The Centers for Medicare & Medicaid Services (CMS) recently opened the floodgates for suggestions on deregulation within the Medicare program, and the nursing home industry wasted no time in submitting extensive wish lists for reduced administrative burdens. As the submission deadline hit, stakeholders expressed widespread desires for greater efficiencies, modernized processes, and, notably, the withdrawal of the controversial nursing home staffing mandate.
The government’s request for information, dubbed “Unleashing Prosperity Through Deregulation of the Medicare Program,” has resonated deeply with providers grappling with what they describe as an overly complex and often counterproductive regulatory landscape. The executive order driving this initiative calls for the elimination of 10 rules for every new one introduced, signaling a potential seismic shift for an industry long burdened by compliance demands.
LeadingAge, a prominent provider association, submitted recommendations across 34 topic areas, highlighting a strong desire to revise federal requirements for enhanced barrier precautions and infection control guidance for respiratory illnesses. “Both create a significant burden on providers, impose on the homelike environment and dignity of residents, and seem to be outdated or ill-advised,” stated LeadingAge in their submission, emphasizing the practical challenges of current regulations. The association also strongly criticized the automatic 1-star rating for staffing for untimely Payroll-Based Journal (PBJ) submissions, arguing it’s an “arbitrary penalty” that misrepresents actual staffing levels.
The American Health Care Association (AHCA) outdid LeadingAge with a staggering 54 pages of recommendations. Their submission called for a less frequent survey cycle, suggesting nursing homes be surveyed not less than every 36 months, a stark contrast to the current roughly annual cycle, in order to “be consistent with other healthcare settings.” AHCA also pushed for allowing non-physician practitioners to conduct initial and routine visits and for such work time to be recognized in PBJ accounting.
Clif Porter, AHCA President and CEO, prefaced his group’s submission by stating, “We have an inconsistent and ineffective oversight system that does not drive quality improvement among nursing homes or enhance the quality of life for residents. What it does drive is highly qualified and dedicated caregivers out of or away from the long-term care profession, contributing to our sector’s ongoing workforce challenges.” This sentiment underscores the industry’s belief that current regulations are actively hindering efforts to attract and retain staff. Indeed, a report by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) revealed that 99% of nursing homes currently have open jobs, with 89% actively trying to hire for registered nurse positions, highlighting the severity of the workforce crisis.
The long-term care medical directors group PALTmed also weighed in, advocating for the revision of the current three-day hospital-stay rule for Medicare coverage of skilled nursing facility stays. They recommended dropping it to the two-midnight inpatient admission benchmark or eliminating the criteria altogether. PALTmed also suggested implementing a standardized CMS-endorsed resident and family experience survey, similar to those used in hospitals, with results potentially contributing to a facility’s survey risk score and offering reduced survey frequency for high-performing facilities.
Technology providers are also seizing this opportunity. Direct Supply, a major supplier, recommended CMS embrace digital transformation to “reduce administrative burden and return valuable time back to resident care.” They suggested digitizing life safety and infection control documentation and streamlining quality reporting by unifying MDS, PBJ, and Value-Based Payment processes, which could save SNFs an estimated “millions” of staff hours annually.
The deluge of deregulation wishes signals a collective outcry from an industry struggling under the weight of compliance and workforce shortages. As CMS reviews these extensive submissions, the future of nursing home regulation could see a significant shift, potentially allowing providers to focus more resources on direct resident care rather than administrative overhead.