MANCHIN LEADS BIPARTISAN EFFORT TO REVERSE NATIONAL NURSING HOME STAFFING REQUIREMENT, PROTECTS ACCESS TO CARE IN RURAL COMMUNITIES

Press Release

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 in 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. We urge you to
rescind CMS' proposed rule and instead commit to working with Congress on the large number
of alternate approaches to ensure the quality and safety 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 and ensuring resident safety. However, a one-size-fitsall 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' proposed federal mandate.1 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 inclusion with RNs in the staffing ratio formula.

More broadly, the federal staffing standards established in the rule 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.2 This issue is exacerbated by the

1 https://www.cms.gov/files/document/nursing-home-staffing-study-final-report-appendix-june-2023.pdf 2 https://bipartisanpolicy.org/download/?file=/wp-content/uploads/2022/05/BPC-Medicare-Rural-EmerHsp_R02.pdf

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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.3 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 country.

Sincerely,

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