CMS has released the proposed minimum staffing rule (see their press release and fact sheet). The proposed rule requires 0.55 HPRD of RN time and 2.45 HPRD of nurse aide time. The rule is silent on LPN hours. If adopted as proposed, Mass Senior Care estimates that a substantial portion of the sector would be out of compliance. The proposed regulation also does not include recognition of these new costs to implement to recognize these potential new mandates. We will be working with AHCA on mounting a vigorous campaign to further shape this rule. The intent is for facilities across the country to register their opposition to the proposed rule. AHCA on Monday, September 11, at 2pm EST will hold a webinar to walk facilities through the process to submit comments to CMS. You can register here for the webinar.
The AHCA/NCAL webinar recording on CMS' minimum staffing proposal is now available for all members. President and CEO Mark Parkinson and the AHCA team provide an overview of the recently released proposed rule on minimum staffing standards, discuss potential next steps, and answer questions. To access the webinar click this link: AHCA Education: CMS’s Minimum Staffing Proposal (ahcancal.org)
Summary of Proposed CMS HPPD Rule
- What workers count? There is a 2.45 HPPD that can only be met by nurse aides and .55 HPPD that can be met only by RNs.
- Waiver - There is a waiver of the minimum staffing standard for facilities that are making a good-faith effort to try to find workers but cannot get them. However, the waiver process is cumbersome and likely unattainable for most facilities.
- New funding - There is no funding for the additional expense of these nurses and nurse aides.
- Timing - Different parts of the rule are phased in at different times.
- The HPRD requirement. This portion of the rule has the longest phase in, which begins once the rule is finalized. For urban buildings, this requirement would be effective three (3) years after it becomes final, for rural buildings this requirement would be effective five (5) years after it becomes final.
- The 24-hour RN requirement. The proposal requires that an RN be on site, 24 hours per day, for 7 days a week would take effect two (2) years after the publication of the final rule for urban facilities, and three (3) years after the publication of the final rule for rural facilities.
- The facility assessment requirement. The proposal includes expanded facility assessment requirements, including requiring direct care staff participation in the assessment, using evidence-based methods and requiring facilities to develop a staffing plan to maximize recruitment and retention. This goes into effect 60 days after the publication of the final rule for all facilities.
- Penalties for non-compliance - Penalties may include actions from termination of the provider agreement to civil money penalties to directed plan of correction or other enforcement actions.
- Disclosure requirements - CMS will require states to be transparent on the percentage of Medicaid payments spent on compensation for direct care workers and support staff for services in nursing and other facilities.