Federal regulators took aim at another stack of nursing home rules Thursday night, and this round goes deeper than paperwork.
In a proposal quietly posted Nov. 5, the Centers for Medicare & Medicaid Services laid out a broad rollback of Medicare and Medicaid conditions of participation across 21 provider types — with nursing homes squarely in the path. The agency calls it the Cutting Administrative Requirements for Excellence in Patient Care rule, or CARE, and estimates the changes would save providers $320 million and return more than 3.26 million hours of staff time.
COVID rules and reporting on the way out
For nursing homes, the most visible change involves the pandemic. Facilities would no longer have to educate staff about the COVID-19 vaccine, offer it to them, or document any of those actions. The remaining vaccine requirements for residents would be streamlined. A continuing respiratory illness data reporting requirement would be rescinded, with reporting obligations kept only for a future Secretary-declared public health emergency.
The proposal also reaches into Medicaid dollars. CMS wants to eliminate requirements that states report what percentage of Medicaid nursing facility payments actually goes toward direct care worker and support staff compensation — data that advocates have leaned on to argue operators shortchange frontline staff.
Buildings, assessments and what’s left of the staffing rule
On the physical side, existing facilities would be exempt from room occupancy and bathroom facility standards, and the requirement that patient care areas have windows or doors with natural light would disappear for nursing homes and several other provider types. CMS would also revise how representatives of direct care staff participate in the required facility assessment, and loosen the ombudsman notification process for certain resident transfers.
The rule further trims what remains of the 2024 staffing mandate, which regulators repealed outright over the summer after a years-long legal and political fight. CMS is also asking publicly whether nurse practitioners and physician assistants should be allowed to perform visits in long-term care facilities that are currently required to be done by a physician.
Not final yet
Nothing here takes effect immediately. The rule is open for public comment, and CMS is soliciting input on several open questions, including whether residents should be able to opt out of having a discharge notice sent to the state ombudsman.
Industry groups are likely to welcome the relief. Consumer advocates are expected to push back hard, especially on scrapping the payment transparency reporting — the one provision that shows where Medicaid money actually ends up.
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