CMS Proposes to Require Minimum Staffing Standards for Long-Term Care Facilities

On September 6, 2023, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule titled, “Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting.”   

The proposed rule would establish minimum staffing standards for long-term care facilities to ensure safe and quality care. The rule requires a registered nurse to be on site 24 hours per day and 7 days per week to provide skilled nursing care to all residents in accordance with resident care plans.  Pursuant to the Regulatory Flexibility Act, CMS certified that the rule would not have a significant impact on a substantial number of small entities.

On November 2, 2023, the Office of Advocacy filed a comment letter to CMS, Minimum Staffing Requirements for Long-Term Care Facilities (PDF, 315 KB) on the proposed rule that argued the following:

  1. Affected stakeholders were concerned that the rule imposes new staffing requirements at a time when there is a severe nursing shortage in the United States. Stakeholders also told Advocacy that the rule would impose significant costs that CMS’ analysis underestimated.
  2. Advocacy suggested that CMS should not have certified the rule. Instead, the agency should have performed an initial regulatory flexibility analysis given stakeholders’ concerns that  CMS’ costs were underestimated.

For more information, please contact Linwood L. Rayford, III, Assistant Chief Counsel for Food, Drug, and Health Affairs, at, or call (202) 205-6533.

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