The House Committee on Energy and Commerce considered and passed several LeadingAge priorities at a legislative markup of the full committee on September 18, 2024. Under the leadership of Chair Cathy McMorris Rodgers (R-WA), the committee adopted legislation to overturn the federal minimum staffing rule, strengthen the long-term care workforce, extend important telehealth flexibilities, and improve access to home and community-based services.

LeadingAge transmitted a letter to all committee members in advance of the markup, expressing its support for the five following bills, some of which were first approved at a May 16 markup of the Energy and Commerce Subcommittee on Health.

H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act, would eliminate the Institutional Level of Care (ILOC) requirement for receipt of Medicaid home and community-based services (HCBS). LeadingAge is supportive both of H.R. 8107 as written, and of the proposed amendment language that requires the Secretary to create a five state pilot program to test elimination of the ILOC requirement for receipt of HCBS. Data collection requirements included within the new proposal would allow states and Congress to assess how Medicaid HCBS expenditures can help stave off more expensive institutional care. This bill was introduced by Reps. Juan Ciscomani (R-AZ) and Marie Gluesenkamp Perez (D-WA). The amendment offered during full committee consideration was adopted by voice vote. The final bill, as amended, was adopted in the full committee by a vote of 43-0.

H.R. 3227, the Ensuring Seniors’ Access to Quality Care Act, would modify a decades-old statutory provision that prohibits a nursing home from running nurse aide trainings and competency evaluations for two years when the nursing home has been subject to civil monetary penalties above a certain threshold. This fix would only apply if the provider has addressed deficiencies associated with the penalties and has not been found to have deficiencies related to patient harm or quality of care. This bill was introduced by Reps. Ron Estes (R-KA) and Gerry Connolly (D-VA) with input from LeadingAge. On May 16, 2024, the House Energy and Commerce Subcommittee on Health favorably forwarded this bill, as amended, to the Full Committee by a recorded vote of 13-12. The final bill was adopted in the full committee by a vote of 20-18.

H.R. 9067, the Building America’s Health Care Workforce Act, would offer states the ability to apply for a waiver of up to three years if they have a self-identified temporary nurse aide (TNA) workforce shortage area. Under this waiver, nursing homes would only qualify if they have not been cited for patient safety concerns by the Centers for Medicare and Medicaid Services (CMS) within the two preceding years. Temporary nurse aides would still be required to perform the duties outlined in statute while working toward attaining the 75 hours of on-the-job training before they can sit for an exam to become a certified nursing assistant (CNA). Further, they would not be able to work by the bedside for longer than 12 months if the 75-hour training requirement is not met. This bill was introduced by Rep. Brett Guthrie (R-KY) and was amended in committee by voice vote to include additional technical changes. The final bill was adopted in the full committee by a vote of 23-17.

H.J. Res. 139, Congressional Review Act (CRA) resolution of disapproval on the minimum staffing rule, would repeal CMS’s minimum staffing rule for nursing homes, which was finalized on May 10, 2024, and would prevent CMS from issuing a substantially similar rule in the future. LeadingAge worked closely with House and Senate offices on the introduction of this legislation. LeadingAge is opposed to implementation of any federal minimum staffing standard until there is a sufficient workforce to staff the proposed standards and the necessary funding is made available to pay these additional staff. Rural and underserved communities already face a crisis in access to care, and the final minimum staffing rule for nursing homes would only make it harder for older adults and families in these communities, and across the country, to get needed care. This resolution was introduced by Reps. Michelle Fischbach (R-MN) and Greg Pence (R-IN). The resolution was adopted in the full committee by a vote of 21-18.

H.R. 7623, Telehealth Modernization Act, would implement a two-year extension for certain telehealth flexibilities under Medicare. The telehealth flexibilities that are extended by this legislation include: removing geographic restrictions, expanding eligibility for practitioners to furnish telehealth services, retaining the waiver process for modifying telehealth services covered under Medicare, implementing a permanent payment system for telehealth services furnished by rural health clinics (RHCs) and federally qualified health centers (FQHCs), and allowing the use of audio-only telecommunications technology. This bill was introduced by Rep. Earl “Buddy” Carter (R-GA) and several bipartisan colleagues. The House Energy and Commerce Subcommittee on Health favorably forwarded this bill, as amended, to the Full Committee by a recorded vote of 21-0.

A substitute amendment was offered during full committee consideration of this bill that included, among other provisions, in-home cardiopulmonary rehabilitation flexibilities, an extension of the hospital at home telehealth program, and pharmacy benefit manager (PBM) reforms intended to delink compensation from the cost of medications and increase price transparency to lower the costs of prescription drugs for seniors. The amendment offered during full committee consideration was adopted by voice vote.

Several members also expressed their concerns regarding the Drug Enforcement Administration’s (DEA) actions to limit telemedicine prescribing of controlled substances, although no language to address this issue was included in the bill. The final bill, as amended, was adopted in the full committee by a vote of 41-0.

LeadingAge is pleased that the House Energy and Commerce Committee approved these bills, and we will continue working to advance these legislative priorities.