Minimum Staffing Final Rule

*Content in this post was corrected on 4/24/2024 at 11:11 Central Time. The HPRD of direct nurse aide care was changed from .45 to 2.45*

On Monday, April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) unveiled a comprehensive 329-page final rule addressing staffing requirements for skilled nursing facilities. Key staffing requirements included in the final rule include:

• • • A total nurse staffing standard of 3.48 hours per resident day (HPRD)
      • This must include:
        • At least 0.55 HPRD of direct registered nurse (RN) care and
        • 2.45 HPRD of direct nurse aide care.
      • 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.
    • A requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care.
    • Enhanced facility assessment requirements

This final rule provides a staggered implementation timeframe of the minimum nurse staffing standards and 24/7 RN requirement based on geographic location, as well as possible exemptions for qualifying facilities for portions of the requirements based on workforce unavailability and other factors. Notably, facilities must meet the Facility Assessment requirements within 90 days after publication of the final rule. Non-rule facilities must meet the minimum total nursing and 24/7 RN requirement within two years and the minimum RN and NA HPRD requirements within three years. Rural facilities will have three years to meet the minimum HPRD for total nursing and 24/7 RN coverage and five years to meet the minimum RN and NA HPRD requirements.

The final rule is available to review today in the Federal Register at: https://www.federalregister.gov/public-inspection/2024-08273/medicare-and-medicaid-programs-minimum-staffing-standards-for-long-term-care-facilities-and-medicaid