CMS starts study to support minimum staffing proposal

Aug 30, 2022 | Minimum Staffing, Studies & Research of PBJ Data

Heavy Resistance to CMS Study to Justify Minimum Staffing Regulations

Following a busy July of new regulations and strong pushback to minmimum staffing proposals, CMS turned on the PR machine with a formal announcement of in-person visits to nursing homes as part of a study.  In addition CMS held a listening session and made available the study authors ABT Associates.

Unsurprisingly, the resistance to minimum staffing was loud, persistent and strong from the industry, while consumer advocates attempted to counter the pushback.


Centers for Medicare & Medicaid Services Staffing Study to Inform Minimum Staffing Requirements for Nursing Homes

In February 2022, President Biden announced a comprehensive set of reforms to improve the safety and quality of nursing home care, hold nursing homes accountable for the care they provide, and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed care choices.[1]  One key initiative within the President’s strategy is to establish new minimum staffing requirements so every nursing home has sufficient staff who are adequately trained to provide the safe and quality care residents need. Evidence has shown that adequate staffing is closely linked to the quality of care residents receive.[2] The COVID-19 Public Health Emergency (PHE) has highlighted and exacerbated the long-standing staffing challenges experienced in many facilities, creating an urgent need to address this issue for the well-being of all individuals residing in our nation’s federally certified nursing homes and the workers who care for them.

The Centers for Medicare & Medicaid Services (CMS) has launched a multi-faceted approach aimed at determining the minimum level and type of staffing needed to enable safe and quality care in nursing homes. This effort includes issuing a Request for Information (which occurred earlier this year as a part of the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule[3]) and conducting a new study. The information obtained through these efforts will inform future proposed rulemaking on minimum staffing requirements, which CMS plans to issue in Spring 2023. Facilities will be held accountable if they fail to meet this standard.


Karikari-Martin PhD, MPH, MSN, PHNA-BC, RN, Pauline. Centers for Medicare and Medicaid Services Staffing Study to Inform Minimum Staffing Requirements for Nursing Homes | CMS. 22 Aug. 2022,


Hello, CMS? This is desperation calling

There was a stark, though not at all unexpected, dichotomy between participants in Monday’s listening session to gather input on coming nursing home staff minimums.On the one hand, you had consumer advocates — armed with the Biden administration’s aggressive reform push and 20 years of resentment about perceived understaffing — ready to throw fuel on the fire.

And on the other, there were nursing home leaders from major organizations, mid-sized chains and tiny, independent facilities in rural settings pleading with federal regulators to douse the flames.

Where a resident advocate might see the potential for more staffing rules to help nursing homes rise from the ashes of COVID, providers are legitimately worried that a well-intentioned but under-supported mandate might just burn the sector down for good.


Marselas, Kimberly. “Hello, CMS? This Is Desperation Calling.” McKnight’s Long-Term Care News, 30 Aug. 2022,


Providers Push Back on CMS’s Move to Zero in on Nursing Roles in Minimum Staffing Study

Nursing home providers and industry leaders renewed their pleas this week to federal government officials to consider non-nursing positions in its proposed minimum staffing requirements, perhaps to no avail.

An upcoming study to help determine an appropriate staffing level will squarely focus on nursing staff, specifically registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs) and certified nursing assistants (CNAs), according to Abt Associates Principal Alan White, the research firm contracted by CMS to study the issue.

The Centers for Medicare & Medicaid Services (CMS) hosted a virtual stakeholder listening session on Monday to provide additional information on its plans to establish a proposed minimum staffing level, in addition to opening the floor for overall feedback on the topic.


Reiland, Jordyn. “Providers Push Back on CMS’s Move to Zero in on Nursing Roles in Minimum Staffing Study.” Skilled Nursing News, 30 Aug. 2022,


Warning on staffing minimum: Studying costs won’t matter if pay doesn’t add up

Cost analysis will be “an important part” of a final report on federal minimum staffing standards, the head of a national study assured nursing home stakeholders Monday.

“I think these cost analyses are really important,“ said Alan White, PhD, principal at Abt Associates, the firm contracted by the Centers for Medicare & Medicaid Services to research the agency’s possible staffing mandate.

“We’ll know from the other analyses … what the benefits of increased staffing are in terms of better quality and better resident outcomes, that sort of thing. Bringing in the cost analysis kind of allows us to understand how those benefits are balanced against the costs that nursing homes would incur to increase staffing to whatever level CMS might specify.”


Marselas, Kimberly. “Warning on Staffing Minimum: Studying Costs Won’t Matter if Pay Doesn’t Add Up.” McKnight’s Long-Term Care News, 30 Aug. 2022,


CMS to Visit Nursing Homes as Part of Minimum Staffing Proposal

Nursing home leaders may soon hear from the federal government, if they haven’t already, to schedule site visits as part of the agency’s efforts toward proposing a staffing minimum sometime next year.

The Centers for Medicare & Medicaid Services (CMS) contractor Abt Associates will visit 65 nursing homes across all 10 regions between August and October, according to an Aug. 10 blog post written by Jodi Eyigor, LeadingAge’s director of nursing home quality and policy.

Facilities have been chosen based on their location, size, ownership type, staffing and quality levels based on the five star quality rating system, use of agency staff and the proportion of Medicaid residents served and/or if the facility is located in a disadvantaged area.


Reiland, Jordyn. “CMS to Visit Nursing Homes as Part of Minimum Staffing Proposal.” Skilled Nursing News, 15 Aug. 2022,


CMS outlines 4-pronged minimum staffing study

The Centers for Medicare & Medicaid Services on Monday revealed more details about how it will use nursing home site visits, data and other tools to formulate a minimum staffing standard, one that is meant to “build on” rather than replace previous studies.

That may mean bad news for operators who had hoped the agency would take a broader view of staffing by including non-nursing positions in its calculations or by creating shift coverage rules instead of hourly minimums.

Agency researchers said Monday that in addition to comments already collected about the potential new rule, they will use four main components in their ongoing work.


Marselas, Kimberly. “CMS Outlines 4-pronged Minimum Staffing Study.” McKnight’s Long-Term Care News, 23 Aug. 2022,