On Monday, CMS came out with its final minimum staffing standards for nursing homes, but the eventual outcome is anything but final. Despite the outcry from nursing home providers from the previous proposed mandate of three hours per resident per day, asking simple questions like how can we pay for this and where will this newly needed staff come from, CMS has now raised the minimum to 3.48 hours per resident day, which includes .55 hours for an RN and 2.45 hours that can be fulfilled by a nurse aid, now including LPNs, which were excluded from the prior version of the rule. It will also require facilities to have a registered nurse onsite 24/7. The rule will be implemented gradually over a period of three to five years and would allow for some exemptions.
The White House also released a statement on the new rule before sending the Vice President to Wisconsin to meet with nursing home workers as part of a campaign event. Hopefully these actions in a battleground state, and the sudden (or arbitrary) increase in required hours, signal that the “final rule” is more political theater than the actual policy that SNFs will be forced to conform to in the future.
There is some bipartisan support in Congress for CMS to reconsider the mandate, and a legal challenge could be on the table. There is also the uncertainty of which Administration will be in charge of implementing the mandate (or tabling it), Biden or Trump, or someone else.
