Industry stakeholders remain divided on the approach, with providers raising concerns about workforce shortages and the feasibility of compliance without additional reimbursement support.
Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS-1765-P)
CMS is seeking input on the effects of direct care staffing (nurses, aides, and other professionals) requirements to improve the LTC requirements for participation and promote thoughtful, informed staffing plans and decisions within facilities to meet residents’ needs, including maintaining or improving resident function and quality of life. Specifically, we are seeking input on establishing minimum staffing requirements for LTC facilities.
Centers for Medicare & Medicaid Services. “Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS-1765-P).” CMS.gov, 11 Apr. 2022, www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2023-skilled-nursing-facility-prospective-payment-system-proposed-rule-cms-1765-p.
Ask the Legal Expert: What Can We Expect From a Staffing Minimum?
Q: What can we expect out of the Centers for Medicare & Medicaid Services’ intention to issue new guidance on minimum staffing measures for nursing homes?
A: Frankly, it means trouble. To begin addressing the minimum staffing requirement, CMS added new requirements for surveyors to incorporate the use of Payroll Based Journal staffing data in their inspections.
This will identify potential noncompliance with CMS nurse staffing requirements, such as lack of a registered nurse for eight hours each day, or lack of licensed nursing for 24 hours a day. This guidance aims to uncover instances of insufficient staffing and will, allegedly, yield higher quality care.
— McKnight’s Long-Term Care News, September 11, 2022
Why the Caregiver Definition Must Be Expanded for Nursing Homes to Overcome Labor Crunch
The current federal requirement does not provide a specific daily minimum standard, rather, it states that nursing homes must provide “…sufficient nursing staff to attain or maintain the highest practicable … well-being” of every resident.
“It’s critically important that we recognize that our caregiving team is not just CNAs, LPNs and RNs … Each of our facilities are very different in makeup and population,” [Massachusetts Senior Care Association President Tara Gregorio] said during a panel discussion. “We just have to make sure that whatever we see on a state and federal level has that flexibility to really reflect the uniqueness of a nursing facility.”
— Skilled Nursing News, August 15, 2022
CMS Heading Into Facilities to Help Determine Federal Staffing Mandate
Contractors will be making 65 nursing home visits over the next three months in a bid to help establish first-ever federal minimum staffing levels.
Frequent Centers for Medicare & Medicaid Services contractor Abt Associates will stage visits at select facilities through October. The White House set a goal of having a new staffing mandate in place by March 2023. Abt researchers will collect information from staff, residents and family members, officials said.
— McKnight’s Long-Term Care News, August 12, 2022
Site Visits Included in CMS Staffing Study
Site visits will take place in 65 nursing homes across all 10 CMS regions between August and October 2022. Abt Associates has identified nursing homes for participation based on several factors: location, size, ownership type, staffing level based on the staffing domain of the Five Star Quality Rating System, quality based on the Quality Measures domain of the Five Star Quality Rating System, use of agency staff, and proportion of Medicaid residents served and/or location in a disadvantaged area.
— Leading Age, August 10, 2022
CMS Reveals Differing Opinions on Minimum Staffing Approach
A study meant to underpin a new federal nursing home staffing minimum will last about seven months and end in December, a Centers for Medicare & Medicaid Services official said Thursday.
The comments typically pitted the concerns of consumer groups against those of nursing home providers, who have expressed concern about the ability to recruit and pay additional frontline workers. Commenters also asked the agency to consider how factors including ownership, proportion of Medicaid beds, size and market competition, could affect a nursing home’s ability to meet staffing minimums.
— McKnight’s Long-Term Care News, August 5, 2022
CMS Shares Updates on Nursing Home Staffing Study
CMS gave an update on the nursing home staffing study during the August 4 SNF Open Door Forum.
CMS reported receiving more than 3,000 public comments in response to the Request for Information. While nursing home residents, families, and consumer advocates generally supported the implementation of mandatory staffing standards, nursing home providers and other “industry groups” expressed concern and largely suggested a delay or phase-in to requirements due to current staffing shortages.
— Leading Age, August 5, 2022
CMS: Nursing Home Minimum Staffing Requirements to Strike Balance Between Opposing Industry Views
While there are clear differences of opinion among stakeholders regarding the implementation of minimum staffing requirements, Ingram said CMS’s goal is to use this information, along with its staffing study, “to strike a balance between the positions” and ensure safe and quality care for residents.
— Skilled Nursing News, August 4, 2022
The Math Doesn’t Work: Nursing Home Staffing Woes Unsolvable Without Immigration Action
As nursing home operators scramble to recruit direct care workers during a historic staffing shortage, many in the sector believe there is one obvious solution that has yet to gain meaningful traction, in part due to legislative gridlock: immigration.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) has honed in on minimum staffing ratios, and is incorporating staffing data into surveys as well as the five-star rating system. Such initiatives come at a time when the sector is operating with 14% less of its pre-pandemic workforce.
— Skilled Nursing News, July 27, 2022
Employment Considerations for Long Term Care Facilities Under the Biden-Harris Administration
Previous CMS research has identified that facilities with staffing levels below 4.1 hours per resident day for long stay residents (i.e., stays of 90 days or more) may provide care that results in harm and jeopardy to residents. The staffing measure proposes to use auditable electronic data reported to CMS’s Payroll Based Journal system to calculate total nursing hours (including registered nurses and licensed practical nurses) per resident day.
— Healthcare Law Insights, July 14, 2022
CMS Opens Up on Approach to Developing Minimum Staffing Requirements
Officials with the Centers for Medicare & Medicaid Services on Wednesday opened up about the “multi-faceted approach” it’s using to develop and propose minimum staffing requirements for nursing homes next year.
“While we are still working on the final methodology for the study, we can say that together the quantitative and qualitative analysis will ensure we have comprehensive research findings to inform our draft proposals on minimum staffing requirements in nursing homes in 2023,” the official said.
— McKnight’s Long-Term Care News, July 14, 2022
CMS Outlines Multi-Faceted Approach to Nursing Home Minimum Staffing Requirements
The “mixed methods” research study will assess the minimum staffing requirements needed to ensure that residents receive safe and quality care, she added.
“We now know that staff turnover does have an impact on quality and that really serves as another tool in addition to raising staffing levels that nursing homes can use to improve quality,” said [CMS Division of Nursing Homes Director Evan] Schulman. “The moment that we learn of a new way to improve quality, we want to put that information out as soon as possible.”
— Skilled Nursing News, July 13, 2022
