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Contact CMS regarding the minimum staffing mandate rule

Patti Cullen, CAE
By Patti Cullen, CAE  |  January 27, 2023  |  SNF/NF providers

Right now, the Centers for Medicare & Medicaid Services (CMS) are drafting a proposed regulation establishing minimum staffing levels in nursing facilities across the country, as an initiative publicly announced by the Biden Administration soon after taking over the presidency. There is much we don’t know about how they are drafting this regulation such as what the magic number will be, what staff are included, whether acuity is being considered, waivers, phase-in periods, and so on. What we do know is they are working on the proposed rule now, and we expect it to be included in the Medicare nursing facility payment rule, which comes out at the end of April/beginning of May. We also know consumer advocates are sending in many comments encouraging CMS to establish a high staffing threshold, regardless of whether the workforce actually exists to meet that threshold. We need to be sure CMS hears our voices as well.

Click on the top gold banner from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) website to get to their action alert center where you can send an email directly to CMS on how the unfunded staffing mandate rule for nursing facilities being written right now would impact access to care for seniors. Please submit your comments by February 28, 2023. AHCA/NCAL would like at least 3,000 different comments to be submitted. If you have a lot to say (more than 5,000 characters), you will have to send the longer letter to CMS—the address is listed in the action center. You may want to develop a word document that you can insert into the text screen on the messaging center; below is a potential outline for your comments:

  1. Explain who you are
    1. What you do and how long you have been in this line of work
    2. Why you work in long-term care
    3. Describe your building: Location, number of units, profile of your residents
  2. Tell them about your commitment to quality
    1. Mention any AHCA Quality Award or other award you have received
    2. Explain what your residents mean to you and your team
  3. Explain how workers are not out there
    1. Explain how hard is to get workers and your challenges to get them; provide any story or example of not being able to get staff
    2. Tell them how many positions you have open, inability to fill shifts, hire new recruits
    3. Discuss your use of agency staff and related costs
    4. Tell them that a staffing mandate will not create workers
    5. Tell them how you have had to delay/deny admissions because you don’t have enough staff to safely care for them and how a new mandate may result in even further access concerns
  4. Asks: Given these ongoing challenges as we still deal with, and try to recover from, the COVID-19 pandemic, encourage CMS to proceed in a thoughtful and deliberate manner and to consider the following recommendations:
    1. If you do it, then phase it in and only when the workforce is back
    2. Any requirement must be paid for completely
    3. Include a broad definition of staff under the requirement

The AHCA/NCAL issue brief on the unfunded minimum staffing requirement can be found here.

Minimum staffing requirements for SNFs webinar recording:
AHCA/NCAL recently hosted a webinar to discuss the importance of and tips on contacting CMS to weigh in on proposals the agency is writing for SNF minimum staffing requirements. The recoded webinar is now available for AHCA/NCAL members. Please log in and register for the webinar in order to view it. Email: if you need assistance with registering or have any questions. 

Patti Cullen, CAE  |  President/CEO  |  |  952-851-2487

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Care Providers of Minnesota is a non-profit membership association with the mission to Empower Members to Performance Excellence. Our 900+ members across Minnesota represent non-profit and for-profit organizations providing services along the full spectrum of post-acute care and long-term services and support. We are the state affiliate for the American Health Care Association/National Center for Assisted Living, and with our national partners we provide solutions for quality care.

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