CMS Announces Final SNF Minimum Staffing Rule; Rule Creates Impractical Requirements That Are Impossible to Meet

On Monday, April 22, CMS announced that its final version of its proposed federal minimum staffing rule for nursing homes will be formally published on May 10, 2024.

Important: The final rule staffing standards are different than the proposed rule and are unfortunately worse in many ways.

There are now three major components of the final rule:

  • There is an overall standard of 3.48 nursing hours per patient day. For purposes of this part of the rule, providers can count CNAs, RNs, and LPNs.
  • There is a specific standard for 0.55 RNs per patient day and 2.45 CNA hours per patient day.
    • Once this specific standard is implemented, along with the .55 RN and 2.45 CNA HPRD requirement, providers will need to fulfill an additional .48 HPRD requirement with a combination of CNA, RN, and/or LPN hours.
  • There is a requirement for an RN in every building 24/7.

Additionally, and most immediately, the rule will require providers to expand the scope of current facility-wide assessments, including incorporating resident/family feedback into the assessment when determining staffing/resource needs.

The timeline for implementation of all of these requirements is:

As you see, the rule has different implementation dates for nursing home providers based on whether they are designated as rural or urban facilities. AHCA/NCAL has indicated that in the coming weeks, providers’ AHCA LTC Trend Tracker profiles will share the final urban/rural determination, along with an estimate of how many staff each facility would need to add to be in compliance with the rule.

According to a preliminary data from AHCA, 4 out of 5 providers will not meet the ultimate HPRD requirement (which includes the prescriptive .55 RN and 2.45 CNA requirement). Prior to implementation of the .55 RN/2.45 CNA requirement, 59% of nursing homes would not meet the general 3.48 HPRD requirement:

Waivers and Flexibilities:

The rule will include hardship exemptions for both the 24/7 RN and HPRD requirements. Each exemption will require a demonstration of good-faith efforts to recruit workers, as well as metrics indicating the geographic location of the facility has a local workforce of RN or CNA at 20% below the national average. AHCA is seeking clarity from CMS on what the metrics will be to determine eligibility. For the HPRD exemption, a facility must first be found out of compliance with the requirement, which gives providers a lot of concern as it exposes them to potential survey liability prior to receiving the exemption, if at all.

Webinar held Tuesday 4/23:

AHCA/NCAL hosted a webinar (link to recording) on Tuesday, April 23 to discuss the final rule. During this members-only briefing, AHCA provided an overview of the key requirements and time frames in the final CMS rule, as well as next steps.

For those who were unable to attend the 4/23 webinar, AHCA will host an encore briefing on the rule on Monday, May 2:

Minimum Staffing Discussion
Thursday, May 2
3:30pm Central

Join from the meeting link:

Next Steps

AHCA/NCAL is already planning a comprehensive campaign against the rule, including Congressional intervention and an alternate legal approach.

AHCA/NCAL CEO Mark Parkinson said: “This rule is impossible to implement. The workforce is not available to meet these new requirements. Our fight on your behalf has just begun.”

WHCA/WiCAL is committed to preventing this rule from ever being implemented, due to its impractical and unworkable standards. WHCA/WiCAL CEO Rick Abrams was recently interviewed by CBS 58 to discuss the association’s practical concerns with the rule: view the interview here.