Consumer groups urge CMS to enforce nurse aide training enforcement initiatives

For all its increased regulatory pressure on nursing homes in recent years, the Centers for Medicare & Medicaid Services hasn’t fully embraced the Biden administration’s full agenda for long-term care. Consumer advocates are now pushing the agency to tighten enforcement.

The Center for Medicare Advocacy shined a spotlight on a 2017 rule that makes it possible for some facilities to maintain nurse aide training and competency evaluation programs through waivers from CMS even after those NATCEPs would have been suspended due to regulatory penalties or extended surveys. 

The Trump-era rule gave CMS the discretion to use case-by-case judgment to allow facilities to maintain their training and evaluation programs — a power which has proved contentious. 

“[CMS] has largely ignored the directive to strengthen the enforcement of standards of care for nursing facilities,” wrote Toby Edelman, Senior Policy Attorney at CMA, in a Dec. 14 article for the organization. “Instead, it has allowed Trump administration policies which explicitly overturned Obama administration policies and otherwise reduced enforcement, to remain in place. The Center for Medicare Advocacy calls on CMS to strengthen enforcement and protect residents.”

But staffing shortages across the country have left many in the long-term care sector frustrated by regulations that suspend the programs working to bring more care staff into the workforce. 

“In the midst of a historic labor crisis, allowing facilities the ability to offer CNA training programs to train crucially needed caregivers is exactly the type of workforce solutions we need,” wrote the American American Health Care Association in a statement to McKnight’s Long-Term Care News. “Now is not the time to take away critically important workforce development resources and programs, such as in-house CNA training.”

Some policymakers sympathize with that sentiment. A bipartisan House bill currently in committee would remove NATCEP suspensions for facilities that didn’t endanger residents, and also offer facilities more and simpler ways to reinstate their programs after correcting deficiencies.

AHCA and LeadingAge have endorsed the bill as a way to improve workforce numbers and quality of care nationwide.

Some experts have gone so far as to suggest CMS should stop suspending NATCEPs entirely until the staffing crisis has been adequately addressed.

“NATCEP programs are sometimes a key lifeblood for facility operations, providing needed advertising of the profession to potential CNAs,” wrote attorney Neville Bilimoria in a blog post for McKnight’s Long-Term Care News. “Taking that crucial program away from nursing homes is especially onerous for facilities trying to improve their staffing numbers in the midst of the very real shortage of CNAs.”
Staffing shortages and proposed regulation are set to continue as vital issues for the skilled nursing sector next year. Whether CMS continues to offer some leniency on NATCEPs or follows advocates’ suggestions and takes a firmer hand could have consequences for already struggling facilities.