The American Health Care Association (AHCA), Texas Health Care Association, and several Texas long term care facilities filed a lawsuit last week against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) over new staffing requirements.
The lawsuit, filed in the Northern District of Texas, claims that HHS and CMS exceeded their statutory authority and arbitrarily and capriciously issuing the Minimum Staffing Standards for Long-Term Care Facilities final rule on May 10. AHCA asks that the court issue an order and judgment setting aside the new staffing requirements.
“We had hoped it would not come to this; we repeatedly sought to work with the Administration on more productive ways to boost the nursing home workforce. Unfortunately, federal officials rushed this flawed policy through, ignoring the credible concerns of stakeholders and showing little regard for the negative impact it will have on our nursing home residents, staff, and the larger health care system,” said Mark Parkinson, president and CEO of AHCA, in an announcement. “We cannot stand idly by when access to care is on the line and federal regulators are overstepping their authority. Hundreds of thousands of seniors could be displaced from their nursing home; someone has to stand up for them, and that's what we're here to do."
Derek Prince, board chair of THCA and CEO of HMG Healthcare, said in the announcements that hundreds of nursing homes are at risk of closure over the federal staffing mandate. More than two-thirds of Texas facilities can’t meet the new requirements, he said.
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Nursing homes that participate in Medicare and/or Medicaid already must meet specific staffing requirements. They must provide 24-hour licensed nursing services to meet the needs of its residents and must use the services of registered professional nurses at least eight consecutive hours a day, seven days a week. However, the final rule deviates from these statutory standards, which the lawsuit states mandates unachievable requirements and imposes a one-size-fits-all quantitative standard.
The complaint argues that the agencies' decision to adopt the new minimum staffing standards was arbitrary and capricious, in violation of the Administrative Procedure Act. “It simply makes no sense to impose a blanket 24/7 RN requirement and rigid staffing ratios on thousands and thousands of nursing homes across the country, regardless of each particular facility's local conditions and unique circumstances,” the lawsuit states. “As CMS and its predecessor agencies have repeatedly explained in a series of regulations spanning more than four decades, the indisputable fact that nursing homes care for a wide range of resident populations with greatly divergent needs renders a one-size-fits-all approach manifestly inappropriate."
The mandate also has a significant economic impact. CMS estimates that the mandate will cost facilities more than $5 billion each year. An AHCA analysis of the final rule using more recent wage data and accounting for inflation found that the mandate would cost closer to $6.5 billion annually.
“To be clear, all agree that nursing homes need an adequate supply of well-trained staff,” the suit states. “But imposing a nationwide, multi-billion-dollar, unfunded mandate at a time when nursing homes are already struggling with staffing shortages and financial constraints will only make the situation worse.”