Medicare Increases Staffing Requirements for Long Term Care Facilities


New regulations, as set forth, and funded in part, by the Centers for Medicare & Medicaid Services (“CMS”) decrease resident-nursing ratios in long term care facilities. This initiative will be enacted in 3 parts over a period of time that will be determined by the size and location of the facility.

The proposed amendments would be a 3-point plan to be implemented over a three-year period. The first point to this proposal mandates new standards of 0.55 “hours per resident day” for Registered Nurses and 2.5 hours for Nurse Aides. The “hours per resident day” (“HPRD”) standard is calculated by dividing the total number of nursing hours by the total number of residents/patients. The second point of the proposal would require an RN to be present 24 hours a day, 7 days a week. The third point of the proposal would enhance requirements for facility assessments.

These amendments also consider the difference in implementation between rural and non-rural facilities. This designation is typically reliant on a combined assessment of the ownership status, size of the facility, and membership in a multifacility organization[1]. Facilities designated as urban will have three (3) years to fully implement these amendments in three phases with the facility assessment requirements beginning within 60 days. The onsite RN requirement will be enacted within two (2) years, and the HPRD minimums will be enforced within three (3) years of the rule’s final publication. Alternatively, facilities designated as rural would still have 60 days to meet the facility assessment requirements but will have three (3) years to meet the RN requirements and five (5) years to meet the HPRD standard. CMS has also established a $175 million in funding for training programs and the promotion of careers in healthcare and nursing.

The attorneys at Airdo Werwas, LLC are available to consult with you on any matter involving Long-Term Care Facilities. If you have any questions or concerns about these issues, or any other matter related to Long-Term Care Facilities, please do not hesitate to contact Alyssa Lane at, or (312) 506-4473.



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