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Ask the payment expert …. about the total nurse staffing measure

Q: What is the Skilled Nursing Facility Value-Based Payment Total Nurse Staffing Measure? A: The Total Nursing Hours Per Resident Day Measure uses auditable electronic data reported to the Payroll-Based Journal system to calculate total nursing hours per resident day. It is one of two new measures that will begin affecting payments in the FY 2026 SNF VBP program year, the other being SNF Healthcare Associated Infections Requiring Hospitalization.

Importance of the human touch

Everyone falls into auto-mode now and then. While SimplePBJ continues to discover and add new verification checks for potential issues, the human touch is still needed to confirm the PBJ data you're submitting is accurate. Don't get lulled into thinking the data from your payroll or timekeeping system is 100% PBJ ready. Many times that ends up not being the case.

‘Powerful Data’ Could Inform CMS’ Nursing Home Minimum Staffing Standards

As federal minimum staffing requirements loom for skilled nursing providers, analysts with the Medicare Payment Advisory Commission (MedPAC) unveiled crucial data detailing the effects of state-level standards on the industry. While research found state minimum staffing requirements increased staffing levels and in some cases improved quality measures, there were some unintended consequences: a decrease in indirect staffing and skill mix, or the number of registered nurses (RNs) and licensed practical nurses (LPNs) relative to certified nursing assistants (CNAs).

Antipsychotics use falls when LTC nurse staffing hours rise

Higher staffing levels in long-term care facilities are linked with lower rates of antipsychotic prescribing, finds a new study representing data from most U.S. nursing homes. Facilities overall had a 15.24% rate of antipsychotic use, with a significant association between how well they were staffed and level of inappropriate prescribing, reported Dallas P. Seitz, MD, PhD, of Queen’s University and Calgary University in Canada.

Employment Considerations for Long Term Care Facilities under the Biden-Harris Administration

The Centers for Medicare and Medicaid Services (CMS), acting under the direction of the Department of Health and Human Services, issued a proposed rule in the federal register in April titled Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule (Proposed Rule). This Proposed Rule contains three provisions likely to impact staffing at LTC facilities in the coming years.

States get needed nurse aide waiver relief but workers’ fates uncertain

Skilled nursing providers in at least 15 states averted the loss of thousands of frontline workers Thursday, when the Centers for Medicare & Medicaid Services let expire a blanket national waiver allowing the use of non-certified nurse aides. Those states had been awarded new waivers through an application process, meaning they demonstrated testing backlogs or other delays that kept providers from converting a large share of temporary nurse aides into permanent certified nurse assistants.

More PBJ Articles

Provider advocates slam ‘unfair’ media take down of nursing home staffing compliance

A major provider organization Thursday called out a newspaper’s national investigation into nursing home staffing as “unfair and mischaracterized.”

USA Today’s lengthy article focused on staffing benchmarks set by federal agencies, understaffing of facilities and the harm it causes residents and staff, and the low percentage of citations compared to the number of understaffed facilities the paper found in its investigation.

“We are extremely disappointed in USA Today’s unfair and mischaracterized reporting,” AHCA leaders said. “The analysis that USA Today bases their claims on is flawed.”

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The minimum staffing cloud looms. Will any sunlight shine through?

As the leaves start to fall in many parts of the US, so has something else: Hope that a rule establishing minimum staffing levels in nursing homes won’t happen in spring.

It’s become abundantly clear over the past few months that the administration will not be deterred from its mission. It will soon tell nursing facilities how many people they have to have to run their businesses. Long-term care’s biggest figureheads have acknowledged as much and have started planning for the next steps.

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Parkinson: Nursing home sector pinning hopes on ‘Medicaid adequacy’ rule

After characterizing business conditions as “never worse,” the skilled nursing sector’s top advocate said stakeholders need more help from both the federal and state governments to forge a viable path forward.

The solution could lie in the Centers for Medicare & Medicaid Services universally demanding that states prop up Medicaid payments, said Mark Parkinson, the president and CEO of the American Health Care Association/National Center for Assisted Living, during a media briefing Tuesday at the group’s annual meeting.

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SNF Operators in Favor of Staffing Standards But Not Without Funding, Role Expansion

Ahead of a federal minimum staffing ratio to be proposed for the nation’s nursing homes, data continues to show a shortfall of available staff to meet such requirements. Many operators are in favor of higher staffing levels, but not without state or federal funding to hire and retain the appropriate level of staff. Others hope the types of positions counted in a staffing minimum will be expanded beyond registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs).

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Studies PBJ Data

Read the studies & media coverage of PBJ based research

Provider PBJ Hub

Links to key PBJ resources for skilled nursing facilities


Memos to states with CMS' PBJ guidance and policies

Tech Users Guide

How to calculate the Five Star ratings on Care Compare

PBJ Policy Manual

CMS' rules & requirements for quarterly PBJ submissions

Get Access to the PBJ Library

Get a free Library Pass to the archives of key PBJ manuals, research, communications and web tools.