LeadingAge National Government News: January 22, 2025

On January 17, the U.S. Department of Justice, on behalf of HHS and CMS, filed the defendants’ Reply Memorandum in Support of Their Cross-Motion for Summary Judgment. This completes a four-step briefing schedule that began in October when LeadingAge, AHCA, and fellow plaintiffs filed their Motion for Summary Judgment. Six substantive legal memos, three by the plaintiffs and three by the defendants, have been filed in all. This Bulletin provides additional information and a link to the government’s January 17 filing. 

On January 16, the Centers for Medicare & Medicaid Services (CMS) released new updates to Appendix PP of the State Operations Manual. Appendix PP, which contains the Long-Term Care Surveyor Guidance, was most recently updated in November 2024. At that time, the effective date of the sub-regulatory guidance was February 24, 2025; however, with these latest updates, which include updates related to nurse staffing and payroll-based journal, the effective date has been extended to March 24, 2025. Read more here. 

On January 14, the White House Office of Management and Budget completed its review of an Occupational Safety and Health Administration (OSHA) proposed rule that would update the agency’s current infectious diseases standards. The content of the proposal is unknown, but OSHA has previously described its intent as follows:  

“Health care workers and workers in related occupations, or who are exposed in other high-risk environments, are at increased risk of contracting TB, SARS, Methicillin-Resistant Staphylococcus Aureus, COVID-19, and other infectious diseases that can be transmitted through a variety of exposure routes. OSHA is examining regulatory alternatives for control measures to protect employees from infectious disease exposures to pathogens that can cause significant disease.”  

LeadingAge will watch for the release of the proposed rule and will provide analysis for members when it emerges. On a related note, and as expected, OSHA has withdrawn a rule that would have made permanent certain regulatory requirements concerning exposure to COVID-19 in the workplace, which the agency first established in June 2021 as a six-month emergency temporary standard. A final COVID-specific rule has been pending at OMB since December 2022, and OSHA formally withdrew the rule concurrently with the advancement of the broader infectious diseases proposal. 

At its January meeting, the Medicare Payment Advisory Commission (MedPAC) met to vote on recommendations for how Medicare payments should be adjusted for 2026. This action is then included in MedPAC’s March 2025 Report to Congress on payment adequacy.  The commission voted and approved a recommendation that Congress reduce Medicare base rates of 3 percent for skilled nursing facilities (SNFs) by 7 percent for home health agencies, and 2.9 percent for hospice.  Members should keep in mind that MedPAC is charged with making annual recommendations to Congress on Medicare payments to providers, but this does not mean that their recommendations become law. Congress must take action to affect these recommendations, which rarely happens.  To read the full article on the meeting discussion and recommendation, click here. 

The National Healthcare Safety Network sent a blast email to users on January 17 with a reminder that the “up to date” definition for reporting COVID-19 vaccination status changed for 2025 Quarter 1 reporting (week beginning December 30, 2024 – March 30, 2025). To be up to date with COVID-19 vaccination, individuals aged 65 years and older need two doses of the 2024-2025 COVID-19 vaccine or one dose in the past six months. Recalling that the 2024-2025 vaccine was only available in September and the CDC recommends that doses are spaced six months apart, most nursing home residents who have received one dose of the 2024-2025 vaccine will remain “up to date” until March. More information on the definition of up to date can be found here. 

The Centers for Medicare & Medicaid Services (CMS) circulated an article on January 17 outlining details of the RN incentive program in the Nursing Home Staffing Campaign. Read the article here. This article will be available on the LeadingAge website in the coming days. 

On January 17, a 50-page menu of options to either reduce or increase federal spending via the budget reconciliation process, reportedly compiled by the House Committee on the Budget, was shared by numerous media outlets. Among the options briefly summarized in the document are several of critical importance to the aging services community. The menu includes repeal of CMS’s nursing home minimum staffing final rule for a savings of up to $22 billion over 10 years (the typical span of time over which federal budget practitioners assess programs’ costs or savings).  

“This option would repeal the final rule, ‘Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting.’ The rule was finalized in May 2024 and would impose minimum staffing standards on long-term care facilities, creating an unfunded mandate on critical health care facilities across the country, threatening provider facility closures and patient access to care,” the menu says.  

LeadingAge has vigorously advocated for the repeal of this infeasible regulation. Other options on the menu do not have LeadingAge’s support as they would undermine the ability of providers to serve older adults. These menu options include lowering the Medicaid matching rate floor (for up to $387 billion in 10-year savings), establishing Medicaid work requirements (for up to $100 billion in 10-year savings), limiting Medicaid provider taxes by lowering the Medicaid provider tax safe harbor from 6% under current law to 4% from 2026 to 2027 and 3% in 2028 and after (for up to $175 billion in 10-year savings), establishing Medicaid per capita caps (for up to $900 billion in 10-year savings), ending the Employee Retention Tax Credit for claims submitted after January 31, 2024 (for up to $70-75 billion in 10-year savings), and eliminating tax exempt bonds and end tax preferences for other bonds (for up to $364 billion in 10-year savings).  

Undefined options on the menu pique LeadingAge’s interest, including an offering of “Unspecified Proposals to Post-Acute Care,” described as a policy that would “facilitate better discharges to post-acute care for patients” that would also cost money. Another undefined policy relates to “Unspecified Proposals to Change FMAPs.” The menu notes this policy would “rebalance Federal Matching Rates to be more fair to states with more people with lower incomes.” Another menu option proposes to eliminate nonprofit status for hospitals for up to $260 billion in 10-year savings as hospitals would be taxed as ordinary for-profit businesses.  

LeadingAge is analyzing the full list of more than 200 options and will be working with House and Senate staff to communicate our goals to protect and strengthen the ability of aging services provider to meet the needs of older adults. Read the menu here. Access LeadingAge’s action alert to protect Medicaid funding and access here.  

Affordable Housing Weekly Recap. Here is your weekly Affordable Housing Weekly Recap. 

• Home Health Weekly Recap. Here is your weekly Home Health Weekly Recap. 

• Hospice Weekly Recap. Here is your weekly Hospice Weekly Recap. 

• Life Plan Community Weekly Recap. Here is your weekly LPC Weekly Recap. 

• Medicaid, HCBS, and PACE Weekly Recap. Here is your weekly Medicaid, HCBS, and PACE Weekly Recap. 

• Nursing Home Weekly Recap. Here is your weekly Nursing Home Weekly Recap. 

Workforce Weekly Recap. Here is your weekly Workforce Weekly Recap.