Final Rule on Nursing Home Staffing and Transparency Moves To Next Stage Ahead of Biden’s State of the Union

Ahead of President Biden’s State of the Union address Thursday, a final rule mandating staffing limits and calling for greater Medicaid payment transparency was submitted for regulatory review to the Office of Management and Budget (OMB).

And while in addressing the joint session of Congress, Biden failed to mention the reforms contained in the rule – and that he has been pushing over the last three years – he did touch upon how Medicare will now be able to negotiate prices for major drugs used by older adults, including those used for treating heart disease, cancer, and diabetes.

“This year, Medicare is negotiating lower prices for some of the costliest of these drugs on the market to treat everything from heart disease to arthritis,” Biden said. “It’s now time to go further and give Medicare the power to negotiate lower prices for 500 different drugs over the next decade,” he said, adding that he wants to cap prescription drug costs at $2,000 a year for all.


Biden’s proposed reforms for nursing homes, developed by the Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS), will set minimum staffing requirements if finalized.

This proposed rule at the OMB titled, “Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting,” was received on March 1 for review.

The rule calls for Medicare- and Medicaid-certified nursing homes to provide a staffing equivalent of 3 hours per resident per day (PRPD), with 0.55 hours of care from registered nurses (RNs) and 2.45 hours of care from nurse aides. Non-rural nursing homes will have 3 years and rural nursing homes have 5 years to meet these standards. The rule also calls for facilities to have an RN on staff 24 hours a day, daily.


The rule is also intended to promote public transparency related to the percentage of Medicaid payments that are spent on compensation to direct care workers and support staff for services in nursing facilities and intermediate care facilities for patients with intellectual disabilities. 

In his last two addresses, Biden consistently mentioned nursing homes, famously calling out private equity-owned facilities and saying in 2022, “As Wall Street firms take over more nursing homes, quality in those homes has gone down and costs have gone up. That ends on my watch.”