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CMS Publishes Final Rule Implementing a Minimum Staffing Standard in Nursing Homes

April 23, 2024

On Monday, April 23, 2024, the Centers for Medicare & Medicaid Services  (CMS) published the final rule implementing a minimum staffing standard in nursing homes. The Biden Administration’s announcement contained few surprises. The rule will require a total minimum staffing standard of 3.48 hours of care per resident per day (HPRD), composed of at least .55 RN HPRD and 2.45 HPRD. In addition, facilities will now be required to have a Registered Nurse onsite twenty-four hours per day.  However, the rule contains long implementation periods, some residents of rural facilities will not feel the effects of the rule for over five years, and waiver provisions that will likely allow many nursing homes to avoid compliance.

Consumer Voice recognizes that this is an important first step in ensuring that all residents have their care needs met. However, 3.48 HPRD is a minimum and not a ceiling. Federal law requires that each facility have sufficient staff to meet the needs of all residents. Most residents will require care that exceeds the 3.48 HPRD. Consumer Voice in its comments on the proposed rule, urged CMS to institute strong staffing requirements based on the acuity (care needs) of each resident.
Stay tuned for a detailed analysis of the rule.

"Ensuring Access to Medicaid Services" Final Rule Published

The Biden Administration also announced the finalization of the "Ensuring Access to Medicaid Services" rule. The rule requires that at least 80% of Medicaid payments for home care services go to direct care workers' wages.  The rule requires states to be more transparent in how much they pay for home care services and how they set those rates.  States are also required to create a home care rate-setting advisory group made up of beneficiaries, home care workers and other stakeholders to advise on provider payment rates and direct compensation for direct care workers.

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