Best pull out your opera gloves and polish up your waltz.
It’s the annual coming out season for the nursing home brass at the Centers for Medicare & Medicaid Services, who’ve recently been spotted at two provider conferences and filled a whole day’s agenda at their own agency’s three-day quality shindig.
That’s the spring cycle for you, a time for CMS to highlight its main priorities as we emerge from the winter doldrums, often doing so in bright sunny spots where colleagues gather for operational insights and inspiration.
But there’s no doubt everyone in attendance at those events felt the shadow looming over all the talk of enhanced barrier precautions, sepsis, antipsychotic reductions and other quality initiatives.
Yes, those CMS speakers are always somewhat scripted, some might even say cagey. But this year, they’re been demure enough on one issue — the forthcoming finalized staffing mandate — to put a debutante to shame.
Federal provisions prevent agency staff from discussing regulations while they’re in the rule-making stage, and for good reason. Lobbying has its place, but it shouldn’t be at the feet of those who propose and craft a sector’s operational playbook.
Still, it’s got to be nearly impossible to focus on anything you’re being told to focus on by regulatory experts when all you really want to know is: Will they or won’t they? Or when will they? Or how much will it cost me? And most critically, where will we find the people?!
The nursing home minimum staffing rule is a prime distractor this spring, its final details still unknown more than two years after the Biden administration first put nursing home ownership and staffing squarely in its crosshairs.
The rule’s possible implications are enough to make even the most solidly performing operators question their future business models — including how to keep investing in improvements and innovation when every spare dollar might soon need to go to recruitment.
(I mean, of course, among those who don’t already feel every spare dollar is going to hiring, or retaining, workers. Are there any of you still out there?)
But check your dance card: The wait is just about over.
The White House Office of Management and Budget finished its review of the mandate’s final version late Monday. That means it’s now back in the hands of those reserved CMS officials, who can, and presumably will, make it live for the rest of us to absorb.
That will take some time. In addition to figuring out what’s changed since the proposed rule was issued in September (and maybe what hasn’t), those digging in for clues about CMS’ evolving thought process when it comes to staffing will have hundreds of pages to review. The agency had to read through and respond to nearly 50,000 comments it received on its first go-round.
But this is not a ball, and there will be no dancing around the key elements, including final hourly requirements for RNs and CNAs, whether the rule found a place for LPNs, and if any of a building’s RN coverage can be filled remotely.
Unless any of those details have been significantly reworked in the last eight months or so, I have a feeling skilled nursing providers are about to meet all that tight-lipped preseason discretion with some terribly noisy objections.
