Congress weighs in on possible minimum staffing rules

Jun 1, 2023 | Minimum Staffing, CMS' PBJ Policies

News Digest: Congress Weighs in on possible minimum staffing rules

CMS took its time between an early 2022 announcement of the INTENTION to create minmium staffing regulations until the Sept 1, 2023 announcement of the ACTUAL Proposed Minimum Staffing ruler.  As associations, providers, and advocates expressed loud support or resistance to the rule, federal senators and congressman got into the action to ensure any rule does not negatively impact their home states or districts.


As SNF staffing mandate inches closer, more lawmakers publicly question its viability

As the clock counts down to the release of the Biden administration’s promised nursing home staffing mandate, providers are hoping that a growing chorus of federal lawmakers opposed to the idea will stem the potential harm.

Sen. Angus King (I-ME) (pictured) pointedly questioned an official from the Centers for Medicare & Medicaid Services about the looming mandate during a hearing last week in the US Senate Committee on Veterans’ Affairs,

“You’re not serving veterans if a home closes because they can’t meet the staffing standards because they can’t find the people,” King said to Jonathan Blum, CMS’ principal deputy administrator. “Let’s get real here. Don’t tell me you’re improving service to veterans when you just said we’re going to see nursing homes close.”


Towhey, Jessica R. “As SNF Staffing Mandate Inches Closer, More Lawmakers Publicly Question Its Viability.” McKnight’s Long-Term Care News, June 2023,


Nursing homes pick up key ally in staffing mandate lobbying

More than 500 long-term care providers are in the nation’s capital today to try to head off a minimum staffing rule and win support for legislation that could make recruiting and training workers easier.

Attendance at this year’s American Health Care Association / National Center for Assisted Living Congressional Briefing is record-setting, said President & CEO Mark Parkinson, who praised participants for coming to advocate for their sector at a critical time.

Parkinson noted that a rule setting a first-ever federal nursing home staffing minimum is currently being reviewed by a White House budget office. It should arrive between this Friday and June 21, the last day of spring, he said. Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure has spoken publicly and specifically about meeting a self-imposed deadline to issue the mandate “this spring.”


Marselas, Kimberly. “Nursing Homes Pick up Key Ally in Staffing Mandate Lobbying.” McKnight’s Long-Term Care News, June 2023,


‘System in Crisis’: US Senate Hearing Calls for More Funding, Staffing for Nursing Home Inspections

The nursing home inspections system is underfunded and understaffed and needs federal assistance for alleviating inspection backlogs, or residents will remain in peril, experts and legislators said at a U.S. Senate hearing on Thursday.

Officials from the long-term care ombudsman program as well as leaders from state inspections and regulatory bodies were among those who testified before the U.S. Senate Special Committee on Aging, following the release of its investigative report.

“The report paints a picture of a system in crisis,” said Sen. Bob Casey (D-Penn), who blamed a shortage of inspectors and low funding as factors that are jeopardizing the annual nursing home inspections process. “The result is that nursing home residents are being put at risk because of this problem … My fear is that the trail is going cold for too many residents before nursing home inspectors can arrive on the scene.”


Siddiqi, Zahida. “‘System in Crisis’: US Senate Hearing Calls for More Funding, Staffing for Nursing Home Inspections.Skilled Nursing News, May 2023,


Lawmakers, union attack AHCA’s opposition to nursing home staffing mandate

Two members of Congress joined national union leaders Thursday in accusing nursing home owners of diverting federal funds away from patient care in what was ostensibly a rally in support of a federal staffing mandate.

In calling on the Centers for Medicare & Medicaid Services to hasten its adoption of a first-ever national staffing minimum to support beleaguered frontline workers already in place, Rep. Jan Schakowsky (D-IL) also painted nursing home owners and their top advocacy organization, the American Health Care Association, as “the opposition.”

She said AHCA had spent $3.9 million lobbying Congress on the staffing mandate issue last year. AHCA leaders say they have embraced the idea of increasing staff, but they also have cautioned that mandating hiring when the sector remains down more than 200,000 workers from its pre-COVID levels could lead to disaster for some facilities.

April 21, 2023


Marselas, Kimberly. “Lawmakers, Union Attack AHCA’s Opposition to Nursing Home Staffing Mandate.” McKnight’s Long-Term Care News, 21 Apr. 2023,


Lawmaker, providers strike back after HHS leader promotes nursing home minimum staffing mandate

A Congresswoman and two major US nursing home associations hit back Wednesday, the day after Health and Human Services Secretary Xavier Becerra defended the administration’s plan to impose first-ever nursing home minimum staffing levels.

Rep. Michelle Fischbach (R-MN) raised the topic during a House Ways and Means Committee hearing Tuesday. Becerra did not directly answer her questions pertaining to the potential effects of a mandate on providers and operators.

[Fishbach told McKnight’s] “I have sent a letter to the Centers for Medicare and Medicaid Services, which is under the purview of the Department of Health and Human Services, encouraging them to reconsider this (minimum staffing) proposal and instead focus on working with stakeholders to develop innovative solutions that boost the recruitment and retention of qualified nursing professionals.”

The American Health Care Association/National Center for Assisted Living, also railed against Becerra’s comments Wednesday.

“Staffing requirements without resources or workforce development programs will not solve this labor crisis,” the AHCA/NCAL statement continued. “We will continue to advocate for meaningful support and investments to help strengthen the long term care workforce.” 

March 30, 2023


Berklan, James. “Lawmaker, Providers Strike Back After HHS Leader Promotes Nursing Home Minimum Staffing Mandate.” McKnight’s Long-Term Care News, 30 Mar. 2023,


‘Imperative’ to finalize staffing rule this year, dozens of House members tell CMS

More than a quarter of the House of Representatives signed a letter last week urging the Centers for Medicare & Medicaid Services to move forward with its plan to institute a nationwide staffing mandate for nursing homes.

They called for the fiscal 2024 payment rule — which is expected to be officially proposed this spring — to include a proposal for “strong mandatory minimum staffing standards” and said it would be “imperative” to finalize requirements this year. The letter, crafted by Reps. Lloyd Doggett (D-TX) and Jan Schakowsky (D-IL), was signed by 113 Democrats.

The letter was dated March 13 but was not publicized by Dogget’s office until later last week. While acknowledging staffing challenges in the sector, the signers urged CMS officials to act anyway.

“CMS should adopt strong nursing staff-to-resident ratios to ensure workers are not overburdened and unable to meet their patients’ needs,” they wrote. “it is clear that chronic understaffing contributes to high rates of stress, injury, and burnout among nursing assistants, and ultimately to high rates of turnover. Thus, we believe that creating a robust staffing standard will also go a long way towards improving the quality of nursing home jobs, which in turn will actually help attract more workers and resolve current workforce shortages in this industry.”

March 20, 2023


Marselas, Kimberly. “‘Imperative’ to Finalize Staffing Rule This Year, Dozens of House Members Tell CMS.” McKnight’s Long-Term Care News, 20 Mar. 2023,


Congress to CMS: Build Staffing Mandate into 2024 Medicare Payment Rule

Democratic lawmakers this week penned a letter urging the Centers for Medicare & Medicaid Services (CMS) to ensure workers aren’t overburdened with high caseloads and inadequate support.

The legislators, led by U.S. Representatives Jan Schakowsky (D-Ill.) and Lloyd Doggett (D-Tex.), also called on CMS to establish robust nursing home staffing standards to ensure residents receive comprehensive, quality care, according to a statement issued by Rep. Schakowsky’s office.

“It has been one year since President Biden’s State of the Union announcement concerning this study and over 20 years since CMS’s last review,” members wrote in the letter. “Meanwhile, many nursing home residents and workers have suffered from insufficient staffing. It is imperative that CMS finalize robust requirements this year.”

March 16, 2023


Stulick, Amy. “Congress to CMS: Build Staffing Mandate Into 2024 Medicare Payment Rule.” Skilled Nursing News, 17 Mar. 2023,


Senators push CMS to issue – and fund – federal nursing home staffing mandate soon

A group of Senators is urging the Centers for Medicare & Medicaid Services to proceed as quickly as possible with setting a minimum staffing mandate for nursing homes. In a nod to skilled care operators, the seven Democrats also urged the agency to look at how a new rule would impact providers with a “more limited workforce.”

Led by Sen. Bob Casey (D-PA), the senators said they “appreciate” CMS’ work to date “to promote safety and quality” throughout the sector. However, the vagueness of federal regulations requiring 24-hour, licensed nursing care proved “insufficient” during the pandemic.

Casey chairs the Senate Special Committee on Aging and has long supported minimum staffing requirements, ostensibly to improve the quality of care for nursing home residents. Other signers of the letter are Sen. Ron Wyden (D-OR), chair of the Senate Committee on Finance, Sen. Richard Blumenthal (D-CT), Sen. Cory Booker (D-NJ), Sen. Sherrod Brown (D-OH), Sen. Kirsten Gillibrand (D-NY), and Sen. Elizabeth Warren (D-MA). 

February 13, 2023


Towhey, Jessica. “Senators Push CMS to Issue — and Fund — Federal Nursing Home Staffing Mandate Soon.” McKnight’s Long-Term Care News, 13 Feb. 2023,


Federal bill returning temporary nurse aide waiver gets new life

A bill that would allow non-certified nurse aides to work in nursing homes longer than four months has been reintroduced in the House of Representatives.

Reps. Brett Guthrie (R-KY) and Madeleine Dean (D-PA) are backing the Building America’s Health Care Workforce Act, which would waive a requirement for temporary nurse aides to complete 75 hours of state-approved training and a competency evaluation in four months. Earlier in the pandemic, a similar waiver provided nursing homes with a new staffing supply after thousands of trained caregivers fled their jobs.

The Centers for Medicare & Medicaid Services allowed the waiver to sunset last summer, forcing TNAs in most states to get certified by October or leave their positions. The agency granted additional waiver extensions to at least 15 states and dozens of individual providers, but in most cases those were tied to the public health emergency.

The new nurse aide waiver legislation would restore the allowance nationally for two years beyond the public health emergency, which is currently slated to end in April.

January 26, 2023


Marselas, Kimberly. “Federal Bill Returning Temporary Nurse Aide Waiver Gets New Life.” McKnight’s Long-Term Care News, 26 Jan. 2023,


13 U.S. Senators Warn CMS: Staffing Mandate May Worsen SNF Access

As the federal staffing minimum mandate proposal and study is due to be revealed in a matter of months, some state leaders are calling on the Centers for Medicare & Medicaid Services (CMS) to rethink the mandate’s “one-size-fits-all” approach.

Thirteen senators across nine rural states last week issued a letter addressed to CMS Administrator Chiquita Brooks-LaSure, concerned the proposal would significantly affect access to nursing home care in more remote markets.

Senators worry the staffing mandate would result in additional closures across rural America, as a result of a disproportionate financial burden placed on such facilities.

U.S. Senators Jon Tester (D-MT), John Barrasso (R-WY), John Hickenlooper (D-CO), and Steve Daines (R-MT) sent the letter on Friday.

Senators John Thune (R-SD), Gary Peters (D-MI), Kevin Cramer (R-ND), Joe Manchin (D-WV), Deb Fischer (R-NE), Kyrsten Sinema (D-AZ), John Hoeven (R-ND), Cynthia Lummis (R-WY), and Mike Rounds (R-SD) also signed the letter.

January 24, 2023


Stulick, Amy. “13 U.S. Senators Warn CMS: Staffing Mandate May Worsen SNF Access.” Skilled Nursing News, 24 Jan. 2023,


Senators call on CMS to end push for mandatory staffing in nursing homes

A bipartisan group of US senators representing rural states is calling on the Biden administration to halt its plan to mandate staffing levels in nursing homes, saying it’s the wrong step to take as facilities are already struggling to retain and hire professional staff.

“We fear a one-size-fits-all staffing mandate would undermine access to care for patients, particularly in rural communities,” reads a Jan. 20 letter from 13 senators to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure. “Additionally, blanket staffing standards may not provide enough flexibility to nursing homes in light of well-known and long-standing obstacles to the recruitment and retention of direct care workers, especially in rural and underserved areas.”

The senators represent Arizona, Colorado, Montana, Nebraska, North Dakota, South Dakota, West Virginia and Wyoming

The minimum staffing push from CMS is part of a broader Biden administration effort to drive quality improvements and increase transparency in the nursing home sector. The federal proposal is expected this spring and comes amid similar efforts by many states to require a certain number of nursing hours per day per patient that most association leaders say will further harm the industry. 

January 24, 2023


Towhey, Jessica. “Senators Call on CMS to End Push for Mandatory Staffing in Nursing Homes.” McKnight’s Long-Term Care News, 24 Jan. 2023,


Barrasso, Tester, Daines, Hickenlooper Push Biden Admin to Address Rural Nursing Home Staffing Shortages

U.S. Senators John Barrasso (R-Wyo.), Jon Tester (D-Mont.), Steve Daines (R-Mont.), John Hickenlooper (D-Colo.), and colleagues today sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure expressing concerns about CMS’ intent to issue additional staffing mandates for nursing homes.

In the letter, the senators discourage CMS from taking a “one-size-fits-all” approach and instead address the significant workforce shortages affecting rural America.

The letter was also signed by Senators John Thune (R-S.D.), Gary Peters (D-Mich.), Kevin Cramer (R-N.D.), Joe Manchin (D-W.Va.), Deb Fischer (R-Neb.), Kyrsten Sinema (D-Ariz.), John Hoeven (R-N.D.), Cynthia Lummis (R-Wyo.), and Mike Rounds (R-S.D.).

January 23, 2023


Roeber, Richard. “Barrasso, Tester, Daines, Hickenlooper Push Biden Admin to Address Rural Nursing Home Staffing Shortages.”, 21 Jan. 2023,

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