Obtaining exemptions for nursing home staffing appears to be an insurmountable challenge due to unclear criteria set by the Centers for Medicare and Medicaid Services.
The article discusses the concerns and challenges surrounding the Centers for Medicare & Medicaid Services' (CMS) final rule on nursing home staffing requirements, particularly with regards to exemptions and hardship waivers. Here are the main points:
Exemptions and Hardship Waivers
- CMS has established a process for nursing homes to apply for exemptions or hardship waivers from the staffing requirements.
- However, industry experts and advocates express concerns that these exemptions may be misused or exploited by some operators.
Competency and Staffing Requirements
- The rule requires nursing homes to have at least one registered nurse (RN) on duty 24/7 and a minimum of 2.5 hours per resident per day of direct care staffing.
- Some experts argue that competency, rather than just numbers, should be the primary focus for staffing requirements.
Consumer Welfare Concerns
- A report from KFF highlights concerns about "financial chicanery" among nursing home operators, who may use exemptions to avoid investing in staff and facilities.
Confusing Criteria
- CMS's criteria for exemptions can be confusing and difficult to prove, particularly with regards to the 20% provider-to-workforce area rule.*
- Industry experts express uncertainty about how providers will know whether they meet the criteria or not.
Good Faith Effort Criteria
- The good faith effort criteria are also seen as ambiguous, with concerns that CMS needs to define and establish clearer guidelines for what constitutes a good faith effort.
Overall, the article suggests that while exemptions and hardship waivers may provide temporary relief for some nursing homes, they also raise concerns about the potential for exploitation and decreased quality of care. Industry experts emphasize the need for clear guidelines, competency-based staffing requirements, and stronger oversight to ensure that nursing home residents receive high-quality care.