Key SNF/LTC Impacts of the One Big Beautiful Bill Act (OBBBA)

Dear Readers,

Congress has passed the One Big Beautiful Bill Act (OBBBA)—a sweeping healthcare reform package that directly affects Skilled Nursing Facilities (SNFs) and the broader long-term care sector.

While some provisions present new financial and operational challenges, others offer valuable opportunities for adaptation and innovation.

Below is a summary of the most important takeaways:

1. CMS Staffing Mandate Delayed
The federal minimum staffing rule for SNFs has been delayed 10 years, giving facilities flexibility to manage staffing levels without immediate penalty.

Key Impact:

• Avoids forced closures due to non-compliance

• Provides time to build sustainable internal staffing pipelines

• Emphasizes the continued importance of acuity-based staffing

2. Medicaid Cuts Introduced
The bill includes substantial Medicaid reductions, including new eligibility limits, reduced retroactive coverage, and restrictions on state-level provider taxes.

Key Impact:

• Financial pressure on high-Medicaid facilities

• Increased importance of budget discipline and payer mix monitoring

3. Telehealth Expansion
Medicare and Medicaid will now permanently cover telehealth services for behavioral health, follow-up care, and rural/underserved populations.

Key Impact:

• Greater flexibility for providers and patients

• Encourages integration of telemedicine into SNF care plans

4. Health IT & Cybersecurity Incentives
Funding is available for EHR modernization and HIPAA-compliant cybersecurity upgrades—especially for rural and small facilities.

 Key Impact:

• Enhanced data protection and interoperability

• Opportunity to improve compliance and efficiency

5. Workforce Development Support
OBBBA introduces grants to train LPNs, RNs, and unlicensed assistive personnel (UAPs) and support internal career ladders in long-term care.

Key Impact:

• Strengthens workforce retention and skill-building

• Encourages investment in long-term workforce planning

6. Ongoing Risk of Inappropriate Sedation
Analysts warn that persistent staffing shortages—now unchecked by immediate federal regulation—could increase reliance on antipsychotics in some settings.

Recommendation:

• Reaffirm commitment to person-centered care

• Monitor sedative use closely and prioritize non-pharmacologic interventions

Summary Table:

Just to keep this medically relevant for the clinicians…
🧠 Teaching Point: A 2025 NEJM study found that prescribing low-dose SGLT2 inhibitors (like empagliflozin 10 mg daily) in older adults with heart failure—even without diabetes—significantly reduced hospitalizations and preserved renal function. Consider SGLT2s in your CHF management toolbox, particularly for SNF residents with recurrent volume overload or CKD.

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All the best!

Christopher DeNapoles M.D.

Chief Medical Officer

Physicians Services Group of Florida

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