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New Staffing and Other Requirements for Medicare and Medicaid Nursing Facilities 

Published on

June 11, 2024

The Centers for Medicare & Medicaid Services (CMS) recently released its Final Rule on minimum staffing requirements and payment transparency for long-term care (LTC) facilities, with some requirements becoming effective by August 8, 2024. 

In September 2023, CMS announced that it was investing over $75 million to launch a national campaign to increase staffing in nursing homes to protect the health and safety of residents. On April 22, 2024, CMS continued its campaign by issuing final regulations to implement minimum staffing requirements for all Medicare and Medicaid nursing facilities. The new regulations also require nursing facilities to conduct comprehensive assessments to determine what resources are available to adequately address resident needs, including plans for staff recruitment and retention. 

The implementation dates for these new regulations (with some exceptions for rural facilities and hardship situations) will occur in three phases, as follows:

  • Phase 1 — Within 90 days of the Final Rule, or by August 8, nursing facilities must comply with the enhanced facility assessment requirements. 
  • Phase 2 — Within two years of the Final Rule, nursing facilities must provide a minimum of 3.48 nursing hours per resident per day, as well as 24/7 on-site RN coverage. 
  • Phase 3 — Within three years of the Final Rule, the staffing requirements must be met with a minimum of .55 RN hours and 2.45 nurse aide hours per resident per day respectively. (Compliance will be calculated by dividing the total number of hours worked for each type of staff per day by the total number of facility residents.) 

Finally, at a later date, CMS will require states to report regarding the percentage of their Medicaid budget spent on compensation for direct care workers and support staff. 

It should be noted that a number of states, including Pennsylvania, already have implemented new regulations to increase nurse staffing and to improve the quality of nursing homes. Like the federal government, Pennsylvania has opted for a phased-in approach that gradually increases nurse staffing – to 3.2 hours per resident per day by July 1, 2024, which may give Pennsylvania facilities a head start in meeting the new federal standards. However, some have argued that increased funding is needed to compensate nursing facilities for the new staffing mandates, reporting that the inability to hire additional staff is requiring facilities to deny patient admissions to preserve staffing ratios. It also is estimated that less than one in five nursing facilities would be able to meet the new federal standards currently. In response, some government agencies are considering new and creative initiatives, including giving high school students credit for working in nursing homes, in order to forestall a larger staffing crisis.     

If you have any questions about the CMS Final Rule or regulatory requirements, please contact partner Christopher J. Churchill or any member of Barley Snyder’s Senior Living Industry Group.


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