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On Wednesday, November 1, WHCA/WiCAL President & CEO Rick Abrams submitted a public comment to CMS on behalf of member providers and partners across the state.

Read the comment letter here.

From the letter:

The rule draft includes unworkable and unrealistic staffing standards that will only serve to create new occasions for Wisconsin’s nursing facilities to be penalized, taking resources away from providers and further limiting their ability to remain competitive for a limited health care workforce. The impact will be disastrous for residents and staff, as providers will be forced to rely even more on current staff to cover more shifts in order to meet a one-size-fits-all requirement, leading to stress, burnout, and higher turnover.

Based on Q1 2023 data compiled by accounting firm Clifton Larson Allen, only 15% of all Wisconsin nursing homes would meet the three primary criteria outlined in the draft rule of 2.45 Nurse Aide HPRD, .55 RN HPRD, and 24/7 RN coverage. In Wisconsin, we are also experiencing caregiver shortages, and the reality is that a rigid minimum staffing rule will not cause new nurse aides and nurses to materialize.

The letter emphasizes in general that CMS should heed providers’ concerns and reconsider the rule draft altogether. In the alternative, WHCA/WiCAL states that if CMS opts to move forward, to at least adopt these changes to the current rule:

1. The policy must be funded fully up-front by the federal government, with updates to keep pace with costs, so providers can be more competitive for a limited health care workforce.
2. The policy should not go into effect until the workforce is sufficient. At a minimum, “sufficient” means that our sector return to at least March 2020 employment levels. While we appreciate the current proposal’s grace period, the reliance on rural vs. urban settings for implementation is too rigid and should instead focus on workforce metrics.
3. The policy must be broadened beyond clinical staff to include other direct care staff, including first and foremost LPNs, but also physical, occupational, and speech therapists; social services; activities; dietary; and housekeeping.
4. CMS must rework the draft rule’s hardship waiver process so that it does not require a facility to be surveyed and cited for failure to comply prior to receiving a waiver. Providers who show a good-faith effort to comply but also provide documentation that their efforts have not produced sufficient staff to be in compliance should not be penalized for forces outside of their control.
5. CMS should phase the policy in and/or conduct a demonstration project prior to full implementation.
6. CMS must consider additional flexibilities to account for workforce realities, including allowing the 24/7 RN requirement to be met at least in part by an on-call nurse.

WHCA/WiCAL is proud of Wisconsin’s advocacy to CMS during the comment period, with Wisconsin generating more than 1,000 comments through AHCA/NCAL’s advocacy portal.

WHCA/WiCAL will also continue Congressional advocacy on the CMS proposal. WHCA/WiCAL has worked with members of both parties to share provider concerns about the draft, and plans additional outreach and meetings with targeted members of Congress.