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Aging Policy in 2025: Rhode Island Legislative Wins and What’s Missing

Published in RINewsToday.com, July 14, 2025 

On June 24, 2025, with a 35-2 vote in the Senate, the Rhode Island General Assembly has given its approval to a $13.963 billion budget for the 2026 fiscal year that directs additional funding toward addressing the state’s housing and homelessness crisis, improving access to health care, supporting municipalities through increased revenue sharing, more funding for the state’s Rhode Island Public Transit Authority, extending childcare subsidies for toddlers and infants, and increasing Medicaid reimbursement to primary care providers, nursing homes and hospitals, among its directives.

Faced with a slowing economy and impending federal budget cuts, lawmakers were tasked with closing a $250 million deficit without resorting to broad tax hikes or cuts to essential services. To generate revenue, they implemented new electric vehicle (EV) registration fees, adjustments to the gas tax, and increases in real estate conveyance and hotel taxes. Additionally, tolls on large trucks (18-wheelers), which were approved in 2016 but delayed due to litigation from the trucking industry, are now set to be implemented following the state’s legal victory. The FY 2026 budget includes revenue from these tolls, which are scheduled to take effect.

According to Larry Berman, House Director of Communications, when the dust settled at the conclusion of this year’s 164-day legislative session, lawmakers introduced 1,430 bills and resolutions in the House and 1,165 in the Senate. Of those, the Governor signed 384 House and Senate bills into law, while another 125 became law without his signature.

The Governor is not required to act on resolutions. During the session, the House passed 238 resolutions and the Senate passed 127, most of which expressed congratulations or condolences, says Berman.

As Rhode Island’s population continues to age, advocacy organizations urged lawmakers to consider an array of legislation aimed at enhancing the delivery of state programs and services for older residents—and strengthening protections for their health, safety, financial security, and overall well-being.

Below is a selection of key laws enacted, organized by category:

Healthcare and Insurance

Lawmakers increased insurance coverage for hearing aids from $1,500 to $1,750 per ear, applicable to all ages. Additionally, the new law allows for hearing aid purchases every year, rather than every three years. Sponsored by Rep. Carol Hagan McEntee (D-Dist. 33, South Kingstown, Narragansett), H 5218,  and Sen. Leonidas P. Raptakis (D-Dist. 33, Coventry, West Greenwich, S 0120, this legislation has been signed by the Governor.

The General Assembly passed S 0610B introduced by Senate President Valarie J. Lawson (D-Dist. 14, East Providence) and Rep. Kathleen A. Fogarty’s (D-Dist. 35, South Kingston), bill, H 5494A.  The new law provides new consumer protections for Medicare Supplement Insurance (Medigap) and aligns Rhode  Island’s market with neighboring states. Additionally, the budget expanded the Medicare Savings Program, helping more beneficiaries with premiums and co-pays.

With the passage of S 0169A  sponsored by Sen. Jacob E. Bissaillon (D-Dist. 1, Providence) and H 5184A by Rep. Mary Ann Shallcross Smith (D-Dist. 46, Lincoln, Pawtucket), the new law protects homeowners from medical debt-related liens on their primary residence. Medical bills are among the top reasons underlying bankruptcy among Americans. This law takes effect on Jan. 1.

Senate President Lawson and Rep. Joshua J. Giraldo (D-Dist. 56, Central Falls) sponsored S 0974aa and H 6066A to expand paid family leave under the Temporary Care Insurance (TCI) program. Starting in January 2027, the TCI wage replacement rate will increase from 60% to 70%, and then to 75% in January 2028. This expansion is funded through a modest increase in the payroll contribution cap, which will not impact the state budget.

Consumer Protections and Financial Legislation

The General Assembly passed S 0016A and H 5121A, introduced by Senate Artificial Intelligence & Emerging Technologies Committee Chairwoman Victoria Gu (D-Dist. 38, Westerly, Charlestown, South Kingstown) and Rep. Julie A. Casimiro (D-Dist. 31, North Kingston, Exeter). Signed by the Governor, the new law aims to prevent scams involving cryptocurrency ATMs, a growing fraud scheme in Rhode Island. 

According to AARP, recently 11 states have passed laws or regulations that put key consumer fraud protections on cryptocurrency ATMs in place. Americans lost more than $246 million to crypto ATM fraud and scams in 2024 alone, and older adults are disproportionately targeted by criminals.

With the passage of H 5042A and S 0229A, sponsored by Rep. Karen Alzate (D-Dist. 60, Pawtucket, Central Falls) and Sen. Ana B. Quezada (D-Dist. 2, Providence), a new law eliminates the special exemption that allowed payday lenders to charge exorbitant interest rates of up to 260% APR. This reform helps protect consumers from falling into predatory debt cycles.

Lawmakers passed H 5185A and S 0133A sponsored by Rep. Susan R. Donovan (D-Dist. 69, Bristol, Portsmouth) and Sen. Matthew L. LaMountain (D-Dist. 31, Warwick, Cranston).  Signed into law by Gov. Dan McKee, it prohibits predatory real estate practices that often target older homeowners, preventing them from facing liens or other issues related to their properties.  The bill is based on model legislation that has been adopted in 30 other states. The legislation was backed by AARP, the American Land Title Association and the National Association of Realtors.

Support for Vulnerable Populations

Rep. Tina L. Spears (D-Dist. 36, Charlestown, New Shoreham, South Kingstown, Westerly) and Sen. Todd M. Patalano (D-Dist. 26, Cranston) sponsored H 6165A and S 0983A to create the PURPLE Alert system. Signed into law, this new initiative is designed to quickly locate missing adults with serious disabilities whose health and safety are at risk.

Legislation (S 0381A / H 5833A), sponsored by Senate Majority Leader Frank A. Ciccone III (D-Dist. 7, Providence, Johnston) and Rep. Mary Ann Shallcross Smith, now law, allows licensed hairdressers to provide in-home services to individuals with special needs or sensory-related disorders. This new law ensures that such services are provided in accordance with individual care plans verified by a licensed healthcare professional.

Now law, (H 5017A/ S 0884), sponsored by Rep. Samuel A. Azzinaro (D-Dist. 37, Westerly),  and Sen. Walter S. Felag Jr. (D-Dist. 10, Warren, Bristol, Tiverton), protects veterans from improper conduct or excessive fees by individuals assisting them in filing disability claims with the Department of Veterans Affairs, except as authorized by federal law, and it imposes penalities under the deceptive trade practices provisions.

The General Assembly passed legislation (S 0884 / H 5017A) that grants people the right to repair their own complex power wheelchairs and mobility aids. Sponsored by Sen. Mark McKenney (D-Dist. 30, Warwick) and Rep. Grace Diaz (D-Dist. 11, Providence), this new law requires manufacturers to provide independent service providers with the necessary tools and repair information. Under the new law, manufacturers are prohibited from using parts that would prevent installation of any non-manufacturer-approved replacement part or component. Also, a health plan’s coverage and payment is not allowed to require any form of prior authorization or medical documentation to complete repairs for consumer-owned complex rehabilitation technology.

Deputy Majority Whip Mia A. Ackerman (D-Dist. 45, Cumberland, Lincoln) and Sen. Pamela J. Lauria (D-Dist. 32, Barrington, Bristol, East Providence) introduced H 5619 and S 0481, directing the Department of Health to collaborate with the state’s advisory council on Alzheimer’s to distribute educational materials. With the bill’s passage, signed into law, these resources will help  educate both the public and medical providers on prevention, early detection, and management of Alzheimer’s and dementia.

Legislative Changes and Reforms

Sen. Melissa Murray (D-Dist. 24, Woonsocket, North Smithfield) and Rep. Brandon Potter (D-Dist. 16, Cranston) sponsored legislation (S 0120, H 5218) to create a three-year pilot program to remove prior authorization requirements for medically necessary care ordered by primary care providers.  Now law, the program is designed to reduce administrative delays and improve patient access to timely care.

Two bills sponsored by Sen. Pamela Lauria and Rep. Michelle McGaw (D-Dist. 71, Portsmouth, Tiverton, Little Compton) improve pharmacy flexibility. The first (H 5633, S 0483aa) allows pharmacists to dispense a one-time refill for up to 100 days if the prescriber is unavailable. The second bill (S 0482A H 5855A) simplifies the process for substituting therapeutically equivalent prescription drugs or devises. Such substitutions typically occur at the request of an insurer, and the current process requires the pharmacist to contact the patient’s prescriber for approval before filling it.

Observations from Aging Advocates:

Lori Light, the state’s Long-Term Care Ombudsman, frequently observes that facility staff accused of abuse are often terminated from one facility only to be rehired by another, with the new administrator unaware of the prior allegations. “While it is important not to penalize individuals based on unproven claims, we believe that repeated allegations involving the same staff member across multiple facilities are unlikely to be coincidental and suggest a recurring issue,” she says.

To address this, H 5303 was introduced to make the complaint histories of licensed care staff accessible to prospective employers. Light expressed disappointment that this bill did not become law and hopes to work closely with the state’s Department of Health to revise and reintroduce it next year.

“We were pleased to see that the Safe Staffing and Quality Care Act, initially passed in 2021, was amended by the state budget to allow for enforcement,” says Light. While she acknowledges that the revised law may not provide the same level of benefit to nursing home residents as originally intended, she recognizes it as a step forward.

Light also expressed disappointment that the Assisted Living Resident Empowerment Act (H5169, S484) did not pass. “Assisted living facilities remain under-regulated, with fewer resident rights despite high monthly costs and regular rate increases,” she said. The unsuccessful legislative change would have strengthened resident and family councils and improved financial transparency within these facilities.

“It’s unclear why the Department of Health’s legislation (H5426, S789), which would have increased financial transparency in nursing homes and limited equity extraction, failed to advance this year, despite having the governor’s support,” says Light. She notes that this is the second year the bill has been introduced.

“With more out-of-state investor groups acquiring facilities, it is critical to ensure that public Medicaid dollars are spent on resident care, not diverted to investors,” she emphasizes, recognizing that the bill represented a modest but essential step in that direction. “We anticipate that RIDOH will reintroduce the bill next session, and we remain committed to supporting it,” she says.

Carol Anne Costa, executive director of the Senior Agenda Coalition of RI (SACRI), notes, “SACRI worked closely with many agencies and individuals in the aging network to advance our legislative agenda. Collaboration is always beneficial for passing good laws, and more importantly, it strengthens the fabric of the coalition,” she says.

Costa continues, “SACRI fully intends to resume pushing for the passage of unsuccessful legislation in the next session, including expanded accessibility in new housing, the development of more housing for older adults, nursing home patient welfare, and assisted living resident councils. Additionally, SACRI will be closely monitoring the impact of the Trump’s Reconciliation Bill on Rhode Island.”

SACRI Policy Advisor Maureen Maigret adds, “It was absolutely wonderful to see the FY 2026 bill include a provision to increase the income eligibility for the Medicare Savings Programs (MSP), which was SACRI’s top legislative priority for 2025.”

Maigret notes that SACRI has worked tirelessly since 2013 to expand the MSP program. “These efforts finally paid off, thanks to the incredible support from community partners and legislative champions, including House Speaker  K. Joseph Shekarchi (D-Dist. 23, Warwick), lead sponsors Sen. Louis DiPalma and Rep. Karen Alzate, and many legislative co-sponsors.”

“Once eligibility is increased, as called for in the budget, potentially several thousand current MSP participants will have their co-payments covered, and thousands more Medicare enrollees will no longer have to pay for their Part B premiums (currently $185/month). These savings will help pay for other basic needs, such as food,” says Maigret.

Rhode Island’s 2025 legislative session brought meaningful advances for older adults, including expanded healthcare coverage, stronger consumer protections, and new programs supporting vulnerable populations.  Despite these successes, important bills on long-term care staff accountability, assisted living oversight, and nursing home financial transparency did not pass, leaving critical issues unresolved.

Expect committed aging organizations and advocates to return next year to advance these and other unfinished legislative priorities including promoting development of accessible housing for those with mobility impairments and caregiver tax credits to help ease the financial burden on unpaid family caregivers.

For a reporting of the provisions in the FY 2026 Rhode Island budget, visit https://rinewstoday.com/house-finance-committees-fy-26-budget-boosts-support-for-older-rhode-islanders-herb-weiss/.

Bipartisan efforts strengthens the Dementia public health infrastructure

Published in RINewsToday on December 2, 2024

In the waning days of the Biden administration, Congress has moved one step closer to assisting states to continue to effectively implement dementia interventions.  Following passage of H. R. 7218 on Sept. 17th, by voice vote on Nov. 21st, the U.S. Senate passed S. 3775, also without objection. At press time, the bipartisan legislation now heads to President Biden’s desk to be signed into law.

Once signed, the new law re-authorizes the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act (P.L.115-406) enacted in 2018, empowering public health departments across the country to implement effective dementia interventions in their communities.

In a March 2024 fact sheet, the Alzheimer’s Impact Movement (AIM) calls for Alzheimer’s and other dementias to be considered an urgent public health issue, noting that nearly 7 million seniors across the nation are currently living with Alzheimer’s.

While partisan bickering has reduced the number of bills passed during the 118th Congress, Democratic and Republican lawmakers seek solutions for containing the skyrocketing costs of care, finding a cure for debilitating brain disorders, and supporting caregivers. 

The nation spends more than $360 billion per year, including $231 billion in costs to Medicare and Medicaid. Barring any major breakthroughs to prevent, slow down, or cure Alzheimer’s, the number of Americans with Alzheimer’s is expected to double by 2060, costing the nation more than $1.1 trillion per year, says AIM’s Fact Sheet.

Congress continues funding of Dementia effective interventions

In the Senate, S. 3775 was spearheaded by Sens. Susan Collins (R-ME) Catherine Cortez Masto (D-NV), Tim Kaine (D-VA), and Shelley Moore Capito (R-WV), and cosponsored by Sens. Jack Reed and Sheldon Whitehouse.  It’s companion measure, H.R. 7218, was introduced in the House by Reps. Brett Guthrie (R-KY), Chairman of the Health Subcommittee of the House Energy & Commerce Committee, along with Chris Smith (R-NJ), Paul Tonko (D-NY), and Maxine Waters (D-CA).

With its enactment in 2018, P.L. 115-406 accelerated a multi-pronged public health approach to reduce risk, detect early symptoms, advance care, improve data, and ultimately change the trajectory of this devastating disease.

Headed by the Centers for Disease and Prevention (CDC), the reauthorization would authorize $33 million per year, in line with current appropriations, over the next five years to support:

1.  Alzheimer’s Disease and Related Dementias Public Health Centers of Excellence dedicated to promoting effective Alzheimer’s disease and caregiving interventions, as well as educating the public on Alzheimer’s disease, cognitive decline, and brain health. 

2.  Public Health Cooperative Agreements with the CDC that are awarded to State Health Departments to help them meet local needs in promoting brain health, reducing risk of cognitive decline, improving care for those with Alzheimer’s, and other key public health activities. 

3.  Data Grants to improve the analysis and timely reporting of data on Alzheimer’s, cognitive decline, caregiving, and health disparities at the state and national levels.

Since the original Bold Infrastructure for Alzheimer’s Act passed, the CDC has made 66 awards to 45 state, local and tribal public health departments to help them implement effective dementia interventions such as reducing risk, increasing early detection and diagnosis, and supporting the needs of caregivers.

“Alzheimer’s disease is one of the greatest and most under-recognized public health threats of our time. Nearly seven million Americans—including 29,600 Mainers—are living with the disease, and that number is soaring as our overall population grows older and lives longer,” said Maine Sen. Collins, a founder and Senate co-chair of the Congressional Task Force on Alzheimer’s Disease in a statement announcing the passage of the legislation.  

“The passage of this bipartisan legislation is a tremendous victory for families and communities nationwide. By reauthorizing the BOLD Infrastructure for Alzheimer’s Act, we are reaffirming our commitments to providing the tools needed to fight this devastating disease, and to not let Alzheimer’s be one of the defining diseases of our children’s generation as it has ours,” says Collins.

“Since the original BOLD Infrastructure for Alzheimer’s Act passed, public health departments have been able to improve brain health across the life course in their communities,” said Robert Egge, Alzheimer’s Association chief public policy officer and AIM president. “The BOLD Reauthorization Act will help public health departments implement effective strategies that promote brain health, address dementia, and support individuals living with dementia and their caregivers,” said Egge. “We urge the President to support the Alzheimer’s community and swiftly sign this bipartisan bill into law,” he says.

Rhode Island response

“Getting this bill across the finish line is a win for the 25,000 Rhode Islanders living with Alzheimer’s, their adult children who work tirelessly as unpaid family caregivers, and for the health and economic needs of the next generation too.  We must continue the progress we’ve made against Alzheimer’s.  We’ve got to find better treatments for Alzheimer’s and related dementias. The federal government must do its part to reduce risk, detect early symptoms, and advance care while lifting the burden on unpaid caregivers,” said RI Sen. Reed.

Since the original BOLD Infrastructure for Alzheimer’s Act passed in 2018, Reed noted that the Rhode Island Department of Health (RIDOH) has been awarded $3.8 million in BOLD Infrastructure for Alzheimer’s Act grants from the CDC. RIDOH has used the federal BOLD grant funds to help to implement effective Alzheimer’s interventions, including boosting early detection and diagnosis, reducing risk, and preventing avoidable hospitalizations, he says.

Victoria O’Connor, program manager at the RIDOH’s Alzheimer’s Disease and Related Disorders (ADRD), who chairs the state’s Advisory Council on ADRD, agrees with Sen. Reed’s assessment about the positive impact of this federal grant on state-wide public health interventions for those caring for persons with dementia.

“The RIDOH Alzheimer’s Disease and Related Disorders Program leads a statewide Advisory Council, convening critical partners, subject matter experts, and people with lived experience to advise implementation of the BOLD funded workplan as well as oversee the Rhode Island State Plan on Alzheimer’s Disease and Related Disorders 2024-2029. This collaborative approach has led to successful implementation of public health interventions statewide that aim to empower all individuals impacted by dementia to achieve their best quality of life.” says O’Connor.

Other congressional actions to combat Alzheimer’s  

Earlier this year, Sen. Reed helped pass the National Alzheimer’s Project Act (NAPA) Reauthorization Act and the Alzheimer’s Accountability and Investment Act (AAIA).  Sen. Whitehouse was also a cosponsor of the National Alzheimer’s Project Act (NAPA) Reauthorization Act.  Both bills were signed into law by President Biden. 

The NAPA Reauthorization Act (P.L.,118-93) reauthorizes NAPA through 2035, considered a roadmap to coordinate federal efforts in responding to Alzheimer’s and other forms of dementia.  Since NAPA was first passed in 2011, Alzheimer’s research funding has increased seven-fold.  Today, funding for research into Alzheimer’s and other dementias totals over $3.8 billion.

The Alzheimer’s Accountability and Investment Act (P.L. 118-93) would require the Director of the National Institutes of Health (NIH) to submit an annual budget to Congress estimating the funding necessary to fully implement NAPA’s research goals.  This will help ensure Congress can make a well-informed decision to determine necessary Alzheimer’s research funding levels.

We have made tremendous progress in recent years to boost funding for Alzheimer’s research, which holds great promise to end this disease that has had a devastating effect on millions of Americans and their families,” said Sen. Collins, who authored NAPA and AAIA.

“These two bills will maintain our momentum and make sure that we do not take our foot off the pedal just as our investments in basic research are beginning to translate into potential new treatments. We must not let Alzheimer’s to be one of the defining diseases of our children’s generation as it has ours,” she says.

And as a member of the Appropriations subcommittee that oversees funding for the National Institutes of Health (NIH), Sen. Reed helped provide a $275 million increase for Alzheimer’s disease research in the fiscal year 2025 Senate Labor, Health and Human Services, Education, and related Agencies Appropriations bill.  In 2019, NIH awarded Brown University researchers, along with Boston-based Hebrew SeniorLife (HSL), over $53 million in federal research funds  to lead a nationwide effort to improve health care and quality of life for people living with Alzheimer’s disease and related dementias, as well as their caregivers.

Advocates, providers on new Nursing Home mandates

Published in RINewsToday on April 29, 2024

In the shadow of Rhode Island’s ongoing staffing shortage, the Center for Medicare and Medicaid Services (CMS) issued its 329-page final rule on Nursing Home Minimum Staffing Standards (CMS 3442-F) on April 22 in the Federal Rule. 

CMS affirmed its commitment to hold nursing homes accountable for providing safe and high-quality care for the nearly 1.2 million residents living in Medicare-and Medicaid-certified long-term care facilities.  

According to CMS, over 46,000 public comments submitted in response to the proposed rule. Central to this final rule are new comprehensive minimum nurse staffing requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.

Just the Nuts and Bolts

CMS say that central to its final rule are new comprehensive minimum nurse staffing requirements that would significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.  The agency is finalizing a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Facilities are given the flexibility to use any combination of nurse staff (RN, licensed practical nurse [LPN] and licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.

CMS is also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

This final rule provides a staggered implementation timeframe for facilities to meet the minimum nurse staffing standards and 24/7 RN requirement based on geographic location as well as possible exemptions for qualifying facilities for some parts of these requirements based on workforce unavailability and other factors. The requirements of this final rule prioritize safety and health care quality while taking into consideration the unique workforce challenges some nursing homes are facing, especially those operating in rural areas. 

CMS will closely monitor and evaluate the provisions of this final rule, including but not limited to, the minimum staffing standards, the 24/7 RN requirement, the exemption process, and the definition of rural, as they are implemented over the next several years to determine whether any updates or changes are necessary in the future. 

Additionally, to increase transparency related to compensation for workers, CMS will also require states to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

Provider, advocate positions on new CMS final rule

At press time, the RI Department of Health (RIDOH) had no comments about CMS’s new final rule released last week, say Joseph Wendelken, RIDOH’s public information officer.  The state agency is reviewing the rule and assessing its impact and applicability in Rhode Island,” he says.

With the final rules release, senior advocates and providers are expressing their opinion about its impact.

Former President Donald Trump, who is challenging President Joe Biden for the presidency, has not addressed quality of care in nursing homes with a formal position.  Kathleen Heren, Rhode Island’s Ombudsman, speculates that by releasing the CMS mandate before the upcoming presidential election, President Biden is just trying “to establish a record” of enhancing quality of care in nursing homes.

“Nursing homes cannot find  Registered nurses (RN), and Nursing Assistances to hire,” notes Heren.  The CMS mandate will force nursing homes to downsize, like we have just seen happen at the Scandinavian Home,” she predicts.

According to Heren, the final CMS rules do not include the minimum staffing of LPNs. More important, “it’s an unfunded mandate,” she says.

Gerontologist Deb Burton, MS, executive director of RI Elder Info, is pleased to see a Federal minimum staffing mandate of 3.48 hours of daily nursing care. “It’s important to understand mandates don’t make workers appear and a minimum staffing mandate is only an average amount of time allotted for care across all residents in the facility,” she says, noting that this rule doesn’t mean each resident will receive 3.48 hours of care each day.

According to Burton, the CMS Nursing Home Compare website, as of April 2024, notes there are 6 Rhode Island facilities that would not meet the lower federal minimum staffing mandate if it were enacted today. “The workforce shortage and the dire need to increase Medicaid reimbursements to attract and retain adequate staff with a proper wage are common topics of meetings,” says Burton. 

“When workers say ‘It’s only me on the floor – do I help the resident eat their supper or take the other resident to the bathroom? I can’t do both,’ – we need to listen,” says Burton. “The new federal minimum staffing mandate is a good step forward, but we need more. One day it will likely be us waiting for that workers’ help,” she warns. 

Like other RI senior advocates, Maureen Maigret, policy director for the Senior Agenda Coalition of RI, sees the importance of CMS releasing its final rules.  “It is important that these regulations have been finalized as providing for minimum nurse staffing levels in nursing homes helps  ensure residents across the country will receive quality and resident-centered care,”  she says. 

According to Maigret, Rhode Island has had a provision for 24/7 RN coverage even before the state’s minimum staffing law was passed so that is not a new requirement here. She pointed out the regulations will also promote transparency and accountability by requiring public reporting on how much of the Medicaid payments are spent on direct care staff and that the federal government has committed to invest over $75 Million in an initiative to increase the number of nurses working in nursing homes through such things as financial incentives for tuition reimbursement.   

“We are dismayed that the Biden Administration is moving forward with this one-size-fits-all staffing mandate,” says John E. Gage, President and CEO of the Rhode Island Health Care Association. “In the midst of a historic and deepening caregiver shortage, this unrealistic policy will put access to care at risk for countless seniors in Rhode Island and across the country,” he warns, noting that when nursing homes can’t find nurses and/or certified nursing assistants (CNAs), they will be forced to downsize or, even worse, close their doors altogether, leaving seniors with fewer options to receive the care they need.

New final rule just another unfunded mandate

Like the 2021 RI staffing law, the Federal rule is an unfunded mandate, charges Gage. “Every nursing home wants more workers, but rather than blanket mandates from Washington, we need supportive policies and investments that will help us recruit and retain caregivers, he states.

According to Gage, nationally, the nursing home workforce has declined by 124,200 individuals (-7.8%) since the start of the pandemic. Rhode Island’s numbers are even worse, down 1,495 individuals (-15.3%). Gage calls on Congress to step up and support the bipartisan Protecting America’s Seniors’ Access to Care Act, which would prevent CMS from enforcing this unfunded and flawed mandate.

“Together with our national association, the American Health Care Association (AHCA), we will continue to fight for more common-sense solutions and do everything we can to preserve access to care for Rhode Island seniors,” says Gage.

“The good news about the Biden Administration’s final rule, there are phase-ins over multiple years that will provide an opportunity to challenge the mandates through legislation and/or possible AHCA litigation on the national level,” adds Gage. “The federal mandate highlights how much of an outlier RI’s staffing mandate is.  The RI statute has the highest staffing metrics and the highest fines in the country – 10% above the federal standards.  Without the Executive Actions of Governor McKee, RI nursing homes would be fined $90 million in the first full year of enforcement – devastating facilities and forcing further closures.  RI excludes hours worked by administrative nurses from counting toward the RN metric, yet they are included in the federal standards.  RI also excludes med techs’ and nurse aides in training’s hours from the CNA metric, while CMS includes them,” noted Gage.

Gage adds that the CMS final rules consider Rhode Island to be “urban.” As a result, the state has 2 years to phase-in the 24×7 RN requirement.

Rhode Island regulations and law have required 24×7 RN coverage in nursing homes for many decades, says Gage. “While challenging to maintain compliance given the shortage of registered nurses, this should not be a major concern for RI facilities,” he adds, noting that there will be 3 years to comply with the required 0.55 HPRD for RNs and 2.45 HPRD for CNAs. 

Additionally, Gage says that there are also waiver opportunities in certain circumstances.  “During the implementation phase, facilities and all stakeholders must be laser-focused on building a sufficient pipeline of qualified nurses and CNAs to the nursing home workforce,” he says.  

Like Gage, James Nyberg, executive director LeadingAgeRI, sees the CMS mandate as less onerous than the RI staffing mandate that “fortunately” remains suspended. “We remain concerned about the impact of this national mandate on providers in Rhode Island, and its broader impact on consumers and the health care industry,” he says.

According to Nyberg, the state’s current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (six nursing homes have already closed since the COVID pandemic began and two more have embarked on significant downsizing). 

“These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes,” says Nyberg, noting that LeadingAgeRI is working with numerous stakeholders on various initiatives to develop a pipeline of workers. “But the simple fact is that it will take time and an infusion of resources,” he adds.

“CMS proposes to spend $75 million on a nursing home staffing campaign.  That amount might help a state like Rhode Island, but that money is national, so it is a drop in the bucket in terms of the support the industry needs, states Nyberg.  “On the home front, we have been working with the Administration and the General Assembly to provide an infusion of funding to try and rescue the homes from their dire financial straits and try to stabilize the industry.  But the federal mandate, and all the related details and requirements embedded in the rule, do nothing to further that cause,” he says.

For the Minimum Nursing Standard final rules, go to https://public-inspection.federalregister.gov/2024-08273.pdf

For the CMS Fact Sheet  on Minimum Nursing Standard final rules, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0