CMS Publishes Final Staffing Requirements Rule
The Centers for Medicare & Medicaid Services (CMS) has released a final rule outlining staffing requirements for nursing homes, including a minimum of 3.48 hours of direct daily care per patient. The rule also requires registered nurses to be on-site 24 hours a day, seven days a week, but allows for exemptions in certain circumstances.
The CMS announced that it will exempt nursing homes from having registered nurse coverage for up to eight hours out of 24 hours a day “under certain circumstances.” Additionally, the director of nursing can count toward the rule’s 24/7 RN requirement. The agency stated that this ensures an RN is available to help mitigate preventable safety events.
The White House announced that the final rule would increase direct daily care per patient from a proposed 3.0 hours to 3.48 hours, with 3.0 of those hours being provided by licensed nurses and nurse aides. The remaining 0.48 hours can be provided by other caregivers. The CMS also established criteria for facilities seeking exemptions from the total nurse staffing requirement, including a minimum combined licensed nurse and nurse aide-to-population ratio in their area that is at least 20% below the national average.
The implementation of the rule will be staggered, with rural facilities having up to five years to meet the last of the requirements, while non-rural providers have three years. Facilities can also apply for exemptions if they demonstrate “good faith efforts” to hire and retain staff, such as through job postings and competitive wage offerings.
The announcement has received mixed reactions from the long-term care industry, with some criticizing the timing and the potential impact on facilities already struggling to recruit and retain staff.