CMS Establishes Minimum Staffing Standards for Long-Term Care Facilities

Centers for Medicare & Medicaid Services pay for a big chunk of the care at skilled nursing facilities via their Medicaid and Medicare programs. As such – they have a keen interest in making sure the care for the people they’re paying for is good.

For the last couple of years, they’ve been reevaluating their standards and expectations for facilities that serve folks via Medicare and Medicaid (nearly 1.2 million residents live in Medicare- and Medicaid-certified long-term care facilities paid for by CMS).

See: Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule (CMS 3442-F) | CMS

Last week, after reviewing 46,000 public CMS just established new rules that will a total nurse staffing standard of 3.48 hours per resident day. CMS is also finishing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

See: How The Republic reported on resident harm in senior living facilities

CMS will also require states (ADHS) to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

They’ll be offering hardship exemptions in limited circumstances to the 3.48 hours of nursing per resident per day and 24/7 onsite RN requirements if they meet several geographic staffing unavailability, financial commitment to staffing, and good faith efforts to hire.

Enforcement is largely up to the state health departments who contract with CMS to do the certification inspections, in our case ADHS.

See Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Director Christ Era &

 The Arizona Republic’s The Bitter End Series

Last week’s directive from Hobbs to agency directors ordering them to implement a hiring freeze (and send her a plan to cut 4% from their current-year spending and additional 2% cuts next FY) undercuts the department’s efforts to improve their performance.

Hobbs’ budget letter points to cuts, hiring freeze for Arizona government

Those moves cast an uncertain shadow on ADHS’ ability to hire and keep adequate staffing to ensure folks are receiving adequate care in licensed care facilities.

For now, I will give the administration the benefit of the doubt that ADHS Licensing (which lives mostly off licensing fees) and the Arizona State Hospital will be exempt from this new directive. For now, those positions in Licensing and ASH are still posted on AZ State Jobs