CMS Proposes Minimum Staffing Standards for Nursing Homes

CMS has proposed minimum staffing standards for nursing homes, requiring facilities to provide residents with at least three hours of care per day.

The Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting proposed rule aims to solidify access to safe and high-quality nursing homes, CMS said.

The rule includes three main staffing proposals for nursing homes participating in Medicare and Medicaid.

First, nursing homes must provide each resident with a minimum of 0.55 hours of care per day from a registered nurse and 2.45 hours per day from a nurse aide. However, facilities must also provide staffing that meets the needs of the individual residents they serve, which may require higher staffing levels than the proposed minimum standards.

CMS estimates that 75 percent of nursing homes would have to bolster facility staffing to meet the proposed standards.

Data from KFF found that almost all facilities would meet a requirement of 2.5 or fewer direct care hours per resident day, while 85 percent would meet a requirement of 3.0 hours per resident day.

Second, nursing homes must have a registered nurse onsite 24 hours per day, seven days a week, who can provide direct resident care. This requirement aims to improve care for residents with complex and acute medical conditions requiring significant resources and care from registered nurses.

Third, nursing homes would be required to complete enhanced facility assessments on staffing needs. Currently, LTC facilities are required to conduct, document, and review annually an evaluation to determine the resources they need to care for residents. CMS has proposed updates to the facility assessment.

Proposals include clarifying that facilities must use evidence-based methods when planning care for their residents, requiring facilities to use the assessments to look at the specific needs of each resident, and requiring facilities to include input from all staff.

Given the ongoing staffing shortages resulting from the COVID-19 pandemic, the proposed standards include staggered implementation and exemption processes. LTC facilities may qualify for a temporary hardship exemption from the staffing standards if they demonstrate workforce unavailability based on their location, good faith efforts to hire and retain staff, and a financial commitment to staffing.

In addition to staffing standards, the proposed rule included provisions to improve Medicaid payment transparency. States would be required to report to CMS on the percentage of Medicaid payments for services in nursing facilities and intermediate care facilities that are spent on compensation for direct care workers and support staff.

Additionally, the rule proposes that states and CMS make the institutional payment information reported by states to CMS available on public-facing websites.