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WASHINGTON – U.S. Senators Bill Cassidy, M.D. (R-LA), James Lankford (R-OK), Jon Tester (D-MT), and colleagues urged the Biden administration’s Centers for Medicare and Medicaid Services (CMS) to rescind their proposed rule that would set minimum staffing requirements for nursing homes. The senators argue that with the ongoing “severe workforce shortage issues” in the health care sector, now is “the worst possible time” to create a federal staffing mandate, citing that it will be overly burdensome and create additional nursing home facility closures, which will hurt seniors adults, their families, and their communities, especially rural communities where access to care is already scarce. “We understand the importance of ensuring beneficiaries of federal health care programs have access to safe and high-quality nursing care. In fact, we share your intended goal of improving the quality of care for seniors. However, a one-size-fits-all staffing mandate significantly undermines access to care for patients, particularly in rural communities. Instead, CMS should work with Congress and stakeholders on policy alternatives that address the severe workforce challenges in our states’ underserved areas,” wrote the senators. Cassidy, Lankford and Tester are joined by U.S. Senators Susan Collins (R-ME), Roger Marshall (R-KS), Tom Cotton (R-AR), Joe Manchin (D-WV), Shelley Moore Capito (R-WV), Jim Risch (R-ID), John Boozman (R-AR), Kyrsten Sinema (I-AZ), Kevin Cramer (R-ND), Steve Daines (R-MT), Angus King (I-ME), Jerry Moran (R-KS), Bill Hagerty (R-TN), Maggie Hassan (D-NH), Cindy Hyde-Smith (R-MS), Marsha Blackburn (R-TN), Mike Lee (R-UT), Marco Rubio (R-FL), John Hoeven (R-ND), Roger Wicker (R-MS), Thom Tillis (R-NC), John Thune (R-SD), Jeanne Shaheen (D-NH), Mike Rounds (R-SD), and Markwayne Mullin (R-OK) in sending the letter. Read the full letter here or below: Dear Administrator Brooks-LaSure: We write to express concerns regarding the Centers for Medicare and Medicaid Services’ (CMS) recent proposed rule establishing staffing mandates for nursing homes. In many parts of the country, America’s long-term care facilities are facing severe workforce shortage issues that are harming access to critical care for our nation’s seniors. With this is mind, we are deeply concerned that now is the worst possible time for the United States to establish the nation’s first federal staffing mandate for long-term care facilities. We believe the rule as proposed is overly burdensome and will result in additional closures and decreased access to care for our nation’s seniors. We urge you to rescind CMS’ proposed rule and instead commit to working with Congress on the large number of alternate solutions to quality of care in skilled nursing facilities. We understand the importance of ensuring beneficiaries of federal health care programs have access to safe and high-quality nursing care. In fact, we share your intended goal of improving the quality of care for seniors. However, a one-size-fits-all staffing mandate significantly undermines access to care for patients, particularly in rural communities. Instead, CMS should work with Congress and stakeholders on policy alternatives that address the severe workforce challenges in our states’ underserved areas. CMS’ own “Nursing Home Staffing Study Comprehensive Report” released in June of this year highlights the disparities between different facilities in different parts of the country as well as the difficulty to implement burdensome national requirements, further emphasizing our concerns over CMS’ federal mandate. This report also notes that current literature “does not provide a clear evidence basis for setting a minimum staffing level.” While the proposed rule does attempt to address some of these disparities, we believe it falls short. For example, we are concerned by the requirement to have a Registered Nurse (RN) on site at all times being omitted from the hardship exemption and Licensed Practical Nurses (LPNs) being omitted from counting them with RNs in the staffing ratio formula. More broadly, establishing federal blanket staffing standards do not provide the flexibility necessary to nursing homes in light of well-known and long-standing direct care workforce challenges, especially in rural and underserved areas. This issue is exacerbated by the fact that the health care sector is projected to have a shortage of nurses, 10 to 20 percent based on a spring 2022 estimate, in the coming years. If large, urban, multistate hospital corporations are having trouble hiring nurses, there is no doubt that this struggle will only be amplified for small rural nursing home providers. Many of these facilities are already expending significant effort and resources to recruit and retain clinical staff, including those facilities in the 38 states and the District of Columbia that have their own localized staff ratio requirements. We recognize CMS as a crucial partner in identifying, mitigating, and preventing future health and safety problems in nursing homes. We stand ready to work with your agency on proposals to improve long-term care for patients. The best way to accomplish this goal is working with Congress and stakeholders to ensure any future actions do not further exacerbate the serious challenges already facing facilities across the county. ### |