HERE.

Read what Members of Congress, policy experts and long term care advocates are saying in opposition to the federal staffing mandate HERE. ​