A lawsuit has been filed in Texas against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), alleging that they exceeded their legal authority and arbitrarily and capriciously issued the Minimum Staffing Standards for long-term workers. Final rule on term care facilities.
The lawsuit, filed by the American Health Care Association (AHCA), joined by the Texas Health Care Association (THCA) and several Texas long-term care facilities in the Northern District of Texas, asks the court to issue an order and ruling vacating the new staffing requirements that were finalized by CMS on May 10.
The new total nursing staffing standard is 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of registered nurse (RN) direct care and 2.45 HPRD of assistant direct care of nursing. Facilities may use any combination of nursing staff (RN, licensed practical nurse) [LPN] and licensed vocational nurse [LVN]or nursing assistant) to represent the additional 0.48 HPRD needed to meet the full nursing staffing standard.
This means that a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nursing assistants, as well as two additional nurses (who could be registered nurses, licensed professional nurses, or nursing assistants) per shift to meet the requirements. minimum staffing standards.
CMS is also finalizing enhanced facility screening requirements and the requirement to have a registered nurse on site 24 hours a day, seven days a week to provide skilled nursing care.
CMS had said the standards take into consideration local realities in rural and underserved communities through tiered implementation processes and waivers. But nursing home operators and associations consider the new rule to be unworkable.
The American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 proprietary, nonprofit skilled nursing facilities, assisted living communities, subacute facilities, and homes for people with intellectual and cognitive disabilities. development.
“We hoped it wouldn’t come to this; We have repeatedly sought to work with the Administration on more productive ways to boost the nursing home workforce. “Unfortunately, federal officials rushed to approve this flawed policy, ignoring credible stakeholder concerns and showing little regard for the negative impact it will have on our nursing home residents, staff, and health care system,” said Mark Parkinson, president and CEO. of AHCA, in a statement. “We cannot stand by when access to care is at stake and federal regulators are overstepping their authority. Hundreds of thousands of older people could be displaced from their nursing homes; “Someone has to defend them and that is why we are here.”
“Hundreds, if not thousands, of nursing homes are at risk of closing due to this federal staffing mandate, and nowhere is this more true than in Texas,” said Derek Prince, president of the THCA board of directors. and CEO of HMG Healthcare, in a statement. “Our state’s nursing homes are notoriously underfunded by Medicaid, a key factor in determining whether a nursing home can meet this mandate. More than two-thirds of Texas facilities cannot meet any of the new requirements and the state anticipates a growing nursing shortage. “We must protect access to care for older Texans and seniors across the country.”
The lawsuit alleges that the new rule exceeds CMS’s legal authority. Congress has already prescribed specific staffing requirements for nursing homes participating in Medicare and/or Medicaid:
• A nursing home “must provide 24-hour licensed nursing service sufficient to meet the nursing needs of its residents.”
• A nursing home “must utilize the services of a registered professional nurse at least 8 consecutive hours per day, 7 days per week.”
The plaintiffs argue that the Final Rule departs significantly from legal standards, requiring unattainable requirements and imposing a one-size-fits-all quantitative standard rather than the qualitative, context-sensitive standard that Congress adopted.
The complaint further alleges that the agencies’ decision to adopt the new minimum staffing standards was arbitrary and capricious, in violation of the Administrative Procedure Act.
CMS executives respond that the initiative focuses on improving the lives of more than 1.2 million residents living in Medicare- and Medicaid-certified long-term care facilities. “Today, we took an important first step to propose new staffing requirements that will hold nursing homes accountable and ensure residents receive the safe, high-quality care they deserve,” CMS Administrator Chiquita Brooks-LaSure said in a statement when the rule was proposed.
