Proposed Federal Long-Term Care Staffing Rules Would Impose Significant and Costly New Obligations on Facilities

Staffing shortages and related challenges have long plagued the long-term care (LTC) industry and the 1.4 million residents receiving care in Medicare and Medicaid certified facilities. To address the issue, the Centers for Medicare & Medicaid Services (CMS) has proposed strict new staffing rules that will impose significant obligations on the facilities, the cost of which may cause more problems than the new rules are intended to solve. The rule would impose staffing requirements that many LTC facilities may find difficult, if not impossible, to attain. 

If finalized in its current form, the proposed rule would impose the following obligations on LTC facilities:

  • An RN must be on site 24 hours per day and seven days per week to provide skilled nursing care to all residents in accordance with resident care plans.
  • Facilities must provide, at a minimum, 0.55 RN hours per resident day (HPRD) and 2.45 Certified Nursing Assistant (CNA) HPRD. RN and CNA staffing could never be lower than these minimum standards.
  • If the acuity needs of residents in a facility require a higher level of care, a higher RN and CNA staffing level will be required. 
  • The rule would also revise existing facility assessment requirements to provide for more evaluation of, and more data regarding, a facility's staffing needs.

Despite CMS admitting that the rule would cost the industry an estimated $40.6 billion over ten years, the proposed rule does not include any funding to help facilities comply with the new standard.

The public comment period for the proposed rule lasts through Nov. 6, 2023.

We will monitor the progress of the proposed rule throughout the comment period. If you have questions about the proposed rule or any other issue pertaining to LTC and senior housing, please contact Ferrier Stillman at Tydings. 

If you have questions about these or other health care issues, please contact Ferrier R. Stillman. The firm has offices in downtown Baltimore and in Towson.

This has been prepared by Tydings for informational purposes only and does not constitute legal advice.