CMS is considering a requirement that nursing homes spend the majority of their payments from Medicaid on direct care for residents. Although this requirement has not formally been proposed, Dan Tsai, a deputy administrator at CMS, told Kaiser Health Network last week that CMS wants “to make sure that the dollars get to the direct care workforce to ensure high-quality care.” Massachusetts, New Jersey, and New York already mandate spending on direct care for residents.In April, CMS published a Notice of Proposed Rule-Making (NPRM) that contained multiple requests for information on nursing home staffing standards and resource spending relating to the quality of patient care.