CMS needs to hear from providers by June 10 about its proposed rule on Medicare payments and staffing minimums. The agency specifically asked for comments on a possible delay or phase-in of the proposed parity adjustment to Medicare rates and mandatory minimum staffing levels. We have prepared tips on preparing your comments to help you.

Submit your comments. The deadline to submit comments is 5:00 pm on June 10, 2022. We encourage you to submit your comments as soon as possible. We have provided information below on how to prepare and send your comments.

About the Proposed Rule 

The agency specifically requested input on two items in the proposed rule:

1. A possible delay or phase-in of the proposed parity adjustment to Medicare rates.

• In the proposed rule, CMS is proposing a $320 million decrease in Medicare Part A payments to SNFs beginning October 1, 2022. CMS has calculated the payment increase it should make to rates, a forecast error adjustment (due to under forecasting inflation), and a required parity adjustment to make sure rates under PDMP are budget neutral with what they would have been under the RUGs model.
• Absorbing the full parity adjustment in one year would be extremely difficult for SNFs, so providers need to ask for a phase-in of the parity adjustment.

2. Information on revising the requirements for LTC facilities to establish mandatory minimum staffing levels.

1. • CMS is seeking information on addressing direct care staffing requirements, especially for RNs, LPNs, and CNAs. The agency also wants input on which individuals should be considered direct care staff, beyond nurses and CNAs.
   • This may be the only chance nursing facilities have to weigh in with CMS on staffing minimum proposals before any regulations are written. Comments about your current staffing challenges are needed.
   • Framing concerns about mandatory staffing levels in terms of how this would affect resident care (i.e., access to care, reduced admissions, etc.) will be most impactful.

For more details on the proposed rule, AHCA/NCAL has developed a summary of the greatest impacts on members. 

Tips on Organizing Your Comments

We are asking members at both the corporate and facility level to submit comments to CMS. It is critically important that the agency hear from as many people in your organization as possible, to help with this effort.

It is easy to submit a letter, and your comments do not need to be long. A meaningful paragraph about how the proposed rule will affect your residents and your organization will have significant impact.

• Keep the focus on the patients and residents.
• The more personalized you can make your comments, the better. Use your own examples.
• Anyone can submit comments—corporate staff, administrators, DONs, CNAs, etc. It is ok to have multiple comments from an organization or facility, but each comment should be unique.
• Important note: Be sure to refer to file code CMS-1765-P at the beginning of your comments. (i.e., in your intro, note that you are commenting on “CMS-1765-P, the proposed rule on the SNF Payment System”)

Use this outline to organize your comments.

Describe Yourself, Your Operation, and Your Commitment to Quality

• Mention what you do, why you work in LTC, and what your residents mean to you.
• Describe your building (i.e., location, # of units, profile of your residents).
• Mention if you are 3-Star or better or have won an AHCA Quality Award; discuss your quality efforts.

Discuss How Difficult the Past Two Years Were

• Describe the sacrifices you and your team have made and the tragedy of the losses.
• Give a specific example of a team member who has worked tirelessly.

Explain the Impact of a 4.6% Reduction

• Tell CMS how a proposed cut to nursing homes’ Medicare rates in FY 2023 would be detrimental to your residents, colleagues, and organization.
• Ask for the parity adjustment to be phased-in.
• Explain from your own perspective how a reduction will impact patient care.
• Explain your loss in census, increased labor costs, and ongoing COVID costs.
• If you are worried about closing, let them know.

Discuss Your Workforce Challenges

• Let them know how many open positions you have and how hard recruitment is.
• Discuss your inability to fill shifts, use of agency staff, and related costs.
• Tell them that a staffing mandate will not create workers—the workers are not out there.

How to Submit Your Comments

Use the AHCA Action Center (Voter Voice) to submit your comments.

We recommend you have your comments prepared before you’re ready to go to the Action Center so you can simply copy and paste your text into the “Message Body” field, complete the additional information, then hit “Send Message.”

Note: the Action Center will address your letter to CMS, so you don’t need to include a formal address block or a “Dear” line.

The deadline to submit comments is 5:00 pm on June 10, 2022.

If you submit your comments in a way other than using the AHCA Action Center, please let AHCA know by emailing ahcaadvocacy@ahca.org, so we are able to track how many comments have been submitted.