CMS Official Confirms Intent to Finalize Nursing Home Minimum Staffing Rule in 2024

In a recent national stakeholder call, the Centers for Medicare & Medicaid Services (CMS) reaffirmed its commitment to completing the nursing home minimum staffing proposal in 2024. Dr. Dora Hughes, acting chief medical officer and director of the Center for Clinical Standards and Quality (CCSQ), revealed that the agency is utilizing feedback from over 46,000 comments received on the proposal to shape the final rule, aiming for its conclusion later this year.

The CMS initially released the staffing proposal on September 1, initiating a 60-day comment period. Despite statutory allowances for up to three years to issue the final rule, concerns have arisen due to the extensive feedback received, leading to expectations that the release might extend beyond 2024. Advocacy groups have expressed worries about workforce shortages and inadequate funding in response to CMS’s proposed timeline.

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) spokesperson conveyed disappointment, emphasizing that the unfunded staffing mandate could negatively impact seniors’ access to long-term care. LeadingAge highlighted broader repercussions across the healthcare system, cautioning against implementing the rule without careful consideration of staffing ratios.

The CMS proposal outlines specific requirements for Medicare- and Medicaid-certified nursing homes, mandating a minimum of 0.55 hours of care from a registered nurse and 2.45 hours of care from a nurse aide per resident per day. Rural nursing homes have a five-year timeline, while non-rural ones have three years to meet these standards.

In addition to the commitment to finalize the staffing rule in 2024, CMS highlighted ongoing programs aimed at improving the quality of long-term care. Dr. Dora Hughes emphasized their focus on safety, quality, equity, and coverage across the care continuum. CMS also provided updates on initiatives, including the launch of a registry to assess the impact of new Alzheimer’s drugs and ongoing efforts to monitor and enforce compliance in long-term care facilities.

Looking ahead to 2024, CMS plans to collect ownership data to examine the role of private equity and real estate investment trusts (REITs) in nursing homes. Dara Corrigan, deputy administrator and director for the Center for Program Integrity (CPI), expressed that this data collection will inform evaluations on whether such ownership structures contribute to increased costs or lower quality of care. In 2023, CMS had issued a final rule requiring greater disclosures about ownership, management, and control of skilled nursing facilities (SNFs).