The rules address minimum staffing standards, as well and Medicaid and Managed Care access.
On April 22, 2024, CMS issued three final rules related to the historic Action Plan for Nursing Home Reform developed in February of 2022, where mandated staffing ratios were proposed. Minimum staffing standards are now part of the final rule issued to fulfill the commitment to improve the safety and quality of care in federally funded nursing homes. The other two areas included in the final rule are access to Medicaid programs, including provider rate transparency and access to Managed Care programs, which includes a limit on appointment wait times and plan performance comparisons.
Acknowledging the receipt of 46,000 public comments about how sufficient staff are necessary to ensure residents receive necessary care, CMS forged ahead with the following nursing staffing standards:
- Total hours per day of 3.48 of which 0.55 must be RN and 2.45 from nurse aides. 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 HPRD needed to comply with the total nurse staffing standard.
- RN coverage is required 24/7.
- Facility assessments will need to identify resources to support day to day operations and emergencies, including participation from direct care workers and others.
- Staffing plans must be developed to maximize recruitment and retention.
The timeline to meet the mandated staffing is proposed in three phases.
- Phase 1 — Within 90 days of the final rule publication, facilities must meet the facility assessment requirements.
- Phase 2 — Within three years of the final rule publication, facilities must meet the 3.48 HPRD total nurse staffing requirement and the 24/7 RN requirement.
- Phase 3 — Within five years of the final rule publication, facilities must meet the 0.55 RN and 2.45 NA HPRD requirements.
CMS is developing a $75 million national nursing home staffing campaign that increases the number of nurses in nursing homes to enhance residents’ health and safety. This includes possible tuition reimbursement for a specific commitment to work in a qualifying nursing home and streamlining the process for enrolling in training programs. Additionally, CMS will partner with states to bolster nurse recruitment.
Polaris Group can help as your facility navigates the staffing mandate. We are available to help create staffing plans, recruitment and retention plans, and the ticket to reducing staff turnover, which is adequate training and ongoing support. Contact us here for support.
