A senior Centers for Medicare and Medicaid Services official pushed back against Republican attacks on the agency's controversial long-term care regulations during a congressional hearing Tuesday.
House Energy and Commerce Committee Chair Cathy McMorris Rodgers (Wash.) and other GOP lawmakers asserted that rules to boost pay for home- and community-based healthcare workers and to mandate minimum staffing levels at nursing homes could jeopardize providers and hamper access to care.
Related: Legal challenges likely for nursing home staffing mandate
Center for Medicaid and Children's Health Insurance Program Services Director Daniel Tsai countered that the agency took those concerns into account when devising its policies.
Last week, the CMS finalized one rule to require that home care providers spend 80% of Medicaid reimbursements on worker compensation and another to require that skilled nursing facilities provide 3.48 hours of nursing care per resident, per day.
Rodgers took aim at both regulations at the hearing her panel's health subcommittee held on Medicaid policy.
"I fear that the minimum staffing rule will force nursing homes to close or reduce the number of seniors served," Rodgers said. "The Medicaid access rule's so-called 80/20 policy will lead to home care agencies reducing the amount of care that they can provide."
Tsai said the rules were designed to both ensure there are enough workers, because they will be paid more, and to promote superior care.
"I don't think we need to choose between a nursing home's economics — recognizing legitimate workforce challenges that we all need to work on creatively together — and safe, dignified care," Tsai said.
"We need to make sure that there is a sufficient workforce available, which requires a sufficient funding for the workforce," Tsai said. "One of the reasons we finalized this rule is to make sure that Medicaid payments for direct care for home- and community -based services should go to direct care workers versus administrative overhead and profit," he said of the 80/20 rule.
Tsai said that CMS consulted with state Medicaid officials and borrowed from similar policies in place at the state level, prompting a skeptical response from Rep. Dr. John Joyce (R-Pa.).
"I can assure you, our state Medicaid directors and counterparts are constantly raising things of the sort, and that is very much part of the daily dialogue that we have with our state partners," Tsai said.
Health Subcommittee Chair Brett Guthrie (Ky.) and other Republicans questioned whether providers can manage the added expenses and, like Rodgers, cautioned that some may fold, echoing criticisms from the long-term care industry.
Guthrie recommended legislation he introduced last year that would allow nursing homes to boost their workforces with nurse aides in training, as they were permitted to do during the COVID-19 public health emergency. Tsai did not comment.
The subcommittee convened to debate a slate of healthcare legislation, including bills that would block CMS from implementing both recent regulations. The House Ways and Means Committee advanced the measure to countermand the staffing rule last month.
Energy and Commerce Committee Democrats seemed unsupportive of those bills, and Rep. Terri Sewell (Ala.) was the only Ways and Means Committee Democrat to vote in favor the nursing home legislation. The majority-Democratic Senate is not likely to take up efforts to halt the long-term care rules.
