Introduction and CMS Final Rule

Speaker 1 0:11

Hello , I will be your host . My name is Deanna Fye . I am a registered nurse and healthcare analyst . Let's get started .

Speaker 2 0:35

The views or opinions expressed in this podcast are for informational purposes only , not intended . Let's get started . Consulting cannot guarantee that all information in this podcast is always complete . All information in this podcast is subject to change without further notice .

Speaker 1 0:52

Welcome to Vital Compliance Insights Today's episode . What I'll do is I'll talk about the CMS guidance related to minimum staffing requirements and facility assessments . Minimum staffing requirements and facility assessments . So I'll talk about those a little bit , just kind of give an overview of those areas . So first of all , back .

Speaker 1 1:11

The final rule came out from CMS in April of 2024 , where the CMS indicated they would like to put forth minimum staffing standards for long-term care facilities and this was focusing on certified Medicare Medicaid facilities . And they said they're doing this in response to the public feedback to improve quality of care . So , in a nutshell , some of those things that were summarized in that had to do with minimum staffing , direct care hours . So CMS indicated 3.48 hours per resident day and that has to be direct care , and of that 3.48 , 0.55 has to be a direct care by a registered nurse . 0.55 has to be a direct care by a registered nurse Okay . Of that 3.48 , 2.45 care direct care provided by a nursing assistant Okay . And then the remaining 0.48 could be a combination of a registered nurse , licensed practical nurse , licensed vocational nurse or a nursing assistant , depending upon your resident population needs . Cms further indicated in this final rule that they would like to see an RN , require an RN on-site 24 hours a day , seven days a week , to provide direct care . And why

Minimum Staffing Requirements Explained

Speaker 1 2:47

? Why is this ? Cms indicated just the nature of the resident population , the medical complexity of the residents . Residents are getting out of hospital sooner they're sick and they have a higher skill level of care and assessment level . In addition , in that final rule , cms indicated that they would like states requiring states to collect and report on the percentage of Medicaid payments , dollars spent on compensation for direct care workers or support staff . So they want this data collected .

Speaker 1 3:27

The CMS further is asking for an emphasis on placing an emphasis on the importance of facilities conducting assessments , a facility assessment , because the facility assessment will tell us what kind of resident populations , what kind of care is required . It'll help build staffing plans to meet those care needs . And it'll also help it would be essential , rather , if residents , the facility then develops evidence-based care guidelines to ensure staff are competent in providing that care . So that's in a nutshell what CMS indicated in their final rule back in April of 2024 . So the facilities some facilities are going to say this is a hardship to do this staffing mandate . And the CMS further said you can apply for an exemption , a hardship exemption and here's the criteria . So what I'll do is I'll upload on the Verity team website the state I'm sorry the CMS memorandum that talks about some of the things that I'm saying .

Speaker 1 4:37

All right , I also want to touch on not only the minimum staffing requirement perspective from the CMS , but

Hardship Exemptions and OIG Oversight

Speaker 1 4:45

OIG the OIG weighed do about this . How are you going to implement this mandate of staffing and how are you going to do it ? How are you going to enforce it ? So in turn and I'll upload this too the CMS , they provided a letter to the OIG that said you know , dear OIG , this is what we're going to do and it outlines all the things they've done already and what they're going to do going forward . We are going to require facility assessments . We are going to require that our surveyors use different tools , for example , the critical element , pathway tools . We're going to do these things . So it's all going to be listed . I'll put that on the website so you can read that . So the OIG said okay , that's what you're going to do to make sure this is implemented and enforced .

Speaker 1 5:54

Well , all of that certainly has not gone unnoticed by the public , by long-term care facility providers , and there has been a great outcry and this was presented to Congress . Congress met , talked about this challenge for facilities to meet the minimum staffing requirements , and what they decided to do is to at this point . Based on all of this feedback , in July , july 4th of 2025 , congress enacted a 10-year moratorium on the CMS staffing mandate , so that's until 2034 . So that's what's happened . So things are kind of on hold that way as far as

Congressional Moratorium on Staffing Mandate

Speaker 1 6:40

the mandate goes , but still the facilities are required to meet the other conditions of participation , which require quality of care with sufficient staff in place , staff that are competent to provide that care . That's not going to change . So as of September of 2025 , and I'll post this on the Verity team website too the CMS indicated they're going to take steps to rescind the final rule on the staffing mandate . So I'm sure they're going to rescind it , and then you never know , they're going to probably regroup and say but this is what we're going to do to revise our approach on this matter . Who knows , stay tuned on that . So , really , now what ? Now what's going to happen ?

Speaker 1 7:25

Well , having been a former federal surveyor and a monitor for the federal OIG , I would say it's going to be business as usual . Facilities , rather , surveyors rather , are going to have surveyors that come in and use the same tools they've always used . They're going to look at the care provided . They're going to look at the staffing for the staff that are scheduled and they're going to continue to ask for the PBJ the payroll-based journals to see who actually worked . They're going to look at that and if they see any kinds of situations where care has not been provided , that will certainly be an issue , a concern .

Speaker 1 8:07

I will go ahead and put on the Verity team website the critical element pathway on sufficient staffing and competent nurse staffing review so you can take a look at that and I would say facilities out there . It's a really good tool to use to do a self-assessment to see how are we doing ? Are we moving in the right direction ? Are we meeting the requirements to provide

Moving Forward: Compliance Strategies

Speaker 1 8:33

resident care that's evidence-based ? So I would definitely say the sufficient and competent nurse staffing review is a great tool to help facilities be ready and prepared .

Speaker 1 8:45

So it's hard to say where things are going to go from here , but I think if , at the very minimum , if facilities conduct comprehensive facility assessments and put forth plans in place to meet the staffing needs and ensure their staff are competent , I think really , you really are in a good place . You're in a good position and , with that said , I think if anyone out there is looking for any assistance in this matter to get some consultation , verity team it would be available for consultation . Please feel free to reach out . I hope this quick overview of what's going on with the minimum staffing requirements was helpful and stay tuned for the next episode of Vital Compliance Insights . Thank

Episode Closing and Contact Information

Speaker 1 9:45

you for listening . Your time is appreciated . We hope you enjoyed this episode of Vital Compliance Insights and found this to be informative . Please feel free to reach out to Verity Consulting at verityteamcom if you'd like further assistance with your healthcare compliance needs . Stay tuned for the next episode , thank you .