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September 15, 2023

CMS Issues Proposed Rule Regarding Minimum Staffing Standard for Long-Term Care Facilities

On September 1, 2023, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule for Minimum Staffing Standards for Long Term Care Facilities and Medicaid Institutional Payment Transparency Reporting.  The proposed rule seeks to create comprehensive nurse staffing requirements and “determin[e] the minimum level and type of staffing needed to enable safe and quality care at [long term care] facilities." 

There are three main staffing proposals in the proposed rule.  First, the rule would set a minimum nurse staffing requirement of 0.55 hours per resident day for Registered Nurses and 2.45 hours per resident day for nurse aides.  Second, the rule would require a registered nurse to be on-site 24 hours a day, seven days a week.  Third, the rule seeks to enhance facility assessment requirements, including by requiring use of “evidence-based methods when care planning”; requiring facilities to review the specific needs of each resident; requiring facilities to include the input of the full facility staff; and requiring facilities to develop “a staffing plan to maximize recruitment and retention.”     

CMS also proposed a potential hardship exemption from the minimum staffing standards if a facility satisfies certain criteria such as workforce unavailability bybased on location;, demonstrated good faith efforts to hire and retain staff;, and demonstrable financial commitments to staffing, as shown by documenting the total annual amount spent on direct care staff.   Overall, CMS  proposed staffing standards are minimums, and while these thresholds would apply across all long-term care facilities if finalized, CMS expects facilities to staff above these minimums to address resident needs.  

The public comment deadline is November 6, 2023. 

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