While on-the-ground providers can do little but wait for a now-overdue staffing minimum to drop, the sector’s top advocates remain furiously at work in the nation’s capital, hoping to mitigate its potential impact.

The stalled staffing rule has put the Office of Management and Budget in the spotlight since the White House body began its wonky review process on May 30. OMB oversees regulatory measures from across the federal government, weighing proposals for economic, regulatory and other effects.

As of Thursday, it was reviewing 25 rules from the Department Health and Human Services, more than from any other department. But it’s the proposed Minimum Staffing Standards for Long-Term Care Facilities rule that is drawing LTC’s attention to the review process.

Now that the rule is out of the hands of its drafters at the Centers for Medicare & Medicaid Services, sector representatives have held meetings with OMB staff and others involved in promulgating the version that will be published for the public.

LeadingAge on June 23 met with OMB, members of the White House Domestic Policy Council, and HHS and CMS leaders in what Nursing Home Quality and Policy Director Jodi Eyigor described as “preemptive advocacy.”

“We’re expecting to see the staffing ratio rule any day now, but it is not out yet,” added Ruth Katz (pictured), senior vice president of public policy and advocacy, explaining the meeting to members during a call earlier this week. “The goal of these meetings is for private groups to bring the government any information we think they need to have to understand the impact of an expected proposed or final rule.”

OMB listened to concerns but didn’t ask questions or comment itself, Katz said.

“We emphasized our commitment to providing high-quality care, noting that potentially taking money out of nursing homes with CMP (civil monetary penalties) for not complying with ratios would detract from quality and inequitably harm small, single-site providers,” she said.

The American Health Care Association, too, has been working with White House and Congressional officials to try and smooth whatever it can at this point in the process. Its leaders, including CEO and President Mark Parkinson, met with OMB on June 14, according to an account on the OMB website.

“We have had discussions with the Administration, as have many other stakeholders, and we believe that the Administration is taking the time to thoughtfully consider how we marry policy with practicality,” AHCA told McKnight’s Long-Term Care News in an email Thursday. “We all want to increase the long-term care workforce, but an enforcement approach will not solve this labor crisis and will only worsen access to care for seniors. We hope CMS is putting together a supportive approach.” 

AHCA also has been working closely with members of Congress opposed to a staffing minimum, many of whom are keeping the pressure while the bill rests with OMB. 

In a letter to OMB Director Shalanda Young, Sen. Jon Tester (D-MT) emphasized that any staffing mandate should include flexibility for rural facilities. Tester sent the letter in mid-June but released it publicly on Tuesday.

“I fear a one-size-fits-all staffing mandate would undermine access to care for patients, particularly in rural communities,” he wrote. “Instead, I urge you to work with Congress and rural stakeholders on tailored solutions that address the severe workforce challenges in underserved areas. …CMS must provide flexibility to nursing homes in light of well-known and long-standing obstacles to the recruitment and retention of direct care workers, especially in rural and underserved areas.”

Those comments echo concerns raised in a June 1 op-ed by Parkinson in The Hill, a newspaper read widely by power players and policymakers in Washington, DC.

“One-size-fits-all regulation is counterproductive and in no way addresses the underlying issue of our persistent workforce challenges,” Parkinon wrote, reminding that skilled nursing lost 250,000 workers during the course of the pandemic, bringing the workforce to 1995 levels.

“To truly solve our labor crisis, we must start with the core need: proactive measures that will support workforce recruitment and retention,” he added.

AHCA commissioned a study that found a 4.1-hour per patient per day standard would require nearly 200,000 new nurses and aides and costs providers more than $11 billion.