In a recent national stakeholder call, officials from the Centers for Medicare & Medicaid Services (CMS) revealed plans to finalize the long-anticipated nursing home minimum staffing proposal in 2024. Dr. Dora Hughes, acting Chief Medical Officer and Director of the Center for Clinical Standards and Quality (CCSQ), confirmed that the agency received over 46,000 comments on the proposal. These comments will shape the final rule, which CMS aims to release this year.
The staffing proposal, issued by CMS on September 1, followed a 60-day comment period. Despite expectations that the final version might not be released until after 2024 due to the significant number of comments received, CMS is moving forward with its intended timeline.
Advocacy groups, including the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and LeadingAge, expressed concerns about the impact of the staffing mandate. AHCA/NCAL emphasized the lack of workers and funding, warning of the adverse effects on seniors' access to long term care. LeadingAge called for careful consideration of staffing ratios and highlighted systemic issues like workforce challenges and inadequate funding.
The CMS proposal requires Medicare- and Medicaid-certified nursing homes to provide a minimum of 0.55 hours of care from registered nurses and 2.45 hours of care from nurse aides per resident per day. Non-rural nursing homes would have three years, and rural nursing homes would have five years to meet these standards.
LeadingAge cautioned against implementing the rule without addressing chronic workforce challenges and inadequate funding. They emphasized the potential impact on the entire care continuum, including home and community-based care providers.
Lawmakers urged CMS to reconsider the staffing proposal, with legislation to block it gaining traction in late 2023. However, CMS remains committed to finalizing the rule in 2024.
In addition to the staffing rule, CMS highlighted ongoing efforts to improve the quality of long-term care. For example, Dr. Hughes emphasized CMS's focus on safety, quality, equity, and coverage across the care continuum. CMS facilitated the launch of a registry to evaluate the impact of new Alzheimer's drugs and conducted thousands of enforcement actions across long-term care facilities in 2023.
Furthermore, CMS plans to collect data on ownership in 2024 to explore the role of private equity and real estate investment trusts (REITs) in nursing home ownership. This initiative builds on a final rule issued in 2023 requiring more disclosures about ownership, management, and control of skilled nursing facilities (SNFs).
As CMS continues its efforts to enhance long-term care, stakeholders remain vigilant, advocating for policies that prioritize quality, equity, and sustainability across the nursing home sector.
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