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Senate Finance Committee Democrats have asked for input on proposals to change nursing home ownership disclosure, spending oversight and workforce policy. Provider representatives expressed support for several ideas, including better training and accountability, but opposed bringing back the 2024 federal staffing mandate. The request for information seeks feedback; it does not itself establish new requirements.
Senate Finance Committee Democrats, led by Ranking Member Ron Wyden, have issued a request for information on reforms to the long-term care system, including nursing home ownership transparency, spending oversight and workforce policy. Provider representatives say they support parts of the agenda, such as improved training and stronger accountability, but oppose reinstating the 2024 federal staffing rule.
The request for information, or RFI, asks for feedback on ways to improve nursing home quality and workforce conditions. Among its proposals are requiring states to report how much Medicare spending reaches direct care workers and setting a federal minimum share of Medicare and Medicaid reimbursements that nursing homes must spend on resident care. The senators are seeking input on what that threshold should be. The proposal would direct attention away from spending on management fees, related-party rent and corporate profits, but the RFI does not set a percentage.
The senators also seek to restore detailed ownership disclosures to the Centers for Medicare and Medicaid Services, which the source report says were suspended by the Trump administration. Other ideas include extending beneficial-ownership reporting requirements to nursing homes, limiting private-equity involvement and having CMS examine an operator’s record before approving an ownership change. These are proposals for feedback, not enacted rules.
Zach Shamberg, chief of government affairs at Saber Healthcare Group, told Skilled Nursing News that the RFI contains “real common ground.” He cited fixing barriers to certified nursing assistant training, updating training requirements, expanding immigration pathways for caregivers, and strengthening oversight through established ownership-change policies. Shamberg said he opposes bringing back the 2024 staffing rule. AHCA/NCAL President and CEO Clif Porter also said the group was willing to work with lawmakers on policies supporting access, workforce development and care quality.
How the Proposals Could Affect Care
The proposals address how nursing homes disclose ownership, allocate public reimbursement and recruit and retain workers. If adopted, a federal spending floor could require facilities to direct a defined portion of public payments to resident care. Additional ownership reporting and scrutiny could give regulators and families more information about who controls a facility and an operator’s history. The RFI does not establish that these measures would improve outcomes; their effects would depend on the final policy design and implementation.
The staffing debate is especially consequential because the proposals combine workforce standards with questions about worker supply, training and wages. Providers’ support for training changes alongside opposition to the prior mandate points to a policy disagreement over whether stronger staffing requirements can be met without additional funding and available workers. The senators’ request seeks views on options rather than resolving that dispute.
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The Staffing Rule and State Models
The RFI describes the existing 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 required 3.48 hours of nursing care per resident per day and an on-site registered nurse around the clock. According to the source report, Congress blocked the rule and the Trump administration rescinded it in December 2025.
The senators point to state approaches as examples for further discussion. The RFI says Massachusetts, New York and New Jersey have enacted spending requirements similar to the proposed federal floor. It also cites Illinois, where Medicaid payment incentives linked to staffing ratios were associated with an 11% increase in staffing levels from 2022 to 2026; the RFI says that growth was four times the national average over the same period. Those figures describe the RFI’s account of the state program, not a national forecast.
On workforce policy, the proposals include updating the 75-hour CNA training standard, including its 16 clinical hours; creating portable credentials; developing competency-based training; and expanding federally supported apprenticeships. The RFI also proposes reviews of long-term care training standards every two to four years. Staffing-related ideas include giving staffing more weight in the Five-Star Quality Rating, measuring day-to-day staffing variation and reducing reliance on self-reported data.
“There is real common ground contained in this RFI.”
— Zach Shamberg, chief of government affairs at Saber Healthcare Group
What the RFI Has Not Decided
The RFI is a request for feedback, not a final rule or legislation. It does not specify the proposed federal spending threshold, detail how a limit on private-equity involvement would work, or establish which ownership disclosures CMS would require. The source material does not provide a response deadline or say what legislative steps will follow.
Providers’ concerns about the staffing mandate are claims about workforce availability and funding. The supplied report does not independently establish how many additional workers or what funding would be needed to meet a future standard. It also remains unclear whether lawmakers will advance any of the proposals and how they might change after receiving comments.
Responses Before Any Policy Changes
Lawmakers are seeking responses to the RFI as they consider potential long-term care reforms. Nursing home operators, industry groups, states and other stakeholders may weigh in on the proposed ownership disclosures, payment rules and workforce options. Any subsequent policy would require further action; the RFI alone changes no facility requirements.
The next developments to watch are whether Senate Finance Committee Democrats publish feedback or draft legislation, whether a spending threshold or staffing approach takes shape, and how providers respond to proposals that could affect ownership reporting and the use of public reimbursements.
Key Questions
Has the Senate adopted new nursing home requirements?
No. The senators issued an RFI seeking feedback. The proposals are not currently requirements under the information provided.
What do nursing home providers support?
Provider representatives cited support for better CNA training, updated workforce pathways and stronger accountability. Their comments do not amount to support for every proposal in the RFI.
Do providers support restoring the 2024 staffing rule?
No. Saber Healthcare Group’s Zach Shamberg opposed reinstating it, while advocating approaches such as modernized training and expanded caregiver pathways.
What ownership changes are being considered?
The RFI seeks feedback on restoring detailed CMS ownership disclosures, extending beneficial-ownership reporting to nursing homes, limiting private-equity involvement and reviewing operators before ownership changes.
Is a federal minimum spending percentage specified?
No. The senators are asking what percentage of Medicare and Medicaid reimbursement facilities should direct to resident care. The RFI does not name a threshold.
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