Nursing Home Minimum Staffing Mandate Leaves OMB, Pending Finalization

The proposed minimum staffing mandate for nursing homes has left the Office of Management and Budget (OMB) and is now pending final approval.

According to the OMB calendar, several industry organizations have met with the office as the staffing mandates nears finalization, including The American Health Care Association (AHCA), officials from the Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS), and officials from the National Rural Health Association.

In the meetings, the National Rural Health Association urged CMS to rescind its minimum staffing proposals, stating that if withdrawal of the policy is not possible, CMS should exempt rural facilities from the requirements.


“We agree that this is a worthwhile cause and is of utmost importance to our organization and its members,” they wrote in a published comment. “NRHA does not take poor patient outcomes and safety risks lightly. Nonetheless we believe the proposed staffing standards come at an inopportune time for the long-term care sector and will significantly impact rural access to these services.”

Since the mandate was first proposed last year, rural providers have been among its most outspoken critics, noting the difficulty – or impossibility – of meeting the standards in the current labor environment. The industry as a whole has launched a concerted effort to defeat or substantially change the proposal, which AHCA CEO Mark Parkinson called “inherently flawed” while speaking last fall at Skilled Nursing News’ RETHINK event.

The exclusion of licensed practical nurses (LPNs), the fact that the proposal ignores regional differences in staffing patterns and needs, and the fact that the mandate is unfunded and would come with a massive price tag are among the concerns and criticisms that nursing home leaders have repeatedly raised.


Operators are anxious to know how the mandate will be enforced – a point that leaders raised just last week at the Capital & Strategy conference, held by Skilled Nursing News and its sister publications in WTWH Media.

“It’s just hard to know how [the mandate] will ultimately be enforced,” Sam Bechtold, Chief Investment Officer at Eduro Healthcare, said last week during the Capital and Strategy conference in Washington, D.C. “Is it funding? Is it some other mechanism to get there? I’m not against the staffing mandate, and our company’s not against staffing mandates. But you’ve got to look at it on a case-by-case basis, on a state-by-state basis.”

Paul Branin, VP of Business Development at Health Dimensions Group, expressed “cautious pessimism” about the ruling.

“I believe the rollout will take two to three years, so there’s some time to ramp up to meet the requirements,” he said. “It seems, from an industry perspective, that there were close to 50,000 comments on the requirements. That’s also very good.”

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