Comments On Mandatory Staffing Ratios for Nursing Homes Due to CMS by June 10

As part of the annual proposed rule updating Medicare Part A payments to skilled nursing facilities, the Centers for Medicare & Medicaid Services (CMS) includes a Request for Information about mandatory staffing levels for nursing homes.[1] CMS asks 17 questions about staffing. Commenters may answer some or all of the questions or they may submit comments focused solely on their own experiences, concerns, and recommendations about nurse staffing levels. 

Recognizing the complexity of the 17 questions in the Request for Information, the National Consumer Voice for Quality Long Term Care hosted a webinar on May 25. Nursing home advocates from California Advocates for Nursing Home Reform, the Center for Medicare Advocacy, Justice in Aging, and the Long-Term Care Community Coalition joined Consumer Voice in drafting a set of comments and discussing these comments and staffing issues at the webinar.

The draft comments, which commenters are invited to use, if they like, to support their own comments, are available at https://theconsumervoice.org/uploads/files/actions-and-news-updates/RFI_Comment_Outline.pdf. Consumer Voice includes more information about submitting comments on its website, https://theconsumervoice.org/. The Center for Medicare Advocacy will also share its comments in early June.

The Center contends that the 1987 Nursing Home Reform Law gives the Secretary full authority to set minimum staffing standards.[2] The Center also recognizes that staffing is a complex issue, requiring many actions in addition to mandatory staffing levels. Nevertheless, there can be no question that mandating staffing levels in nursing homes is one of the most important ways to improve staffing and make residents’ lives better. President Biden’s nursing home reform agenda[3] puts this decades’ long advocacy goal within reach. Anyone with experiences in nursing homes is encouraged to submit comments to CMS by the June 10 deadline.

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[1] CMS, “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023; Request for Information on Revising the Requirements for Long-Term Care Facilities to Establish Mandatory Minimum Staffing Levels,” CMS-1765-P, https://www.govinfo.gov/content/pkg/FR-2022-04-15/pdf/2022-07906.pdf, discussed in “CMS Begins Process of Setting Mandatory Nurse Staffing Standards for Nursing Facilities” (CMA Alert, Apr. 14, 2022), https://medicareadvocacy.org/cms-begins-process-of-setting-mandatory-nurse-staffing-standards-for-nursing-facilities/
[2] The Secretary has the duty and responsibility “to assure that requirements which govern the provision of care in skilled nursing facilities under this subchapter, and the enforcement of such requirements, are adequate to protect the health, safety, welfare, and rights of residents and to promote the effective and efficient use of public moneys.”  42 U.S.C. §§1395i-3(f)(1), 1396r(f)(1), Medicare and Medicaid, respectively.  These dual duties – ensuring that care standards and their enforcement adequately protect residents and effectively and efficiently using public reimbursement – give the Secretary ample authority to develop and enforce minimum mandatory staffing standards.
[3] “Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes” is at https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/, discussed in “Biden Administration Issues Bold and Comprehensive Nursing Home Reform Agenda” (CMA Alert, Mar. 3, 2022), https://medicareadvocacy.org/bidens-bold-2022-nursing-home-reform-agenda/