Oregon’s U.S. senators are asking the Trump Administration to clarify what they call “intact” staffing and training requirements for skilled nursing facilities (SNFs), declaring state Medicaid offices are befuddled as to what to do on SNF-related rules and other topics amid an upheaval in the program resulting from massive funding cuts in the Republican “Big Beautiful Bill” that became law in July.

The legislation includes $1 trillion in Medicaid program funding cuts over a decade, even though the nursing home industry won a major victory by “carving out” SNFs from the cuts.

In their letter to Mehmet Oz, the administrator of the Centers for Medicaid and Medicare Services (CMS), Oregon Sens. Ron Wyden and Jeff Merkley, both Democrats, said they “write with grave concern that states are already facing significant operational challenges and a lack of clarity as they work to implement the Medicaid cuts in the Republican budget bill that immediately went into effect upon enactment.”

The pair said, “as part of Trumpcare, Republicans placed a nine-year moratorium on implementing and enforcing three rules finalized under the Biden-Harris Administration to improve Medicaid enrollment, reduce Medicare costs for low-income seniors, and ensure adequate, safe staffing in nursing homes.”

Democrats Cite Confusion

The situation is muddled given that parts of the staffing and training requirements from the Biden-era staffing rule are already in effect and need clarification from the government.

Senate Democrats, the letter said, “successfully preserved select, critical provisions within these rules,” such as “improving assessment and transparency tools nursing homes use to make sure there is sufficient staff.” Further, the senators told Oz that “the Senate Parliamentarian ruled that targeting regulatory provisions that have already gone into effect or that do not have a federal budgetary impact violates Senate budget reconciliation rules, meaning Congressional Republicans could not enact a blanket repeal of these final rules.”

The letter said absent CMS guidance, “it is essential to clearly identify which sections of the Medicaid Eligibility and Enrollment final rules, and the Nursing Home Staffing Rule remain enforceable.”

The letter said, for example, that the section of the rule titled, “Increasing Training Requirements for Nursing Home Staff” expands training requirements for nursing homes by requiring these facilities to determine the type and amount of training necessary based on the updated facility assessment required in the final rule.

Rule Still Not Final

The White House Office of Management and Budget (OMB) is currently reviewing an interim final rule from the Centers for Medicare and Medicaid Services (CMS), which has the title of “Repeal of Minimum Staffing Standards for Long-Term Care Facilities.” The title indicates that the rule will end staffing standards that already have been gutted in the courts and by Congress.

With the federal government shutdown, there is no expectation that OMB will move on the rule until the impasse ends.

Nursing Care at Issue

The letter from the senators cites inadequate staffing, but nursing homes have been and continue to be required to have sufficient nursing staff with the appropriate competencies to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident.

The nursing home sector came out strongly against the staffing mandate, calling the proposed changes unnecessarily burdensome in requiring nursing home staff as well as surveyors to divert time and resources to this administrative and paperwork compliance.

CMS, under the previous administration, established a mandate, which has never gone into effect, to ensure that SNFs provide 3.48 hours of nursing care per resident per day and that a registered nurse be onsite 24/7, among many other measures.

AHCA Keeps Positive

In reaction to the issues tied to the issues surrounding the staffing and training rule, Holly Harmon, senior vice president of quality, regulatory, and clinical services for the American Health Care Association, said, “We look forward to the release of the rule currently at OMB to fully understand CMS’ intentions regarding requirements for providers.”

The association remains “optimistic that continued dialogue between CMS and the sector will encourage decisions that prioritize the well-being of seniors without creating duplicative reporting requirements for the communities that provide the care and services.”

Read the Wyden-Merkley letter at 102125 Medicaid E&E and Nursing Home Rule Letter.

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.