Editor’s Note: Nearly a month after this article was posted, the Federal Register on Nov. 1 showed more than 22,000 comments had been submitted regarding the proposed nursing home staffing rule.

DENVER — Leaders of the nation’s largest nursing home association said Monday that they would continue to fight against and eventually “triumph” over a proposed federal staffing mandate that would cost providers as much as $6.8 billion annually and require facilities to hire 100,000 new workers.

The proclamations at the American Health Care Association/National Center for Assisted Living’s Convention & Expo came as lawmakers in Washington delivered their own battle cry on the Centers for Medicare & Medicaid Services‘ proposed rule.

Nearly one-third of the Senate signed on to a letter Friday asking CMS to withdraw the mandatory staffing rule, saying this is the “worst possible time” for the mandate.

“Coming out of COVID and dealing with severe workforce supply challenges, wouldn’t it have been great to have felt the support of our president and CMS?” AHCA Board Chair Phil Fogg asked here Monday, noting the agency’s lack of team members with a long-term care or post-acute background. “This absence of experience makes it difficult for them to understand how policy impacts our day-to-day work lives and it is unfortunate. … While it doesn’t always feel like it, we have the ability to lead and triumph.” 

AHCA President and CEO Mark Parkinson called the proposal “a bad idea that’s been put together in a bad way.” While he noted some factors are starting to turn around for providers, the clinical “nightmare” of COVID and occupancy among them, he noted the sector was still experiencing a 10% decline in workforce, while all other healthcare sectors had rebounded since the pandemic’s start.

He called on providers to continue submitting comments to CMS on its proposal, which had already garnered more than 4,000 responses by Monday with just over a month to go in the formal comment period. He also urged providers to work with their members of Congress to show them the work nursing homes are doing.

“I know if we do this, we will eventually prevail on this issue,” Parkinson said during the event’s opening session. “My hope and belief is that, this time next year, when we do all this work that needs to be done … we’ll be able to continue to say that the clinical nightmare is over. We may be able to say that the business nightmare is over, and we’ll be well on our way to saying that the policy nightmare is almost over as well.”

Senators: ‘worst possible time’ for mandate

In Washington, providers got a strong showing of support over the weekend. Sen. Jon Tester (D-MT) led 28 senators hailing from a range of rural and small states and representing a mix of political ideologies: Democrat, Republican and Independent. Tester has been a vocal critic of the staffing rule since CMS first floated the idea. 

“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,” the senators wrote. “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.”

CMS released the long-awaited staffing mandate Sept. 1. It would require nursing homes to provide 0.55 hours of direct RN care per patient day and 2.45 hours of nurse aid care. While the rule would go into effect in three years after being finalized, it gives an extra two years for rural facilities to get up to speed on the overall hourly rate. Rural facilities would have an extra year to meet the proposal for 24/7 RN coverage while all other nursing homes would have just two years after the rule is finalized to meet this requirement. 

The rural flexibilities appear to be a nod to the pushback from Tester and other senators who represent rural states.

In January, McKnight’s Long-Term Care News reported on a letter — also led by Tester — from 13 senators representing Arizona, Colorado, Montana, Nebraska, North Dakota, South Dakota, West Virginia and Wyoming calling the proposal a “one-size-fits-all staffing mandate [that] would undermine access to care for patients, particularly in rural communities.”

The other senators signing the latest letter are: Marsha Blackburn (R-TN), John Boozman (R-AR), Shelley Moore Capito (R-WV), Bill Cassidy (R-LA), Kevin Cramer (R-ND), Susan Collins (R-ME), Tom Cotton (R-AR), Steve Daines (R-MT), Bill Hagerty (R-TN), Maggie Hassan (D-NH), John Hoeven (R-ND), Cindy Hyde-Smith (R-MS), Angus King (I-ME), James Lankford (R-OK), Mike Lee (R-UT), Joe Manchin (D-WV), Roger Marshall (R-KS), Jerry Moran (R-KS), Markwayne Mullin (R-OK), Jim Risch (R-ID), Mike Rounds (R-SD), Marco Rubio (R-FL), Kyrsten Sinema (I-AZ), John Thune (R-SD), Thom Tillis (R-NC), Jeanne Shaheen (D-NH) and Roger Wicker (R-MS).