In response to the publication of the final CMS minimum staffing requirement rule, AHCA/NCAL has issued a special edition of the LTC Trend Tracker Top-Line Report. The LTC Trend Tracker is a free service available to all AHCA/NCAL members.

The report focuses on the minimum staffing rule, using Payroll Based Journal (PBJ) data to outline how each member facility compares to the new minimum staffing rule requirements, including:

• 3.48 Total Nurse Hours Per Resident Day (HPRD)
• 2.45 Nurse Aide HPRD
• 0.55 RN HPRD
• 24/7 RN on-site requirement

The report outlines compliance deadlines for each above requirement, hours needed by the facility to meet each requirement (if not met), and possible census decrease to meet the requirement. The report also details whether your center has been designated “urban” or “rural” for purposes of this rule, which impacts compliance timelines.

The report also includes information on the hardship exemption. Specifically, it summarizes the workforce in your building’s geographical area and whether it would currently meet the first requirement for an exemption: that workforce is “unavailable” as measured by having a nursing workforce that is a minimum of 20% below the national average.

AHCA has also completed a Staffing Mandate Analysis, which shows how impossible this final rule is to implement. The analysis concludes that nationwide, nursing homes will have to hire an additional 102,000 nurses and nurse aides to comply with the mandate at a cost of $6.5 billion annually. Additionally, more than 290,000 residents may be at risk of displacement, as facilities are forced to reduce their census in order to comply with the mandate or close altogether.

Specifically for Wisconsin, the analysis concluded that as many as 1,766 current SNF residents may be displaced so that providers can meet the national staffing requirement HPRD standards. 90% of Wisconsin facilities with moderate Medicaid census (64-75%) would not currently meet the .55 RN HPRD requirement, only 28% would meet the 2.45 CNA HPRD requirement, only 14% would meet the 24/7 RN requirement, and 51% would meet the overall 3.48 total HPRD requirement.

WHCA and AHCA are working hard to reverse this policy, including via Congressional intervention and legal relief. WHCA will provide members with more information on ongoing advocacy efforts as they develop.