CMS Researchers Enter Nursing Homes to Establish a Federal Staffing Standard

Posted on August 25, 2022 by Anna Mowry

This week, the Centers for Medicare & Medicaid Services (CMS) announced plans to conduct a four-part analysis in pursuit of establishing a federal minimum staffing standard in nursing homes. As part of their study, researchers will visit 75 nursing homes across the country over the next three months though none are planned for Minnesota sites. A national staffing plan would be incorporated into skilled nursing proposed rules published next spring.

Background

Earlier this year, the Biden Administration released a plan for nursing home reform that included conducting a staffing study and proposing nursing home staffing standards. As part of this plan, CMS included a Request for Information on staffing standards in the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System proposed rule in April.

We submitted comments to CMS on behalf of our members in response to the proposed rule and Request for Information. CMS received over 3,000 responses regarding the minimum staffing standard, including comments from providers, residents, families, and consumer advocate groups.

On July 29, the final 2023 Skilled Nursing Facility Prospective Payment System rule was published in the Federal Register. It did not include information about staffing standards. To continue their study on federal minimum staffing standards, CMS will be conducting nursing homes site visits over the next three months.

For more information on what was included in the final rule, read CMS Releases Final SNF PPS Rule; Includes Cuts Related to Impact of PDPM.

About the Site Visits

CMS will send contract researchers from Abt Associates to conduct the visits. To ensure a representative sample and ample data is collected, the visits will take place in all ten CMS regions across the country and facilities of varying size, ownership type, and quality star ratings will be included in the study.

Last week, researchers began contacting nursing homes on the visit list in the following states: CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY.

At this time, Minnesota nursing homes have not been selected for site visits. Nursing homes who are contacted can decline to participate in the site visit and will not be penalized. For facilities that agree, the site visits will occur over two days and will take place in coordination with facility operators and only when the administrator and nursing director are available. The researchers will also try to avoid visiting during state survey visits, mealtimes, and shift changes.

During the visits, researchers will interview registered nurses, licensed practical nurses, and certified nursing aides, from both day and evening shifts. They will also collect information from residents and families during their two-day visit.

What’s Next

Over the next few months, CMS will continue to review the 3,000 public comments that were received in the Request for Information and will conclude their nursing home site visits at the end of October. Their study also will include an analysis of the relationship between staffing and quality, an analysis of the potential costs of a minimum staffing requirement, and a literature review of previous studies. To learn more about the study, read the recently published CMS bulletin.

After completing their study and analysis, CMS will propose mandatory staffing standards – likely in early 2023.

Our Take

LeadingAge Minnesota continues to express serious and grave concerns with pursing a national staffing-standard. Minnesota has one of the most severe workforce shortages in the nation, and as recent survey data indicate, a growing population of seniors are lacking access to care they need. We will continue to engage our federal partners including LeadingAge, members of Congress and other stakeholders to influence the course of this study and proposed rule.  .