HAPPENING TODAY:
AHCA Member Webinar on CMS Minimum Staffing Rule

AHCA/NCAL will host a webinar today at 12 PM Central to discuss the CMS Minimum Staffing final rule.  During this members-only briefing, AHCA/NCAL President and CEO Mark Parkinson and team will provide an overview of the key requirements and time frames in the CMS final rule, as well as next steps.

Registration is required and is available exclusively for AHCA/NCAL members. The webinar will be recorded and available for members to access following the live event. 

Tips for registering:
  • To avoid technical problems, use Google Chrome. 
  • Members will need to log in using their existing email and password first. 
  • Once you are logged into the website, you will be able to register by clicking the green register button at the top of the page. 
  • Click here if you have forgotten your password. 
  • If you are new to the site, you can create an account here. Answer all fields on the create an account page- especially locating your company name. You can search by name or zip code, and you will be able to register after creating an account. 

A certificate of attendance will be available after the webinar (no CEs). Email educate@ahca.org if you need assistance with registering.  
In Case You Missed It - Updates from Monday, April 22, 2024
Update #1

A Message from the President & CEO Mark Parkinson from Monday morning

April 22, 2024

White House Announces Release of Final Minimum Staffing Rule; Register for Member Webinar Tomorrow

This morning, the White House announced the release of the minimum staffing requirements at the end of today. The final rule staffing standards are different than the proposed rule and are unfortunately worse.

There are now three components.
  1. There is an overall standard of 3.48 nursing hours per patient day. For purposes of this part of the rule, we can count CNAs, RNs, and LPNs.
  2. There is a specific standard for 0.55 RNs per patient day and 2.45 CNA hours per patient day.
  3. There is a requirement for an RN in every building 24/7. Every shift.

Additional details regarding waivers and when different parts of the rule will be in effect, based on whether a facility is in an urban or rural area, will be available this evening. 

This rule is impossible to implement. The workforce is not available to meet these new requirements. Our fight on your behalf has just begun. We will continue to work with Congress to prevent this rule from being implemented. We will also take our fight to the courts by filing litigation to challenge CMS’ authority to issue these requirements.

AHCA/NCAL will host a webinar tomorrow, April 23 at 12 PM Central to discuss the final rule. During this members-only briefing, the team and I will provide an overview of the key requirements and time frames in the final CMS rule, as well as next steps.

Registration is required and available for AHCA/NCAL members. The webinar will be recorded and available for members to access following the live event. Email educate@ahca.org if you need assistance with registering. 

As mentioned, we will provide more details later today once the final rule is released, and I hope you will join us tomorrow for the member webinar. 

Sincerely,
Mark Parkinson
President & CEO, AHCA/NCAL

As Reported by:
Update #2

A Message from the President & CEO Mark Parkinson from Monday Evening

April 22, 2024

Staffing Rule is Irresponsible, Impossible to Implement
The Fight Has Just Begun
The White House continues to disappoint with its release of the final staffing rule today. It’s not possible to implement this rule. The nurses and nurse aides are not available, and there is no funding. 

As disappointing as this is, rest assured that the fight has just begun. We will take our case to Congress and seek relief. In addition, it is very likely that the Board will instruct us to take this battle to the courts. 

Below you will find a high-level outline of the provisions of the rule. Tomorrow, April 23 at 12 PM, we will have a member webinar to discuss the rule and our strategies in greater detail. Registration is available to AHCA/NCAL members, and it will be recorded for those unable to attend live. 

CMS today also released the Medicaid access and Medicaid managed care final rules. Our team is reviewing these rules, and we will share summaries soon.

MAJOR COMPONENTS OF THE RULE

Staffing Standard
The staffing standards are different than the proposed rule. Unfortunately, they are worse. There are now three components. 
  1. There is an overall minimum standard of 3.48 total nurse staff hours per resident day (HPRD). 
  2. Within the 3.48 HPRD, a minimum 0.55 hours must be delivered by RNs and 2.45 hours must be provided by CNAs. For the remaining 0.48 hours, we can count any combination of CNAs, RNs, and LPN/LVNs. 
  3. There is a requirement for an RN onsite in every building 24 hours a day, 7 days a week.

Phase In
Different parts of the rule go into effect at different times, based on whether a building is urban or rural.
  1. The 24/7 RN requirement goes into effect in urban areas in two years and in rural areas in three years.
  2. The 3.48 overall staffing requirement goes into effect in urban areas in two years and in rural areas in three years.
  3. The 0.55 RN and 2.45 CNA requirement goes into effect in urban areas in three years and rural areas in five years.
  4. All facilities must meet new facility assessment requirements within 90 days of the final rule publication. 

Waivers
There are waivers, but we are skeptical that providers will qualify. These include:
  1. For the 24/7 RN requirement, there are two options. First is the existing RN waiver process for SNFs, which is only available to rural facilities that meet the criteria. This waiver is subject to annual review. Second is the hardship exemption, which has extensive criteria including local workforce supply, good faith efforts to hire, and demonstrated financial commitment. The term of the hardship exemption is until the next standard recertification survey. 
  2. For the HPRD requirements, there is a hardship exemption option, which requires a facility to be found noncompliant and has extensive criteria – including local workforce supply, good faith efforts to hire, and demonstrated financial commitment. The term of the hardship exemption is until the next standard recertification survey.

Funding
There is no funding for the additional staff. This is only one of the reasons that the policy is not possible to implement. 

CMS estimates the total cost of the rule at $43 billion over 10 years – or about $4.3 billion per year. We believe it is closer to more than $6 billion per year. There are no provisions requiring Medicare, Medicaid, or other payors to increase payment rates to providers for any of the rule requirements. 

Penalties
CMS will publish more details on how compliance will be assessed and how enforcement remedies will be imposed after the publication of this final rule in advance of each implementation date for the different components of the rule.

WHAT COMES NEXT

We realize that it is not possible to implement this rule. This is not a serious policy. This is all about politics. We are not about to let you, your employees, and your residents to be used as political pawns. We will take our case to the courts and Congress, and I remain confident that we will ultimately prevail. 

For that to happen, we need your help. We need you to let your members of Congress and Senators know how impossible this proposal is to implement. Congressional Briefing is the perfect time to do that. Join hundreds of your fellow providers from across the country on June 3 & 4 in Washington, D.C. as we work to reverse this impossible policy.

We hope you can join us for the member webinar tomorrow. The fight has just begun. 

Sincerely,
Mark Parkinson
President & CEO, AHCA/NCAL