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Staffing Level Final Rule for Nursing Homes

On April 22, Center for Medicare and Medicaid Services (CMS) released the final rule on minimum staffing level requirements for nursing homes. This rule aims to improve quality care within long term care facilities. CMS stated it received over 46,000 public comments in response to the proposed rule.

Staffing Level Final Rule Overview

Facilities are required to provide at a minimum:

  • 3.48 HPRD (hours per resident day) of total direct nursing care to residents
  • 0.55 HPRD of care must be provide by RNs
  • 2.45 HPRD of care provided by nurse aides
  • RN coverage is required 24 hours a day/7 days a week

Facilities must meet the minimum HPRD standards regardless of the individual facility’s resident case-mix. If the acuity needs of residents in a facility requires a higher level of care, a higher total RN, and NA staffing level will likely be needed.

The facility is also required to update their facility assessment with the new requirements to have RN coverage 24/7.

CMS is staggering the implementation of the requirements over a period of five years for rural facilities and three years for non-rural facilities.

Implementation Timeline

Here is the timeline of implementation for both rural and non-rural facilities.

Photo describes the three implementation phases when it comes to the CMS Final Ruling.

The scheduled publication date for this rule is 5/10/2024.

Final Ruling Exceptions

Exceptions from the minimum standards will be available in limited circumstances. In order to qualify you will have to meet the following criteria:

  1. Workforce unavailable- nursing workforce per labor category is a minimum of 20 percent below the national average.
  2. Facility is making a good faith effort to hire and retain staff.
  3. Facility provides documentation to support its financial commitment for staffing.
  4. Facility post notification it is exempt in a publicly viewable location.
  5. Facility provides notice of exception to the Office of the State Long Term Ombudsman

CMS will display determinations of facilities’ compliance with the minimum staffing standards on Care Compare and it will also post notices of exemption status.

Contact Us

Blue & Co. has consultants that specialize in a number of categories to assist you with any of your Post-Acute Care needs. If you need help with PBJ (Payroll Based Journal), 5-Star, Surveys, VBP (Value Based Purchasing), updating your staff assessment or QRP (Quality Reporting Program) contact a member of our Post Acute team below or your local Blue & Co. advisor.

Stephanie Fitzgerald RN, RAC-CTA, CPC, Manager

Kayla May, CPA, Manager

Missy Deeg, CPA, Manager

Landon Hackett, CPA, MSA, Director

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