HOUSTON
Volume 14 | Issue 7
Inside This Issue
Dr. Roderic Pettigrew Ascends to Pivotal Role at Texas A & M See pg. 9
INDEX Oncology Research......... pg.3 Mental Health...................... pg.5 Healthy Heart....................... pg.6 The Framework.................... pg.8 Financial Forecast............ pg.12
Take a Keto-Break See pg. 10
July Edition 2024
New Staffing Rules Published Amidst the Current SNF Staffing Crisis
By Meredith Duncan, J.D. Ellie Tucker, J.D. Polsinelli, PC
O
verview The Centers for Medicare and Medicaid Services (“CMS”) recently published a final rule implementing required mandatory hours per resident day (“HPRD”) for various levels of nursing staff in nursing facilities and skilled nursing facilities (“SNFs”) through a phased-in approach. Although the existing federal requirements to ensure SNFs have “sufficient staff” to meet residents needs and well-being remain, these mandatory staffing minimums further complicate SNF operations while still facing massive staffing shortages. Key Deadlines • August 8, 2024 - All SNFs, are required to document an update to their annual facility assessments pursuant to 42 CFR 483.70(e) to determine what resources are currently necessary to care for residents competently in day-to-day operations as well as emergencies. • May 11, 2026 - Non-rural facilities will have 2 years to increase their registered nursing staff (“RNs”) to ensure at least one RN is present and on-site 24 hours a day, 7 days a week. Rural facilities have 3 years, until May 10, 2027, to meet this requirement. • May 10, 2027 - Non-rural facilities will have 3 years to adjust their staffing to ensure overall staffing meets 3.48 HPRD, with a minimum
of 0.55 HPRD for RNs and 2.45 HPRD for nursing assistants (which includes certified nurse aides, aides in training, and medication aides/ technicians). Rural facilities have 5 years, until May 10, 2029, to meet this requirement. • May 10, 2028 – Date by which Medicaid-certified nursing facilities and intermediate care facilities for individuals with intellectual disabilities will be required to comply with the staffing requirements. Notably, CMS did not impose any mandatory HPRD requirements for licensed professional nurses (“LPNs”) and licensed vocational nurses (“LVNs”), citing a lack of correlation between increased quality of care with an LPN/LVN HPRD requirement. However, LPN/LVN hours can apply to the overall 3.48 HPRD minimum. Exemptions A SNF provider may qualify for an exemption to the staffing rule if it: 1) it is located in a region where the provider-to-population ratio is at least 20% below the national average, and 2) it demonstrates good faith efforts to hire and retain staff, and 3) it demonstrates financial commitment
to retain direct care staff. “Good faith efforts” can include documented job postings, job vacancies and job offers extended for prevailing wages, as well as written staffing plans. “Financial commitment” will be evaluated by the amount spent on nurse staffing relative to revenue. If granted an exemption, the SNF must post a notice of its exemption status at the facility, inform each current and prospective resident, and send a copy of the notice to State Long-Term Care Ombudsman. Additionally, exemption status will be published on Care Compare. Exemptions are not available to SNFs with staffing-related violations, SNFs that have failed to submit PBJ staffing data, or Special Focus Facilities. Adds to Existing Requirements It is important to note that although minimum staffing ratios will become an important marker of sufficient resident care, the new rule supplements, and does not supersede or replace, the current requirements that a facility have “sufficient staff” to meet residents needs safely and
see Rules ...page 14
PRSRT STD US POSTAGE PAID PERMIT NO 1 HOUSTON TX