CMS proposes new minimum staffing standards for long-term care facilities

Key Takeaways

On September 1, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would impose minimum staffing standards for the approximately 758 county-owned or operated long-term care facilities that participate in Medicare or Medicaid.

Key highlights of the proposed rule:  

• Requires long-term care facilities to have an average daily nurse staffing level equivalent to at least 0.55 hours per resident, or one registered nurse for every 44 residents 
• Requires 2.45 nurse aide hours per resident per day, or approximately one aide for every 10 residents  
• Requires at least one registered nurse to be on site 24 hours a day, seven days a week  
• Does not include new funding for additional staff but sites recent workforce incentive initiatives under HHS 
• Includes a “hardship exemption” which exempts the facility from punitive assessments for up to 1 year 

CMS estimates that approximately 75 percent of long-term care facilities would be required to add staffing to comply with the new standards. The agency is soliciting public comments on the proposed rule through October 30.  

NACo will submit comments on behalf of county-owned and operated facilities and will continue to monitor further developments on the rule.  

Additional Resources

• CMS Fact Sheet: Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting
• NACo Brief: The County Role in Long-Term Care
• NACo Brief: Nursing Homes & COVID-19