On Monday, April 22, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for “Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule (CMS 3442-F)”. The rule requires Medicare- and Medicaid-certified long-term care facilities to have in place a minimum requirement of 3.48 hours per resident day (HPRD) for total nurse staffing which 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], licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard. CMS is also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. The implementation timeframe of the minimum nurse staffing standards and 24/7 RN requirement is 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. Additionally, CMS will require states to collect and report publicly on the percentage of Medicaid payments that are spent on compensation for direct care workers and support staff who deliver care in nursing facilities and intermediate care facilities for individuals with intellectual disabilities.
Click here to view the fact sheet, and here for the unpublished final rule. The final rule is scheduled to be published on Friday, May 10.