No matter what role you have when it comes to nursing homes, you’ll have to agree.
Whether you’re an operator, employee, patient, family member or ally of any of the above, the Centers for Medicare & Medicaid Services deserves a hand. Perpetually an author of many of the most dramatic long-term care moments of the year, the regulatory agency may have outdone itself this week.
With details of the story of the year expected at any moment, CMS made its big announcement about the proposed 2024 Medicare Part A payment rule … and then punted on unveiling the White House’s first-ever nursing home staffing mandate.
Regulators first said that a much-feared mandate would be in place within a year of the Feb. 28, 2022, announcement about the White House’s intentions. Feb. 28, 2023, came and went while word was spreading like wildfire that the staffing proposal would be attached to the fiscal 2024 SNF pay rule proposal.
… and it wasn’t, as we all found out Tuesday.
That brings us to our present state of limbo. “We’re in OT, bay-beeee!” as one of my favorite sports announcers would gleefully shout.
Now that’s drama.
There have been some indications that CMS officials have been concerned about getting the parameters for the staffing rule just right. They’ve acknowledged that it is not an easy task finding the proper formula that would work alike for rural and city, big and small, and high-performing and low-performing facilities all at the same time.
That, ostensibly, is why they’re taking more time. Sounds plausible. We haven’t heard any rumblings that the computers or printers at CMS HQ in Baltimore are down and holding up this show.
So far, no one other than federal health authorities really knows the full reason for this delay. Speculation has charged the air. Will the mandated number of nursing hours per patient day be doable? Will any funding to pay for the extra labor be supplied? Is this even a realistic pursuit any more, or are regulators perhaps getting cold feet?
Most providers I’ve heard from still believe a mandate is coming — there’s no way the feds back out entirely at this point. But the question remains when? And how? (Or better: “How bad?”)
Provider lobbying organizations (and consumers’) have kicked their campaigns on the mandate into high gear. They’re especially worried about a new rule that doesn’t come with adequate additional funding. (Is any funding ever enough?)
Most providers are resigned to the fact that some kind of new labor requirement will be here soon. The widespread hope is that it will be a pilot project first, or at least be delivered with one of those long phase-in periods.
But the waiting is the hardest part, as the song goes. You’ll notice that even in Tuesday’s pay rule announcement, CMS said the staffing mandate proposal would be coming “later this spring.” They could have given a date to prepare for, but no. (Let me now take the opportunity to note that while spring months are unofficially considered March, April and May in most of the US, technically the season lasts until the morning of June 21.)
So until we all hear that a firm plan is being released, let the tension continue to build. The working mantra will be “no news is no news.” Ironically, though, you can be sure the nursing home associations and their consumer-driven counterparts will be trying to make all the headlines they can in an effort to help their followers’ interests.
Federal regulators are certainly remaining tight-lipped about details — if they even know them themselves, that is.
Remind yourself, too, that since this is the feds we’re talking about, should June 21 arrive with no staffing mandate announcement, they can extend this drama even further. You may recall that the Patient Driven Payment Model was so important and generated so many stakeholder comments, regulators paused the process for a full year to modify plans, right down to giving it a totally different name before unveiling it to the public.
That brings to mind the most sensational question of the day: Anybody up for double-overtime?
James M. Berklan is McKnight’s Executive Editor.Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
