An amendment for a bill that aims to alleviate staff shortages at nursing homes passed Wednesday, allowing nurse aides to continue their training at facilities facing violations and fines.
As the bill titled, “Ensuring Seniors’ Access to Quality Care Act,” now moves on to the next stage of review, the amendment signals a shift in how nursing homes can proceed with their education programs for certified nursing assistants (CNAs).
Under the revised regulations, nursing facilities facing potential suspension due to violations of Medicare rules would be able to continue their training programs under certain conditions. Specifically, these facilities would be able maintain their CNA training operations as long as the fines imposed are for deficiencies unrelated to direct patient care.
The current statute prevents nursing homes from conducting CNA training for a two-year period if they are assessed civil monetary penalties above the $12,924 threshold – a required suspension even if the fines are unrelated to the quality of care given to residents.
During the House Ways and Means Committee’s deliberations, the amendment garnered both support and criticism.
“That’s a common sense solution to help keep CNA education programs operational and assist nursing homes across the country with staffing levels,” said Rep. Ron Estes (D-Kan.), who co-sponsored the bill. “I’ve heard from numerous constituents and nursing home leaders about how much good this bill will do, with some going so far to say, ‘Nearly 50% of the CNAs on our staff were trained in house. If this training isn’t available, we do not have the capability to care for vulnerable Kansans.’”
During the markup session for the bill, Rep. Estes said the provisions contained in it will assist in meeting the “disastrous” final rule on minimum staffing issued by Centers for Medicare & Medicaid Services (CMS) in April.
“While I disagree with this rule, my bill will help nursing homes comply by allowing them to train the necessary staff to meet the rule’s requirement,” Estes said.
Introduced in the Senate in the summer of 2022, the bill itself repeals certain restrictions under Medicare and Medicaid that prohibit the approval of nurse aide training and competency evaluation programs in skilled nursing facilities (SNFs) that are cited or fined.
Currently, nursing homes can seek a waiver to request a continuation of the training if they had been found to be facing regulatory action. However, even though about 52% of training programs would be eligible for that waiver, they have not applied, according to experts present at the deliberations.
Despite receiving criticism from several lawmakers, including from Rep. Lloyd Doggett (D-Texas) who insisted on better pay for nursing home workers, the amendment passed by 25 to 18 votes.
“Those who violate will somehow be able to provide us quality care in the future – that just is not going to work,” said Doggett. “Facilities offering substandard care and cutting corners should not be permitted to train new workers. Indeed, qualified workers are already available. But you know, people are not too willing to accept just above minimum wage to do the hard work of emptying bedpans, lifting people out of their beds and other demanding tasks,” he said.
Other lawmakers shared Doggett’s skepticism on the amendment.
Representative Judy Chu (D-Calif.) raised concerns about the potential impact of the amendment on patient care quality. She argued that the legislation could inadvertently allow underperforming nursing facilities to continue training CNAs, even in cases where serious violations, such as falsified patient records or failure to report abuse, were present.
Lawmakers opposed to the amendment instead are advocating for policies aimed at improving training, retention, and working conditions for health care workers, particularly those in nursing homes.
Nursing home advocacy groups, welcomed the amendment.
LeadingAge, the trade association representing more than 5,400 nonprofit and mission-driven aging services providers, including nursing homes, stressed the urgency of the change to the original bill in the aftermath of the minimum staffing requirements.
Katie Smith Sloan, president and CEO of LeadingAge, said in an emailed statement: “By our calculations at least 78,000 additional full-time nurse aides will be needed in nursing homes nationwide to comply with the new requirements.”
Meanwhile, Clif Porter, senior VP of Government Relations at the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), said the revisions will strengthen the long-term care workforce.
“In the wake of the unfunded federal staffing mandate, legislation like this is a welcome, stark contrast that helps bolster our workforce to meet future demands and directly improves access to care for our nation’s seniors,” Porter said. “We thank the committee for its leadership on this issue and we urge Congress to pass the bill swiftly.”
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