On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) posted the public inspection version of a proposed rule titled, Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. This proposed rule is scheduled to be published to the Federal Register on 09/06/2023. The comment submission deadline is 11/06/2023.
In a related fact sheet, CMS indicates that the proposed rule “seeks to establish comprehensive nurse staffing requirements to hold nursing homes accountable for providing safe and high-quality care” and provides a link to the CMS Nursing Home Resource Center, where the 2022 Nursing Home Staffing Study can be accessed.
CMS notes that the proposed rule consists of the following three core staffing proposals with staggered implementation timelines:
Core Staffing Proposals: Enhanced facility assessment requirements
Proposed Implementation Timeline for Non-rural Facilities: By 60 days after the publication date of the final rule
Proposed ImplementationTimeline for Rural Facilities: By 60 days after the publication date of the final rule
Core Staffing Proposals: Requirement to have an RN onsite 24 hours a day, seven days a week
Proposed Implementation Timeline for Non-rural Facilities: By two years after the publication date of the final rule
Proposed ImplementationTimeline for Rural Facilities: By three years after the publication date of the final rule
Core Staffing Proposals: Minimum nurse staffing standards of 0.55 hours per resident day (HPRD) for Registered Nurses (RNs) and 2.45 HPRD for Nurse Aides (NAs)
Proposed Implementation Timeline for Non-rural Facilities: By three years after the publication date of the final rule
Proposed ImplementationTimeline for Rural Facilities: By five years after the publication date of the final rule
In addition, the proposed rule includes:
- Proposed flexibilities that allow for a temporary hardship exemption in limited circumstances
- Proposed updates to the facility assessments
- New proposed institutional payment reporting requirements for states
- Provisions for promoting the public availability of Medicaid institutional payment information
CMS is also soliciting comment on:
- Alternative policy options that should be considered for establishing minimum nurse staffing standards
- Alternative policy options that would be better suited to meet and maintain acceptable quality and safety within long-term care facilities, with consideration for external factors affecting staffing
- The benefits and tradeoffs of different standards, evidence, or methodologies states use to establish minimum staffing standards and other key considerations
Additionally, in a related press release, CMS provides a brief overview of announcements regarding the following related issues:
- Increasing Audits of Nursing Homes’ Staffing
- Improving Nursing Home Inspections
- Ensuring Taxpayer Dollars Go Toward Safe, High-Quality Care
- Cracking Down on Inappropriate Antipsychotic Prescribing Practices and Risks
- Enhancing Resident Safety During Emergencies
Resources:
- Federal Register webpage for the Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment TransparencyReporting Proposed Rule
- CMS Press Release - HHS Proposes Minimum Staffing Standards to Enhance Safety and
Quality in Nursing Homes - CMS Fact Sheet - Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting (CMS 3442-P)
- CMS Nursing Home Resource Center
■ 2022 Nursing Home Staffing Study Final Report
■ Literature Review Results Table
■ State Minimum Staffing Requirement Table
If you have questions or need additional information, please contact the Powerback Rehabilitation and Powerback Respiratory email inquiry system at askregulatory@powerbackrehab.com.
