News Digest: Thousands of Comments On 2023 Proposed Rule
On April 11, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for skilled nursing facilities for Fiscal Year 2023. Of particular interest, CMS opened up the Minimum Staffing debate with a specific request:
Specifically, we are seeking input on establishing minimum staffing requirements for LTC facilities.
The Minimum Staffing discussion quickly spilled into the media and CMS received thousands of comments to its proposed rule.
In July, CMS announced on a Stakeholder Forum that they are absorbing the comments and continuing to study Minimum Staffing rules, with a goal to release new policies in the next 6 to 12 months (calendar year 2023).
Ask the legal expert: What can we expect from a staffing minimum?
Q: What can we expect out of the Centers for Medicare & Medicaid Services’ intention to issue new guidance on minimum staffing measures for nursing homes?
A: Frankly, it means trouble. To begin addressing the minimum staffing requirement, CMS added new requirements for surveyors to incorporate the use of Payroll Based Journal staffing data in their inspections.
This will identify potential noncompliance with CMS nurse staffing requirements, such as lack of a registered nurse for eight hours each day, or lack of licensed nursing for 24 hours a day. This guidance aims to uncover instances of insufficient staffing and will, allegedly, yield higher quality care.
CMS also intends to issue a proposal in 2023 on a minimum staffing measure.
Cunningham, Norris. “Ask The Legal Expert: What Can We Expect From a Staffing Minimum?” McKnight’s Long-Term Care News, 11 Sept. 2022, www.mcknights.com/print-news/ask-the-legal-expert-what-can-we-expect-from-a-staffing-minimum.
Why The Caregiver Definition Must Be Expanded For Nursing Homes to Overcome Labor Crunch
As the Centers for Medicare & Medicaid Services (CMS) works to establish federal minimum staffing levels, industry leaders are calling on the government agency to broaden the caregiver definition.
The current federal requirement does not provide a specific daily minimum standard, rather, it states that nursing homes must provide “…sufficient nursing staff to attain or maintain the highest practicable … well-being” of every resident.
However, some state standards and what CMS has previously recommended in past reports to Congress, largely only factor in certified nursing assistants (CNA), licensed practical nurses (LPN) and registered nurses (RN) when breaking down the minimum amount of time a staff member should be directly caring for a resident.
Reiland, Jordyn. “Why the Caregiver Definition Must Be Expanded for Nursing Homes to Overcome Labor Crunch.” Skilled Nursing News, 16 Aug. 2022, skillednursingnews.com/2022/08/why-the-caregiver-definition-must-be-expanded-for-nursing-homes-to-overcome-labor-crunch.
CMS heading into facilities to help determine federal staffing mandate
Contractors will be making 65 nursing home visits over the next three months in a bid to help establish first-ever federal minimum staffing levels.
Frequent Centers for Medicare & Medicaid Services contractor Abt Associates will stage visits at select facilities through October. The White House set a goal of having a new staffing mandate in place by March 2023.
Abt researchers will collect information from staff, residents and family members, officials said.
Facilities spread across all 10 CMS regions will take part in the site visits.
Berklan, James. “CMS Heading Into Facilities to Help Determine Federal Staffing Mandate.” McKnight’s Long-Term Care News, 12 Aug. 2022, www.mcknights.com/news/cms-heading-into-facilities-to-help-determine-federal-staffing-mandate.
Site Visits Included in CMS Staffing Study
CMS contractor Abt Associates will be conducting site visits at select nursing homes between August and October 2022 as part of the CMS nursing home staffing study.
Centers for Medicare and Medicaid Services (CMS) contractor Abt Associates has begun reaching out to select nursing homes for participation in site visits as part of the CMS nursing home staffing study. The staffing study is part of the White House plan for nursing home reform and will help inform the development of minimum nursing home staffing standards through feedback from staff, residents, and families on staffing challenges and perspectives on a federal minimum staffing requirement.
Site visits will take place in 65 nursing homes across all 10 CMS regions between August and October 2022. Abt Associates has identified nursing homes for participation based on several factors: location, size, ownership type, staffing level based on the staffing domain of the Five Star Quality Rating System, quality based on the Quality Measures domain of the Five Star Quality Rating System, use of agency staff, and proportion of Medicaid residents served and/or location in a disadvantaged area.
Eyigor, Jodi. “Site Visits Included in CMS Staffing Study.” Leading Age, 10 Aug. 2022, leadingage.org/node/493353.
CMS reveals differing opinions on minimum staffing approach
A study meant to underpin a new federal nursing home staffing minimum will last about seven months and end in December, a Centers for Medicare & Medicaid Services official said Thursday.
That confirmation came during an Open Door Forum conference call Thursday, and amid a fierce, ongoing debate how mandated staffing levels can be equitably determined at all.
The CMS call came nearly a week after the agency issued its final 2023 pay rule. In it, CMS acknowledged there had been a “significant response” to its request for information on establishing mandatory minimum staffing levels.
Marselas, Kimberly. “CMS Reveals Differing Opinions on Minimum Staffing Approach.” McKnight’s Long-Term Care News, 5 Aug. 2022, www.mcknights.com/news/cms-reveals-differing-opinions-on-minimum-staffing-approach.
CMS Shares Updates on Nursing Home Staffing Study
CMS gave an update on the nursing home staffing study during the August 4 SNF Open Door Forum.
At the end of February 2022, the Biden Administration released a plan for nursing home reform that included conducting a staffing study and proposing nursing home staffing standards within one year. The Centers for Medicare and Medicaid Services (CMS) included a Request for Information on staffing standards in the Fiscal Year (FY) 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) proposed rule, released in April 2022, as part of this plan. The final rule was published in the Federal Register on August 3 and while the rule did not include additional information about future staffing standards, CMS shed light on the topic during a SNF Open Door Forum on August 4.
CMS reported receiving more than 3,000 public comments in response to the Request for Information. While nursing home residents, families, and consumer advocates generally supported the implementation of mandatory staffing standards, nursing home providers and other “industry groups” expressed concern and largely suggested a delay or phase-in to requirements due to current staffing shortages.
Eyigor, Jodi. “CMS Shares Updates on Nursing Home Staffing Study.” Leading Age, 5 Aug. 2022, leadingage.org/node/493327.
CMS: Nursing Home Minimum Staffing Requirements to Strike Balance Between Opposing Industry Views
Nursing home minimum staffing requirements has been a hot topic for the industry from the moment the initiative was introduced by the Biden administration back in February.
After soliciting feedback through a request for information (RFI) on the topic back in April as part of the proposed rule, the Centers for Medicare & Medicaid Services (CMS) received more than 3,000 comments on the issue.
Parties including advocacy groups, long-term care ombudsman, industry associations, labor unions and organizations, nursing home staff and administrators, industry experts and other researchers and family members and caretakers of nursing home residents, were among the commenters.
Reiland, Jordyn. “CMS: Nursing Home Minimum Staffing Requirements to Strike Balance Between Opposing Industry Views.” Skilled Nursing News, 4 Aug. 2022, skillednursingnews.com/2022/08/cms-nursing-home-minimum-staffing-requirements-to-strike-balance-between-opposing-industry-views.
The Math Doesn’t Work: Nursing Home Staffing Woes Unsolvable Without Immigration Action
As nursing home operators scramble to recruit direct care workers during a historic staffing shortage, many in the sector believe there is one obvious solution that has yet to gain meaningful traction, in part due to legislative gridlock: immigration.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) has honed in on minimum staffing ratios, and is incorporating staffing data into surveys as well as the five-star rating system. Such initiatives come at a time when the sector is operating with 14% less of its pre-pandemic workforce, according to data from the Bureau of Labor Statistics (BLS).
Providers have taken it into their own hands to bring direct care workers in from overseas, with little success.
Stulick, Amy. “The Math Doesn’t Work: Nursing Home Staffing Woes Unsolvable Without Immigration Action.” Skilled Nursing News, 27 July 2022, skillednursingnews.com/2022/07/the-math-doesnt-work-nursing-home-staffing-woes-unsolvable-without-immigration-action.
Employment Considerations for Long Term Care Facilities under the Biden-Harris Administration
In support of these [Biden-Harris Administration] goals, the Centers for Medicare and Medicaid Services (CMS), acting under the direction of the Department of Health and Human Services, issued a proposed rule in the federal register in April titled Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule (Proposed Rule). This Proposed Rule contains three provisions likely to impact staffing at LTC facilities in the coming years. The comment period for the Proposed Rule closed on June 10, 2022. More than 6,800 public comments were submitted.
Ruetz, Shawna. “Employment Considerations for Long Term Care Facilities under the Biden-Harris Administration.” Healthcare Law Insights, 14 July 2022, www.healthcarelawinsights.com/2022/07/employment-considerations-for-long-term-care-facilities-under-the-biden-harris-administration.
CMS opens up on approach to developing minimum staffing requirements
Officials with the Centers for Medicare & Medicaid Services on Wednesday opened up about the “multi-faceted approach” it’s using to develop and propose minimum staffing requirements for nursing homes next year.
“This is an incredibly important body of work that we hope to ensure that nursing residents are receiving safe and quality care that they need,” a CMS official said Wednesday while speaking during a nursing home stakeholder call.
The agency is in the midst of examining ways to set minimum staffing requirements for nursing homes as part of President Joe Biden’s nursing home reform initiatives, and called on providers to give input on the matter when it issued its proposed 2023 Skilled Nursing Facilities Prospective Payment System in mid-April.
Brown, Danielle. “CMS Opens up on Approach to Developing Minimum Staffing Requirements.” McKnight’s Long-Term Care News, 14 July 2022, www.mcknights.com/news/cms-opens-up-on-approach-to-developing-minimum-staffing-requirements.
CMS Outlines Multi-Faceted Approach to Nursing Home Minimum Staffing Requirements
In an industry stakeholder call on Wednesday, Centers for Medicare & Medicaid Services (CMS) Social Science Research Analyst Pauline Karikari-Martin said the agency is using a “multi-faceted” approach to proposing a minimum staffing ratio – stakeholder commentary tied to the SNF Prospective Payment System (PPS), a long-awaited study and listening sessions to be held in August.
The listening sessions will be used to inform the agency’s research study design, according to Karikari-Martin.
The “mixed methods” research study will assess the minimum staffing requirements needed to ensure that residents receive safe and quality care, she added.
Stulick, Amy. “CMS Outlines Multi-Faceted Approach to Nursing Home Minimum Staffing Requirements.” Skilled Nursing News, 13 July 2022, skillednursingnews.com/2022/07/cms-outlines-multi-faceted-approach-to-nursing-home-minimum-staffing-requirements.
