CMS Finalizes Minimum Staffing Requirements for Nursing Homes

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 (see also the related CMS fact sheet). The final rule establishes minimum staffing requirements for nursing homes with the goal of ensuring safe and quality care in long-term care facilities. The final rule follows the proposed rule that CMS issued in September. CMS received more than 46,000 public comments in response to the proposed rule.

Specifically, the final rule requires nursing homes to provide a minimum of 3.48 hours per resident day (HPRD) of direct nursing care, of which at least 0.55 HPRD of care must be provided by a registered nurse (RN) and 2.45 HPRD of care must be provided by a nurse aide. The remaining 0.48 HPRD can be met using any combination of nurse staff, including RNs, licensed practical nurses (LPNs), licensed vocational nurses (LVNs), or nurse aides. Additionally, the final rule requires that at least one RN be onsite 24 hours a day, seven days a week, to provide skilled nursing care. The final rule also establishes enhanced facility assessment requirements and staffing plans to maximize workforce recruitment and retention.

The timeframes to implement the requirements are as follows.

• Facility assessment requirements: Within 90 days.
• Staffing requirements for nursing homes in non-rural areas:
• Within two years for the 24/7 RN requirement;
• Within two years for the 3.48 HPRD minimum staffing requirement; and
• Within three years for the 0.55 RN and 2.45 nurse aide HPRD requirements.
• Staffing requirements for nursing homes in rural areas:
• Within three years for the 24/7 RN requirement;
• Within three years for the 3.48 HPRD minimum staffing requirement; and
• Within five years for the 0.55 RN and 2.45 nurse aide HPRD requirements.

For purposes of the implementation timeframe, “rural” is defined according to the Census Bureau definition and encompasses all population, housing, and territory not included within an urban area.[1] The deadlines listed above are measured from the date of publication of the final rule, which is expected to be May 10, 2024. The final rule provides possible exemptions for qualified nursing home facilities based on workforce unavailability and other factors.

For more information, please contact Gerald Aben (gaben@dykema.com or 734-214-7648) or Kathleen Reed (kreed@dykema.com or 231-348-8134).

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[1] https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural.html#:~:text=Rural%20encompasses%20all%20population%2C%20housing,and%2For%20population%20density%20req