MedPAC’s recommendations: state staffing policies could hamper federal mandate

Sep 30, 2022 | Minimum Staffing, Nursing HPRD & Turnover


Nursing facility staffing

Federal staffing requirements have been unchanged since 1987.  38 states and DC have implemented stricter minimum staffing requirements than federal requirements.

The PBJ system has improved the accuracy of nursing facility staffing data. This report analyzed 2019-2021 PBJ data to show aggregate, sector-wide trends in total staffing, total resident days, staffing level and mix changes and changes in use of contract staff.


Linehan, Kathryn and Stubbs, Lauren. “Nursing Facility Staffing.” The Medicare Payment Advisory Commission, 2022. 


‘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).

Multiple board members commented on the “powerful” data, yet others were unsure if MedPAC would be “positioned or capable” of drawing up their own suggestion for a minimum staffing requirement.

Instead, members hope the data will better inform CMS’ development of new standards where they are warranted.


Stulick, Amy. “‘Powerful Data’ Could Inform CMS’ Nursing Home Minimum Staffing Standards.” Skilled Nursing News, 30 Sept. 2022,


State staffing policies could hamper MedPAC’s recommendations on federal mandate

A federal minimum staffing mandate is on the horizon for nursing homes at the beginning of 2023. Providers and experts wonder just how the proposed mandate might address historic staffing shortages without resources or support.

Although a minimum staffing ratio for nursing homes sounds like a good policy, money is needed to turn the idea into reality, the Medicare Payment Advisory Commission (MedPAC) said at its Sept. 30 meeting.

State staffing policies for nursing homes would also come into play, which could complicate their ability to make quality recommendations to the Centers for Medicare & Medicaid Services and Congress.

MedPAC could help CMS develop its standard using payroll-based journal data. MedPAC, however, is not in a position to release any specific recommended staffing minimum.


Gaivin, Kathleen Steele. “State Staffing Policies Could Hamper MedPAC’s Recommendations on Federal Mandate.” McKnight’s Senior Living, 11 Oct. 2022,