September 1, 2023
On September 1, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting proposed rule, which seeks to establish comprehensive nurse staffing requirements.
The proposed rule consists of three 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);
- a requirement to have an RN onsite 24 hours a day, seven days a week; and
- enhanced facility assessment requirements.
The proposed rule also includes a staggered implementation approach and possible hardship exemptions for select facilities. This proposed rule would also promote public transparency related to the percentage of Medicaid payments for services in nursing facilities and intermediate care facilities for individuals with intellectual disabilities that are spent on compensation to direct care workers and support staff. The Medicaid institutional payment transparency provision is intended to align with a similar transparency provision focused on specific Medicaid home and community-based services in the Ensuring Access to Medicaid Services proposed rule (CMS-2442-P), published in the May 3, 2023, issue of the Federal Register.
Additionally, CMS announced a national campaign to support staffing in nursing homes. CMS will work with the Health Resources and Services Administration (HRSA) and other partners to make it easier for individuals to enter careers in nursing homes, investing over $75 million in financial incentives such as scholarships and tuition reimbursement. This staffing campaign builds on other actions through the HHS Health Workforce Initiative, including the recent announcement that HRSA awarded more than $100 million to train more nurses and grow the nursing workforce.
The Society will be reviewing and submitting comments on the proposed rule by the November 6, 2023, deadline.
The proposed rule is available at https://www.federalregister.gov/public-inspection/current
AMDA reacts to proposed rule about staffing requirements for nursing homes.