Minimum Staffing Rule’s Facility Assessment Mandate

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. This final rule mandates the following minimum staffing hours per resident day (HPRD):

• • • 55 Registered Nurse (RN)
    • 45 Nursing Aides (NA)
    • 48 Total Nursing HPRD, which is an increase from the level proposed of 3.0 HPRD.
    • 24 hours a day, 7 days a week on-site RN and available to provide direct resident skilled nursing care. The DON hours may be used toward this requirement if they are available onsite to provide direct resident care.

The final rule clarifies that facilities may use any combination of nurse staff to include Registered Nurses (RN), Licensed Practical Nurses (LPN), License Vocational Nurses (LVN), or Nurse aides (NA) to account for the additional 0.48 HPRD necessary to meet the minimum total nurse staffing mandate.

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 some parts of these requirements based on workforce unavailability and other factors.

For non-rural facilities the following timeline applies:

• • • April 22, 2026 — Within two years of the final rule publication, facilities must meet the 3.48 HPRD total nurse staffing requirement and the 24/7 RN requirement.
    • April 22, 2027 — Within three years of the final rule publication, facilities must meet the 0.55 RN and 2.45 NA HPRD requirements.

For Rural facilities, CMS recognizes the unique challenge that rural facilities face related to staffing and as a result the following timelines apply:

• • • April 22, 2027 — 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.
    • April 22, 2029 — Within five years of the final rule publication, facilities must meet the 0.55 RN and 2.45 NA HPRD requirements.

The final rule also contains enhanced facility assessment requirements that must be implemented no later than 90 days from the date the final rule was published. As a result, by August 8, 2024, facilities are required to meet the following Facility Assessment mandates:

• • • Use evidence-based methods when care planning for their residents, including consideration for those residents with behavioral health needs.
    • Use the facility assessment to assess the specific needs of each resident in the facility and to adjust as necessary based on any significant changes in the resident population.
    • Include the input of the nursing home leadership, including but not limited to, a member of the governing body and the medical director; management, including but not limited to, an administrator and the director of nursing; and direct care staff, including but not limited to, RNs, LPNs/LVNs, and NAs, and representatives of direct care staff as applicable.
    • Solicit and consider input received from residents, resident representatives, and family members.

• • • Develop a staffing plan to maximize recruitment and retention of staff consistent with what was described in the President’s April Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers.

Facilities should be preparing to update the facility assessment as identified above and focus on developing a staffing plan that will assist in meeting the mandatory staffing requirements based on the timeline identified. Need assistance? Contact Proactive for a facility assessment review and revision consultation. Also, stay tuned for an updated version of Proactive’s user-friendly Facility Assessment Tool coming soon pending CMS’ expected guidance on the requirements.