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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.

Here is a summary of the article in three parts:

Background and Issue‍

The Centers for Medicare & Medicaid Services (CMS) has introduced new regulations that mandate minimum staffing levels for nursing homes. The final rule requires a minimum of 3.48 hours per resident per day (HPRD) of total staffing, with specific allocations for registered nurses (RN) and nurse aides. This standard encompasses 0.55 HPRD of direct RN care and 2.45 HPRD of direct nurse aide care.

Industry Concerns and Challenges

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) estimates that the new regulations will cost $6.5 billion annually and require an additional 102,000 clinicians. Industry leaders have expressed concerns about the feasibility of meeting these requirements, citing existing staffing shortages and high turnover rates. Many nursing homes rely on agency workers to fill gaps in their staffing, but this is seen as a less desirable solution due to inconsistent care.

Path Forward

Nursing homes will need to develop robust recruitment and retention strategies, utilize effective facility assessments, and apply for exemptions and waivers where necessary. The focus should be on ensuring that staffing levels are not only compliant with federal requirements but also sufficient to provide high-quality care tailored to the specific needs of residents. Industry experts advise reducing reliance on agency staff and instead employing a stable, dedicated team. However, this will be challenging in the current labor market.

Overall, the new regulations pose significant challenges for nursing homes, and industry leaders are calling for support and resources to help them adapt to these changes.

It appears that this text is a newsletter or update from a law firm, Nelson Mullins. The content includes various articles and updates on different legal topics, including employment law, financial regulations, healthcare law, intellectual property law, and more. There are also announcements for upcoming legal education events.

Here's a brief summary of each article:

1. 2024 Mid-year Employment Law Updates: This article discusses recent developments in employment law, including changes to non-compete agreements, minimum wage laws, and accommodations for employees with disabilities.
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The newsletter also includes announcements for upcoming events, including a value-based care conference, an IP conference, and a law of product distribution and franchise seminar.

The Centers for Medicare and Medicaid Services (CMS) has finalized its staffing mandate for skilled nursing facilities, which will require an additional 101,500 full-time equivalent (FTE) staff members nationwide over the next decade at a cost of $5.8 billion. The rule, which was widely criticized by industry leaders, requires facilities to have a minimum of 3.48 hours of direct care per resident day (HPRD), including 0.55 HPRD for registered nurses (RNs) and 2.45 HPRD for nurse aides.

Experts from CliftonLarsonAllen (CLA) advise facility operators to review the final regulations thoroughly and understand their implications, as well as prepare for compliance with the new requirements. The experts recommend conducting a gap assessment to identify areas needing improvement and integrating these findings into strategic and financial planning. They also caution against simply accepting penalties for non-compliance, as CMS tends to increase penalties over time.

The enhanced facility assessment requirement applies universally, regardless of the facility's location, and is due August 8. The assessments will help facilities identify gaps in their current staffing levels and develop plans to meet the new requirements. Industry leaders have expressed concerns about the feasibility of meeting the new requirements, but experts from CLA emphasize that preparing for compliance is essential, given the trend towards increased staffing mandates at both state and federal levels.

The CMS staffing mandate has been widely criticized by industry leaders, who argue that it will be difficult to meet the new requirements without significant increases in funding. However, experts from CLA believe that preparing for compliance is essential, regardless of potential legal challenges or changes in administration. They recommend that facilities start assessing their current status and identifying gaps to ensure compliance over the next few years.