Sen. Bob Casey (D-PA), chairman of the Senate Special Committee on Aging, noted that nearly 4 million older adults reported having a substance use disorder in 2022, with 1.8 million of those involving drug use. Mortality from drug overdoses among seniors also more than tripled between 2000 and 2022, he added, citing federal data. 

“Older adults are not immune to these issues, and this a growing and evolving crisis in America,” Casey said in opening the hearing, which focused both on access to opioids and gaps in care. 

“Older adults tend to be overlooked for substance use disorders in typical screenings and prevention efforts, even though they are more susceptible to developing substance use disorders than other age groups and at higher risk of undiagnosed and untreated substance use disorders,” he added. “The people, the problems and the solutions remain largely invisible to our society.”

Nursing homes are increasingly being called on to treat patients with substance use disorders, with both federal regulators and state law enforcement officials reminding facilities that they cannot turn away such patients when they are also in need of skilled care.

Some nursing homes have begun to specialize in providing such care, particularly for opioid-addicted patients requiring administration of suboxone treatments.

OIG keeps focus on needs, treatment access

Thursday’s hearing coincided with the publication of an annual brief from the Health and Human Services Office of Inspector General that examines access to treatment for opioid use disorder and the opioid overdose-reversal drug naloxone.

It found that about 52,000 Medicare enrollees experienced an opioid overdose in 2022. Of the 1.1 million enrollees who have opioid use disorder, just 18% received medication to treat that disorder. In some states, the OIG found far lower access, with Florida the worst with just 6% receiving treatment medication.

While naloxone has been an important tool in addressing the nation’s opioid crisis — one Senate witness credited with “saving countless Americans from death” — it last year became an over-the-counter medication. That could mean less affordable access for some Medicare patients, and the OIG warned CMS to make sure providers know how to educate patients and prepare for additional need.

The OIG report recognized that CMS and the department “had taken a number of actions” to increase access to suboxone and other opioid use disorder treatments. 

“However, the low percentage of enrollees receiving medication to treat their opioid use disorder calls for additional action,” the report said.

David Skoczulek, vice president of business development and communications at Connecticut-based iCare Health Network, said providing access to “patient-centered, specialized substance use treatment and care in the skilled nursing setting is critical.”

“Substance use disorder crosses all social and demographic lines,” he added. “The need for these services is not going away and it’s not even appearing to ebb over time. We will be living with the impacts of the opioid epidemic for a very long time in all aspects of healthcare, and skilled nursing care is not an exception. It’s highly prevalent and we will need increasing supports, access and coverage to provide quality care to these individuals.”

Medicare coverage gaps remain 

Much of the conversation Thursday revolved around the inability of Medicare-covered seniors to access residential treatment and other services under either traditional or managed care plans.

While commercial insurance providers in the US must provide parity in the way they cover physical health needs and behavioral health needs, the Medicare system has not been changed to reflect that standard.

“Older adults and people with disabilities deserve non-discriminatory coverage of substance use disorder and mental health treatment,” said Deborah Steinberg, senior health policy attorney at the Legal Action Center. “We urge you to ensure that Medicare beneficiaries do not continue to be left behind.”

She pointed to the 2018 SUPPORT Act, which first added coverage of opioid use treatment to Medicare, as the start of improved treatment for opioid use disorder. This year, Congress included coverage of addiction counselors (under the umbrella of mental health counselors) and intensive outpatient treatment in its consolidated appropriations bill.

And CMS has also issued regulatory guidance and coding to make sure beneficiaries have more access to peer support specialists and community health workers, Steinberg noted. The agency also increased Medicare reimbursement for psychotherapy and office-based substance use treatment to “address barriers to provider participation,” Steinberg said.

Nursing homes, however, aren’t paid extra by the federal government for substance use disorder care provided to their residents, despite its additional staffing and safety demands and costly counseling services. State Medicaid plans, however, do in some cases help offset the cost of bringing in behavioral health professionals.

Also Thursday, Sen. Mike Braun (R-IN), the committee’s ranking member, issued a new report emphasizing concerns about the illicit opioid trade and the increasing ways seniors may interact with fentanyl-laced drugs.

“Despite [a] dramatic increase in overdoses due to synthetics, prevention messaging for older adults still reflects traditional concerns about prescription opioid misuse but does not focus on synthetics like fentanyl increasingly infecting drugs taken by older Americans,” the report stated.

But whether it will stop the rule dictating registered nurse and certified nurse aide coverage “dead in its tracks,” as one co-sponsor boasted, is far from a foregone conclusion.

The widely anticipated Protecting Rural Seniors Access to Care Act, S. 3410, had been held up for weeks as Sen. Deb Fischer (R-NE) sought bipartisan co-sponsors. By Tuesday night’s  introduction, Sens. Roger Marshall (R-KS.), James Lankford (R-OK), Jon Tester (D-MT), Kyrsten Sinema (I-AZ), Joe Manchin (D-WV), Roger Wicker (R-MS), Susan Collins (R-ME) and Angus King (I-ME) had signed on.

“Nursing homes across the country face historic staffing shortages, and nowhere are those challenges more real than in rural states like Nebraska,” Fischer said in a press release issued Wednesday. “This mandate from the Centers for Medicare and Medicaid Services would force many facilities to reduce their number of patients or even close their doors for good.”

She said a legislative blockade of the staffing mandate would allow lawmakers and regulators time to find “a fairer solution that protects rural facilities.” 

The American Health Care Association, not surprisingly, endorsed the legislation Wednesday.

“This unfunded mandate threatens access to long-term care for seniors everywhere, but especially our nation’s rural and underserved communities,” the organization said in a statement. “It requires substantial resources that nursing homes simply don’t have to hire more than 100,000 additional caregivers that simply don’t exist, ultimately threatening to close nursing homes across the country. … We fully support this bill and look forward to working with Congress on more productive solutions.”

There is a possible path forward for the bill, given some Democratic support, particularly from lawmakers in largely rural states. And it aligns with a companion House bill filed in late September by Rep. Michelle Fischbach (R-MN). H.R. 5796 would prohibit federal officials from finalizing the CMS draft rule and convene a nursing home workforce advisory panel instead. 

The House bill had 17 co-sponsors, all Republicans, as of Nov. 28 and has been referred to the Committee on Energy and Commerce, and the Committee on Ways and Means.

In addition, nearly 100 national and state advocacy groups and healthcare provider organizations have signed on in support of the bills, Fischer’s office said. The questions now are whether the bills will resonate with enough lawmakers from non-rural states to advance through their respective legislative bodies — and how the White House might respond.

“I personally doubt that the administration will go to great lengths to rally around this effort because Democrats also seem divided on it,” said R. Tamara Konetzka, Louis Block Professor in the Department of Public Health Sciences and the Department of MedicineThe University of Chicago. “If there is bipartisan opposition, it may not be the battle to pick.”

But Steve Laforte, chief legal officer and executve vice president of corporate affairs for Idaho-based Cascadia Healthcare, said Democrats could instead “go on a hard offensive charge.”

“They have staked a fair amount of political capital on the issue, at a time, post-COVID, where the industry’s profile was already in the public eye,” he told McKnight’s Long-Term Care News in an email. “As we move along the demographic curve, the importance of the care increases, so that’s likely another reason to maintain a push. That concern noted, I do think the bill evidences a bipartisan response. … In a very practical way, that heartens me to the unlikeliness of the implementation of the rule without a great deal of further inquiry/study and/or dilution as to the negative impacts on the industry.”

Provider approved

Earlier Wednesday, Katie Smith Sloan, president and CEO of LeadingAge, applauded the Senate bill’s introduction and said it could help providers and states meet a shared goal of ensuring “access to quality care in nursing homes.”

“The CMS proposed nursing home staffing requirement is the wrong approach,” Sloan said. “By prohibiting this unrealistic and unfunded mandate, the Protecting Rural Seniors’ Access to Care Act will help to ensure older adults can get the care and services they need and also fend off more nursing home closures. It further offers a path to much-needed solutions by establishing a panel to address workforce shortages that are chronic throughout the sector.”

Nate Schema, president and CEO of the Good Samaritan Society, the  nation’s largest nonprofit provider of skilled nursing care, has more than 1,500 job openings across its mostly rural facilities. That’s about 20% of the providers’ workforce across 139 nursing homes.

Schema has met with several lawmakers in recent weeks to express his organization’s concerns with the rule, chief among them that less than 4% of locations could meet a condition of the rule calling for 24/7 registered nurse coverage.

“The bipartisan support for this bill reinforces that the proposed minimum staffing rule is out of touch with reality,” he said in a statement Wednesday. “It signals a broad recognition among lawmakers that the focus needs to turn to more meaningful solutions — like creating a path for virtual RN coverage in rural nursing homes and bolstering the nursing workforce pipeline.”

Konetzka, however, noted that the need to improve nursing home staffing is something “everyone agrees on.” The contentious issue continues to be the approach to making meaningful change.

“Although the research on the staffing-outcomes relationship is not perfect, there aren’t good substitutes to having enough staff. If we care about nursing home quality, we have to want higher staffing in most facilities. And if not now, then when?” Konetzka asked in an email. 

A member of the Medicare Payment Advisory Commission, Konetzka also wanted that providers’ concerns about their ability to meet the mandate “are legitimate.”

“In my opinion, the solution isn’t to throw out the proposed regulation but rather to fund it,” she said. “We have underfunded long-term care for a long time, and it’s unrealistic to expect substantially higher quality under those circumstances.”

Mandate ‘dead’?

In his press release, co-sponsor and frequent mandate critic Tester said the rule could result in “mass facility closures across Montana.”

“I’ve told the Biden Administration from the jump that imposing a burdensome one-size-fits-all staffing mandate simply won’t work for Montana’s rural nursing homes,” he said. “Our long-term care facilities are already facing severe workforce shortage issues, and this federal staffing mandate could force facilities to shut their doors. My bipartisan bill will stop this rule dead in its tracks, and I’m committed to working with my colleagues to address the nursing home workforce so we don’t leave rural seniors in the lurch.”

In September, Tester led a letter signed by 28 senators demanding the Biden Administration and CMS abandon a rule they had proposed just weeks before. It was part of a volley of intense lobbying of CMS from federal and state elected officials that followed the rule’s official publication on Sept. 6.

Some Democrats have lined up behind the mandate, but others have broken ranks on the presidential priority. Many of the loudest objections have come from providers in rural communities and their representatives.

But hiring has also been remarkably challenging in many more urban settings where direct care staff have more employment options. CMS itself has acknowledged those challenges, admitting that more than 75% of nursing homes could not currently meet the proposed requirements, regardless of location.  

“Urban nursing homes are also concerned about the labor market and ability to meet the mandate, so blocking the mandate might be popular among lawmakers from urban areas as well,” Konetzka said. “Or at least they might not be opposed, or willing to fight for the mandate.”

The Senate bill aims to bring voices from both rural and urban communities together to look for workforce solutions. An advisory panel including such stakeholders would submit a report to Congress that analyzes shortages and make practical recommendations to strengthen the workforce.

Coming after more than a year’s wait, the proposed rule would require nursing homes to provide 0.55 hours of direct RN care per patient day and 2.45 hours of nurse aid care. While the rule would go into effect in three years after being finalized, it gives an extra two years for rural facilities to get up to speed on the overall hourly rate. Rural facilities would have an extra year to meet the proposal for 24/7 RN coverage while all other nursing homes would have just two years after the rule is finalized to meet this requirement. 

The proposal drew nearly 47,000 formal comments, each of which requires analysis by CMS. Observers have said that will slow any final proposal from being issued, with some predicting any implementation is at least a year away.

In the meantime, LaForte thinks the advisory body called for in the Congressional legislation could unearth more workable solutions.

“I think we have gotten on legislators’ radar screens in a meaningful way to our benefit and applaud the bill as being very realistic,” he said.

Sen. John Tester (D-MT) led 28 senators in sending a letter to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure, calling for the mandate’s withdrawal because it came at the “worst possible time.”

“A one-size-fits all staffing mandate significantly undermines access to care for patients, particularly in rural communities,” they wrote Sept. 29, the same day a House bill to stop the mandate was introduced.

Nursing home advocates continue to press owners and operators to share their concerns about implementing the rule with CMS. The American Health Care Association was aiming for 10,000 comments by Nov. 6. Officials must review and address each as part of the rule-making process. n

While testimony did not specifically focus on nursing homes, several senators and witnesses raised labor solutions providers have said will be key to recovery in long-term care — among them immigration reform, nurse training and targeted attention for the direct care workforce.

“Our country is perilously short of nurses and those we do have are often not working in the settings that could provide the most value,” testified Sarah Szanton PhD, RN, dean of the Johns Hopkins University School of Nursing. “The average age of nurses today is 54 years old, and 19% of them are 65 or older, so you can imagine we’re worried about the future as well, coupled with an aging population that has more and more chronic conditions.”

Szanton and others noted that, despite rebounding interest in nursing education, access to training and testing programs has been limited by a lack of nursing faculty, clinical preceptors and proctors. COVID-related educational delays among recent graduates also have left some candidates for nursing positions less ready for the job, noted a health economics expert who cited declining pass rates.

Staff shortages have hit nursing homes particularly hard. Nursing facilities have lost more than 200,000 nurses and aides since the start of the pandemic, according to federal labor statistics. While other sectors have essentially returned to pre-pandemic staffing levels, nursing homes have fallen far short.

Increasing access and affordability to nurse training programs was a major theme of Thursday’s more-than two-hour hearing. Sen. Tim Kaine (D-VA) also raised specific concerns about bolstering the direct care workforce, which he said was often left out of conversations about broader healthcare shortages.

“Direct care professionals make an average of $11.75 an hour. They’re some of the lowest paid workers in the economy, but they provide difficult, hands-on care to seniors and people with disabilities,” Kaine said. “And this workforce shortage kind of compounds other workforce shortages. I go to hospitals and they say, ‘We have to keep people longer because the direct care workforce shortage means there’s no placements where we can discharge someone from a hospital to a long-term care setting or to appropriate home healthcare.’”

Immigration gets fresh attention

While several senators used the hearing to pitch training and education bills they planned to introduce this session, Sen. Bill Cassidy, MD, (R-LA), the ranking committee member, said he wanted to see something that would pay off “relatively quickly.”

Immigration “would be huge,” said Cassidy, who also spoke about improving medication-assisted therapy options to relieve pressure on hospitals.

“Frankly, we need to encourage immigration,” agreed James Herbert, PhD, president of the University of New England. “In a state like Maine, where we are losing native population, the only way our population is staying stable and even growing is through immigration.”

Maine has seen several nursing homes close since 2021, with some providers blaming lack of affordable housing in rural and touristy areas.

Sen. Mitt Romney (R-UT) noted that, typically, nearly 20% of nurses and medical professionals in this country are foreign-born. But those trying to get here since the pandemic started have largely been blocked from helping the US address “desperate” healthcare needs.

“The backlog of medical professionals that want to come into this country has become enormous. We require them to be interviewed … but apparently the state department is still so concerned about COVID that they’re not interviewing people,” Romney said. So in places like the Philippines, where there are some 30,000 people who want to come here and serve as nurses, we can’t get those nurses in.”

He added: “If we have a nursing shortage and a doctor shortage, let’s let those who are in line, that are qualified, come here.”

Congress last year let die several immigration bills that had been backed by long-term care advocates.

In a statement submitted to the Senate committee ahead of Thursday’s hearing, LeadingAge called on members to support workforce policies that would “establish and retain a pipeline of foreign aging services workers, and support the enactment of a temporary guest worker program for aging services providers, and improve the process for allowing registered nurses to permanently enter the US.”

The organization also recounted the efforts of Sanford Heath and the Evangelical Lutheran Good Samaritan Society to hire 500 international nurses, as their hospitals also battled this healthcare staffing crisis. Good Sam leaders have told McKnight’s that, although hundreds have committed to working for the system since 2021, only a few have trickled in.

Exhausted but looking ahead

In a statement issued before the hearing, the American Health Care Association / National Center for Assisted Living cautioned against trying to fill positions through increased regulation.

“The pandemic has taken a physical and emotional toll on our healthcare workers, especially our nation’s long-term caregivers,” Mark Parkinson, president and CEO of AHCA/NCAL, said. “Even after taking unprecedented steps to support our workforce, nursing homes have experienced the worst job loss of any healthcare sector.”

A recent AHCA survey found that 84% of providers are still facing moderate or high levels of staffing shortages. At that pace, AHCA predicts nursing homes won’t see a return to pre-pandemic workforce levels until 2027. 

 “An unfunded federal staffing mandate, as has been proposed, will only make the situation worse. What is needed instead are meaningful investments and programs that will help nursing homes compete for caregivers, address nationwide nursing shortages, and ensure we have a strong workforce for a growing elderly population. We stand ready to work with Members of Congress on comprehensive solutions that will better support and strengthen the long term care workforce.”

LeadingAge also asked the committee to implement what it calls “common sense proposals” before the Center for Medicare & Medicaid Services enacts its mandate. The organization laid those out in a letter to Congressional leaders earlier this month.

In addition to its staffing mandate and immigration asks, the association for nonprofit aging services providers also encouraged the committee Thursday to consider policies that would:

1. Bolster wages for aging services professionals

2. Offer incentives and federal grants to expand training and advancement opportunities, specifically those that hold promise for aging services professionals

3. Mitigate temporary nurse staffing agencies price gouging

4. Enact meaningful, equitable long-term care financing

Named the Improving Care and Access to Nurses (ICAN) Act, the measure was introduced last week and proposes to allow NPs to order and supervise cardiac and pulmonary rehabilitation; certify when patients with diabetes need therapeutic shoes; have their patients fully included in the beneficiary attribution process for the Medicare Shared Savings Program; refer patients for medical nutrition therapy; and certify and recertify a patient’s terminal illness for hospice eligibility.

Rep. Lucille Roybal-Allard (D-CA) and Rep. Dave Joyce (R-OH) introduced the US House companion bill Sept. 13. The proposals seek to improve healthcare access for Medicare and Medicaid beneficiaries by increasing what NPs and advanced practice registered nurses are authorized to do.

More than 160 national, state and local organizations support the legislation.

“Today, millions of Medicare and Medicaid patients choose NPs as their health care providers, and it is critical these patients receive timely, high-quality health care from their providers of choice,” said American Association of Nurse Practitioners President April Kapu. “AANP is thrilled that Sen. Merkley has introduced the ICAN Act in the U.S. Senate and has taken another step forward to improve health care delivery for Medicare and Medicaid patients.”

Approximately 40% of Medicare beneficiaries receive care from NPs, who represent the fastest growing Medicare provider group, according to AANP.

Sen. Jeff Merkley (D-OR) introduced the Improving Care and Access to Nurses (ICAN) Act on Thursday. It follows a House companion bill introduced in September. The legislation would remove Medicare and Medicaid laws and regulations that the legislators said prevent APRNs from practicing “the full scope of their education and clinical training.”

“Outdated” barriers to care

The legislation would eliminate outdated federal barriers to care, reported the American Association of Nurse Practitioners, which supports the bill. Specifically, it would authorize nurse practitioners to perform tasks such as providing all mandatory examinations in skilled nursing facilities, and ordering and supervising cardiac and pulmonary rehabilitation, for example.

It also would authorize APRNs to certify when patients with diabetes need therapeutic shoes, have their patients fully included in the beneficiary attribution process for the Medicare Shared Savings Program and recertify a patient’s terminal illness for hospice eligibility, among other things.

The American Nurses Association applauded the Senate support for the Act. 

“The ICAN Act is a significant bill that will eliminate many of the burdensome laws and regulations that have prevented patients from getting access to the kind of timely, evidenced-based care that APRNs are clinically trained and qualified to provide,” said ANA President Ernest J. Grant, PhD, RN, FAAN, in a Thursday statement.

Pandemic-era flexibilities

The idea is to allow APRNs to practice “at the top of their license,” with flexibilities similar to what they were allowed at the height of the pandemic, Grant said. He called the ICAN Act “an overdue starting point to remove outmoded barriers to practice, and hopefully end tiresome debates over hierarchies by placing the needs of patients first.”

More flexibility will improve patient outcomes and lower costs, and ensure that rural and underserved communities have access to healthcare, he added.

Physicians groups are less keen on the legislation, with many groups protesting the original House bill. Their argument is that it will result in removing physician involvement in patient care, McKnight’s Business Daily has reported.

Less oversight

APRNs have master or doctoral level education and provide primary, acute, chronic and specialty care. More than 200,000 advanced practice clinical nurses are treating Medicare patients, and approximately 40% of Medicare beneficiaries are receiving care from these professionals. 

The National Academy of Sciences (NAS) has advocated for removing practice barriers across all levels of nursing to expand patient access to care. According to the authors of a 2021 NAS report, “nurses at all levels and in all settings have the education, skills, experience and training to fill this critical care gap and address health disparities, if they are given the autonomy and institutional support to do so.”

The authors envisioned a scope of practice that would allow APRNs to prescribe medication, diagnose patients and provide treatment independent of a physician. They called for pandemic-era changes to scope of practice to become permanent in 2022.

In nursing homes, as part of the emergency blanket waivers passed during the pandemic, physicians were temporarily allowed to delegate some responsibilities to nurse practitioners and clinical nurse specialists, within the strictures of state laws. They were also given the flexibility to delegate their required in-person patient visits to the nurses. These flexibilities were later rescinded.

Related articles:

Physician groups ‘concerned’ about bill to expand nonphysicians’ scope of practice in SNFs

CMS: End to pandemic waivers helps nursing homes ‘redirect efforts’ to meet residents’ needs

Full-time nurse program cuts ED visits, saves $31 million for MO nursing homes

One speaker, Sen. Richard Burr, (R-NC) of the Committee on Health, Education, Labor and Pensions, asked officials what they would do to restore confidence with the American people and show that there is a strategy for testing, treatments, and for fixing their communication problems.

He and other senators noted delays in promised testing supplies, conflicting mask and booster messaging and uncertainty about whether testing was needed after isolation and quarantine, among many other issues. The Centers for Disease Control and Prevention has been the focus of many of these complaints.

Officials pushed back. The acting head of the Food and Drug Administration agreed that her agency had experienced challenges during the pandemic but that the focus should be on handling surging omicron variant cases, according to a report by Reuters.

“I think it’s hard to process what’s actually happening right now, which is most people are going to get COVID,” Janet Woodcock told the Senate committee, according to the news outlet. “And what we need to do is make sure the hospitals can still function, transportation, other essential services are not disrupted while this happens. I think after that will be a good time to reassess how we’re approaching this pandemic.”

Public guidance not intended for nursing homes

The bipartisan grilling comes after the Centers for Medicare & Medicaid Services and the CDC reached out last week to nursing home stakeholders in an attempt to clear up the most recent questions about visitation, boosters and new recommendations for shortened isolation and quarantine times.  

Regarding isolation and quarantine, speakers on the call acknowledged potential misunderstandings about the difference between guidance for the general public and for healthcare workers, and how the entirely separate recommendations for each group might affect facility residents and visitors. The CDC’s Karen Jacobs-Slifka, M.D., referred nursing home decision-makers to guidance released on Dec. 23 on the CDC’s website that addresses work restriction for healthcare personnel with SARS-CoV-2 infection or with exposures to infection.

“I want to make it really clear that that guidance for the general public is not intended for the nursing home population, it is not intended for nursing home residents, nor is it intended for individuals working in nursing homes,” she said at the time. 

And regarding visitors, she said: “We do not want individuals who are visiting nursing homes to apply this guidance and then go see a family member who might be vulnerable.”

Senators have agreed to vote on the proposal this week before adjourning Friday for a two-week recess, according to a report in Modern Healthcare. The moratorium on the 2% sequestration of Medicare payments, which was put in place and extended during earlier COVID-19 relief packages, is set to expire Thursday, March 31.

Any Senate action would come on the heels of House lawmakers last week voting to delay the 2% across-the-board cut to Medicare through Dec. 31. The House measure also addressed the anti-deficit provision known as PAYGO, or “pay as you go,” which was triggered by the passage of the $1.9 trillion American Rescue Plan. PAYGO requires Congress to offset deficit spending with automatic across-the-board cuts to the federal budget. The House exempted that funding cut. 

If the Senate does not pass similar legislation creating an exemption, the law would require an additional 4% reduction to Medicare reimbursements that would take effect in the fiscal year starting Oct. 1. 

The bill expected to be voted on by Senators this week would only delay sequestration and doesn’t address the PAYGO issue, according to the Modern Healthcare report. The House is also expected to approve the Senate’s version easily. 

Long-term care and other healthcare advocates have argued that American’s healthcare safety net could be at risk of collapse without ongoing sequestration relief because providers will continue to see higher overhead costs and lost revenue through 2021.

“Many care providers are still struggling to catch up from the crippling cost of COVID,” LeadingAge President and CEO Katie Smith Sloan said in a statement Wednesday. “Cutting support for older Americans in the middle of a pandemic makes no sense. The Senate needs to head off these billions of dollars in Medicare sequestration cuts by April 1.”

The 2% sequestration reduction to Medicare payments has been in place since 2013. A 2013 analysis found that it would reduce payments to skilled nursing facilities by $9 billion over 10 years.