CMS Readies Nursing Home Staffing Mandate Proposal, Reviews Study Recommendations

May 15, 2023 | Minimum Staffing

News digest: CMS does not fulfill spring promise to release minimum staffing standards


A possible escape from the nursing home staffing mandate?

Yet another week came and went without the much-awaited unveiling [of the staffing mandate] announcement.

National provider leaders said again this week they have had no indications from federal officials as to what’s ahead. All the latter have said is that an announcement will come “this spring.” Last week, Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure doubled down on that by emphasizing that she likes to hit her deadlines.

The hope inside AHCA is that an announcement doesn’t occur until well into June, or some other “late” date that would make it impossible to implement a new system by Jan. 1, 2024. That could buy as much as another 12 months’ time. The big prize then could be that a different administration might be on its way into the White House, and that could mean a whole new ballgame.

May 15, 2023


Berklan, James. “A Possible Escape From the Nursing Home Staffing Mandate?” McKnight’s Long-Term Care News, 15 May 2023,


Providers have every right to dread what’s coming

It’s probably safe to say very few long-term care operators want to see staffing mandates.

But the time has come to face an unpleasant truth: They are coming.

In fact, the only real surprise in this ongoing saga is that they continue to be delayed. Many industry observers expected the requirement to appear in last week’s rate hike announcement. So a bullet of sorts was dodged. But it would be unwise to confuse a delay with a reprieve.

For now, that leaves operators in a purgatorial state. They know all too well that what’s coming will hurt, they just don’t know how much. Either way, there will be pain.

April 8, 2023


O’Connor, John. “Providers Have Every Right to Dread What’s Coming.” McKnight’s Long-Term Care News, 8 Apr. 2023,


Concerns continue after CMS delays staffing rule unveiling

Skilled nursing providers who had readied themselves for the unveiling of a national staffing mandate as part of the 2024 pay rule were left reading the tea leaves this week after federal regulators delayed their announcement.

The Centers for Medicare & Medicaid Services said Tuesday that it was still committed to issuing a rule “later this spring.” 

On Monday, the American Hospital Association took the unusual step of standing alongside AHCA on what has traditionally been viewed as a post-acute issue. In a letter sent to CMS Administrator Chiquita Brooks La-Sure, the two heavyweight associations urged not to enact a staffing mandate that could further harm the nursing home sector’s workforce.

“Federal staffing mandates for nursing homes in the middle of a labor crisis would exacerbate the current access to care crisis,” they wrote. “We anticipate many nursing homes will be forced to further reduce their capacity and even close their doors if they are unable to meet these staffing mandates. This would accelerate the domino effect across the entire continuum of care and leave vulnerable seniors with fewer care options.”

Few think CMS will actually abandon its proposal altogether, but at least for now they are pleased to have extra time to prepare for the rule.

April 7, 2023


Towhey, Jessica, and Kimberly Marselas. “Concerns Continue After CMS Delays Staffing Rule Unveiling.” McKnight’s Long-Term Care News, 7 Apr. 2023,


CMS says final hours requirement still undecided on looming staffing rule

Federal officials are still trying to determine just how many minutes or hours a day it takes for direct care staff to perform tasks key to nursing home quality, a Centers for Medicare & Medicaid Services official said Wednesday.

Jean Moody-Williams, deputy director of the CMS Center for Clinical Standards & Quality, said data related to time requirements “is still being collected and analyzed,” although she described a broader study related to creation of a nursing home staffing minimum as being complete.

The staffing rule study included a literature review, nursing home site visits and qualitative and costs analyses, Moody-Williams reminded the audience. Almost 12 months after federal officials said they would take a year to explore a new possible federal staffing standard, providers are anxiously awaiting the release of a CMS proposal.

“The final report includes recommendations on potential barriers to, and unintended consequences of, implementing recommendations and also some of the cost implications [of a minimum staffing rule],” Moody-Williams said. “We are currently reviewing it to determine what policies will come from that. … We will keep you posted on the progress that we’re making.”

February 23, 2023


Marselas, Kimberly. “CMS Says Final Hours Requirement Still Undecided on Looming Staffing Rule.” McKnight’s Long-Term Care News, 23 Feb. 2023,


CMS completes minimum staffing study; targeting ‘onerous’ MA authorizations

[T]he Centers for Medicare & Medicaid Services has completed a study of minimum staffing standards for nursing homes and is considering its policy options.

“The report includes recommendations of potential barriers to and unintended consequences of implementing the recommendations and cost implications,” Moody-Williams said. “We are currently reviewing it to determine our policy direction.”

A minimum staffing proposal, first broached by the White House last February, is widely expected to be proposed some time this spring. Just this week, senators from several states asked CMS to resist a “one-size-fits-all” approach, given labor issues that are worse in some areas of the country.

January 25, 2023


Marselas, Kimberly. “CMS Completes Minimum Staffing Study; Targeting ‘Onerous’ MA Authorizations.” McKnight’s Long-Term Care News, 25 Jan. 2023,


CMS Readies Nursing Home Staffing Mandate Proposal, Reviews Study Recommendations

The Centers for Medicare & Medicaid Services (CMS) confirmed Tuesday that it is currently reviewing a year-long study to determine “policy direction” and cost implications of its proposed federal staffing mandate.

The study includes potential barriers to and unintended consequences of staffing recommendations, Jean Moody-Williams said during a call to stakeholders. Moody-Williams serves as deputy director at the CMS Center for Clinical Standards and Quality.

Moody-Williams rehashed the multifaceted nature of the study, stating that it includes a literature review with quantitative analysis and cost analysis as well as qualitative data from nursing home site visits.

Qualitative components of the study are made up of primary data collected during site visits, like interviews, surveys and observation data. Meanwhile, quantitative analysis consists of Medicare Payroll-based Journal (PBJ) data, Minimum Data Set (MDS) and Medicare claims, the agency said.

There was no indication that the study would be released to the public, only that CMS plans to issue proposed federal minimum staffing requirements this spring.

January 24, 2023


Stulick, Amy. “CMS Readies Nursing Home Staffing Mandate Proposal, Reviews Study Recommendations.” Skilled Nursing News, 24 Jan. 2023,

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