Earlier today, the U.S. Department of Labor finalized a rule that dramatically expands overtime eligibility for millions of salaried workers. The release of the rule comes a day after the Centers for Medicare and Medicaid Services (CMS) released final rules that would impose new requirements on Medicaid Home and Community Based Services (HCBS) providers and establish federal staffing requirements on long-term care facilities.

Argentum will be covering the impact of the rules on assisted living communities during tomorrow's Argentum Advocates member briefing. The session will also share updates on on new long-term care workforce legislation and the forthcoming “Health Over Wealth Act,” calling for greater transparency and accountability for private equity in health care, including assisted living.

Argentum Advocates Member Briefing
Wednesday, April 24, 2024
2:00 PM ET

Read more for a detailed summary of the new rules:

The Centers for Medicare & Medicaid Services (CMS) will host an Application Office Hour on Thursday, January 11, 2024 at 2:00 p.m. ET for the "Guiding an Improved Dementia Experience" (GUIDE) model. The session will provide a brief overview of the GUIDE model and offer a forum to address questions about the model, the Request for Applications, and the application process.

Earlier today, the Centers for Medicare & Medicaid Services (CMS) announced that it is now accepting applications for the Guiding an Improved Dementia Experience (GUIDE) Model, a package of care coordination and management, caregiver education and support, and respite services to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities.

Argentum joined with a coalition of industry stakeholders to submit comments in response to the proposed rule issued in September that would establish federal staffing requirements on long-term care facilities. The rule would apply only to Medicare and Medicaid-certified skilled nursing facilities (SNFs), and not residential senior living communities.

Under CMS’s proposal, nursing homes participating in Medicare and Medicaid would be required to provide residents with a minimum of 0.55 hours of care from a registered nurse per resident per day, and 2.45 hours of care from a nurse aide per resident per day. In addition, nursing homes would also be required to ensure a registered nurse is on site 24 hours per day, 7 days per week and to complete robust facility assessments on staffing needs. CMS would also impose new reporting requirements for states to report on the percentage of nursing home Medicaid payments that go to compensation for direct care workers and support staff.

Our comments specifically called attention to potential unintended impacts of the rule on settings that are otherwise not directly impacted, due largely to the long-term care industry's workforce shortages. Earlier this year, Argentum released a report showing a need to recruit more than 20 million workers by 2040 to keep pace with our rapidly aging population. We argued in our comments that imposing a minimum staffing standard will not create more caregivers; it will simply further exacerbate the current shortage.

Argentum met with representatives from the CMS Center for Medicare and Medicaid Innovation (CMMI) yesterday to discuss the recently released Guiding an Improved Dementia Experience (GUIDE) Model, a package of care coordination and management, caregiver education and support, and respite services to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities.

The meeting provided an opportunity for Argentum to share the value of senior living for people with dementia, including care models led by Argentum member companies that better serve this population. This was Argentum's second meeting this year with CMMI where we discussed opportunities for potential cost savings to Medicare and Medicaid that could be evaluated through demonstration projects. We anticipate continued outreach to CMMI on potential new models to be deployed in senior living communities.

The GUIDE model is primarily focused on better supporting caregivers of people with dementia through care coordination (primary and behavioral health services). It calls for providing a care navigator to help access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations. GUIDE will be tested nationwide from 2024-2032 as a voluntary alternative payment model (APM) through CMMI.

Argentum submitted a comment letter last Monday in response to a proposed rule issued in May by the Centers for Medicare & Medicaid Services (CMS), intended to increase transparency and accountability, standardize data and monitoring, and create opportunities for states to promote active beneficiary engagement to improve access to care, including in home and community-based services (HCBS) programs.

We recommended that CMS withdraw the proposed rule and instead work with stakeholders to identify other approaches, particularly by addressing the inadequacy of state Medicaid reimbursement rates for assisted living and similar residential communities participating in HCBS programs.