Nursing home associations are clashing with the Biden administration in a federal lawsuit seeking to block a newly implemented staffing mandate. This policy, championed by the administration as a necessary measure to safeguard nursing home residents, has sparked fierce opposition from the industry, citing potential negative impacts on both residents and facilities.
The lawsuit, filed by the American Health Care Association (AHCA), the Texas Health Care Association, and three Texas nursing home operators, targets a final rule issued by the Centers for Medicare & Medicaid Services (CMS) on May 10th. This rule outlines minimum staffing requirements for nursing homes receiving Medicare and Medicaid funding.
“We had hoped it would not come to this; we repeatedly sought to work with the Administration on more productive ways to boost the nursing home workforce,” Mark Parkinson, AHCA President and CEO, said in a press release announcing the lawsuit. “Unfortunately, federal officials rushed this flawed policy through, ignoring the credible concerns of stakeholders and showing little regard for the negative impact it will have on our nursing home residents, staff and the larger healthcare system.”
The crux of the lawsuit lies in CMS’s authority to implement such a mandate. AHCA argues that existing Congressional legislation, enacted “decades ago,” already outlines fundamental staffing requirements for Medicare and Medicaid participating nursing homes. These requirements include having a registered nurse on-site for at least eight consecutive hours daily and providing sufficient 24-hour licensed nursing services to meet resident needs.
The lawsuit contends that CMS, dissatisfied with these existing measures, “decided to take matters into its own hands” by introducing a rule that overrides Congressional mandates. This, according to AHCA, constitutes an arbitrary and capricious action on the agency’s part, violating the Administrative Procedure Act.
The contested final rule establishes a minimum total staffing standard of 3.48 hours per resident per day, further specifying ratios for registered nurses (0.55 hours per resident per day) and nurse aides (2.45 hours per resident per day). Additionally, it mandates at least one registered nurse to be present on-site 24/7. These changes are to be phased in gradually, with some facilities, particularly those in rural areas, receiving extended timelines for compliance.
AHCA and other industry groups have consistently opposed the staffing requirements since their initial proposal last year. Their primary concern revolves around the potential for reduced access to care due to widespread staffing shortages and financial constraints faced by nursing homes.
An analysis co-authored by AHCA and the National Center for Assisted Living, released earlier this month, projected a staggering need for an additional 102,000 nurses and nurse aides to meet the new staffing standards, translating to a collective annual expense increase of $6.5 billion. The analysis further cautioned that over 290,000 current nursing home residents could be displaced due to facility closures or reduced capacity.
“Hundreds of thousands of seniors could be displaced from their nursing home; someone has to stand up for them, and that’s what we’re here to do,” Parkinson said.
The nursing home industry’s position has garnered support from Republican lawmakers. The House Ways and Means Committee previously sent a bill to the House floor specifically designed to block the staffing mandate. More recently, Representatives Michelle Fischbach (R-Minn.) and Greg Pence (R-Ind.) introduced their own measure aiming to reverse the policy.
This ongoing debate highlights the complex challenges associated with balancing the need for improved staffing in nursing homes with the financial and logistical realities faced by these facilities. The lawsuit’s outcome will have a significant impact on the future of resident care and the overall operation of nursing homes across the United States.
