On April 22, 2024, CMS issued their Minimum Staffing Standards for long-term care (LTC) facilities and Medicaid Institutional Payment Transparency Reporting final rule to be published in the Federal Register on May 10, 2024, with an effective date of June 21, 2024.
Industry leaders, including the American Health Care Association (AHCA), LeadingAge, and ADVION, have swiftly responded with comments. AHCA President, Mark Parkinson, is quoted in Skilled Nursing News saying, “It is unconscionable that the Administration is finalizing this rule given our nation’s changing demographics and growing caregiver shortage…” He also stated, “…Our fight on your behalf has just begun. We will also take our fight to the courts by filing litigation to challenge CMS’ authority to issue these requirements.”
Please find below a brief overview of key elements within the mandate.
The Required Staffing Standard
- 3.48 hours per resident day (HPRD)
- .55 HPRD minimum of direct registered nurse (RN) care
- 2.45 HPRD of direct nurse aide care
- .48 HPRD made up of any combination of nursing staff (RN, LPN, LVN, CNA)
- RN on site 24/7 based on geographic location (urban vs rural) as well as possible exemptions based on workforce unavailability and other factors (DON can count if available for direct patient care)
- Reporting of Medicaid payments spent on compensation for direct care workers and support staff delivering care
Phase In Requirements
- Phase 1 – Within 90 days of the final rule publication (Thursday July 8, 2024, if published May 10, 2024) facilities must meet the facility assessment requirements
Facility assessments have been a CMS annual requirement since 2016. There is no mandated form; however, this CMS optional tool includes an overview designed to clarify and meet the requirements of identifying residents’ needs and ensure provision of the resources necessary for subsequent care.
- Phase 2 – Timeline to meet the 3.48 HPRD total nurse staffing and 24/7 requirements
- Non-rural: Within 2 years of the final rule publication
- Rural: Within 3 years of the final rule publication
- Phase 3 – Timeline to meet the .55 RN and 2.45 nurse aide HPRD requirements
- Non-rural: Within 3 years of the final rule publication
- Rural: Within 5 years of the final rule publication
Exemption Opportunities Defined
24/7, onsite requirement exemption to allow 8 hrs./day vs 24 hrs. in limited circumstances. Qualification based on meeting five criteria. ADVION provided the below clarification:
- The workforce is unavailable as measured by having a nursing workforce per labor category that is a minimum of NEW: 20 percent below the national average for the applicable nurse staffing type, as calculated by CMS, by using the Bureau of Labor Statistics and Census Bureau data
- The facility is making a good faith effort to hire and retain staff
- The facility provides documentation of its financial commitment to staffing
- NEW: The facility posts a notice of its exemption status in a prominent and publicly viewable location in each resident facility
- NEW: The facility provides individual notice of its exemption status and the degree to which it is not in compliance with the HPRD requirements to each current and prospective resident and sends a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman
The Point Is: Now is the time to focus on advocating strongly for the establishment of actionable solutions to address the reality of our workforce shortage amid increasing demands. QRM will continue to monitor and share updates and opportunities for your voices to be heard. Please let us know if you have any questions, we are here to help.
