(Iowa Capital Dispatch) – Iowa's lawsuit to block new regulations continues to move forward as Texas courts break efforts to raise nursing home staffing levels, Congress opposes those same efforts.
Last fall, Iowa joined representatives from 19 other states and nursing home industries when suing the Biden administration to block implementation of new taxpayer-funded nursing home staffing requirements.
The new standards will ultimately require an assessment of residents' needs to be conducted, providing 3.48 hours of direct nursing care per day for each resident, and then available 24 hours a day, seven days a week.
The lawsuit, filed in U.S. District Court for the Northern District of Iowa, seeks to overturn a requirement approved by the Centers for Medicare and Medicaid Services last year.
In their court petition, 20 states and more than 12 industrial associations argue that staffing requirements pose existential threats to the nursing home industry as many already struggling nursing homes have no choice but to go out of business.
A Texas judge says CMS has no authority
The Iowa lawsuit is roughly the same as that filed April 7th in the U.S. District Court for the Northern District of Texas, when District Judge Matthew Caxmalick eliminated the new requirement.
Kacsmaryk found the goal of the new rules to be “admired” but not consistent with legislation approved by Congress.
“The CMS does not have the authority to issue regulations that will independently replace the minimum council time priority, which is exactly what the 24/7 requirement does,” Kacsmaryk said in his ruling. “The council took itself to set up a minimum-hour nursing home where the services of registered professional nurses should be used,” that level was set as “at least eight hours in a day.” The 24/7 requirement effectively amends the statute to attack the “8” of Congress and replace it with the “24” of the agency. ”
The ruling was not unexpected. When the Texas lawsuit was filed, the consumer group said Kakusmalik, the only judge to which it was assigned, was primarily sided in multiple health care cases that previously controlled against government regulators.
A judge in January denied the state's claims for a preliminary injunction to block the implementation of the rules, in Iowa. Three weeks ago, CMS suggests that despite administrative changes made in January when Donald Trump took office as president, the CMS still supports the new rules, at least to some extent.
On the same day, the CMS filed a summary with the Court of Appeals, and the state of Iowa and its joint plaintz submitted a summary to the underlying case, even if CMS was granted a statutory authority to establish such rules, and the Congressional mandate of its powers was unconstitutional. “There is no limit to what CMS can do if that authority justifies the rules,” the plaintiff argued. “The rules impose billions of dollars in expenses, override state laws, and effectively rewrite other provisions of Medicaid and Medicare law.”
Congress was ready to block rules
Some consumer advocates believe that savings from repealing government abolition could be partially offset by $880 billion cut proposals in the Medicaid budget, as CMS, currently led by Robert F. Kennedy Jr., is fishing to bolster Congressional action.
Similar to the possibility of an Iowa court ruling that could contradict Kaxmalick's decision, industry officials and GOP lawmakers are pushing for CMS to manageably abolish or simply block Congress.
US Rep. Michel Fischbach, a Minnesota Republican, recently added that he believed staffing orders would threaten rural nursing homes and that Texas courts would pursue “the law because they need to ensure that the rules have been overturned.”
Fischbach introduced the Rural Elderly Access Act in 2023 shortly after the CMS proposed a preliminary version of the regulations. Rep. Randy Fencestra of Iowa was co-sponsor of the bill.
Fischbach reintroduced the bill in February this year. In the Senate, Oklahoma Republican James Lankford and Nebraska Republican Deb Fisher introduced a similar version of the bill.
Iowa home cited due to shortage of staff
Last year, the Iowa Capital Dispatch reported that the Iowa Nursing Home has compiled the sixth record nationwide for staffing level violations. Data from the CMS showed that 14% of the state's 422 nursing facilities were cited due to inadequate staffing in 2023. This was more than twice the national average, at 5.9%.
Only five other states, Hawaii, Michigan, Montana, New Mexico and Oregon, had poor records of compliance with sufficient personnel requirements.
The Fleur Heights Care facility in Des Moines has compiled Iowa's worst compliance records. For nine months from May 2023 to February 2024, Fleur Heights was cited but was not fined, but was fined five times for inadequate staff.
Federal data suggests that many care facilities already meet new standards, but industry officials argue that nursing homes will need to hire an additional 27,000 full-time registered nurses and 78,000 full-time certified nurse aides to meet the requirements, at a cost of more than $7 billion.
A report from the Long-Term Care Community Coalition earlier this year showed that six in 10 of all U.S. nursing homes met the new 3.48-hour nurse staffing criteria in the fourth quarter of 2023.
The fact that a large portion of the facility has already met new minimum standards while facing issues of quality of care is a concern for many advocates who say the new standards are not fully advanced. They point to federal studies showing that each resident needs at least 4.1 hours of nursing care each day. This indicates that it is the standard standard in only 26% of all nursing homes across the country.
A study from the University of Pennsylvania recently concluded that new staffing obligations would save around 13,000 lives a year if left intact. In Iowa alone, researchers said the mandate would save 101 to 250 lives a year.
Nursing Home Staffing Lawsuit
Other plaintiffs in the Iowa-led lawsuit regarding nursing home staffing include Nebraska, Kansas, South Carolina, Alabama, Alaska, Arkansas, Florida, Georgia, Idaho, Indiana, Kentucky, Missouri, Montana, Oklahoma, Oklahoma, North Dakota, South Dakota, Utah and West.
The Joint Plains include reading lobbying and professional associations in Iowa, Nebraska, South Dakota, Kansas, Oklahoma, South Carolina, Missouri, New Jersey, Ohio, Colorado, Delaware, Virginia, Maryland, Pennsylvania, Tennessee and Michigan.
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