Sen. Deb Fischer (R-NE) has pledged to introduce a highly anticipated bill to block the Centers for Medicare & Medicaid Services from implementing its proposed nursing home staffing mandate, although the timing remained unclear Wednesday.
Fischer announced her plans in a weekly column posted to her Senate website, saying the legislation would prevent CMS’ “misguided standards” from going into effect. It also would establish an advisory panel on nursing home workforce issues.
“This mandate from CMS would devastate facilities across Nebraska and other rural states. It would force many facilities to reduce their number of patients or close their doors for good,” wrote Fischer (pictured). “The Biden administration must hear from voices outside the big cities on the coasts. This proposed rule is a one-size-fits-all solution that simply doesn’t fit. It’s a misguided mandate that will prove destructive for communities that most need care.”
Fischer’s planned legislation appears to mirror a bill already introduced in the House. In late September, Rep. Michelle Fischbach (R-MN) sponsored the Protecting Rural Seniors Access to Care Act, H.R. 5796, which would prohibit federal officials from finalizing the draft rule introduced on Sept. 1 and convene a nursing home workforce advisory panel instead. It was still gaining sponsors leading up to the Thanksgiving recess.
Provider groups have been watching carefully over the last few weeks to see if a Senate version of the bill would emerge, and how many co-sponsors it might get.
In a divided Congress, House bills often go to the Democratic-led Senate to die. But at least five Democratic senators and two Independents already have publicly expressed their opposition to the staffing rule, giving the promised Fischer bill potential legs.
Many of the non-Republican opponents were among 13 Senators who signed on to a January letter opposing a potential rule before it was even issued. In October, another bipartisan missive from 28 Senators called on CMS Administrator Chiquita Brooks-LaSure to withdraw the rule.
That letter was led by Democratic Sen. John Tester of Montana, who also blasted the rule’s “one-size-fits-all” nature and its timing, given the labor crisis. In addition, senators on the Veterans Affairs committee wrote to CMS to raise concerns about the rule’s possible “unintended consequences” for veterans homes.
But not everyone in the Senate is lining up in opposition to the rule. A dozen senators earlier this month pushed CMS to move forward with its rule, even while acknowledging the complexity of mandating staffing across the entire country.
“The proposed rule takes a vital step towards ensuring residents receive this high quality care by establishing common sense staffing minimums and improving enforcement,” wrote the senators, led by Bob Casey (D-PA).
The staffing mandate hasn’t broken down along typical party lines, but tends to skew more as a geographic issue.
For her part, Fischer is concerned about creating major access issues in Nebraska and other rural states. Since 2015, 44 Nebraska nursing homes and 35 assisted living facilities have closed, reducing the state’s long-term care beds by more than 3,000. Eleven of the closures occurred in 2022, most in rural communities, according to a report from the Nebraska Health Care Association
“While highly populated urban areas may host several long-term care options, these facilities are few and far between in the rural areas of our country — including in parts of Nebraska,” wrote Fischer, noting the rule’s crushing demand for registered nurses could be especially harmful for providers.
“In 80% of Nebraska counties, the number of registered nurses (RNs) and licensed practical nurses (LPNs) per capita is lower than the national average,” she reported. “Nine counties in Nebraska do not have any practicing RNs available.”
