Specialized Information for:
Long-Term Care ConsumersFamily MembersAdvocatesDecember 05, 2018
On November 30, 2018, the Centers for Medicare and Medicaid Services (CMS) released a memo outlining several actions it is implementing related to staffing. Two key steps the agency is taking are described below.
1. CMS is requiring a) states to target certain facilities with low weekend staffing for weekend surveys; and b) surveyors to investigate compliance with the requirement for an RN eight hours a day, seven days a week in facilities with reported days without an RN onsite.
CMS review of the new Payroll-Based Journal (PBJ) data has determined that some facilities are reporting days without any RN on duty and/or significantly low nurse staffing levels on weekends. As a result, CMS will use the PBJ data to prepare a list of facilities with potential staffing issues that it will provide to state survey agencies. CMS Regional Offices will also receive this information.
The list will be used to focus greater attention on facilities with possible insufficient staffing levels as follows:
2. Clarifying policies in the Payroll-Based Journal (PBJ) manual related to reporting hours for universal care workers.
To-date, facilities have been directed to report hours based on an employee’s primary role. However, in some nursing homes, certified nursing assistants serve as universal care workers. This means that in addition to carrying out CNA duties, they also perform non-CNA responsibilities, such as cooking and housekeeping. It is therefore inaccurate to report all their time as CNA hours. To address this issue, CMS is instructing facilities to use a reasonable procedure to determine the number of hours certified nursing assistants are providing CNA services and report these hours accordingly. Other duties such as housekeeping and cooking are not to be reported as CNA hours.
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