CMS Calls for Novel Federal Staffing Standards in Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) issued a proposal on September 1 calling for the first national minimum staffing standards for nursing homes. The Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting proposed rule outlines comprehensive requirements for nurse staffing to allow for greater transparency and higher quality care for more than 1.2 million patients currently residing in Medicare and Medicaid-certified LTC facilities.

The proposed rule would require a minimum of 0.55 hours of care from a registered nurse per resident per day along with 2.45 hours of care from a nurse aide per resident per day – a standard that the majority of these LTC facilities currently do not meet. The rule also requires a registered nurse to be onsite around the clock and would enhance facility oversight by strengthening the facility assessment requirements. This includes:

• Ensuring the LTC facilities are using evidence-based methods for resident care;
• Requiring the facility to make individualized assessments for residents and make necessary adjustments;
• Soliciting the input of facility staff in management and care; and
• Developing a staffing plan to maximize recruitment and retention.

CMS is permitting regulatory flexibility, recognizing that nursing homes may face staffing hurdles due to external factors such as local workforce unavailability. Additionally, CMS is soliciting comments for “alternative policy options” for establishing minimum national nurse staffing standards. Facilities may qualify for temporary hardship exemptions if they meet criteria proving that:

• There is workforce unavailability based on location either due to lower-than-average provider-to-population ratios for the nursing workforce or the existence of another facility at least 20 miles away;
• Good faith efforts to hire and retain staff have been made through the development and implementation of a recruitment and retention plan; and
• A financial commitment has been made through the documentation of the total annual amount spent on direct care staffing.

The plan would be implemented in stages. LTC facilities in urban areas would be given three years to come into compliance, while rural facilities would have three years to meet the registered nurse 24/7 onsite requirement and five years to come into total compliance.