At the end of February 2022, the Biden Administration released a plan for nursing home reform that included conducting a staffing study and proposing nursing home staffing standards within one year. The Centers for Medicare and Medicaid Services (CMS) included a Request for Information on staffing standards in the Fiscal Year (FY) 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) proposed rule, released in April 2022, as part of this plan. The final rule was published in the Federal Register on August 3 and while the rule did not include additional information about future staffing standards, CMS shed light on the topic during a SNF Open Door Forum on August 4.

CMS reported receiving more than 3,000 public comments in response to the Request for Information. While nursing home residents, families, and consumer advocates generally supported the implementation of mandatory staffing standards, nursing home providers and other “industry groups” expressed concern and largely suggested a delay or phase-in to requirements due to current staffing shortages.

Suggestions for staffing models included basing staffing requirements on resident acuity per shift rather than enforcing broad staffing minimums, a hybrid model that included minimum staffing standards with the facility assessment being used to determine staffing needs beyond minimums, and a minimum staffing standard based on residents with the lowest assessed need according to the Minimum Data Set (MDS). Resident and facility factors impacting a nursing home’s ability to staff included higher Medicaid census, higher bed capacity, for-profit ownership, higher in-county competition and, for Registered Nurse (RN) staffing specifically, higher community poverty and lower Medicare census.

CMS confirmed that a staffing study is currently underway, having begun at the end of May and will extend through December. Mandatory staffing standards will be proposed within a year. LeadingAge has provided feedback to CMS through the Request for Information in the proposed rule and through participation in stakeholder listening sessions.