CMS Releases Controversial Minimum Staffing Rule

April 30, 2024

On April 22, 2024, the Centers for Medicare and Medicaid Services (CMS) released a final rule that will implement for the first time at the national level minimum staffing level requirements for long-term care (LTC) and skilled nursing facilities certified under the Medicare and Medicaid programs. The rule aims to address ongoing safety and quality concerns at nursing homes.

The rule will require nursing homes to provide a minimum of 3.48 hours of nursing care per resident day and will require a registered nurse (RN) to be on-site 24 hours per day and 7 days per week. In addition, nursing homes must provide 0.55 hours of care from a RN per resident day and at least 2.45 hours of care from a nurse aide per resident day. Facilities may use any combination of nurse staff (RN, licensed practical nurse (LPN) and licensed vocational nurse (LVN) or nurse aide) to account for the additional 0.48 hours per resident day needed to comply with the total nurse staffing standard.

The rule provides for a staggered implementation timeframe of the minimum standards and 24/7 RN requirement based on geographic location as well as possible exemptions for qualifying facilities for some parts of the requirements based on workforce unavailability and other factors.

Since 2022, CMS has been working towards addressing nursing home staffing levels after a research study it commissioned found that LTC facilities face chronic staffing, patient safety, and quality of care challenges driven by high nursing staff turnover rates.

Although skilled nursing providers and associations have acknowledged the need to ensure quality care in nursing homes, they strongly oppose the rule. They assert that while the rule may be well intentioned, the rule is an unreasonable standard that threatens to shut down nursing homes and displace residents. The American Hospital Association has also noted that they believe the rule will exacerbate ongoing nurse and skilled healthcare workforce shortages and force nursing homes to reduce their capacity or close permanently.

The rule has caught the attention of Congress, where both the House and Senate are considering legislation that would block CMS from implementing the rule.

The rule will go into effect on June 21, 2024.