More than 500 skilled nursing providers are expected to arrive in Washington, D.C., Monday ready to press federal lawmakers for solutions on staffing and revenue issues that threaten patient access across the country.

Those dual challenges will inform most conversations as members of the American Health Care Association try to bring their elected officials onto their side and exert pressure on the Centers for Medicare & Medicaid Services ahead of a major funding decision.

Clif Porter
Clif Porter

“The topline message is on continuing our recovery from the pandemic. Obviously, we’re nowhere close to being finished,” Clifton J. “Clif” Porter II, senior vice president of government affairs for AHCA, told McKnight’s Long-Term Care News on Wednesday. “Ensuring stability from the payment perspective is critical.”

Porter said members would ask Congressional leaders to not “effectively reduce our reimbursement all at once,” referring to a 4.6% parity adjustment proposed by CMS to restore the Patient Driven Payment Model to its intended budget neutral position.

Though the cut would be offset by a 3.9% upward adjustment in Medicare Part A payments, Porter noted that absorbing a net $320 million sector-wide cut would be most difficult for those already “teetering.” Formal comments on the rule are due by June 10, with Porter and other industry observers expecting a final rule by late July.

The push to share deep concerns with members of Congress follows a series of regional meetings AHCA members have had with CMS leaders this spring.

“The emphasis now will be on Congress and getting them to weigh in in support of us,” he said. While AHCA recognizes that CMS needs to adjust PDPM payments, the association is urging the agency to stagger the cut over three years. Many of the comments pouring into CMS echo that request.

Providers say the timing of an all-at-once cut would be staggering on top of increased labor costs. Workforce is another subject AHC members will focus on next week in D.C.

Historic staffing problems

Porter said the low availability of workers for long-term care settings is “unprecedented,” with the total number employed sinking to 1997 levels. One key piece of legislation to watch is a bill that would extend a waiver enabling the less-restrictive use of temporary nurse aides. CMS plans to sunset that waiver next week, after which nursing homes will have four months to get all non-certified nurse aides to pass state certification exams. On the bill to delay the sunset by two years, Porter is notably optimistic.

“We do have the expiration … but the goal will ideally be to get this passed with the continuing resolution in October,” he said. “Hopefully, that will materialize.”

As other public health emergency flexibilities wane, including FMAP rate add-ons, the focus for many nursing homes will be on finding new ways to survive financially. While some states have increased Medicaid funding, given their solid financial positions, providers in other states haven’t been so lucky.

In addition, many are still facing steep pricing for contracted agency workers. Despite some conversations with the Federal Trade Commission, Porter said the sense is that there will be no action without some proof of collusion on the agencies’ part. Instead, he said, providers need to keep telling their stories to magnify the “atrocities,” “aberrations” and “mutations” related to agency pricing and higher wages across the industry. That may eventually move Congress to work next year on providing more support.

“The more we can highlight the issue, the more we can sensitize the legislators,” Porter said, noting the combined effect of suspended federal COVID relief and increased staffing costs even as COVID continues. “Providers are in a very precarious situation. We’ve got more facilities closing — not [just] going bankrupt, but closing their doors — than ever in my career.”

Other pressing concerns may cut into the time Congress has to spend on nursing home reform this year. That may help, at least temporarily, alleviate regulatory concerns that have been front and center since President Biden pitched a 20-point reform plan in late winter. It’s unlikely, for instance, that Congress will be swayed to budget an additional $500 million for surveying activities, which is just fine by AHCA.

“We must have regulations and efforts to ensure quality care. But we have different ideas on how $500 million could be used to ensure that goal…We can’t spend $500 million to continue the same approach that has not been working,” Porter said. “We need to make Congress understand the importance of all these policies on residents and staff. It does affect them. Transfer trauma, the increased mortality of moving residents when facilities close, it’s real.”