Thousands of long term and post-acute care professionals are facing very real impacts that decisions made in Washington, D.C., have on centers across the nation. This year, two issues have risen to the top of the list of priorities for those advocating for the industry: the Centers for Medicare and Medicare Services’ (CMS) Fiscal Year (FY) 2023 Proposed Payment Rule and the ongoing workforce shortage within long term and post-acute care. Read on for details of each issue and how leaders can ask for the best solution from their elected officials at the local, state, and federal levels.

Issue 1: CMS Payment Rule

CMS has proposed a payment rule that would negatively impact the skilled nursing facility (SNF) sector by $320 million.

The Request: CMS should consider public comments from the sector regarding the appropriate percentage methodology before determining the final parity adjustment. CMS also should work with the sector to ensure the annual Market Basket update adequately accounts for labor cost increases. CMS should phase in any reduction over three years to allow the sector to create realistic adjustments in operations to guarantee the continuity of quality care.

The Background: For FY 2023, CMS has proposed a skilled nursing facility net rate cut of 0.7 percent, resulting from a 3.9 percent adjusted market basket increase offset by a 4.6 percent parity adjustment reduction. CMS is proposing a parity adjustment to ensure costs under the new payment system, the Patient-Driven Payment Model (PDPM), are no more than under the old payment system. CMS is not required by law to use a budget neutral transition. Due to the proposed parity adjustment, CMS estimates that the net market basket update would decrease Medicare SNF payments by approximately $320 million. The SNF sector cannot absorb such a cut.

The Impact: Due to ongoing workforce issues and low occupancy rates, labor costs have increased by nearly 18 percent in a single year, according to the Clifton Larson Allen State of the SNF Industry Report published in February 2022. These increased costs, combined with a nominal improvement in census rates from about 73 percent to 76 percent in 2022, mean residents and patients are facing a real risk of displacement as centers grapple with sustaining operations on a projected negative 4.8 percent margin. This CMS rate cut would increase the projected margin to -5.9 percent, creating additional risk of closures and displacement.

Issue 2: The Workforce Crisis

Providers are experiencing a loss of staff due to pandemic impacts and lack of supply and availability of staff to fill vacancies.

The Request: Policymakers must prioritize the nation’s caregivers with the resources and support they deserve, specifically through the recruitment and retention of the long term care workforce.

The Background: A recent report from AHCA/NCAL summarized Bureau of Labor Statistics (BLS) data showing that that long term care facilities have lost more than 400,000 caregivers since the beginning of the pandemic, more than any other health care sector. According to the BLS, overall long term care workforce levels are the lowest they have been in 15 years. Nearly every nursing home and assisted living community in the United States is facing a workforce crisis

In addition, the issue of potential anti-competitive practices by temporary staffing agencies is a concern in nursing homes and assisted living communities. At a time when long term care facilities are struggling to make sure they have enough staff to serve their residents and keep their doors open, staffing agencies are charging exorbitant rates and giving only a fraction to their clinical personnel.

The Impact: Without support from policymakers, the long term care sector is facing decisions and scenarios that put the care of our nation’s seniors and individuals with disabilities at risk. Staffing shortages are forcing many facilities to limit admissions or close their doors completely. Notably, at least 75 percentof operators had to limit admissions in 2021 due to a lack of staff, according to a survey of more than 300 long term care owners, operators, and administrators. More than 300 nursing homes have closed since the pandemic began, according to data available through Quality, Certification, & Oversights Reports. The sector cannot continue without new and/or reinforced support from the nation’s leaders.

To learn how to get involved in your community’s grassroots advocacy efforts, contact AHCA/NCAL’s Advocacy team at