Don’t be fooled by the public civility. The relationship between long-term care providers and regulators is, by nature, one of shared mistrust.
Providers tend to see regulators as meddlesome at best, business killers at worst. Conversely, regulators tend to see providers as insubordinate at best, people killers at worst. You might say there’s a certain level of built-in tension.
Reminds me a bit of two feuding relatives who must put on a show of unity at a family gathering. The façade can quickly crumble once the drinks start to flow. Well, consider the liquor cabinet officially unlocked.
And this time, it’s the Center for Medicare & Medicaid Services holding the keys.
After months of promising, federal regulators have released a proposal that requires skilled care operators to hire more workers. Specifically, facilities would need to ensure each resident receives a minimum of 0.55 hours of registered nurse care and 2.45 hours of nurse aide care each day.
However, the proposal does not include funds for the new mandate. Nor does it allow licensed practical nurses to be counted toward fulfilling the mandate. You can probably imagine how the industry has responded.
The American Health Care Association blasted the proposed mandate as being impossible to comply with (given existing labor challenges) and flat-out unaffordable.
Facilities would need to spend nearly $7 billion annually to comply, according to an AHCA-sponsored study by accounting and consulting firm CliftonLarsonAllen.
“What CLA’s analysis confirms is that this proposed rule is deeply flawed, and the Biden Administration has woefully underestimated the feasibility and cost of this unfunded mandate,” said AHCA President and CEO Mark Parkinson.
Already, industry players are leaning on Congress to oppose the mandate. A bill that would do just that has been introduced; others may soon follow.
It’s also entirely possible the sector may sue CMS over the requirement. It’s clear that both AHCA and LeadingAge are rallying the troops for battle.
Nor are regulators sitting quietly on the sidelines. As McKnight’s reported, Health and Human Services Secretary Xavier Becerra last week thanked union members for their role as staffing mandate catalysts — at a union event.
Make no mistake: What we are seeing here are opening rounds of a fight that could turn extremely nasty. It’s going to be fought in various settings, including the court of public opinion. Perhaps in actual courtrooms as well.
If you thought the relationship between these two parties was frosty before, just wait. It’s about to get a lot colder.
John O’Connor is editorial director for McKnight’s.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
