Implementation is phased over two to five years depending on facility location, and facilities that have failed to submit Payroll-Based Journal (PBJ) data are explicitly barred from qualifying for hardship exemptions.
CMS is finalizing a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Facilities may use any combination of nurse staff (RN, licensed practical nurse [LPN] and licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard. Facilities are not eligible for an exemption if they have failed to submit their data to the Payroll Based Journal System.
Centers for Medicare & Medicaid Services. “Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule (CMS 3442-F).” Centers for Medicare & Medicaid Services, 22 April 2024. https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0
‘Moment of Decision’ Appears Near on Nursing Home Staffing Rule
About 30 Senators, most Republicans, signed onto a resolution of disapproval, including sponsor James Lankford (R-OK) and Jon Tester (D-MT). If both the House and Senate bills passed within 60 days of the CMS rule’s publication, they could reverse the CMS rule. “It’s just a matter of time before this hits the floor, and it will be very close,” Rep. Lloyd Doggett warned. The nursing home industry is also processing forward with a federal lawsuit that argues CMS overstepped its authority when setting hourly direct care minimums and adding a new requirement for 24/7 registered nurse coverage.
— McKnight’s Long-Term Care News, June 06, 2024
Reactions to the Finalized CMS Nursing Home Staffing Standards
“It’s been estimated that 24,000 new registered nurses will be required to meet the standard, and nursing schools are struggling to expand capacity to meet the rising demand for care. Additionally, 77,000 aides will be required to fulfill the new standard.” Carrie O’Connell, RN, vice president of clinical strategy, WellSky, further noted that facilities unable to meet the requirement will have to reduce capacity or close, with downstream effects across the care continuum: “Reduced nursing home beds will threaten access to multiple types of care within the entire care continuum, which is especially of concern in rural and underserved communities.”
— I Advance Senior Care, June 06, 2024
CMS Issues Final Rule Mandating New Minimum Staffing Standards for Long-Term Care Facilities
A facility will be ineligible for an exemption if it: (1) has failed to submit payroll based journal data; (2) is a Special Focus Facility; (3) has been cited with widespread insufficient staffing and resulting resident harm; or (4) has been cited at the “immediate jeopardy” level of severity with respect to insufficient staffing within the 12 months preceding the non-compliant survey. The requirements of the Final Rule have the potential to increase quality of care by reducing staff burnout and turnover and promoting more consistent care, as well as increasing public transparency in relation to Medicaid payments.
— JD Supra / Arnall Golden Gregory LLP, May 22, 2024
CMS Publishes Final Rule for Minimum Staffing Standards in Skilled Nursing Facilities
By CMS’s own calculations, 79% of facilities are currently not in compliance with the requirements of the final rule. Industry groups have estimated that percentage to be closer to 95% of all facilities. CMS estimates the final rule will cost facilities $43 billion over 10 years ($4.3B per year). Provider trade associations have published analysis estimating the cost at over $6 billion per year. LPN/LVN care does count toward the total 3.48 HPRD requirement; however, CMS clarified that “LPN/LVN staffing levels do not appear to have a consistent association with safety and quality of care, unlike RN and NA staffing levels,” and therefore LPN/LVN hours cannot count toward the individual 0.55 RN or 2.45 NA HPRD minimums.
— The National Law Review / Bradley Arant Boult Cummings LLP, May 14, 2024
CMS Releases Final Rule Regarding Minimum Staffing Requirements
Facilities will not be eligible for an exemption if (1) they have failed to submit payroll-based journal (PBJ) data, (2) they have been designated as a Special Focus Facility (SFF), (3) they have been cited for widespread insufficient staffing resulting in actual harm or a pattern of insufficient staffing with resultant resident actual harm, or (4) have been cited at the “immediate jeopardy” level of severity with respect to insufficient staffing within the last 12 months preceding the survey. Granted exemptions will be posted on the CMS Care Compare site, along with the degree to which the facility is not in compliance with the requirements.
— Forvis Mazars US, April 26, 2024
Who Counts? A Staffing Rule Conundrum
Nursing home operators are still missing one key detail needed to complete the complicated mathematical equations that will dominate their planning and spending for the next few years: exactly who counts in the RN categories for both round-the-clock coverage and hourly commitments? The requisite six-digit occupation codes are conspicuously missing. The Centers for Medicare & Medicaid Services did expand on the topic when it released the 329-page final rule — tucked into that was some good news: directors of nursing can count toward the RN requirement. But by Wednesday, individual providers and at least one major provider group said they were left taking calculated guesses as to whether and how other nurse supervisors or those with administrative duties could be counted.
— McKnight’s Long-Term Care News, April 25, 2024
CMS Finalizes Federal Minimum Staffing Standards for Nursing Homes
Despite industry-wide opposition to federal minimum staffing standards and the lack of any new funding, CMS believes that these new standards will increase staffing in more than 79 percent of nursing facilities nationwide. Notably, the Final Rule establishes staffing requirements that exceed the current minimum staffing standards in all 50 states. CMS anticipates using a combination of PBJ data and on-site surveys to assess compliance with the Final Rule and will publish detailed information on the assessment process in sub-regulatory filings.
— The National Law Review / Sheppard, Mullin, Richter & Hampton LLP, April 25, 2024
ANA Commends CMS’ Newly Established Nurse Staffing Standards for LTC Facilities
“For the first time, a minimum staffing requirement for nursing homes has been implemented on a federal level, and we are hopeful that this rule will provide support and resources for overworked nurses in LTC facilities that will only improve the care residents receive,” said ANA President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA, FAAN. “We are so pleased to see this rule be issued and are especially glad that the agency included ANA’s recommendations to ensure nurse input is included in facility assessments. Without taking the voice of nurses in LTC facilities into account, it is impossible to improve their place of work in a meaningful way.”
— American Nurses Association / NursingWorld.org, April 24, 2024
CMS Sets Minimum Staffing Standards for Nursing Homes
A new final rule from CMS establishes minimum staffing standards for nursing homes at a national level for the first time in history. The rule states that nursing homes participating in Medicare and Medicaid must provide residents with a minimum of 3.48 hours of nursing care per day, including at least 0.55 hours of care from a registered nurse per resident per day and 2.45 hours of care from a nurse aide per resident per day. Additionally, nursing homes in the federal programs will also need to have a registered nurse on-site at all times to provide skilled nursing care to prevent patient safety events.
— TechTarget / RevCycleManagement, April 23, 2024
BREAKING: CMS Increases Hours to 3.48 in Final Staffing Rule
“It is unconscionable that the Administration is finalizing this rule given our nation’s changing demographics and growing caregiver shortage,” Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living said in a statement. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis. The Administration has gone even farther than originally proposed, making these requirements even more out of touch and out of reach.”
— McKnight’s Long-Term Care News, April 22, 2024
EXTRA: CMS Publishes Rule Outlining Final Staffing Requirements
“These new required minimum staffing requirements will increase staffing in more than 79 percent of nursing facilities nationwide, and the specific RN and NA HPRD requirements exceed the existing minimum staffing requirements in nearly all States,” the agency said. CMS also said it will indicate if a facility has obtained an exemption on Care Compare, a move some providers had anticipated and been concerned about. A director of nursing also can count toward the rule’s 24/7 RN requirement, CMS said, noting a change that providers will likely appreciate given their persistent challenges hiring RNs across the country.
— McKnight’s Long-Term Care News, April 22, 2024
Nursing Home Minimum Staffing Rule Finalized
KFF performed an analysis and estimates that only 19% of nursing facilities would meet the minimum HPRD staffing standards under full implementation of the final rule with their current staffing levels, and nearly 60% of facilities would meet the interim requirement of an overall 3.48 HPRD standard. The nursing home industry is expected to challenge the ruling; the industry is currently exploring various options including legal action. Additionally, several Senators and other officials have publicly expressed their concerns with the mandate and encouraged CMS and the current administration to reconsider.
— National Investment Center for Seniors Housing & Care (NIC), April 2024
How Nursing Home Staffing Compares to New Rules
Nearly all nursing homes in America will have to hire more nurses and aides under a new rule that mandates a minimum level of staffing with numeric standards for the first time, which will be phased in over three years. A USA TODAY analysis of summer 2023 quarter CMS staffing data shows how short the average federally funded skilled nursing facility was from meeting the new requirements — with many facilities in southern states showing the greatest gaps.
— USA Today Data, 2024
