Regulatory Update

Understanding the Proposed CMS Staffing Mandate

Polaris Group Profile
Polaris Group
September 5, 2023
September 6, 2023
Polaris Group Profile
Polaris Group
September 6, 2023

On September 1st, CMS released a proposed staffing mandate. Understand what it means for your facility and what you can do next to prepare.

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On September 1, the Centers for Medicare & Medicaid Services (CMS) released the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting proposed rule. Widely referred to as the “staffing mandate” this CMS policy looks to establish the nurse staffing levels required to provide safe and quality care. A federal staffing mandate has been a key topic of conversation and concern for long-term care providers for almost a year.

What does the proposed staffing mandate include?

  • United States nursing homes would have three years to provide a minimum of 3.0 hours per patient day of direct care. 0.55 hours would be from a registered nurse and 2.45 hours by a nurse aide per.  CMS says that the mandated per-day levels are below the 4.1 cumulative hours per day level recommended by a 2001 study commissioned by CMS.
  • Non-rural nursing homes would have three years to comply with some elements of the rule, with rural facilities given five years to get up to speed on the overall hourly rate.
  • A requirement calling for 24/7 RN coverage, which is triple the current standard, would go into effect two years after the rule is finalized for urban providers. Rural providers would have another year to comply. The government currently requires RN coverage 8 hours per day with LPNs able to cover the remaining 16 hours.

How might the new CMS staffing mandate affect your facility? Contact us to learn more.

What can providers do?

Providers have pushed back against a federal staffing mandate since it was suggested by the Biden administration a year ago. AHCA/NCAL, LeadingAge, and other provider associations have argued that a staffing mandate could create a punishing cycle where out of compliance facilities are penalized financially or via the star system, further hurting their ability to attract patients and pay staff.

AHCA President and CEO Mark Parkinson said, “We hope to convince the administration to never finalize this rule as it is unfounded, unfunded, and unrealistic." Here’s how providers can continue advocating for their facilities and prepare for the staffing mandate if it does go into effect:

  • Continue to advocate for a proposal that includes hardship waivers given the long-term care sector’s ongoing workforce crisis.
  • Provide feedback to CMS, particularly on the hourly standards and RN requirements. CMS is still finalizing its policy and the statement “to meet and maintain acceptable quality and safety within LTC facilities” may portend a more extreme final mandate.
  • Focus on staffing key leadership and reimbursement positions so you have the operational talent and financial ability to adjust your staffing model and fund staffing increases. Polaris can support finding skilled administrators, DONs, MDS coordinators, and other specialized positions. Learn more here.
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