WASHINGTON, D.C. — This week, U.S. Senator Deb Fischer (R-Neb.) introduced the Protecting Rural Seniors’ Access to Care Act. The legislation would prohibit the U.S. Department of Health and Human Services (HHS) Secretary from finalizing a proposed nursing home staffing rule that would hurt facilities across rural Nebraska and could force many to close.

In addition to Senator Fischer, the legislation is cosponsored by U.S. Senators Roger Marshall (R-Kan.), James Lankford (R-Okla.), Jon Tester (D-Mont.), Kyrsten Sinema (I-Ariz.), Joe Manchin (D-W.Va.), Roger Wicker (R-Miss.), Susan Collins (R-Maine), and Angus King (I-Maine).

The legislation would also establish an advisory panel on nursing home staffing that includes voices from both urban and rural communities. The panel would submit a report to Congress that analyzes workforce shortages and makes practical recommendations to strengthen the workforce.

“Nursing homes across the country face historic staffing shortages
, and nowhere are those challenges more real than in rural states like Nebraska. This mandate from the Centers for Medicare and Medicaid Services would force many facilities to reduce their number of patients or even close their doors for good. My legislation will stop this staffing rule and allow time to find a fairer solution that protects rural facilities across our state,” said Senator Fischer.

“Imposing a one-size-fits-all staffing mandate on nursing homes will have costly and devastating impacts on Kansas seniors’ access to care. The pandemic, compounded with reimbursement challenges and staffing shortages, has led to the closure or reduced services in nearly 50 nursing homes across Kansas. The importance of having access to local long-term quality care facilities for seniors cannot be understated. Kansas seniors should be able to live and age comfortably in a local community where they can stay connected to their families. This unachievable rule further highlights the Biden Administration's continued disregard for rural America. I'm proud to champion this important bipartisan legislation,” said Senator Marshall.

“Oklahoma seniors, especially in rural communities, deserve quality, safe health care. CMS has proposed a one-size-fits-all staffing mandate that has significantly threatened the ability for patients to receive post-acute care in rural communities. My colleagues and I are taking all available steps to stop the overreaching staffing mandate from CMS—they are not in our communities and clearly do not adequately understand the problems families and seniors are facing when finding care in rural America,” said Senator Lankford.

“I’ve told the Biden Administration from the jump that imposing a burdensome one-size-fits-all staffing mandate simply won’t work for Montana’s rural nursing homes. Our long-term care facilities are already facing severe workforce shortage issues, and this federal staffing mandate could force facilities to shut their doors. My bipartisan bill will stop this rule dead in its tracks, and I’m committed to working with my colleagues to address the nursing home workforce so we don’t leave rural seniors in the lurch,” 
said Senator Tester.

“We’re strengthening rural nursing home care by pushing back against a misguided federal rule that could result in the closure of rural nursing home facilities. I support efforts to ensure our seniors receive the best care from dedicated nursing and health staff, but a one-size-fits all approach does not work for Arizona communities,” said Senator Sinema.

“Allowing the Centers for Medicare and Medicaid Services’ staffing mandate to be forced upon all nursing homes would be a disaster for older Americans who reside in rural areas, as many do in the State of Maine. This bipartisan legislation would allow for the chance to negotiate fair rules for all long-term care facilities, helping to avoid wide-scale displacement of residents and closures of rural nursing homes that are facing severe staffing shortages,” said Senator Collins.

“The Biden administration recently proposed a national plan to address healthcare provider shortages, a challenge which especially hurts rural areas. But what works in one state may not work in Mississippi,” Wicker said. “Closing our rural-urban healthcare gap will require tailored solutions designed by those who know their communities best – local leaders. This legislation empowers them to make decisions they believe are best for their towns while rejecting the Biden administration’s one-size-fits-all approach," said Senator Wicker.

The bill is endorsed by over 90 organizations. Please click here for the full list of endorsements.

Senator Fischer criticized the CMS mandate in a 
speech on the Senate floor last week. In her remarks, Senator Fischer argued the rule could force many nursing facilities around the country to close, which would especially devastate rural communities.


On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that would mandate new minimum staffing standards for long-term care (LTC) facilities. According to CMS, 75% of nursing homes would have to increase staffing to comply with the proposed standards. This standard will be even harder to meet in rural areas, which already face historic staffing shortages.

While CMS estimates the cost for this rule is $4 billion, LeadingAge, the association for nonprofit providers of aging services, believes that the CMS proposed budget is significantly underestimated. LeadingAge estimates that the rule’s staffing requirements will cost providers nearly $7 billion in the first year alone.

In 80% of Nebraska counties, the number of registered nurses (RNs) and licensed practical nurses (LPNs) per capita is lower than the national average. Nine counties in Nebraska do not have any practicing RNs available. The Center for Rural Affairs found that 64 of Nebraska’s 93 counties are at least partially in a primary care health professional shortage area. Nebraska nursing facilities are already being staffed by temporary workers, and many positions are being filled by LPNs. LPNs do not contribute to the number of staff required by the proposed rule.

In September, Senator Fischer 
joined the Nebraska congressional delegation in sending a letter to CMS Administrator Chiquita Brooks-LaSure opposing the agency’s nursing home staffing rule.

The House-version of this legislation was 
introduced by U.S. Representative Michelle Fischbach (R-Minn.) in September.

Click here to read the text of the bill.

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