Congress is active in nursing home issues. H.J. Res 139, filed May 10, 2024 under the Congressional Review Act, disapproves the final minimum staffing rule for nursing homes.
Nurse aide training rules are also under attack. On May 16, 2024, the Health Subcommittee of the Energy and Commerce Committee, on a party-line vote, forwarded to the full Committee, H.R. 468, Building America’s Health Care Workforce Act. The bill would reinstate for two years the pandemic-era waiver of federal nurse aide training requirements that expired on May 11, 2023 and would allow for time worked under the waiver to count toward the 75 hours’ minimum nurse aide training requirements. The Subcommittee also passed H.R. 3227, the Ensuring Seniors’ Access to Quality Care Act, which would reduce the number of nursing facilities that are barred for two years from conducting their own nurse aide training programs; the bill limits the ban on nurse training to facilities with large penalties for “quality of care” deficiencies. On a party-line vote on May 8, the House Ways & Means Committee had approved a similar bill, H.R. 8244, also named the Ensuring Seniors Access to Quality Care Act.
Residents’ advocates and unions and other members of an ad hoc coalition supporting nursing home reform opposed the bills weakening longstanding nurse aide training rules.
Meanwhile, the ad hoc coalition supporting nursing home reform wrote to CMS Administrator Chiquita Brooks-LaSure expressing concerns with the Risk-Based Survey process that the Centers for Medicare & Medicaid Services is currently testing.
Comment Letters
- Consolidation in Health Care
The Federal Trade Commission and the Departments of Justice and Health and Human Services issued a Request for Information, with multiple questions, to hear from the public about the effects of consolidation in health care markets. They later extended the comment period to June 5. The Center for Medicare Advocacy submitted comments on May 17, focused on nursing homes and private equity.
- Medicare Part A Reimbursement for Skilled Nursing Facilities
The Center for Medicare Advocacy and the Long Term Care Community Coalition together submitted comments on proposed rules to update Medicare Part A reimbursement for skilled nursing facilities. The letter supports giving the Centers for Medicare & Medicaid Services authority to impose both per day and per instance civil money penalties for the same survey. It also urges reinstatement of the Obama surveyor guidance in 2014 that made per day civil money penalties the default type of penalty; in 2017, the Trump Administration replaced the Obama guidance and made per instance CMPs the default penalty. The joint comment letter also repeats concerns about the dramatic reduction in therapy services for residents under Medicare’s Patient Driven Payment Model for Part A reimbursement. The concern is particularly acute for residents needing maintenance therapy. In January 2013, the federal district court in Jimmo v. Sebelius confirmed that Medicare covers medically necessary maintenance therapy in skilled nursing facilities, home health, and outpatient therapy.
Comments on the proposed rules are due May 28, 2024.
May 23, 2024 – T. Edelman