By: Christopher A. Parrella, Esq., CPC, CHC, CPCO
Parrella Health Law, Boston, Ma.
A Health Law Defense and Compliance Firm

The Centers for Medicare & Medicaid Services (CMS) has unveiled a pivotal regulation that redefines staffing requirements for nursing homes, representing the most significant changes in over three decades. This move is a response to the long-standing issue of understaffing in nursing homes—a concern dramatically highlighted during the COVID-19 pandemic.

Key Elements of the CMS Final Rule
The CMS rule establishes minimum staffing levels for long-term care facilities to ensure residents receive safe and high-quality care. Here’s an overview of the requirements:

• Minimum Staffing Levels: Nursing homes must provide an average of 3.48 hours of nursing care per resident per day. This includes 0.55 hours from registered nurses (RNs) and 2.45 hours from nurse aides (NAs).
• 24/7 RN Presence: Facilities are now required to have an RN on-site 24 hours a day, seven days a week. This change aims to enhance the immediate availability of medical care and supervision.
• Comprehensive Facility Assessments: Facilities must conduct detailed assessments to determine staffing needs based on resident acuity and other factors. This is to ensure staffing levels are responsive to the specific needs of residents.

Implementation and Compliance
To facilitate a smooth transition, CMS has staggered the implementation timeline:

• Immediate Requirements: Within 90 days of the final rule publication, facilities must comply with the new facility assessment requirements.
• Gradual Staffing Increases: Over a three-year period, facilities are required to meet the progressive staffing requirements. This phased approach gives facilities the necessary time to adjust and ensure compliance without disrupting care.

Financial Implications and Support
The rule does not include additional Medicare or Medicaid funding to support these changes, meaning that facilities will need to manage these costs within their existing budgets. This financial strain could impact the feasibility of implementing the new standards for some facilities, particularly in rural areas where staffing shortages are more acute.

At Parrella Health Law, we understand the complexities these changes bring. Our team is ready to assist nursing homes in navigating these new regulations, ensuring compliance, and advocating for the necessary support to implement these critical improvements effectively. For more details on navigating these changes, Parrella Health Law is here to guide you through every step of the process. Please call us at 857-328-0382 or email me personally at cparrella@parrellahealthlaw.com

Christopher Parrella, ESQ, CPC, CHC, CPCO, is the founding partner of Parrella Health Law in Boston, Mass. The firm focuses exclusively on healthcare defense and compliance matters. Chris also travels the country on behalf of a wide range of healthcare organizations, lecturing on a variety of health care enforcement and compliance topics. Chris is one of a handful of health care attorney’s that are also Certified Professional Coders (CPC) and is a member of the AAPC’s National Legal Advisory Board and Ethics Committee.  He is also a Certified Professional Compliance Officer (CPCO) and Certified in Health Care Compliance (CHC.)