Central ND News

The Centers for Medicare and Medicaid Services (CMS) announced a final rule in April that imposes minimum staffing requirements for long-term care facilities (LTC), which serve nearly 1.2 million residents nationwide. This new rule, first proposed in September 2023, will require almost 80% of nursing facilities to hire more nurses to comply with the regulation. However, states already experiencing staffing shortages may find these requirements nearly impossible to meet, potentially leading to the closure of many facilities.

U.S. Senator Kevin Cramer (R-ND) delivered remarks on the Senate floor today, highlighting the dangers of the CMS minimum staffing rule and discussing administrative bureaucracy and punitive 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 of the opportunity to receive care in their own communities.”

“The minimum staffing rule is part of a broader pattern of CMS’s bureaucratic crackdowns on facilities for no reason other than it can," added Cramer. "That’s what bothers me so much about bureaucratic bullies; they’re bullies because they can be without materially improving the health and safety of long-term care residents... Civil Monetary Penalties or 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... 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... 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 nursing home staffing standards. He sent a letter to CMS in January 2023 urging them to avoid one-size-fits-all mandates for nursing homes and support provider flexibility in addressing recruitment issues. In June 2023 as part of his role on the Senate Veterans Affairs Committee he questioned CMS officials about how mandates impact stressed staff.

In October 2023 Cramer led a bipartisan letter asking CMS Administrator not finalize current rules but work with Congress on flexible solutions instead. Alongside U.S Senator Angus King (I-ME), he introduced VA Report on Proposed CMS Staffing Ratios Act requiring Department Veterans Affairs report regarding impacts on veterans' access LTC while requesting VA study potential harmful effects from proposed regulations further cosponsoring Congressional Review Act resolution disapproving final rule issued by agency.