On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. According to CMS, this rule aims to hold nursing homes accountable for providing safe and high-quality care to the nearly 1.2 million residents living in Medicare- and Medicaid-certified long-term care facilities. Here are the key points:
Comprehensive Minimum Nurse Staffing Requirements:
- The final rule establishes new comprehensive minimum nurse staffing requirements to reduce the risk of residents receiving unsafe and low-quality care within LTC facilities.
- The total nurse staffing standard is set at 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care.
- Facilities can use a combination of nurse staff (RN, licensed practical nurse (LPN), licensed vocational nurse (LVN), or nurse aide) to meet the additional 0.48 HPRD needed to comply with the total nurse staffing standard.
- An RN must be onsite 24 hours a day, seven days a week to provide skilled nursing care.
Staggered Implementation and Exemptions:
- The rule provides a staggered implementation timeframe for the minimum nurse staffing standards and 24/7 RN requirement based on geographic location.
- Qualifying facilities may receive exemptions for some requirements based on workforce unavailability and other factors.
- According to CMS, the goal is to prioritize safety and healthcare quality while considering unique workforce challenges, especially in rural areas.
Transparency on Compensation for Workers:
- CMS will require states to collect and report on the percent of Medicaid payments spent on compensation for direct care workers and support staff in nursing facilities and intermediate care facilities for individuals with intellectual disabilities.
CMS said they will closely monitor and evaluate the provisions of this final rule over the next several years to determine if any updates or changes are necessary. You can find more details here.
Compliance Perspective
Issue
Staffing in LTC facilities has remained a persistent concern. CMS is finalizing a total nurse staffing standard, based on public comment feedback, that requires facilities to provide a minimum of 3.48 HPRD of total direct nursing care to residents, of which at least 0.55 HPRD of care must be provided by RNs and 2.45 HPRD of care provided by nurse aides. While these are minimum staffing standards, CMS expects LTC facilities to use the updated and newly strengthened facility assessment to determine whether their staffing needs to be set above these minimums, based on resident acuity and individual care needs.
Discussion Points
- Review policies and procedures on recruiting and retaining staff. Update your policies as needed.
- Train staff who are responsible for hiring to develop innovative and effective ways to recruit and retain staff. Document that these trainings occurred and file in each appropriate employee’s education file.
- Periodically audit staff opinions to learn their satisfaction with their jobs, and seek their input on how to achieve adequate staffing.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
