On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. This rule aims to hold nursing homes accountable for providing safe and high-quality care for nearly 1.2 million residents living in Medicare and Medicaid-certified long term care facilities. Central to the rule are comprehensive minimum nurse staffing standard requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within LTC facilities. As the long-term care sector continues to recover from the COVID-19 pandemic, the final standards also consider the local realities in rural and underserved communities via staggered implementation and exemptions processes. Highlights of finalized policies include a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. CMS also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. Finally, CMS finalizing to define “rural” in accordance with the Office of Management and Budget (OMB) definition. OMB designates counties as Metropolitan (metro), Micropolitan (micro), or neither. “A Metro area contains a core urban area of 50,000 or more population, and a Micro area contains an urban core of at least 10,000 (but less than 50,000) population. All counties that are not part of a Metropolitan Statistical Area (MSA) are considered rural”. As of 2022 the Rural Health Research & Policy Centers Nursing Home Chartbook, 87 percent of non-core counties have dually/Medicaid certified nursing homes while 82 percent of non-core counties have dually/Medicare-certified nursing homes.
