Congressional Leaders Move to Overturn New Nursing Home Staffing Mandates

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Congressional leaders are moving to overturn the federal government’s new nursing home staffing mandates as part of a larger effort to cut Medicaid and other forms of government spending. Earlier this week, Sens. Deb Fischer, a Nebraska Republican, and James Lankford, an Oklahoma Republican, reintroduced a bill to overturn the mandates through legislation they call the Protecting Rural Seniors’ Access to Care Act. Companion legislation was introduced in the House last week by Rep. Michelle Fischbach, a Minnesota Republican. Rep. Randy Feenstra of Iowa is a co-sponsor of the House bill.

Senate leaders have already indicated they intend to include the legislation in budget reconciliation efforts, citing estimates that the new staffing requirements would cost Medicaid and Medicare, which pays for much of the care delivered by nursing homes, as much as $22 billion over 10 years. A budget resolution passed by the House on Feb. 25 calls for $880 billion in cuts to Medicaid over the next 10 years, in part to pay for border security. A senior-advocacy group called the Center for Medicare Advocacy argues such cuts would be “devastating for nursing facility residents” and would decimate the entire Medicaid program. The center notes that the average annual cost of a nursing home bed ranges from $104,025 for a semi-private room to $116,800 to a private room, making Medicaid a crucial source of funding for many residents.

The staffing mandates, which were approved by the Biden administration, are being phased in over a period of years and include exemptions for care facilities in rural areas as well as facilities that have shown they’ve made a good faith effort to increase staffing without meeting the new standards. The mandates include a requirement for 24/7 coverage by a registered nurse, as well as 3.48 hours of total nursing care per resident, per day. Fischer has said such requirements will harm the residents of nursing homes, are impossible for rural facilities to meet, and will force some homes to simply close. She noted that even without the new mandates in place, Nebraska saw 44 nursing homes close during the past 10 years, highlighting the staffing challenges faced by these facilities.

A University of Pennsylvania study recently concluded that the staffing mandates, if left in place, would save roughly 13,000 lives per year. In Iowa alone, the researchers said, the mandates would save 101 to 250 lives per year. However, the industry and GOP state attorneys general oppose the mandates, arguing they are too costly and could lead to widespread closures. The American Health Care Association has warned that the rule would force further closures and “displace tens of thousands of nursing home residents in communities across the country.” The association and other industry groups are seeking legal relief in two federal court cases, arguing that the mandates are arbitrary, capricious, or illegal, and that they would exacerbate the existing workforce shortages in the sector.

In addition to congressional challenges, the staffing mandates are being challenged in two separate federal court cases filed in Iowa and Texas by industry officials and GOP state attorneys general. The cases are pending, and the outcome is uncertain. However, the debate over the staffing mandates highlights the complex issues surrounding nursing home care, including the need for adequate staffing, the challenges faced by rural facilities, and the importance of ensuring access to quality care for all residents. The following are some key points related to the issue: * The new staffing mandates require 24/7 coverage by a registered nurse and 3.48 hours of total nursing care per resident, per day. * The mandates are being phased in over a period of years and include exemptions for care facilities in rural areas. * The estimated cost of the new staffing requirements is $22 billion over 10 years. * Medicaid is the primary payor for 63% of all nursing home residents in the US. * The average annual cost of a nursing home bed ranges from $104,025 for a semi-private room to $116,800 to a private room. * A University of Pennsylvania study found that the staffing mandates would save roughly 13,000 lives per year if left in place.