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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.

The article discusses how the Centers for Medicare & Medicaid Services (CMS) has updated its guidance on nursing home staffing, which is expected to result in more citations and penalties for facilities that fail to meet minimum staffing requirements.

Key points:

• The CMS update requires surveyors to ask direct care staff and directors of nursing about staffing levels and how they are determined.
• Facilities will be cited if they fail to submit staffing data through the Payroll-Based Journal (PBJ) system.
• The updated guidance aims to reduce inconsistency in how surveyors apply staffing standards, with some states having much higher or lower citation rates than others.
• Industry experts expect the new guidance to result in more citations and penalties for facilities that do not meet minimum staffing requirements.

Experts quoted in the article:

• Steven Littlehale, executive vice president of Zimmet Healthcare Services Group: "When you push a little bit, facilities will often say that they staff based on their budget, and not on their casemix... That's a significant problem."
• Mark Morton, NASL's Director of Government Relations: "It's another breadcrumb, the administration is definitely telling us operators, staffing matters significantly to us and so we're going to measure you on that any way we can."

The article suggests that the CMS update is part of a broader effort by the Biden administration to prioritize staffing in nursing homes.

The Centers for Medicare & Medicaid Services (CMS) is reviewing a year-long study on staffing mandates for nursing homes as it prepares to issue proposed federal minimum staffing requirements this spring. The study, which includes quantitative and qualitative data, aims to determine policy direction and cost implications of implementing a federal staffing mandate. CMS Deputy Director Jean Moody-Williams said the agency will use the study's findings to inform its proposal, but there is no indication that the study itself will be made public.

The proposed staffing mandate has been met with resistance from skilled nursing operators and industry organizations, who argue that they cannot support the initiative due to ongoing staffing crises and lack of federal or state funding. Federal law currently requires nursing homes to provide 24-hour licensed nursing services, using a registered nurse (RN) for at least 8 consecutive hours a day, seven days a week.

CMS plans to issue its proposal for minimum staffing requirements this spring, which will then undergo a notice-and-comment rulemaking process. This will give industry stakeholders another opportunity to weigh in on the proposal. The agency has also taken steps to increase transparency of facility information and improve oversight of nursing homes, including publicly displaying disputed survey citations and conducting off-site audits.

The CMS call on the proposed staffing mandate came after federal lawmakers urged the agency to reconsider a one-size-fits-all staffing mandate. Skilled nursing operators have expressed concerns that such a mandate would be too rigid and fail to account for individual facility needs and circumstances.

This article discusses the Centers for Medicare and Medicaid Services' (CMS) final rule on minimum staffing requirements for nursing facilities, which aims to improve the quality of care for residents. Here are the main points:

Key Findings:

• 19% of nursing facilities would meet the minimum Health Personnel-to-Resident Day (HPRD) staffing standards under full implementation of the final rule with their current staffing levels.
• Nearly 60% of facilities would meet the interim requirement of an overall HPRD of 3.48, but fewer facilities would meet the RN and nurse aide provisions that are required when the rule is fully implemented (49% and 30% respectively).

Analysis:‍

• The analysis uses Nursing Home Compare data from March 2024, which includes 14,403 nursing facilities (97% of all facilities, serving 1.18 million or 98% of all residents), and reflects staffing levels from July to September 2023.
• Due to data limitations, this analysis does not look at the 24/7 RN requirement.

Final Rule:‍

• The final rule includes new reporting and assessment requirements and the process by which facilities may qualify for an exemption from the minimum staffing provisions.
• CMS will release additional details later this year on how the $75 million investment in a nursing home staffing campaign will be structured.

Limitations:‍

• The analysis does not evaluate facilities' ability to comply with other requirements in the final rule, including the requirement to always have a registered nurse on duty 24/7 or the ability to meet the new reporting and assessment requirements due to data limitations.
• The analysis also does not estimate which facilities would qualify for an exemption or how staffing levels will change between now and when the staffing standards take effect.

Future Analysis:

• A forthcoming analysis will look at the share of facilities that currently meet the new standards across a variety of dimensions, including ownership, state, and urban or rural location.