(Washington, DC) – The Centers for Medicare and Medicaid Services (CMS) yesterday released final rules that would impose new requirements on Medicaid Home and Community Based Services providers and establish federal staffing requirements on long-term care facilities. Maggie Elehwany, Argentum Senior Vice President of Public Affairs, issued the following statement:
Argentum is disappointed that CMS has chosen to move forward with sweeping new regulations that require that 80 percent of state payments for certain home and community-based services (HCBS) be allocated to compensation for direct care workers, and establish unprecedented federal minimum staffing ratios for nursing homes in the United States.
We are analyzing the final rules, and specifically, how the Medicaid rule impacts assisted living communities that provide HCBS services. However, as in the initial draft of the rule that was published last year, there remains a lack of clarity on how the final rule will apply to assisted living. As the implementation date has been pushed back from four years to six, Argentum will continue to analyze the language as well as reiterate to the Administration the harm that this rule could have on seniors in assisted living; namely, that it could force assisted living communities to either reduce HCBS services they are currently providing, or cease participation in the Medicaid program altogether, which ultimately would have a negative impact on direct care workforce participation and Medicaid beneficiary access to care.
While we support policies to increase the number of caregivers and to improve Medicaid reimbursement for HCBS providers, we are concerned that these mandates may not effectively achieve these goals and could potentially have unintended negative consequences for both seniors and caregivers.
Ensuring Access to Medicaid Services
In a comment letter to CMS, Argentum supported the stated goals of the proposed rule to improve access to care for Medicaid beneficiaries and to address shortages in the direct care workforce. These caregivers are central to the senior living workforce and are at the heart of many of the services our members provide.
However, we expressed concern that the proposal to require that 80% of state payment for certain Home and Community Based Services (HCBS) be allocated to compensation for direct care workers was not the right approach to address workforce shortages or to increase access to services for Medicaid beneficiaries.
We also indicated that the proposed rule was ambiguous, making it unclear whether, and to what extent, the policy would apply to assisted living or similar residential facilities that provide HCBS under state Medicaid programs. While Argentum appreciates that CMS incorporated some flexibilities in response to stakeholder feedback, we remain concerned that without also addressing inadequate reimbursement rates, the rule may make it difficult, if not impossible, for these communities to continue to serve vulnerable residents.
By some estimates, assisted living saves Medicaid upwards of $40 billion annually. This rule could lead to the unnecessary utilization of Medicaid skilled nursing care in more restrictive settings and at substantially higher cost, placing further financial pressure on federal and state Medicaid budgets.
Minimum Staffing Standards for Long-Term Care Facilities
While the proposed staffing rule would apply only to Medicare and Medicaid-certified skilled nursing facilities (SNFs), and not residential senior living communities, it would have a potentially devastating impact on the senior care sector more broadly. Many senior living communities continue to deal with labor shortages and have not returned to pre-pandemic workforce levels. The combined long-term care industry lost more than 400,000 jobs during the pandemic, and the assisted living industry alone lost roughly 110,000. As Senate Aging Committee Chair Robert Casey (D-PA) said in his opening remarks at a recent hearing on the long-term care workforce, “between 50 to over 90 percent of long-term care settings and providers report significant staffing shortages, affecting their ability to provide services, accept new clients, or even to remain open.”
Regardless of an assisted living community’s workforce situation, a federal minimum staffing mandate threatens to reduce the available pool of essential caregivers that assisted living and other senior living communities also depend on to serve more than 1.4 million residents each year. With more than 10,000 Americans turning 65 each day, the long-term care industry will need to attract more than 20 million workers by 2040. A federal minimum staffing standard will not create more caregivers; it will simply further exacerbate the current shortage.
Argentum encouraged CMS to reconsider implementing the rule and instead focus on efforts to strengthen the long-term care workforces through policies to assist in training, recruiting and retaining staff, including, but not limited to, addressing the nationwide nursing and caregiver shortages, as well as attracting both to the profession; investing in developing full-time, dedicated caregivers instead of costly agency or temporary staff that would be required to comply with a staffing mandate; and recruiting and retaining LTC and senior living professionals by offering loan forgiveness, tax credits, apprenticeship opportunities, immigration reform and other incentives.
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About Argentum
Argentum is the leading national association exclusively dedicated to supporting companies operating professionally managed, resident-centered senior living communities and the older adults and families they serve. Since 1990, Argentum has advocated for choice, independence, dignity, and quality of life for all older adults.
Argentum member companies operate senior living communities offering assisted living, independent living, continuing care, and memory care services. Along with its state partners, Argentum’s membership represents approximately 75 percent of the senior living industry—an industry with a national economic impact of nearly a quarter of a trillion dollars and responsible for providing over 1.6 million jobs. For more information, visit www.argentum.org.
Contact:
Michael Keegan Manager
Media and Public Affairs ARGENTUM
703-599-7412 | [email protected]
