CMS Issues Final Rule Establishing Mandatory Staffing Levels for Healthcare Providers.
The Centers for Medicare and Medicaid Services (CMS) has released a final rule establishing minimum staffing standards for long-term care (LTC) facilities that participate in Medicare and Medicaid. The rule aims to ensure safety and quality concerns for residents in these facilities, but it does not provide additional funding to support the increased staffing requirements. Despite industry concerns about the feasibility of meeting these new standards, CMS has implemented a multistage implementation process to allow facilities to prepare.
The final rule requires LTC facilities to meet four daily staffing requirements: a minimum of 3.48 total nurse staffing hours per patient day (HPRD), including RNs, LPNs/LVNs, and nurse aides; a minimum of 0.55 RN HPRD; a minimum of 2.45 NA HPRD; and an RN on site 24 hours per day, seven days a week. Facilities that fail to meet these requirements may be eligible for exemptions in limited circumstances, but they must demonstrate good faith efforts to hire and retain staff, provide documentation of their financial commitment to staffing, and post notices of their exemption status.
The rule also revises the Facility Assessment process to ensure that facilities use evidence-based, data-driven methods to determine staffing needs based on the specific care requirements of their residents. The assessment must incorporate input from facility staff and representatives, as well as include staffing decisions to ensure a sufficient number of qualified staff are available. Enforcement actions, including termination of provider agreements, denial of payment for new admissions, and civil money penalties, may be taken against facilities that fail to meet these requirements.
The implementation timeline varies by urban and rural areas, with some requirements taking effect as soon as 90 days after the final rule's publication and others phased in over a period of two to five years. Industry stakeholders have expressed concerns about the feasibility of meeting these new standards, citing workforce shortages and lack of funding.