Photo credit: Hispanolistic/Getty Images

Two senators have introduced a bill to determine exactly what “unintended circumstances” could result for elderly veterans if a federal rule mandating staffing levels at all US nursing homes is allowed to proceed.

S. 3841 was introduced Thursday and referred to the Veterans Affairs Committee, on which co-sponsors Angus King King (I-ME) and Kevin Cramer (R-ND) both serve.

The bill would require the VA to study potential risks associated with the proposed Center for Medicare and Medicaid Services rule — especially as they pertain to rural providers. The senators said the proposal would “unsustainably change staffing ratios at nursing homes.”

“The bill requires an assessment of the VA’s ability to continue meeting the long-term care needs of veterans at VA and VA affiliated nursing homes, with a focus on rural areas, if the rule were to be implemented as currently proposed,” the senators explained in a statement issued Friday.

The measure would require the secretary of Veterans Affairs to submit the department’s findings to Congress within 60 days of passage.

“Senator King and I are simply asking the VA to conduct a study to prove what we already know: This misguided proposal will negatively impact veterans’ access to long-term care services,” Cramer said. “Every state and community are different, and setting an unrealistic, national standard for all nursing homes and facilities serving veterans will further inflame existing staffing shortages and deprive veterans of the long-term care options they earned.”

King and Cramer last fall blasted the Sept. 1 CMS call for round-the-clock registered nurse staffing and hourly minimums for certified nurse aides and registered nurses. They warned the rule “may have unintended consequences that will close nursing homes.”

Veterans Affairs offer long-term care through a network of more than 100 federal community living centers, about 150 state veterans homes and private sector nursing homes with VA contracts. The state facilities alone serve some 15,000 residents and wait lists have been a sporadic problem in many communities.

Maine concerns

King’s home state of Maine has experienced a spate of nursing home closures in recent years, even as Maine is predicted to be one of few states where a majority of nursing homes could comply if a mandate were to be enacted. More than 75% of nursing homes there could meet the mandate as initially proposed, while 80% of those across the US could not.

CMS may make changes to its proposal before issuing a final rule, which agency leaders have said they plan to do this year. A final version arrived the White House Office of Management and Budget Friday for review, a process that could take weeks or months.

Veterans Affairs already has its own regulations requiring RNs at all hours, but that is driving up staffing costs borne by the American taxpayers, Maine Veterans’ Homes leaders have said. A shared job board shows dozens of open positions for nursing jobs at the state’s six facilities.

Some have questioned publicly whether increased competition for the same workers could limit hiring by government facilities unable to increase pay rates quickly.

Other avenues

“While the CMS rule aims to improve the quality of long-term care for veterans by increasing staffing requirements, this one-size-fits-most policy could cause facilities in rural areas to shut down,” King said Friday. “This bill will allow us to take a closer look at the impact that the proposed CMS rule would have on VA and VA affiliated nursing homes so we can best protect access to long-term care options for veterans in Maine.”

This latest bill seeks more evidence that could force CMS to reconsider its approach to a final rule. A pair of companion bills in the Senate and House, meanwhile, would block the bill from taking effect during the ongoing workforce crisis.

The Protecting Rural Seniors Access to Care Act, S. 3410, was introduced in December, and King (I-ME) was one of eight initial co-sponsors. That bill mirrors one introduced in the House in late September by Rep. Michelle Fischbach (R-MN) and would prohibit federal officials from finalizing the draft rule and convene a nursing home workforce advisory panel instead.