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? 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 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 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 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 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.