LeadingAge National Government Updates: November 6, 2024

On October 24, the American Hospital Association (AHA) and the Texas Hospital Association filed a friend-of-the-court brief in the U.S. District Court for the Northern District of Texas in support of our legal challenge to the CMS minimum staffing mandate for nursing homes. The brief explains that AHA’s member hospitals “have a strong interest in ensuring that the federal government does not adopt increasingly one-size-fits-all regulation of staffing in medical facilities …. [and] a specific interest in the question here, because imposing inflexible numerical thresholds on long-term-care facilities will lead to worse patient outcomes and less patient-care capacity across the entire healthcare system.”  
It argues that the mandate not only is incapable of mitigating the nursing shortage but also is counterproductive: “Nursing homes may be forced to reach compliance by increasing demands on their existing staff (fueling additional burnout), or hiring more staff from a limited labor pool (reducing the availability of qualified staff for all healthcare providers). Alternatively, many facilities will cut beds so that they can meet the prescribed ratios with existing staffing levels, leading both to less overall capacity and to more crowding in, and more staffing pressure on, other facilities” including hospitals. AHA’s statement and a link to the brief are available here. 

LeadingAge’s press statement on the rule can be found here. The fact sheet, which contains a link to the rule itself, on the final rule can be found here.  

• Home Health: In its CY2025 Home Health Prospective Payment System Final Rule, released November 1, CMS finalized a 0.5% aggregate increase ($85 million) for CY2025. It also finalized a -1.975% permanent prospective payment adjustment, which was half of the calculated amount of -3.95%. While a smaller cut is a slight improvement over the proposed, home health agencies have incurred 9% cuts to their base payments since 2023. Additionally, CMS has still not acted on the outstanding temporary adjustment currently calculated at $4.5 billion. CMS also finalized a new Condition of Participation that sets new requirements around posting patient acceptance to service requirements that LeadingAge opposed. 

• Nursing Homes: In this rule, CMS also finalized provisions for nursing homes regarding respiratory virus reporting through the National Healthcare Safety Network (NSHN) system. These requirements include making NHSN reporting of resident respiratory illness data a permanent Requirement of Participation and extending this requirement to include other respiratory viruses beyond COVID-19, such as flu and respiratory syncytial virus (RSV). LeadingAge notes, however, that reporting was significantly streamlined through these finalized provisions, including allowing requirements for healthcare personnel data reporting to expire in December 2024 as planned. The rule additionally finalized the ability for the Secretary to increase both the frequency of reporting and the required data elements during a future public health emergency without notice and comment rulemaking but did not finalize the proposal for these flexibilities to be applied in the event of a likely public health emergency. LeadingAge congratulates its members on their advocacy on these provisions and will be working with CMS to address the outstanding issue of duplicative reporting caused by reporting resident vaccination status through both NHSN and the Minimum Data Set (MDS). 

Register for November 7 NHSN Webinar: The National Healthcare Safety Network (NHSN) will host a webinar on November 7 to review updated reporting forms and how reporting included on these forms meets newly updated requirements for nursing homes to report respiratory illness data through NHSN. Register for this webinar here. 

The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control & Prevention (CDC) met at the end of October to vote on updates to COVID-19 vaccination recommendations. CDC now recommends a second dose of the 2024/2025 COVID vaccine for individuals over the age of 65 and individuals who are moderately or severely immunocompromised. This second dose is recommended six months after the first dose. Read more here. While the Centers for Medicare & Medicaid Services (CMS) no longer requires vaccination of healthcare personnel and does not require vaccination of residents, nursing homes are required to educate residents and staff on vaccination and to offer access to these vaccinations. Nursing homes must also continue to report vaccination rates of both residents and staff through the National Healthcare Safety Network (NHSN). 

In an August 27 letter, LeadingAge requested the Centers for Disease Control & Prevention (CDC) reconsider duration of isolation for nursing home residents following respiratory virus infection. LeadingAge asked the agency to review available evidence to determine the advisability of adjusting respiratory virus isolation duration to be consistent with public health guidelines for the general public, citing the negative impacts of social isolation on the cognitive, emotional, and physical functioning of older adults. The agency responded on October 22, acknowledging LeadingAge’s concerns.  

LeadingAge encourages members to advocate to CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) on these and other important issues facing nursing home providers and the residents they serve. 

On October 24, LeadingAge sent a coalition letter to Congress with 10 faith-based, mission-driven organizations who represent thousands of health and aging services providers, urging House Speaker Mike Johnson (R-LA) and Minority Leader Hakeem Jeffries (D-NY) to prioritize the Ensuring Seniors’ Access to Quality Care Act (H.R. 8244) for inclusion in a year-end legislative package.  

This bipartisan bill, introduced by Representatives Ron Estes (R-KS) and Gerry Connolly (D-VA), would address an outdated provision in federal law that is hindering nursing homes from training the Certified Nursing Assistants (CNAs) they desperately need. Specifically, it would allow nursing homes that have resolved their compliance issues to continue their CNA training programs as long as their penalties are not related to the quality of care provided to residents.  

H.R. 8244 was considered and passed by the House Ways and Means Committee on May 8, and an identical companion measure (H.R. 3227) was considered and passed by the House Energy and Commerce Committee on September 18. This coalition letter builds on that momentum with the goal of addressing the CNA lockout before Congress adjourns for the year.

LeadingAge has been working with the Centers for Medicare & Medicaid Services (CMS) regarding issues related to on-site verification visits. CMS released a memo on November 4 to provide clarification to nursing homes and other provider regarding these visits. Read more here. LeadingAge appreciates CMS’s response to our request to improve communication around these visits. 

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• Affordable Housing Weekly Recap. Here is your Affordable Housing Weekly Recap. 
• Home Health Weekly Recap. Here is your Home Health Weekly Recap. 
• Hospice Weekly Recap. Here is your Hospice Weekly Recap. 
• Life Plan Community Weekly Recap. Here is your LPC Weekly Recap. 
• Medicaid, HCBS, and PACE Weekly Recap. Here is your Medicaid, HCBS, and PACE Weekly Recap. 
• Nursing Home Weekly Recap. Here is your Nursing Home Weekly Recap. 
• Workforce Weekly Recap. Here is your Workforce Weekly Recap.