CMS Backtracks on Nursing Home Staffing Mandate: What it Means for home Health
The long-awaited federal rule requiring minimum staffing levels in nursing homes has hit a meaningful roadblock. The Centers for Medicare & medicaid Services (CMS) is now moving to repeal those standards, a growth welcomed by the home health industry which previously braced for increased competition for a limited pool of skilled clinicians. LetS break down what happened, why it matters, and what you can expect moving forward.
The Original Rule: A Push for Improved Care
In early 2023, CMS proposed a rule intended to dramatically improve nursing home quality and safety. Key components included:
* Increased Staffing: Facilities would have been required to staff at levels based on individual resident needs, potentially exceeding current levels.
* 24/7 RN Coverage: A registered nurse (RN) would have been mandated on-site around the clock to provide skilled nursing care.
* Minimum Hours of Care: The rule specified minimum hours of direct care per resident daily, with varying requirements based on acuity.
The intention was clear: to address longstanding concerns about understaffing and its impact on resident well-being.CMS believed these changes would lead to safer, higher-quality care in nursing homes. You can find details in the original fact sheet.
Legal Challenges and Delays
However, the rule faced immediate legal challenges. Two federal court decisions vacated the staffing standards, essentially halting their implementation. The Department of Justice, representing the Department of Health and Human Services (HHS), filed motions to dismiss appeals of these rulings.
The Fifth Circuit Court of Appeals granted the dismissal for the Texas decision.A similar motion is pending with the Eighth Circuit regarding the Iowa decision, and is expected to be granted as well.
Further complicating matters, HR 1 delayed the implementation of the final rule entirely by nine years. This means, even if the rule had survived legal challenges, the new staffing standards wouldn’t have taken effect until January 1, 2035.
CMS Shifts course: The Repeal Rule
Now, CMS is actively pursuing a repeal of the original staffing standards. An interim final rule,titled “Repeal of Minimum Staffing Standards for Long-Term Care Facilities,” has been submitted to the Office of Management and Budget (OMB) for review.
According to Jodi Eyigor, senior director of nursing home quality and policy at LeadingAge, the title itself strongly suggests a focus on repealing the standards. However, the full scope of the rule remains unknown until it’s officially released. Will CMS simply repeal the standards, or will they introduce option requirements? We’re all waiting to see.
What This Means for Home Health
Initially, the proposed rule sparked concern within the home health industry. The worry was that increased staffing demands in nursing homes would intensify the already fierce competition for qualified clinicians.
As Mary Carr,vice president of regulatory affairs at the National Alliance for Care at Home (The Alliance),explains,”Our fear was they were going to take people away.” Home health and hospice agencies often recruit from the same talent pool as nursing homes, hospitals, and health systems. These other sectors sometimes offer higher wages, making recruitment even more challenging.
Fortunately, the home health industry was largely spared immediate impact. The key provisions weren’t scheduled to take effect until 2026. Because of the legal challenges and subsequent delays, no significant impact was felt.
Beyond Staffing: A Lingering Concern
the repeal of the nursing home staffing mandate doesn’t entirely eliminate concerns for home health providers. There’s still a fear that a successful staffing model in the skilled nursing facility sector could prompt CMS to consider similar regulations for home-based care.
This potential for future mandates underscores the importance of proactive engagement with CMS and advocating for policies that support the unique needs of the home health industry.
Looking Ahead
The CMS decision to repeal the nursing home staffing mandate is a win for the home health industry in the short term