Earlier this month, the Centers for Medicare & Medicaid Services (CMS) drafted a rule that would repeal the federal staffing mandate for nursing homes – a move that would send ripple effects through the home health industry.
The rule was controversial among nursing home operators, but it also received pushback from home health providers who were concerned that the mandate would lead to further staffing scarcity.
“The repeal is positive for home health agencies,” Katy Barnett, director of home care and hospice operations and policy at LeadingAge, told HHCN in an email. “LeadingAge has in comment letters repeatedly cited concerns about this staffing mandate’s impact on home health and hospice providers. The entire post-acute care sector needs a commitment from CMS to invest in attracting more staff to these professions, rather than implementation of rules creating competition between settings for limited staff.”
The staffing mandate was originally proposed by the Biden administration in 2023, and the final rule was issued last year. The rule requires nursing homes that receive federal funding through Medicare and Medicaid to have a total nurse staffing standard of 3.48 hours per resident day. The mandate also includes instructions regarding hours for registered nurses (RN) and nurse aides.
“This means a facility with 100 residents would need at least two or three RNs and at least 10 or 11 nurse aides as well as two additional nurse staff (which could be registered nurses, licensed professional nurses, or nurse aides) per shift to meet the minimum staffing standards,” the Biden administration wrote in a fact sheet at the time. “Many facilities would need to staff at a higher level based on their residents’ needs. It will also require facilities to have a registered nurse on-site 24 hours a day, seven days a week, to provide skilled nursing care, which will further improve nursing home safety.”
In August, CMS submitted an interim final rule to the Office of Management and Budget (OMB) titled the “Repeal of Minimum Staffing Standards for Long-Term Care Facilities.” Currently, the rule is under review by OMB, the last step before a rule is released to the Federal Register, Jodi Eyigor, senior director of nursing home quality and policy at LeadingAge, explained.
“We don’t know what is in the rule; however, given the title … certainly the staffing standards repeal is a focus,” she told Home Health Care News in an email. “Still, we don’t know exactly what that looks like. Is the focus only on the staffing standards? Is a different requirement being put in its place that CMS feels fits within the bounds of statutory authority? We won’t know until the rule is released.”
The Department of Justice, on behalf of the Department of Health and Human Services (HHS), has filed motions to dismiss the appeals of the two federal court decisions that vacated the staffing standards.
“The Fifth Circuit Court of Appeals has granted the motion to dismiss the appeal of the Texas decision; the motion filed with the Eighth Circuit to dismiss the appeal of the Iowa decision is still pending, but we expect it to be granted,” Eyigor said. “Additionally, as part of HR 1, the implementation of the final nursing home staffing rule was delayed, in its entirety, by nine years. These staffing standards would not take effect until Jan. 1, 2035.”
Implications for home health
Home health providers were worried about the potential increase in competition for recruiting staff, as nursing homes would need more clinicians.
In general, home-based care providers are often recruiting from the same talent pool as nursing homes, as well as hospitals and health systems. Sometimes these other sectors are in a better position to pay clinicians higher wages, turning the heat up on staffing competition.
The home health industry was spared because the main provisions of the rule were not scheduled to take effect until 2026, according to Mary Carr, vice president of regulatory affairs at the National Alliance for Care at Home (The Alliance).
“Our fear was they were going to take people away,” Carr told HHCN. “We were going to have a smaller staffing pool if skilled nursing facilities had to hire more nurse aides. We were concerned that it would impact us, but because these provisions weren’t even scheduled to take effect yet, we haven’t seen any impact.”
Carr also noted that home health and hospice providers feared that if the nursing staffing mandate proved to be successful for that sector, it could lead CMS to consider introducing a similar rule for home-based care companies.
The post Home Health Industry Welcomes CMS’ Repeal Of Nursing Home Staffing Mandate appeared first on Home Health Care News.
