More than a month after the announcement of the federal minimum staffing proposal, an official with Centers for Medicare & Medicaid Services (CMS) reinforced the agency’s commitment to the rule and urged providers and other stakeholders to continue submitting comments on the matter by Nov. 6.
Dr. Dora Hughes, acting CMS Chief Medical Officer and acting Director of the Center for Clinical Standards and Quality, said during a quarterly stakeholder call on Tuesday that the agency took a multifaceted approach to help inform its proposal, and that it reflects “ all the available evidence.”
“We believe that our staffing proposals are balanced and achievable,” Hughes said. “They would help advance safe quality care for residents, while also striking an appropriate balance that considers the current challenges some nursing homes are experiencing particularly in rural areas.”
The agency took numerous steps in crafting the mandate, including conducting a staffing study, reviewing more than 3,000 comments from last year’s request for information, hosting listening sessions, analyzing payroll-based journal and survey data, examining state standards and reviewing the literature, Hughes said.
Medicare- and Medicaid-certified nursing homes must provide a staffing equivalent of 3 hours per resident per day (PRPD), with 0.55 hours of care from registered nurses (RNs) and 2.45 hours of care from certified nursing assistants (CNAs), in what Hughes called a “core” part of the proposed rule.
Other core aspects include 24-hour RN coverage and a tightening of care assessment requirements.
The proposal aims to hold nursing homes accountable for providing safe and high quality care to the over 1.2 million residents they serve, she noted.
Still, Hughes said public comment and “any additional evidence” will help the agency inform its final approach.
CMS already has received more than 7,000 comments on the proposal. As of Tuesday afternoon, the most recently submitted comment came from Todd Muckey, who serves as executive director for a 66-bed SNF in rural Nebraska.
Muckey suggested CMS include directors of nursing in the 24-hour RN proposal, along with licensed practical nurses in the wider minimum staffing hour requirement. As a five-star facility on Care Compare, he said Arbor Care Center-Valhaven utilizes other specialists to get to that level of quality, including a social services director, medication aides, a recreational and activities director, housekeeping aides and nutritional services aides.
All of these roles would be beneficial to include, he wrote, as many already hold active LPN and CNA licenses.
More financial support besides the $75 million is imperative as well, he said.
“Throughout my experience, I support and highly encourage quality improvement and changes that positively impact the quality of care we as health care professionals’ delivery, but I want to request support funding with these proposed changes,” he said in his comment to CMS. “We are a small skilled nursing facility with about 75% of our census being Medicaid long-term care seniors, which makes the cost associated with hiring additional employees and meeting these new proposed requirements extremely difficult.”
Many of Muckey’s comments echo those made by many nursing home professionals and industry advocates, who have sharply criticized the exclusion of LPNs from the proposal, highlighted serious concerns with the viability of the 24/7 RN requirement, and warned of devastating effects on facilities in rural markets.
The American Health Care Association (AHCA) has set a goal of submitting more than 10,000 comments to CMS on the proposed rule, along with “rolling fly-ins” from its members to Washington, hosting facility and community tours and organizing district meetings.
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