On April 22, 2024, the Facilities for Medicare and Medicaid Companies (CMS) launched a highly-anticipated closing rule that creates new necessities for nurse staffing ranges in nursing services, settings that present medical and private care providers for 1.2 million People, and for which the adequacy of staffing has been a longstanding challenge. CMS obtained almost 50,000 feedback on the proposed rule, starting from feedback that strongly supported the proposed requirements to people who opposed them. Amongst these feedback, the nursing residence trade prompt the rule was too onerous, given staffing shortages and prices, and will result in nursing facility closures, whereas resident and household advocates prompt the proposed requirements have been too weak to handle high quality issues.
Within the closing rule, CMS adopted staffing requirements which might be largely just like the staffing necessities within the proposed rule. Necessities will take impact in several phases. When absolutely carried out for all services, nursing services might be required to satisfy minimal nurse staffing ranges of three.48 hours per resident day (HPRD), together with 0.55 registered nurse (RN) and a couple of.45 nurse aide HPRD. Moreover, they are going to be required to have an RN on responsibility 24 hours a day, 7 days per week (24/7). By Could 2027, previous to full implementation, the ultimate rule requires nursing services to have an RN on responsibility 24/7 and not less than 3.48 HPRD of complete nurse staffing hours regardless of employees kind, with out the extra particular RN and nurse aide necessities that take impact when the rule is absolutely carried out. Timelines for assembly the interim and closing necessities will differ for city (10,400 services, or 73% of services) and rural services (4,000 services, or 27% of services). The interim necessities have to be met by Could 2026 for city services and Could 2027 for rural services. The ultimate necessities have to be met by Could 2027 for city services and Could 2028 for rural services (although HHS press supplies acknowledged Could 2029).
This evaluation makes use of the latest publicly-available knowledge to look at the share of nursing services that at the moment meet the minimal staffing necessities within the closing rule, which phases in starting in Could 2026 for some services. Particularly, this evaluation calculates the share of services that at the moment meet the general requirement of three.48 HPRD (no matter employees kind) and the share that meet the absolutely carried out, extra particular staffing requirements (HRPDs of three.48 general, 0.55 for RNs, and a couple of.45 for nurse aides). This evaluation makes use of Nursing Dwelling Evaluate knowledge from March 2024, which incorporates 14,403 nursing services (97% of all services, serving 1.18 million or 98% of all residents), and displays staffing ranges from July to September 2023. As a result of knowledge limitations, this evaluation doesn’t have a look at the 24/7 RN requirement. See Strategies for extra info.
KFF estimates that 19% of nursing services would meet the minimal HPRD staffing requirements beneath full implementation of the ultimate rule with their present staffing ranges (Determine 1). Practically 60% of services would meet the interim requirement of an general requirement of three.48 HPRD, however fewer services would meet the RN and nurse aide provisions which might be required when the rule is absolutely carried out (49% and 30% respectively; knowledge not proven).
The ultimate rule additionally consists of new reporting and evaluation necessities and the method by which services could qualify for an exemption from the minimal staffing provisions. The ultimate rule additionally signifies that CMS will launch extra particulars later this yr on how the $75 million funding in a nursing residence staffing marketing campaign might be structured. As famous within the proposed rule, CMS goals to stability the aim of creating stronger staffing necessities in opposition to the practicalities of implementation and prices.
The evaluation doesn’t consider services’ skill to adjust to different necessities within the closing rule, together with the requirement to at all times have a registered nurse on responsibility 24/7 or the power to satisfy the brand new reporting and evaluation necessities as a consequence of knowledge limitations (see Strategies). The evaluation additionally doesn’t estimate which services would qualify for an exemption or how staffing ranges will change between now and when the staffing requirements take impact.
A forthcoming evaluation will have a look at the share of services that at the moment meet the brand new requirements throughout quite a lot of dimensions, together with possession, state, and concrete or rural location.
Strategies
This evaluation makes use of Nursing Dwelling Evaluate as of March 2024 and displays staffing ranges from July to September 2023. Nursing Dwelling Evaluate is a publicly accessible dataset that gives a snapshot of knowledge on high quality of care and key traits for about 14,900 Medicare and/or Medicaid-certified nursing services. This evaluation drops about 3% of nursing services, together with the services in Guam and Puerto Rico and nursing services for which there was not staffing knowledge accessible for the fourth quarter of 2023, for a complete analytic pattern of 14,403 services. The variety of services recognized on this evaluation as assembly/not assembly necessities could differ from CMS’ estimates as a consequence of totally different years and quarters of information used for estimates.
The Workplace of Administration and Finances’s (OMB) delineation of metropolitan and micropolitan statistical areas have been used to designate rural and concrete areas. City and rural services have totally different timelines to return into compliance with the rule, which this evaluation doesn’t bear in mind. This evaluation displays compliance charges if the HPRD necessities have been in impact now for all services.
Because of the limitations of publicly accessible knowledge, this evaluation doesn’t have a look at services that meet the requirement to have an RN on employees 24 hours a day, seven days per week (24/7). Nursing residence staffing knowledge is calculated from the Payroll Primarily based Journal (PBJ), which incorporates knowledge on the whole variety of RN hours labored per day at a facility, however no knowledge on the timing of shifts. This limits our understanding of whether or not shifts have been labored concurrently by a number of workers (presumably not fulfilling the 24-hour requirement) or whether or not these hours have been unfold out over a 24-hour interval (fulfilling the 24-hour requirement).