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Senate Finance Committee Democrats have issued a request for information on long-term care reform, covering nursing home ownership transparency, staffing, training and the use of public funds. Nursing home representatives say they support several proposals but oppose reinstating the 2024 federal staffing rule; the senators are seeking feedback, not announcing a final policy.
Senate Finance Committee Democrats, led by Ranking Member Ron Wyden, have issued a request for information on long-term care reform, and nursing home providers say they support parts of the proposal while opposing a return to the 2024 federal staffing rule. The RFI asks for input on ownership transparency, workforce standards and nursing home spending, but it does not establish new requirements.
The senators’ request seeks feedback on ways to strengthen oversight and improve quality and staffing in long-term care. Proposals include restoring detailed ownership disclosures to the Centers for Medicare and Medicaid Services, scrutinizing operators’ records before ownership changes, and extending beneficial ownership reporting requirements to nursing homes. The RFI also raises the possibility of limiting private equity influence in operations.
On spending, the senators propose requiring states to report how much of their Medicare payments reaches direct care workers. They also ask about a federal minimum share of Medicare and Medicaid reimbursement that nursing homes would have to spend on direct resident care, rather than management fees, related-party rent or corporate profits. The RFI seeks views on what percentage would work; no threshold has been set.
Providers support some workforce ideas, including modernizing training and expanding caregiver pathways, but oppose reviving the 2024 staffing mandate. Zach Shamberg, chief of government affairs at Saber Healthcare Group, said he saw “real common ground” in the RFI. He backed proposals such as updating CNA training and improving accountability while saying he opposed reinstating the staffing rule. AHCA/NCAL President and CEO Clif Porter also said the organization was ready to work with lawmakers on policies supporting access, workforce and care quality.
Funding and Staffing at Issue
The proposals could affect how nursing homes are monitored, how public reimbursement is used and what staffing expectations providers face. For residents and families, the issues touch both care quality and accountability: ownership information can help regulators identify who controls facilities, while spending rules could direct more public funding toward resident care.
The disagreement over staffing shows the practical and political challenge. Senators argue that staffing standards need to improve, while provider representatives say mandates cannot work without enough available workers and funding. Shamberg’s alternative emphasis is on training, recruitment and workforce pathways. The RFI gathers perspectives on these competing approaches; it does not resolve them or demonstrate that any proposed measure would produce a particular outcome.
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Earlier Staffing Rule Reversed
The RFI describes the existing federal staffing floor as 18 minutes of direct care per resident per day, unchanged for nearly 40 years. The Biden administration’s 2024 rule would have raised the standard to 3.48 hours per resident per day and required a registered nurse on site around the clock. According to the source report, Congress blocked that rule and the Trump administration rescinded it in December 2025.
The senators point to state policies as examples for further discussion. The RFI says Massachusetts, New York and New Jersey have adopted spending requirements resembling the proposed direct-care floor. It also cites Illinois, where Medicaid payment incentives tied to staffing ratios were associated with an 11% increase in staffing from 2022 to 2026, which the RFI says was four times the national average increase over the same period. Those figures are presented as the RFI’s account of the state program.
The document also proposes updating the current 75-hour CNA training standard, of which 16 hours are clinical, and creating portable credentials and competency-based training. Other ideas include apprenticeships and a federal review of long-term care training standards every two to four years.
“There is real common ground contained in this RFI.”
— Zach Shamberg, chief of government affairs at Saber Healthcare Group
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Policy Details Remain Open
The RFI is a request for feedback, not enacted policy. The source report does not give a closing date for responses or identify a final legislative timetable. Key design questions remain open, including the proposed spending floor’s percentage, how it would apply across facilities and how CMS would assess ownership and operator history.
It is also unclear whether lawmakers will pursue limits on private equity involvement, changes to staffing measures, or updates to training requirements in legislation. Providers’ support for some elements should not be read as agreement on the full package: Shamberg specifically rejected reinstating the 2024 mandate, and the report does not say that provider groups have endorsed a replacement staffing standard.
Medicare reimbursement tracking device
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Responses Will Shape Proposals
Senate Finance Committee Democrats are seeking responses to the RFI as they consider possible changes to long-term care policy. The next step is for lawmakers to review feedback from providers and other stakeholders and decide whether to advance any proposals. Until then, the staffing threshold, spending requirement and ownership rules remain questions under discussion rather than new federal obligations.
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Key Questions
What did Senate Finance Committee Democrats announce?
They issued a request for information seeking input on long-term care reform, including nursing home ownership, spending, staffing and workforce training. The RFI itself does not create new rules.
Which proposals do nursing home providers support?
Representatives cited support for measures such as updating CNA training, expanding caregiver pathways and strengthening accountability and oversight. AHCA/NCAL said it was willing to work with lawmakers on workforce and quality policies.
Why do providers oppose reinstating the 2024 staffing rule?
Provider representatives argue that there are not enough nurses to meet the mandate and that funding is inadequate. Those are the providers’ stated objections; the RFI does not settle the dispute.
Would nursing homes have to spend a set share on direct care?
Not under the RFI alone. Senators are asking what percentage might be appropriate for a federal minimum share of Medicare and Medicaid reimbursement to go to direct resident care. No percentage has been chosen.
What happens after the request for information?
Lawmakers are expected to consider feedback before deciding whether to develop or advance policy proposals. The source report does not specify a response deadline or legislative schedule.
Source: rss
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