Compliance determinations are made quarterly using CMS PBJ data, meaning any gap in staffing documentation creates direct exposure to civil penalties. Facilities have only 10 business days from a notice of noncompliance to request redetermination or apply for a penalty reduction. Operators must also track concurrent PBJ deadlines alongside state cost report and safe staffing survey submissions, all of which interact with the same minimum spending and staffing thresholds.
New York State has begun imposing penalties for not meeting specific staffing requirements, including maintaining a minimum 3.5 hours of direct care per resident per day (HPRD). Recently, over 20 facilities in the state have started receiving fines, which stem from staffing shortages that began in 2022. Despite good faith efforts to staff facilities, the state-level mandate remains difficult to meet. “The amount of dollars involved is extreme,” Almer said. “It will only make it harder for facilities to manage.”
— Skilled Nursing News, April 8, 2026
Emerging Legal Issues for Skilled Nursing Facilities in New York: A Year in Review
Federal rollbacks aside, SNFs in New York will still need to navigate state staffing standards, which require every nursing home to maintain daily staffing hours equal to 3.5 HPRD by a certified nurse aide, licensed practical nurse, or RN. Compliance with these requirements is determined on a quarterly basis using the most recent data available from the CMS Payroll Based Journal. Nursing homes that fail to adhere to the minimum staffing standards are subject to civil penalties, with the potential for DOH to impose a penalty of up to $2,000 per day for each day in a quarter that a facility fails to comply.
— Crowell & Moring LLP, December 22, 2025
Chronic Staffing Shortages Plague New York Nursing Homes
A 2022 New York law requiring nursing homes to provide at least 3.5 HPRD of care has seen little enforcement. Over 400 facilities are currently out of compliance and subject to $2,000 daily fines. However, no penalties have been issued due to delays by the Department of Health (DOH) in finalizing enforcement actions. New York ranks worst nationally for administrator time per resident, a critical role responsible for overseeing operations and ensuring compliance with regulatory standards.
— Outsource Accelerator, December 10, 2024
In New York, Gov. Kathy Hochul (D) declared an acute labor shortage, which allows homes to petition for reduced or waived fines. The state health department said it had cited more than 400 of the state’s 600-odd homes for understaffing but declined to say how many of them had appealed for leniency. In more than two-thirds of nursing homes in New York and more than half of those in Massachusetts, staffing was below the state’s required minimums.
— McKnight’s Long-Term Care News, July 12, 2024
Nursing Homes Face Four Important Deadlines
Quarterly Payroll Based Journal (PBJ) data for the quarter ending June 30, 2024, is due by Aug. 14th. RHCF Medicaid cost reports are due on Aug. 19th. Please keep in mind that operator and CFO electronic certifications are due at the same time. Complete and accurate reports are critical should the data be used to update Medicaid rates.
— LeadingAge New York, August 13, 2024
DOH Requests Nursing Homes to Submit 2020 Data
The Department is circulating this survey to ensure that their calculations of 40/70 spending thresholds are compliant with the approved Medicaid State Plan Amendment (SPA) when it comes to determining eligibility for staffing funding. This survey will provide them with the information needed to do this, thereby paving the way for the distribution of the remaining (federal share) of $93 million in “safe staffing” funding.
— LeadingAge New York, July 30, 2024
Layering of Fines Amid State, Federal Staffing Rule Conflicts Tops Providers’ Worry List
“The worst case scenario will be layering of fines, and if there’s layering, you will see nursing homes close,” Stephen Hanse, president and CEO of the New York State Health Facilities Association, told McKnight’s. Some 470 of 610 nursing homes in New York have been unable to comply regularly with the 3.5 hour standard. Still, no blanket exemption has been issued and providers must continue to document their attempts to hire and retain staff, with voluminous reporting demands.
— McKnight’s Long-Term Care News, May 2, 2024
State’s Minimum Staffing Law Cost $55M While in Place for Just 10 Months
States are seeing in real time what a federal minimum staffing mandate may cost them, as a disagreement between Connecticut and its nursing homes has come to a head. The state owes its nursing homes $55 million for staffing requirements imposed between March 2023 and this past January when an enhanced version of the directive was discontinued. It’s unclear whether the state would be able to recoup even half of the $55 million through federal Medicaid reimbursements.
— Skilled Nursing News, February 27, 2024
$2K Daily Fines Poised to Begin ‘Within Days’ as NY Staffing Rule Upheld
“Right now, there are a little over 600 nursing homes in the state of New York. Three-quarters of them cannot meet the 3.5 [hours per resident per day] staffing mandate. Every nursing home in the state of New York would welcome the opportunity to staff at 3.5. The workers are not there.” The fine reprieve appears to be coming to an end, however, as health officials confirmed that the initial batch of fines were being assessed for enforcement last week.
— McKnight’s Long-Term Care News, January 16, 2024
Landmark Legal Decision in New York Sets Stage for Imposing Fines on Understaffed Nursing Homes
The lawsuit, brought forth by LeadingAge and that challenged the New York state’s 2021 nursing home staffing law, was dismissed by Justice James Gilpatric. The judge rejected arguments presented by LeadingAge, emphasizing that the lawsuit was an ill-advised attempt to legislate through the courts, disregarding the separation of powers outlined in the New York Constitution. Potential fines for nursing homes will hinge on their ability to demonstrate efforts to bolster staffing, state officials said.
— Skilled Nursing News, January 9, 2024
Fines Suspended for Nursing Homes That Violate Minimum Staffing Law
New York is facing similar enforcement challenges after it also passed a staffing mandate in 2022, which went into effect in April. That state notified nursing homes that were in noncompliance with the rule in August of 2023. Continued noncompliance could result in $2,000 per day fines for those facilities. But the fines are still in limbo at the New York Department of Health for at least the next several weeks, and the department admitted that a severe shortage of healthcare workers is widespread across the state.
— McKnight’s Long-Term Care News, January 3, 2024
Assessments to Begin for Unfunded Nursing Home Staffing Mandate in NY, $2,000 Daily Fines in Play
Nursing home operators in New York can expect to see assessments tied to the state minimum staffing standard as early as July 10, the state Department of Health said in a memo. Facilities that are out of compliance with the new staffing standards could receive civil monetary penalties of up to $2,000 per day. Initial determinations of compliance will be issued based on data from the Centers for Medicare & Medicaid Services (CMS) Payroll Based Journal.
— Skilled Nursing News, July 7, 2023
Cautionary Tale: Staffing Mandate Collides with Nursing Home Labor Crisis and Referral Bottleneck
Based off PBJ data, 75% of the state’s 614 nursing homes cannot meet the state’s 3.5 hour staffing mandate, and from 2019 to 2022, the number of empty nursing home beds in the state increased to 6,700. Post-acute operators in the Empire State are being forced to limit new admissions to comply with staffing ratios, creating bottlenecks. “Mandated staffing minimums and referral bottlenecks, unfortunately, go hand-in-hand in the state of New York,” Hanse told Skilled Nursing News.
— Skilled Nursing News, January 27, 2023
Staffing Mandate Leads to NY Lawsuit, Foreshadows Potential National Challenges
With 75% of New York’s 614 nursing homes unable to meet the new minimums, many are opting to limit beds or close wings. Penalties can be applied retroactively to April 2022. “Every nursing home administrator and owner I speak to says they’d love to have 3.5 [hours of nursing per resident per day], but they can’t get the workers,” Hanse said. A state health department statement said “no enforcement actions have been taken to date, but the department will begin monitoring compliance.”
— McKnight’s Long-Term Care News, January 6, 2023
New York Revises Nursing Home Minimum Staffing Penalties Just Months After Implementation
The New York State Department of Health (NYSDOH) is already revising its minimum staffing regulations for nursing homes just months after the policies were officially implemented in April. A $300 per day minimum penalty was removed from legislation if there is an “extraordinary circumstance,” like severe staffing shortages or an ongoing union dispute. Those without a valid mitigating factor will have to pay fines up to $2,000 each day they don’t meet staffing levels.
— Skilled Nursing News, August 21, 2022
Nursing Home Staffing Minimum Law Takes Effect in New York
Nursing homes across the state of New York must now abide by a new law that requires facilities to meet minimum staffing levels. The state’s health department said it will view payroll based journal (PBJ) data to ensure nursing homes are complying with the laws. Fines for noncompliance could be up to $2,000 a day. Before the law even went into effect, of the 611 nursing homes in the state 383 (63%) were considered below 3.5 hours per resident day staffing requirements.
— Skilled Nursing News, April 3, 2022
NY Delays Resident Care, Staffing Mandates as Hundreds of Nursing Homes Sue Over Policy
New York Gov. Kathy Hochul (D) has delayed a new state law that requires nursing homes to spend a minimum of 70% of revenue on direct patient care and at least 40% of that on resident staffing. Hochul issued the 30-day stay of the law just days after more than 250 New York operators filed a lawsuit seeking to overturn it. “This law completely ignores the fact that nursing homes are on the front lines battling the COVID-19 pandemic while facing a nursing home staffing shortage crisis,” Hanse said.
— McKnight’s Long-Term Care News, January 3, 2022
New Minimum Staffing Mandates Finalized for NY Providers
New York nursing homes will soon be required to meet minimum staffing requirements. Gov. Andrew Cuomo (D) signed two measures that set statewide mandates for nursing homes and hospitals. The legislation for nursing homes requires facilities to provide a daily average of 3.5 hours of care per resident by a nurse or nursing assistant. At least 2.2 hours of care must be provided by a certified nursing assistant, and at least 1.1 hours of care must be given by a licensed nurse.
— McKnight’s Long-Term Care News, June 24, 2021
Nursing Home Minimum Staffing and Direct Resident Care Spending — NYSDOH
These [state] minimum standards require every nursing home to maintain daily staffing hours equal to 3.5 hours of care per resident per day by a certified nurse aide, licensed practical nurse, or registered nurse. Of the 3.5 hours required, at least 2.2 hours of care per resident per day must be provided by a CNA and at least 1.1 hours of care per resident per day must be provided by a licensed nurse.
Compliance with the minimum nursing staff requirements is determined on a quarterly basis using the most recent data available from the federal Centers for Medicare and Medicaid Services (CMS) Payroll Based Journal (PBJ). The Department of Health will impose a penalty of up to $2,000 per day for each day in a quarter that a facility fails to comply. Penalty reduction and redetermination requests must be submitted within 10 business days.
— New York State Department of Health
