Oct. 12,  2023

Analysis of Proposed CMS Hours Per Resident Day Hardship Exemption Shows Only 18% May Qualify

On October 12, 2023 by Mark Schulz

All but 62 of Minnesota’s nursing homes would not be eligible for a hardship exemption to CMS’s hours per resident day requirement found in the proposed staffing standard rule. Only approximately 18% of providers would qualify.

A new analysis of the 3.0 hours per resident day (HPRD) hardship exemption location criteria shows that 62 facilities would qualify for one or both provider-population ratios or 20-mile geography factors. Qualification would permit the facility to continue assessing if it could meet the other criteria for the hardship exemption.

Exemption requirements

To request a hardship exemption under the proposed rule standard, nursing homes must meet three criteria and not be ineligible to receive an exemption. You can read more about these criteria details here.

Location criteria analysis

We analyzed the location criteria because it is the gateway to the exemption. A facility must meet one of the location criteria to continue with its eligibility for a hardship exemption. The two criteria are:

• Meeting either the registered nurse provider-population ratio or the nurse aide provider-population ratio
• Being more than 20 miles from another nursing home

If your nursing home doesn’t meet one of its two factors, you are not eligible for a hardship exemption to the 3.0 HPRD proposed standard requirement. The remaining hardship exemption criteria involve financial and other considerations and are facility-specific to operations and financial considerations outside the ability to be analyzed.

Analysis results

Based upon the proposed rule definitions, instructions on how to calculate provider-population ratios, and the linear distances between Minnesota facilities (and those within border states within 20 miles of the state borders), we have identified what we believe is the list of potential nursing facilities that might be eligible to receive a hardship exemption for the location criteria for the 3.0 HPRD proposed standard.

We have done our best to use the most recent and accurate information to develop these lists. If you are not on these lists, it is unlikely you would be eligible for any hardship exemption to the 3.0 HPRD proposed rule standard.

In summary:

• 13 (3.7%) nursing homes would qualify for the registered nurse provider-population ratio.
• 36 (10.5%) more would qualify for the nurse aide provider-population ratio.
• 13 (3.7%) additional nursing homes would qualify for the 20-mile geography factor.

Facilities that would meet the Location – Registered Nurse Provider-Population Ratio factor:

• Aicota Health Care Center
• Aitkin Health Services
• Bigfork Valley Communities
• Essentia Health Homestead
• Good Sam International Falls
• Grand Village
• Littlefork Medical Center
• Mn Veterans Home Silver Bay
• North Shore Health
• Sandstone Health Care Center
• St. Clare Lvg Comm of Mora
• The Emeralds at Grand Rapids
• The Waterview Shores LLC

Facilities that would meet the Location – Nurse Aide Provider-Population Ratio factor:

• Bay View Nursing & Rehab Center
• Divine Providence Community Home
• Good Sam Albert Lea
• Good Sam Society Comforcare
• Good Sam Society St James
• Koda Living Community
• Lake Winona Manor
• Lakeshore Rehabilitation Ctr
• Lakeview Methodist HCC
• Living Meadows at Luther
• Mayo Clinic Health System-Lake City
• Meadow Manor
• New Richland Care Center
• Northfield Care Center Inc
• Oak Hills Living Center
• Parkview Care Center Wells
• Pine Haven Care Center Inc
• Prairie Manor Care Center
• Sacred Heart Care Center Inc
• Saint Anne Extended Healthcare
• Sauer Health Care
• Seasons Healthcare
• Sleepy Eye Care Center
• St John's on Fountain Lake
• St. Crispin Living Community
• St. John Lutheran Home
• St. John's Lutheran Home
• St. Lukes Lutheran Care Center
• St. Mark's Living
• The Emeralds at Faribault LLC
• Thorne Crest Retirement Center
• Three Links Care Center
• Truman Senior Living
• Whispering Creek
• Whitewater Health Services
• Zumbrota Care Center

Facilities that would meet the Location – Geography (20-mile between facilities) factor:

[Note: Facilities with * next to the name also qualify for the Location exemption criteria for either the RN or NA Provider-to-Population Ratio. See the above lists to determine which one.]

• Avera Sunrise Manor
• Bigfork Valley Communities *
• Boundary Waters Care Center
• Cook Community Hospital C&Nc
• Good Samaritan Society - Blackduck
• Good Samaritan Society - Pine River
• Jourdain Perpich Ext Care Fac
• Kittson Memorial Healthcare Center
• Lakewood Care Center
• Mahnomen Health Center
• Meadow Lane Restorative Care Center
• Mille Lacs Health System
• Minnesota Veterans Home - Silver Bay *
• Moose Lake Village
• North Shore Health *
• North Star Manor
• Sandstone Health Care Center *
• The Waterview Shores LLC *

These facilities are also highlighted in the below image, indicated by a red, semi-transparent circle surrounding their address reflecting the 20-mile radius.

As a reminder, the HPRD hardship exemption is separate from the 24/7 registered nurse waiver request. That waiver process is already defined in current federal regulations at 42 CFR §483.35(f).

Oct. 3 Coaching Room

The Oct. 3 Coaching Room focused on learning about the federal system and process for submitting comments to federal rulemaking efforts. Our former colleague Jonathon Lips, Vice President of Legal Affairs with LeadingAge, provided this overview. You can view it here; use the passcode T.%j0jU@ to access it.

Action alert and congressional advocacy fly-in

Our members of Congress need to hear from us about the impact of this rule and what it will mean for Minnesota seniors across the state. Contact your members of Congress now.

LeadingAge Minnesota is planning a fly-in opportunity for care center leaders to meet with our delegation in Washington, DC, later this year to supplement Congressional visits while they are in Minnesota—details to come later this fall.  If you want to learn more, please contact Erin Huppert at ehuppert@leadingagemn.org to be added to the communication list. 

You can read the full proposed rule here. 

Please reach out to:

• Mark Schulz with any questions, concerns, or comments regarding the proposed rule
• Erin Huppert, with any questions regarding the advocacy actions you can take