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House of Representatives
Session of 2021 - 2022 Regular Session


Posted: November 5, 2021 10:32 AM
From: Representative Timothy R. Bonner
To: All House members
Subject: Registration and Oversight of Contract Health Care Service Agencies
In the near future, I plan to introduce legislation that would require Contract Health Care Service Agencies who provide temporary employment in nursing homes, assisted living residences and personal care homes to register with the Department of Human Services (DHS) as a condition of their operations in Pennsylvania.

The COVID-19 pandemic has both exacerbated and accelerated the workforce crisis in Pennsylvania’s long-term care sector. A recent survey of providers, conducted and published by the Pennsylvania Health Care Association (PHCA), found that nursing homes have incurred an 18% loss in their workforce and 68% of the facilities are struggling to meet minimum staffing requirements.  Due to these shortages, the vast majority of long-term care providers have been forced to rely on contract agency staff to fill the critical positions needed to provide care and meet minimum staffing requirements. Long term sustainability of nursing homes is now becoming a critical concern as 39% of responding facilities stated they cannot afford to keep facilities open for more than a year. 

However, throughout the past nineteen months, these same staffing agencies have seized on the pandemic and the critical need for workers, and have raised their hourly rates to 100%, 200%, or even 400% above the current median wage rate within these long-term care facilities. Not only that, staffing agencies are recruiting full time employees from the same long-term care facilities where they’re sending temporary staff. And last-minute call-offs and cancellations from agencies have plagued the sector, especially at the height of the pandemic.

Currently, state agencies do not have oversight of supplemental health care service agencies. Recognizing the increased role that these agencies play in the day-to-day operations of nearly 700 nursing homes and 1200 assisted living residences and personal care homes, we must ensure they are operating in a manner that supports the long-term care sector and high-quality resident care. This proposed legislation would place registration requirements on health care service agencies operating in long-term care facilities, as well as require a system for reporting and establishing penalties.

Additionally, more than 70% of all care provided in Pennsylvania’s nursing homes is paid for by the state’s Medicaid program. The Commonwealth is a principal partner in the long-term care continuum, and these excessive hourly rates charged by supplemental health care service agencies are draining the already-underfunded Medicaid program and taking valuable dollars away from full time employees and resident care.

Though assisted living and personal care providers are not eligible for Medicaid reimbursement in Pennsylvania at this time, rising agency costs could force providers to raise their monthly rates, which, in turn, would exhaust the assets of private-pay residents quicker and bring more seniors into the state’s Medicaid program.

This proposed legislation would establish maximum rates on agency health care personnel to end the practice of ‘gouging’ the Medicaid program and Pennsylvania taxpayers, which was already exacerbated by the COVID-19 pandemic.

At the national level, the American Health Care Association (AHCA) recently sent a letter to the Federal Trade Commission (FTC), requesting that the FTC use its authority to protect consumers from anticompetitive and unfair practices regarding agency staffing.

This measure is supported by the Pennsylvania Health Care Association (PHCA).

Please join me in cosponsoring this important legislation, especially as we continue to combat the COVID-19 pandemic.

Introduced as HB2293