Senator Cramer Delivers Floor Speech on Unworkable Nursing Home Rules, Bureaucratic Intransigence at CMS

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WASHINGTON, D.C. - The Centers for Medicare and Medicaid Services (CMS) announced a final rule in April, imposing minimum staffing requirements for long-term care facilities (LTC), which provide care to nearly 1.2 million residents across the nation. This rule will exacerbate the existing workforce shortages and significantly harm access to care in rural communities. This new standard, which was first proposed in September 2023, will require nearly 80% of nursing facilities to hire more nurses to comply with the regulation. However, in states already facing staffing shortages, these requirements will be nearly impossible to meet and will likely force closure on many facilities across the country.

U.S. Senator Kevin Cramer (R-ND) delivered remarks on the Senate floor today to highlight the dangers of the CMS minimum staffing rule. He also spoke on the dangers of administrative bureaucracy the punitive nature of survey fines experienced by LTC facilities.

"In North Dakota, our facilities are really feeling the squeeze, and the issue is really twofold," said Cramer. "In May, CMS issued this minimum staffing rule, which requires long-term care facilities to implement new staffing requirements. These are already institutions that are already woefully understaffed because of a lack of workforce. Most burdensome is the new requirement to have a Registered Nurse on site 24 hours a day, seven days a week, rather than the previous eight hours a day, seven days a week. Less than a quarter of North Dakota facilities meet this requirement, and among rural facilities, only 14 percent will meet that mandate.

"To meet these elevated staffing levels, our facilities really have no good options, if they have any options at all," continued Cramer. "At existing staffing levels, North Dakota facilities would need to reduce the average number of residents served per day by about 74 people to satisfy this mandate. […] In my state, we've had six facilities close since 2021, indicating the already challenging operating environment. I fear this misguided rule will supercharge this trend and deprive rural individuals the opportunity to receive care in their own communities, near the people they love and know the best: their families, and their friends, their loved ones."

"The minimum staffing rule is part of a broader pattern of CMS's bureaucratic crackdowns on facilities for no reason other than it can, that's what bothers me so much about bureaucratic bullies is they're bullies because they can be, without materially improving the health and safety of long-term care residents," added Cramer. "Civil Monetary Penalties, or in bureaucratic-speak, CMPs, are punitive, monetary actions CMS can take against long-term care facilities in situations where CMS determines they do not substantially comply with Medicare or Medicaid participation requirements, the requirements that the bullies create out of thin air. These penalties are heavily used to punish facilities beyond a simple correction."

"If these rules and penalties were really about better care for residents, CMS should yield to reason," concluded Cramer. "However, the actions of the bureaucrats at CMS prove they are out of touch with operational challenges actually facing these facilities and the people they serve. If they in fact want to achieve the stated goal of improving quality, these decisions do just the opposite. […] I have little faith in their ability to do the right thing and reverse course, but I pray they will."

For nearly two years, Cramer has pushed back against the nursing home staffing standard, beginning with sending a letter to CMS in January 2023 urging the agency to avoid one-size-fits-all staffing mandates for nursing homes and to support provider flexibility in addressing recruitment and retention issues. Several months later, in June 2023, as a member of the Senate Veterans Affairs Committee, he questioned CMS officials at a hearing about the mandate's impact on already stressed staffing challenges.

In October 2023, Cramer led a bipartisan letter to the CMS Administrator requesting the agency refrain from finalizing the rule as written and instead work with Congress on flexible, commonsense solutions. Cramer and U.S. Senator Angus King (I-ME) joined forces to introduce the VA Report onProposed CMS Staffing Ratios Act to require the Department of Veterans Affairs to submit a report regarding the proposed rule's impact on the access of veterans to LTC. The senators later requested the VA study the potential harmful effects of the staffing rule on LTC facilities. Cramer also joined U.S. Senator James Lankford (R-OK) in cosponsoring a Congressional Review Act resolution of disapproval to overturn the final rule issued by CMS.

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