Leaked CMS Study Conflicts with Minimum Staffing Plans

Aug 31, 2023 | Minimum Staffing, Research Studies of PBJ Data

News Digest: Leaked CMS Study Conflicts with Minimum Staffing Plans

A comprehensive report prepared under contract to CMS by ABT Associates summarizes results from a Nursing Home Staffing Study including reseach activities between May and December of 2022. The report presents options for minimum nurse staffing requirements for consideration by the Centers for Medicare & Medicaid Services to prepare a minimum staffing regulation.

This study was posted in error by CMS, and discovered by KFF Health News and offers a rare insight into the deliberations and considerations used by CMS in constructing Rules of Participation. Due to the controversial nature of a minimum staffing rule, the industry and advocates interpreted the findings in this report in various ways.

Kaiser health news

Exclusive: CMS Study Sabotages Efforts to Bolster Nursing Home Staffing, Advocates Say

The Biden administration last year promised to establish minimum staffing levels for the nation’s roughly 15,000 nursing homes. It was the centerpiece of an agenda to overhaul an industry the government said was rife with substandard care and failures to follow federal quality rules.

But a research study the Centers for Medicare & Medicaid Services commissioned to identify the appropriate level of staffing made no specific recommendations and analyzed only staffing levels lower than what the previous major federal evaluation had considered best, according to a copy of the study reviewed Monday by KFF Health News. Instead, the new study said there was no single staffing level that would guarantee quality care, although the report estimated that higher staffing levels would lead to fewer hospitalizations and emergency room visits, faster care, and fewer failures to provide care.

Patient advocates said the report was the latest sign that the administration would fall short of its pledge to establish robust staffing levels to protect the 1.2 million Americans in skilled nursing facilities. Already, the administration is six months behind its self-imposed deadline of February to propose new rules. Those proposals, which have not been released, have been under evaluation since May by the Office of Management and Budget. The study, dated June 2023, has not been formally released either, but a copy was posted on the CMS website. It was taken down shortly after KFF Health News published this article.


Rau, Jordan. “Exclusive: CMS Study Sabotages Efforts to Bolster Nursing Home Staffing, Advocates Say – KFF Health News.KFF Health News, 30 Aug. 2023, kffhealthnews.org/news/article/cms-study-nursing-home-staffing-levels.


CMS Study Undercuts Potential Nursing Home Minimum Staffing Mandate

The White House’s ambitious plans for a federal nursing home staffing mandate might have hit a snag due to the inadvertent online release and subsequent removal of a study commissioned by the Centers for Medicare & Medicaid Services (CMS).

KFF Health News first reported on the study on Tuesday, after which CMS removed the report, which was compiled by Abt Associates, from the agency’s website.

CMS has long advocated for higher staffing standards. In a report issued to Congress in 2001, CMS recommended a daily minimum standard of 4.1 hours of total direct care nursing time per resident: 2.8 hours from certified nursing assistants (CNAs); 0.75 hours from registered nurses (RNs); and 0.55 hours from licensed practical/vocational nurses.


Grebbin, Shelby. “CMS Study Undercuts Potential Nursing Home Minimum Staffing  Mandate.Skilled Nursing News, Aug. 2023, skillednursingnews.com/2023/08/leaked-cms-study-undercuts-a-potential-nursing-home-minimum-staffing-mandate.


CMS vows to move forward with staffing proposal ‘soon’ despite ‘inconclusive’ research

Federal officials vowed Tuesday night to issue a nursing home staffing requirement “soon,” despite the premature publication of a federal study that appears to support skilled providers’ objections regarding the feasibility of such a measure.

The accidental online posting Tuesday afternoon of the study, conducted by Abt Associates on behalf of the Centers for Medicare & Medicaid Services, at first seemed to undercut a 18-month-old White House plan to institute an hourly direct care minimum at 15,000-plus nursing homes nationwide.

The report has since been removed from the web by CMS, but it is still available through KFF Health News, which broke news of the study Tuesday afternoon. Researchers made no recommendations in the report but said there was “no single staffing level that would guarantee quality care.”


Marselas, Kimberly. “CMS Vows to Move Forward With Staffing Proposal ‘Soon’ Despite ‘Inconclusive’ Research.McKnight’s Long-Term Care News, Aug. 2023, www.mcknights.com/news/cms-vows-to-move-forward-with-staffing-proposal-soon-despite-inconclusive-research.


Leaked CMS Study Calls Into Question Basis For Federal Staffing Minimums In Nursing Homes

A study commissioned by the Centers for Medicare & Medicaid Services (CMS) intended to identify appropriate staffing levels for nursing homes found there was no single staffing level that would guarantee quality care, KFF Health News exclusively reported yesterday. The findings call into question the evidence and rationale of a federal staffing mandate expected to be issued soon by the Biden Administration.
“This report confirms what we’ve been saying for more than a year – that an arbitrary staffing mandate is not feasible and will not equate to higher quality care,” said Mark Parkinson, president and CEO of the American Health Care Association (AHCA). “There needs to be a comprehensive approach to staffing beyond numbers, acknowledging that each resident and facility is unique. We all want to increase the nursing home workforce, but instead of blanket requirements during a historic labor shortage, we need resources and policies that will help recruit and retain more caregivers. In light of these findings, we urge the Administration to reconsider this proposal and focus on more meaningful ways to improve quality and address the long term care workforce crisis.”
According to KFF Health News, the study was commissioned by CMS to identify the appropriate staffing levels, but made no specific recommendations and ultimately found there was “no obvious plateau at which quality and safety are maximized or ‘cliff’ below which quality and safety steeply decline.” Researchers also wrote that, “Recent literature underscores the relationship between nursing home staffing and quality outcomes… However, it does not provide a clear evidence basis for setting a minimum staffing level.”
AHCA’s Senior Vice President of Quality, Regulatory and Clinical Services Holly Harmon told KFF Health News, “What is clear as you look across the country is every nursing home is unique and a one-size-fits-all approach does not work.”


Leaked CMS Study Calls into Question Basis for Federal Staffing Minimums in Nursing Homes.” Www.ahcancal.org, www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Leaked-CMS-Study-Calls-Into-Question-Basis-For-Federal-Staffing-Minimums-In-Nursing-Homes.aspx. Accessed 2 Oct. 2023.


CMS Officials Foreclose Questions on Staffing Mandate During Nursing Home Stakeholder Call, with Proposal Looming

At the Open Door Forum hosted by the Centers for Medicare & Medicaid Services (CMS)  Thursday, officials declined to field questions related to the potential federal minimum staffing mandate for nursing homes even as the proposal has progressed to the next stage.

Industry insiders shared with Skilled Nursing News that the Biden Administration’s highly anticipated proposed rule on nursing home staffing mandates, which has been under review at the Office of Management and Budget (OMB) for months, is in a new phase – it’s moved on from OMB and could be released any time.

“We know that many of you may have questions about the forthcoming minimum nursing home staffing standards,” Jill Darling from the CMS Office of Communications, said during the forum. “CMS is committed to improving safety and quality of care for nursing home residents and looks forward to sharing the proposal with you soon.”

Grebbin, Shelby. “CMS Officials Foreclose Questions on Staffing Mandate During Nursing Home Stakeholder Call, With Proposal Looming.” Skilled Nursing News, Sept. 2023, skillednursingnews.com/2023/08/cms-officials-foreclose-questions-on-staffing-mandate-during-nursing-home-stakeholder-call-with-proposal-looming.


[Updated] Providers bracing for CMS release of federal nursing home staffing mandate at ‘any time’

Mandate watch 2023 ramped up markedly Wednesday, following a series of events that appeared to signal the nation’s first federal minimum staffing requirement was about to be proposed after an 18-month process.

Observers noted early Wednesday that the Office of Management and Budget, which has been reviewing a proposal by the Centers for Medicare & Medicaid Services since May, had canceled planned meetings with stakeholders that were to be held the first two weeks of September. That came on the heels of the accidental online posting Tuesday of a CMS study commissioned to inform the agency’s proposal.

The study gave the nursing home sector and consumer advocates their first solid insights to possible CMS strategies.

The proposed rule’s official status on the OMB website was still “pending review” by Wednesday evening, but that could change quickly, experts told McKnight’s Long-Term Care News.


Marselas, James M. Berklan, Kimberly. “[Updated] Providers Bracing for CMS Release of Federal Nursing Home Staffing Mandate at “Any Time.”” McKnight’s Long-Term Care News, 31 Aug. 2023, www.mcknights.com/news/providers-bracing-for-cms-release-of-federal-nursing-home-staffing-mandate-at-any-time/. Accessed 2 Oct. 2023.


Industry Leaders Question Leaked CMS’ Staffing Study Data, Worry About Shortages

Industry leaders continued to have mixed reactions about the fate of the Biden Administration’s nursing home staffing mandate after the accidental online release of a staffing study commissioned by the Centers for Medicare & Medicaid Services (CMS), with some insiders questioning the leaked study’s data.

Industry stakeholders doubted the reliability of the study conducted by Abt Associates.

“Abt Associates sourced data from several SNF domains in their analysis,” Marc Zimmet, CEO of Zimmet Healthcare Services, told Skilled Nursing News (SNN).  “These source documents are flawed, outdated, inconsistent, and inaccurate to begin with.  When cross-contextualized, outcomes are effectively arbitrary.”


Grebbin, Shelby. “Industry Leaders Question Leaked CMS’ Staffing Study Data, Worry About Shortages.Skilled Nursing News, Aug. 2023, skillednursingnews.com/2023/08/industry-leaders-question-leaked-cms-staffing-study-data-worry-about-shortages.

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