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Senate Finance Committee Democrats have issued a request for information on long-term care reform, including nursing home ownership transparency, workforce development and spending on resident care. Nursing home representatives welcome several proposals but oppose reinstating the 2024 federal staffing rule; the senators are seeking feedback, not announcing final policy.
Senate Finance Committee Democrats have asked for input on proposals to change nursing home ownership rules, workforce standards and oversight, while providers say they support parts of the agenda but oppose restoring a 2024 federal staffing mandate. The request for information, led by committee Ranking Member Ron Wyden, is a call for feedback rather than a final legislative plan.
The RFI seeks views on requiring states to report how much of their Medicare payments reaches direct-care workers and setting a federal minimum share of Medicare and Medicaid reimbursement that nursing homes must spend on resident care. The proposal would limit the portion available for items such as management fees, related-party rent and corporate profits. The senators are asking what threshold would work; the document points to similar policies in Massachusetts, New York and New Jersey.
Other proposals target ownership disclosures and accountability. The senators want to reinstate detailed disclosures to the Centers for Medicare and Medicaid Services that were suspended by the Trump administration, extend beneficial-ownership reporting requirements to nursing homes and have CMS review an operator’s record before approving ownership changes. The RFI also raises limiting private equity involvement in nursing home operations.
Providers’ responses are supportive but qualified. Zach Shamberg, chief of government affairs at Saber Healthcare Group, told Skilled Nursing News there was “real common ground” in the RFI. He cited CNA training changes, expanded caregiver immigration pathways, quality measures and stronger accountability around ownership changes, while opposing a return to the 2024 staffing rule. The American Health Care Association and National Center for Assisted Living said it was ready to work with lawmakers on policies supporting access, workforce and care quality.
How the Proposals Could Change Care
The proposals could affect how nursing homes report ownership, use public reimbursement and demonstrate staffing levels. A federal spending floor, if enacted, could make a defined share of public payments subject to direct-care spending requirements. Ownership disclosures and review of operator histories could give regulators more information when facilities change hands. These are proposed approaches, however, and the RFI does not establish new requirements.
The staffing debate has direct implications for residents and providers. The senators argue that staffing standards should be paired with better wages and training pipelines. Provider representatives say a mandate without enough available nurses or funding would not add caregivers. Their disagreement leaves open how any future policy might balance staffing expectations with workforce supply and the cost of meeting them.
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The Staffing Rule Dispute
The RFI describes the current federal staffing floor as 18 minutes of direct care per resident per day, a standard it says has not changed in nearly 40 years. The Biden administration’s 2024 rule would have raised the minimum to 3.48 hours per resident per day and required a registered nurse on-site around the clock. Congress blocked the rule, and the Trump administration rescinded it in December 2025.
Rather than relying only on a minimum staffing mandate, the RFI also proposes revising training and measurement. Ideas include updating the 75-hour CNA training requirement, creating portable credentials, expanding apprenticeships and adding a measure of day-to-day staffing variation to the Five-Star Quality Rating. The document cites Illinois, where staffing levels rose 11% from 2022 to 2026 under value-based Medicaid incentives, as an example; it says that growth was four times the national average over the same period.
The senators also connect the reform effort to Medicaid financing, arguing that nearly $1 trillion in Medicaid cuts in the 2025 federal budget reconciliation law have harmed long-term care and make action urgent. That is the lawmakers’ assessment stated in the RFI, not an independently established finding in the source report.
““There is real common ground contained in this RFI.””
— Zach Shamberg, chief of government affairs at Saber Healthcare Group
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What the RFI Leaves Open
The RFI does not specify a final spending-floor percentage, nor does it lay out finalized legislative language or a timetable for action. It is not clear which proposals, if any, will be introduced as bills or gain support beyond the Democrats who issued the request. The source report also does not provide the full text of providers’ objections to the staffing mandate or details of the particular changes they would accept.
The practical effects of proposals such as expanded ownership reporting, limits on private equity involvement and new staffing metrics would depend on how lawmakers define them and how agencies implement them. The RFI’s claims about Medicaid cuts and Illinois staffing results are attributed to the senators’ document; the report does not independently assess their methods or broader effects.
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Feedback Before Policy Decisions
The immediate next step is for stakeholders to respond to the senators’ request for information. The committee can use those submissions to assess possible policy options, including the spending threshold, training standards and methods for measuring staffing. The source report does not state a response deadline or a date for a hearing, bill or committee vote.
Providers have signaled willingness to discuss training, workforce recruitment and oversight while continuing to resist a return to the 2024 staffing rule. Any later proposal would need to clarify whether it includes funding or workforce measures alongside staffing expectations, and how ownership and payment requirements would be enforced.
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Key Questions
Have the proposed nursing home reforms become law?
No. The Senate Finance Committee Democrats issued an RFI seeking feedback. It is not a law or a final set of requirements.
What changes are providers supporting?
Provider representatives cited CNA training updates, expanded caregiver recruitment pathways, quality improvements and stronger accountability for ownership changes. Their support is not blanket support for every proposal in the RFI.
Why do providers oppose restoring the 2024 staffing rule?
Shamberg said he opposed reinstating it. The report says providers argue that there are not enough nurses to meet the mandate and no funding to pay for it, and favor workforce training and recruitment measures instead.
What ownership changes are under consideration?
The RFI seeks feedback on restoring detailed CMS ownership disclosures, extending beneficial-ownership reporting to nursing homes and scrutinizing operators’ records before ownership changes. It also raises limiting private equity involvement.
What happens after the request for information?
Lawmakers can review responses and decide whether to develop legislation or pursue other policy steps. The report does not give a deadline or confirm a next hearing or vote.
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