Plans to Defeat CMS’ Proposed Minimums Rule

Nov 4, 2023 | Minimum Staffing, CMS' PBJ Policies

News Digest: Various Strategies Floated to Avoid Proposed Minimum Staffing Rule

With widespread opposition to CMS’ Proposed Rule, a variety of tactics are under consideration to overcome the potential regulations.  Both a Congressional over ride and legal challenge to the rule are being openly considered and discussed.


AHCA/NCAL Urges CMS To Rescind Federal Staffing Mandate In Final Comments To The Agency

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes and other long term care facilities across the country that provide care to approximately five million people each year, submitted their final comments today to the Centers for Medicare & Medicaid Services (CMS) on the proposed federal staffing mandate for nursing homes. As the comment period closes today, AHCA/NCAL’s submission formally requests that CMS rescind the unfunded mandate. Implementation of the unfunded, one-size-fits-all rule amid a historic and nationwide labor shortage threatens the displacement of nearly 300,000 nursing home residents.

AHCA/NCAL also reaffirmed their shared desire to enhance quality of care while growing the long term care workforce. They highlighted their proactive and robust reform package, the Care for Our Seniors Act, which lays out comprehensive proposals that will aid in workforce recruitment and retention.


AHCA/NCAL Urges the Centers for Medicare and Medicaid Services to Rescind Federal Staffing Mandate in Final Comments to the Agency.


Minimum staff proposal will fail, provider groups warn CMS

After 60 days of public and often-heated debate, the formal comment period on one of the most controversial federal healthcare regulations ever proposed comes to a close tonight.

Associations representing US nursing homes came out swinging in their official letters to the Centers for Medicare & Medicaid Services. It is the agency poised to impose the nation’s first federal nurse staffing minimums dictating the amount of direct patient care provided daily by certified nurse aides and registered nurses.

It is a sweeping effort that nursing home providers — and allies from other healthcare settings — argue will devastate nursing homes financially and lead to reduced access to care for patients.


Marselas, Kimberly. “Minimum Staff Proposal Will Fail, Provider Groups Warn CMS.” McKnight’s Long-Term Care News, 5 Nov. 2023,


Ensign CEO: Efforts to Strike Down CMS Staffing Rule Appear ‘Futile’ – But It Can Be Shaped

Nursing home industry stakeholders should try to shape the proposed federal minimum staffing policy to best fit with what providers can handle rather than railing against the rule completely.

At least that’s what leaders of the Ensign Group (Nasdaq: ENSG) plan to do, CEO Barry Port said during the company’s third quarter earnings call on Thursday.

Efforts to strike down the proposal altogether would be a “futile effort,” he said, and not worth the energy, given the strength of White House and union-driven interest. There’s “far too much” support for the staffing rule, added Port.

“The ultimate goal here isn’t necessarily to fight it, although you see some legislation that’s been proposed,” said Port. “Given the continuing resolution around the budget, there is a window and potentially an opportunity to have that legislation somehow make its way into a voting situation – but that’s an outside chance.”


Stulick, Amy. “Ensign CEO: Efforts to Strike Down CMS Staffing Rule Appear ‘Futile’ – but It Can Be Shaped.” Skilled Nursing News, 26 Oct. 2023,


Former Speaker Ryan says CMS staffing mandate can be overruled, tabs senior care workforce solutions

Former US House Speaker Paul Ryan delivered on his mission of framing US economic and public policy issues here Tuesday, optimistically emphasizing that immigration reform and technology are the two best tools to help senior care operators overcome their dire staffing shortages.

But he probably raised the most interest among skilled nursing leaders at the National Investment Center for Seniors Housing and Care (NIC) conference when he explained Congress has a clear ability to block a federal nursing home staffing mandate if it has the collective will to do so.

“The Congressional Review Act gives us [Congress] the ability to pass a law that says that the minimum staffing rule is repealed because it was a bad rule,” said Ryan, who delivered Tuesday’s keynote. “It can’t be filibustered in the Senate. If it passes in the Senate, it happens and it goes away, no matter who the president is. That kind of stuff can happen.”

As part of a broader discussion of today’s partisan political climate, he noted that aligned interests need to control Congress and certain circumstances need to fall into place, “But you can repeal recent rules if you have Congress. So there’s a lot you can do.”


Berklan, James M. “Former Speaker Ryan Says CMS Staffing Mandate Can Be Overruled, Tabs Senior Care Workforce Solutions.” McKnight’s Long-Term Care News, 25 Oct. 2023,


Paul Ryan: Even Obama Did Not Pursue Staffing Mandate – But Nursing Home Workforce Crisis Can Be Solved

Past White House administrations – including those headed by Democratic presidents – have not tried to enact a federal nursing home staffing mandate, former Speaker of the House Paul Ryan observed on Tuesday.

“Even the Obama administration didn’t do that,” Ryan commented, during a discussion with Direct Supply Founder and CEO Bob Hillis at the National Investment Center for Seniors Housing & Care (NIC) conference in Chicago.

Ryan, a Republican, served as speaker from 2015 to 2019, which was a period that included the last two years that Obama was in the White House.

While workforce pressures are widespread across the U.S. economy, the nursing home and senior living sectors are facing a “very unique” staffing challenge, given the “demographic crunch” caused by the drastic increase in older people who need services versus the dwindling supply of available younger workers, he acknowledged.

Still, Ryan emphasized an optimistic message.

“The point I’m trying to say is, it’s a good news story; this is not an unsolvable problem, it is a solvable problem,” he said.


Mullaney, Tim. “Paul Ryan: Even Obama Did Not Pursue Staffing Mandate – but Nursing Home Workforce Crisis Can Be Solved.” Skilled Nursing News, 26 Oct. 2023,


Providers pledge ‘triumph’ over staffing rule as pressure grows in Washington

Leaders of the nation’s largest nursing home association said Monday that they would continue to fight against and eventually “triumph” over a proposed federal staffing mandate that would cost providers as much as $6.8 billion annually and require facilities to hire 100,000 new workers.

The proclamations at the American Health Care Association/National Center for Assisted Living’s Convention & Expo came as lawmakers in Washington delivered their own battle cry on the Centers for Medicare & Medicaid Services‘ proposed rule.

Nearly one-third of the Senate signed on to a letter Friday asking CMS to withdraw the mandatory staffing rule, saying this is the “worst possible time” for the mandate.


Towhey, Jessica R. “Providers Pledge ‘Triumph’ Over Staffing Rule as Pressure Grows in Washington.” McKnight’s Long-Term Care News, 1 Nov. 2023,

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