More than a quarter of the House of Representatives signed a letter last week urging the Centers for Medicare & Medicaid Services to move forward with its plan to institute a nationwide staffing mandate for nursing homes.
They called for the fiscal 2024 payment rule — which is expected to be officially proposed this spring — to include a proposal for “strong mandatory minimum staffing standards” and said it would be “imperative” to finalize requirements this year. The letter, crafted by Reps. Lloyd Doggett (D-TX) and Jan Schakowsky (D-IL), was signed by 113 Democrats.
“It has been one year since President Biden’s State of the Union announcement concerning this study and over 20 years since CMS’s last review. Meanwhile, many nursing home residents and workers have suffered from insufficient staffing,” the letter stated.
The letter was dated March 13 but was not publicized by Dogget’s office until later last week. While acknowledging staffing challenges in the sector, the signers urged CMS officials to act anyway.
“CMS should adopt strong nursing staff-to-resident ratios to ensure workers are not overburdened and unable to meet their patients’ needs,” they wrote. “it is clear that chronic understaffing contributes to high rates of stress, injury, and burnout among nursing assistants, and ultimately to high rates of turnover. Thus, we believe that creating a robust staffing standard will also go a long way towards improving the quality of nursing home jobs, which in turn will actually help attract more workers and resolve current workforce shortages in this industry.”
CMS has heard from multiple federal lawmakers on this issue already. Last month, Sen. Bob Casey (D-PA) and six Democratic co-signers also urged quick action, saying the current requirements for RN staffing aren’t enough to ensure quality care.
In January, a bipartisan group of 13 senators from largely rural states had asked the agency to slow the introduction of any federal staffing mandate, fearing it would imperil nursing homes in areas unable to recruit staff because of supply issues.
The latest Congressional letter writers also acknowledged special circumstances in rural areas, as well as “complex and nuanced issues, such as variations in acuity levels and case mix.” But they insisted a lengthy study period and previous responses to information requests should have given CMS insights on how to address those challenges.
The letter, like Casey’s, also encouraged CMS to continue pursuing a regulation that would better measure the adequacy of state Medicaid payments. Shoring up Medicaid payments could ultimately provide key revenue for providers to spend on staffing improvements.
Both the American Health Care Association and LeadingAge, the sector’s two largest provider advocacy organizations, have said a nursing home staffing minimum cannot work without more financial support.
“If there is evidence that current payment rates are insufficient to support safe staffing levels, CMS should take further steps to ensure that nursing facilities have the financial resources to comply with, if not exceed, minimum standards,” the members of Congress wrote last week.
“We believe that the separate rulemaking to strengthen enforcement of the Medicaid ‘equal access’ provision … currently underway at CMS offers an important opportunity to move toward this goal by creating a robust system for states to demonstrate that Medicaid rates for nursing homes are adequate to support staffing and wage levels necessary to attract and retain sufficient staff to meet staffing requirements, and that these dollars actually go to support care for residents.”
