LSA Blog

Build Back Better Timeline Slips to January

Blog Date: 
Friday, December 17, 2021

While President Biden and Senate Democratic leadership have continued to work toward final passage of the Build Back Better Act before Christmas, they have not yet secured the support of Senator Joe Manchin (D-WV) for the bill.  Unanimous support of all 50 Senate Democrats is needed to pass the legislation under the rules of the reconciliation process.  Sen. Manchin is currently objecting to the way in which the bill extends the Child Tax Credit.  Until an agreement is reached with Sen. Manchin there are not enough votes to move the legislation, and it now appears unlikely the legislation will pass before January.

We continue to hear that the $150 billion for home and community-based services remains in the package for now, but Lutheran Services in America will continue to advocate to retain key provisions that would help address the acute direct care workforce shortage and expand access to home and community-based services including:

  • $150 billion to incentivize states to deliver or improve home- and community-based service programs, including through increasing wages and benefits for direct care workers;
  • $1 billion for a grant program funding strategies to recruit and retain direct care workers; and
  • the provisions of the WORK NOW Act to create a $50 billion grant program supporting nonprofits in paying wages and benefits.

However, there are two provisions which are problematic for our members providing skilled nursing services which we’re asking Senators to oppose and remove:

  • Mandating a registered nurse on staff 24 hours a day at skilled nursing facilities (from 8 hours/day), a late addition to the House bill and one that doesn’t include additional funding
  • Requiring a three-year study of minimum skilled nursing staff levels and that the minimums be met within one year and without additional funding

 Please join us in raising our voice to Senators on these issues through our advocacy alert.


Court Lifts Injunction on CMS Vaccine Mandate for 26 States

On Wednesday, December 15, the Fifth Circuit Court of Appeals scaled back an injunction on the Centers for Medicare and Medicaid (CMS) mandate that all eligible staff at specified health care facilities that participate in the Medicare and Medicaid programs be fully vaccinated against COVID-19 by January 4, 2022.  That injunction was originally put in place nationwide by a Louisiana-based federal judge in late November.

Under the new ruling, the injunction remains in place only for those states where judges have directly applied it.  These states are: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia, Wyoming.

It is not yet clear whether the original January 4 compliance deadline will remain in place for the remaining 26 states or be adjusted.  While CMS issued a memo earlier this month telling surveyors to pause enforcement of the mandate while any injunctions against it are in place, industry stakeholders and legal experts seem to agree that the best practice for providers is to prepare to meet the final deadline as court challenges play out.

The other two major mandates impacting employers remain at least temporarily halted nationwide. While the Biden Administration is in the process of appealing rulings, and most experts suggest that covered employers should continue planning as though they will eventually have to comply, currently those mandates may not be enforced.

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