[UPDATED] CMS Official Confirms Agency’s Intention to Finalize Nursing Home Minimum Staffing Rule in 2024

The Centers for Medicare & Medicaid Services (CMS) officials are looking to finalize the nursing home minimum staffing proposal in 2024, an official at the federal agency confirmed at its national stakeholder call on Tuesday.

Dr. Dora Hughes, acting chief medical officer and director of the Center for Clinical Standards and Quality (CCSQ), said, “The team received more than 46,000 comments on the proposal which are being used to inform development of the final rule which we intend to finalize this year.”

CMS issued the long-awaited staffing proposal on Sept. 1. This followed a 60-day comment period, after which the federal agency could choose to issue a final rule any time, although it is statutorily allowed up to three years to do so.


However, the federal agency received many comments, and some nursing home advocates and even executives expected the final version to not be released until past 2024.

In response to CMS’ latest intended timeline for 2024, advocacy groups told Skilled Nursing News that they had grave concerns about the lack of workers and funding.

“It is unfortunate that CMS plans to move forward with this rule despite the vast amount of concerns from a variety of stakeholders. This unfunded staffing mandate will have a compounding and detrimental effect on seniors’ access to long term care,” a spokesperson for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said in an emailed statement to SNN.


LeadingAge, which represents 5,000 nonprofit aging services providers and other mission-driven organizations, said in an emailed statement, “No matter when the rule is made final, the Center for Medicare and Medicaid Services must – before any mandates are implemented – get it right on ratios by first addressing the long-term care’s systemic issues: chronic workforce challenges and inadequate funding that does not cover the cost of care and services provided.”

If a staffing mandate is issued without careful review of the ratios, reverberations will be felt across the entire care continuum, LeadingAge told SNN.

“Nursing homes aren’t the only part of the healthcare system that will be affected if the administration continues to miss the mark and the [staffing] rule is implemented as proposed,” the LeadingAge statement noted. “The administration has said it’s committed to ensuring access to home and community based care, but their actions are working against that goal, as homecare and hospice providers – already navigating workforce challenges – will be short even more workers if they move to nursing homes.”

The CMS proposal calls for Medicare- and Medicaid-certified nursing homes to provide a minimum of 0.55 hours of care from registered nurse per resident per day and 2.45 hours of care from a nurse aide per resident per day, with non-rural nursing homes having three years and rural nursing homes five years to meet these standards.

“Nursing homes are in competition with hospitals for attracting new hires. Shuffling the relatively small number of care workers available between settings won’t solve the problem,” LeadingAge said. 

In the last months of 2023, lawmakers urged CMS to scrap the staffing proposal altogether as legislation to block it gained traction.

CMS touts 2023 wins, says ‘laser focused’ on quality in 2024

Aside from its commitment to finalize the staffing rule in 2024, CMS touted some ongoing programs to improve quality of long-term care.

“In 2024, we remain laser focused on improving safety, quality, equity and coverage across the care continuum,” Hughes said.

Last summer when broader Medicare coverage became available for new Alzheimer’s drugs, CMS facilitated the launch of a registry to test the impact of these drugs. Work on the registry and collecting data on the efficacy of new Alzheimer’s drugs is ongoing, said Hughes. “That will help us understand how the drug works and [its] safety concerns.”

The federal agency’s survey and certification team at CCSQ also worked on approximately 10,000 enforcement actions across long-term care facilities nationwide in 2023, Hughes noted.

Meanwhile, Hughes said that the statistics on Covid-19 vaccination rates show that CMS’ vaccination program has been working well.

“[O]ur initiatives to reach nursing homes have been very successful,” she said. “Last year through continued vaccination efforts by our quality improvement organizations more than 1,200 vaccination clinics occurred, [and] over 21,000 residents and over 6,000 staff were vaccinated.”

Evaluating nursing home ownership data 

The federal agency also plans to collect data on ownership in 2024 for further exploring the role played by private equity and real estate investment trusts (REITs), according to Dara Corrigan, deputy administrator and director for Center for Program Integrity (CPI) – CMS’ arm that monitors and addresses fraud, waste and abuse related to Medicare and Medicaid.

“We will collect this data in 2024, which will lay the groundwork for evaluating whether these types of ownership lead to increased costs or lower quality of care.”

In 2023, CMS issued a final rule requiring more disclosures about ownership, management and control of skilled nursing facilities (SNFs).

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