Nursing home staffing mandate ‘dead’ after Trump win, but workforce and pay issues persist

A day after President-elect Donald Trump won a surprisingly decisive victory, many long-term care stakeholders were anxiously awaiting sweeping policy changes. But some experts also warned Wednesday that a Trump victory would cut both ways.

Providers are hoping to take advantage of Trump’s anti-regulatory views, roll back the Biden administration’s onerous new staffing requirements set to take effect starting in 2026 and eliminate current opposition to for-profit ownership of nursing homes.

“Certainly, as with other Republican administrations, this will be more beneficial if you are the owner or operator of a skilled nursing facility or network,” said Fred Bentley, managing director of Medicare innovation at ATI Advisory. “Staffing ends upon arrival. They will reduce or reduce regulatory and survey scrutiny. You can kind of go down this path and it will be a more supportive environment.”

However, years of work towards immigration reform The need to increase the long-term care workforce won’t even be discussed under the next president, Bentley said. McKnight Long Term Care News. Also likely to disappear are tougher rules for Medicare Advantage plans, which have increasingly denied access to post-acute care.

Trump’s victory and Republicans’ return to the Senate could give the party a clear path to enacting significant changes. The only major questions remaining unanswered by Wednesday evening were how big the party’s Senate majority would be and whether Republicans could also maintain control of the House.

Centenarian rights groups weigh in

Clif Porter, president and CEO of the American Health Care Association/National Center for Aging, said in a statement Tuesday that he welcomed the opportunity to work with Trump.

“It is critical that our nation’s leaders prioritize, support and invest in America’s seniors and their caregivers,” Porter said, inviting Trump and the 119th Congress to work together to address quality care and the growing shortage caregivers, and in defense of the aging population. population.

“While we are looking forward to getting started, there is still a lot that can be done before the end of the year,” Porter added. “We urge legislators to pass legislation during a lame session that streamlines regulations, expands workforce development and expands access to care for seniors and people with disabilities.”

Providers view this lame session — the period after the election until Inauguration Day on Jan. 20 — as an opportune time to win support from outgoing members of Congress on issues they may have avoided before. It could also be a chance for those leaving to push through reforms that didn’t get a vote earlier in the session.

Sen. Jon Tester (D-Mont.), for example, supported legislation blocking the Centers for Medicare and Medicaid Services nursing home staffing rule. He was removed from office Tuesday, but LTC supporters believe Tester and others could still have major influence on the rule and other bills in the final days of the 118th Congress.

“We are optimistic that the Trump administration will end the unrealistic staffing mandate, but Congress and the courts still have several options to address this issue,” Porter said. McKnight’s. “We will continue to pursue every opportunity to protect access to health care and strive for more meaningful workforce solutions.”

Linda Couch, senior vice president of policy at LeadingAge, said that if no mismanagement results in repealing the staffing mandate, the Trump administration could decide to pause implementation and issue a final rule repealing it.

“We view this action as an opportunity; however, we will continue our legal defense until a decision is made to remove any agency,” she said. McKnights in an email.

Efforts are also already underway to understand what the new administration can focus on first and help put some skilled nursing and other long-term care initiatives at the top of that priority list.

“In the near future, we will focus on working with the Trump transition teams to share the LeadingAge agenda and gain a clear understanding of the new administration’s goals in the areas of housing, aging, health care and long-term care,” LeadingAge President and CEO Katie Smith Sloan. said on Wednesday. “As we learn more, we will better understand their potential impact on our members and those they serve – wherever they are. This is our main priority in the short term.”

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During it first day of presidency In 2017, Trump used the usual CEO maneuver and ordered a freeze on all pending regulatory actions. This could also be useful during his second term.

As of Wednesday afternoon, several rules that could impact emergency care providers were still under review by the White House Office of Management and Budget. Among them were five CMS rules, including a proposal that would govern policy and technical changes to the Medicare Advantage and PACE programs in 2026. There are six more Department of Labor regulations under review, including proposed updates to the Fair Labor Standards Act and finalization of the law. rule to limit exposure to COVID among medical personnel.

Any rule that remains on this list until mid-January could be permanently frozen, and any rule approved before then could be subject to congressional review.

“If the new administration is serious about reducing regulation and burden, healthcare has plenty of it,” Dan Mendelson, CEO of Morgan Health and founder of Avalere Health, wrote on LinkedIn Wednesday.

It’s unclear whether Trump would go so far as to roll back Biden-era rules that were aimed at increasing transparency in nursing home ownership and providing state licensing boards and others with better information that could be used when reviewing future deals.

Provider advocates, however, fully expect Trump to reverse his rhetoric and create a much more favorable environment for healthcare mergers and acquisitions.

“President Biden has brutally maligned the nursing home sector,” said Brendan Williams, CEO of the New Hampshire Health Care Association. McKnight’s Wednesday. “President-elect Trump has no such animosity toward this sector, and I expect his administration to scale back Biden’s bizarre regulatory vendetta.”

Mendelson said he expects “a more liberal deal environment and increased deal activity in the healthcare space.”

One important factor in determining the extent to which Trump will be able to remove barriers to mergers and acquisitions is who he appoints as his secretary of the Department of Health and Human Services. The president-elect said former independent candidate and vaccine conspirator Robert F. Kennedy Jr. will play a “big role” in his administration’s health care, with influence over food and drug regulation. Trump did not specify whether this would be in an advisory capacity or in a more formal capacity.

Williams said he was “very unsure” how Kennedy’s promised role would interact with a struggling sector that has seen both staff and residents largely refuse COVID vaccines this fall.

Medicare and MA Expectations

As Trump campaigned on protecting Medicare and the nation rapidly ages, Bentley predicted Trump might act with typical Republican expectations on the issue.

“I don’t get the sense that budget hawks are going after Medicare. They may try to follow Medicaid’s lead and cut Medicaid spending, and that could have negative consequences,” he said. “But it looks like the tap will be wide open.”

Bentley predicts that this will include more favorable reimbursement for Medicare Advantage insurers, which may (or may not) pass on any profits from the rates they pay to qualified health care providers. But Bentley cautioned that it “could vary.”

“The extent to which the Biden administration was focused on improving access to skilled nursing and home health services and requiring MA plans to provide the same level of access and coverage that Medicare beneficiaries receive has disappeared or declined significantly,” Bentley noted. .

Big budget issues

Bigger questions about Trump’s approach to federal budget negotiations could also weigh heavily on the sector. Congress still needs to pass another short-term government funding bill in December to avoid a shutdown.

“Both sides have a motivation to prevent a government shutdown. Budget concerns are legitimate not just for health care providers, but for all industries,” added Melissa Schakowsky, director of government relations at Ambassadors Group, an advocacy organization for long-term care providers. “It is also unknown how boldly the Conservatives will cut government spending, especially on entitlement programs.”

Couch said the big question is what will happen to the balance of power in the House.

“The answer could directly impact Congress’s willingness to take up legislation for FY25, and we want them to do that as quickly as possible,” she explained. “Continuing resolutions do not benefit programs or agencies, especially long-term CRs. If all the FY25 work is pushed into the next session, these bills could get tangled up with decisions to raise the debt ceiling and other very sticky wickets.”

And what happens in the future, full-year budget processes could also be bad news for patients and healthcare providers.

Some Republicans are pushing for across-the-board spending cuts that would lower health care costs. While some countries may rely on insurance companies and private payouts to boost profits, skilled nursing workers depend almost primarily on Medicare and Medicaid payouts.

Trump invited his confidant Elon Musk join his office as “cost cutting secretary”; Musk said he wants liquidate $2 trillion from the federal budget.

On Wednesday, Williams said he hoped no proposals from Musk would emerge “that would harm Medicaid and Medicare.”