June 05, 2023

Comments to CMS: FY 2024 SNF Proposed Rule Will Limit Older Adults Access to Care

Following LeadingAge’s submission of comments to the Federal Register on the Centers for Medicare and Medicaid Services (CMS) (FY) 2024 SNF PPS proposed rule, president and CEO Katie Smith Sloan elaborated on our response in a June 5, 2023 statement to the press.

“The proposed payment rule does not address the reality of providers’ operating environments, and will, ultimately, limit older adults’ access to much-needed care and services. Nursing homes’ costs will most certainly rise in the coming year. Members will be required to purchase more personal protective equipment and COVID-19 testing supplies to comply with Centers for Disease Control & Prevention (CDC) recommendations; they’ll have to budget funds to ensure compliance with new or enhanced requirements, such as those related to water management programs and emergency preparedness activities. These increases are essentially unfunded mandates that our mission-driven, nonprofit providers have no choice but to manage – on top of anticipated cost increases from soon-to-come federal staffing requirements.

“Labor costs in long-term care have ballooned. There simply aren’t enough applicants. Over and over again, members tell me, as they shared in our most recent member snap poll, that labor shortages jeopardize their ability to continue to operate. Mandates will almost certainly force members to allocate more money for recruitment and retention in order to comply with staffing standards. 

“In addition, we share CMS’ goal of ensuring quality care; our members are committed to compliance.  We particularly oppose two elements in the proposed rule – one on quality reporting, the other on value-based purchasing – which aren’t fair, reasonable or within providers’ control.” 


COVID-19 Vaccination Coverage Measures in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP): on page 2 of the 9 page PDF comments to CMS, LeadingAge explains why the proposals related to two measures of COVID-19 vaccination coverage – a modification of the existing measure COVID-19 Vaccination Coverage among Healthcare Personnel and a new measure, COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date, for FY 2026 – are not reasonable. To be sure, LeadingAge does not question vaccines’ efficacy and importance in keeping residents and staff healthy – and has demonstrated, via numerous initiatives in partnership with both the Department of Health and Human Services and the Centers for Disease Control and Prevention, support for vaccine uptake and education. Continuing to include the staff vaccination measure, despite CMS’ rescinding the staff COVID-19 vaccine mandate and adding the resident vaccination measure penalizes providers for allowing residents and staff to exercise personal choice and manipulates information that is already available to the public in a more meaningful manner. 

Total Nurse Staffing Turnover: CMS proposes to adopt the Total Nurse Staffing Turnover measure for SNF VBP FY 2026. While staffing levels could provide important information about nursing home quality, LeadingAge explains (on page 6 of its 9 page comment PDF) why this is not the right measure for the job, and reiterates its disagreement with how this measure is calculated. What’s more, CMS’ focus on staff turnover places inappropriate blame on providers, who are doing their utmost to ensure quality care with sufficient staffing levels – even as employees’ changing workplace preferences, including flexible hours and work-from-home options, are in conflict with traditional healthcare staffing models. Providers often turn to staffing agencies to fill openings; which could result in high turnover rates. For those two reasons, we do not support the inclusion of a nurse staffing turnover measure in SNF VBP.

Read an overview of the rule here and a more detailed analysis of the rule here.