The highly anticipated Nursing Home Minimum Staffing Standards final rule was released to the Federal Register on April 22. The rule finalized a new hours per resident day (HPRD) requirement of 3.48 total nurse staffing, which includes the proposed requirements of 0.55 HPRD for registered nurses (RNs) and 2.45 HPRD for nurse aides. In addition to HPRD requirements, the rule finalized the proposed 24/7 onsite RN requirement. Staffing standards will be implemented on a phased-in timeline as proposed.

Responding to the rule in a press statement, LeadingAge president and CEO Katie Smith Sloan said: “The final rule, while well-intentioned, will not achieve the goals we all desire: ensuring older adults’ and families’ ability to access quality nursing home care. In fact, it threatens to exacerbate the current challenges including limited admissions, fewer beds and, worse yet, nursing home closures, that are already limiting care access.”

Additional details include:

• Nursing homes in non-rural areas will implement standards within two years for the 24/7 RN requirement, and three years for the RN and nurse aide HPRD requirements.
• Nursing homes in rural areas will implement standards in three years for the 24/7 RN, and five years for the RN and nurse aide HPRD requirements.
• The 3.48 HPRD total nurse staffing requirement will be implemented with the 24/7 RN requirements.

Waivers and exemptions have been finalized, though they differ slightly from what was proposed and nursing homes will be required to post exemption status and the degree to which the nursing home is not compliant with staffing standards in a publicly available and easily visible location in the nursing home.

Nursing homes will also be required to provide individual notice to current and prospective residents and ombudsmen of exemption status and degree of noncompliance, and CMS will post this information publicly on Care Compare.

The rule also finalized expanded Facility Assessment requirements with an extended implementation timeline of 90 days, compared to the proposed 60-day timeline and Medicaid payment transparency requirements with a four-year implementation date as proposed.

LeadingAge will provide analysis in the coming days and on the national member call on Wednesday, April 24.

Save the date for a live LeadingAge webinar on Tuesday, April 30, to take a deep dive into the rule and what nursing homes need to consider as they work toward compliance. Register for the April 30 webinar on the LeadingAge Learning Hub.