Biden Administration Proposal to Overhaul Federal Nursing Home Oversight

Industry, Legislative,

This information is provided by national senior living partner, Argentum.

Yesterday, the Biden Administration released a fact sheet detailing plans to study and overhaul nursing home regulations relating to staffing, performance, care quality, transparency, and other issues. It is anticipated that President Biden will speak to these efforts during tonight’s State of the Union address at 9:00 p.m. EST.

Argentum is closely monitoring these proposals, which at this time, do not cover assisted living. We have repeatedly stressed to federal regulators that assisted living is regulated at the state level and that CMS does not have federal oversight of providers. Most recently, we submitted comments in response to the CMS Interim Final Rule (IFR) vaccine mandate, underscoring that CMS issued clarifying guidance that the agency “does not have regulatory authority over care settings such as Assisted Living Facilities.”

According to the fact sheet provided by the Administration, the need for increased federal oversight is prompted by reports showing high COVID-19 fatality rates in nursing homes, staffing shortages and lower care outcomes for residents at private equity-owned nursing homes, and insufficient accountability and transparency in the sector. The fact sheet identifies several recommendations, which include:

  • Establishing a minimum nursing home staffing requirement and supporting state efforts to improve staffing and workforce sustainability;
  • Reducing resident room crowding and increasing single-occupancy rooms;
  • Reinforcing safeguards against unnecessary medications and treatments;
  • Adequately funding inspection activities and increasing scrutiny on poorest performers, to include additional financial penalties and other enforcement sanctions;
  • Increasing accountability for chain owners of substandard facilities and transparency of facility ownership and finances;
  • Examining the role of private equity to include establishing a database of nursing home owners and operators; and
  • Enhancing requirements for pandemic and emergency preparedness and integrating pandemic lessons into nursing home requirements.

The only reference to assisted living relates to rapid antigen tests that have been supplied to both nursing homes and assisted living facilities. We have called on the Administration to directly distribute a reliable and consistent supply of test kits to providers, and recently met with senior members of the HHS testing team to inform them of the challenges providers have experienced during the Omicron surge so that federal and state testing supplies can be better allocated to meet providers’ needs.