A long-awaited federal rule that could rewrite how nursing home owners and operators staff their buildings is in the final stage of review before being released publicly.

The Centers for Medicare & Medicaid Services’ Minimum Staffing Standards for Long-Term Care Facilities proposed rule was received by the Office of Management and Budget on Monday. Its cost implications are being reviewed by the White House team, and it’s next stop should be the Federal Register.

CMS has given little insight to its general approach to the mandate, it potential structure or any conditions that would allow providers to be phased in or seek waivers until local labor shortages improve.

During a study period, at least one expert involved in a review of previous studies and a cost analysis had said the agency’s work was building on previous recommendations that called for 4.1 hours per patient per day of direct care. 

OMB has labeled the proposed rule’s likely effects as having significant financial impact. Per a memo published earlier this year, that means benefits, costs or transfers could be at least $200 million in at least one year, or the rule could “adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, territorial, or tribal governments or communities.”

The advance to OMB review overlapped with the publication of a new op-ed from American Health Care Association CEO and President Mark Parksinson. “Mandates Are Not The Solution To Our Growing Nursing Home Crisis” was published in The Hill and ostensibly targeted policymakers as well as lawmakers who may be able to offer alternatives to or financial support for a staffing mandate.

In it, he criticized legislators for ignoring potential solutions to the nurse staffing crisis, which he and many other providers have said make a staffing mandate untenable for now.

“We are seeing the consequences of our labor crisis in real time. Nursing homes limiting the number of residents they can accept is becoming all too common. For others, staffing shortages are leading to the devastating decision to close entirely,” he wrote. “Yet Washington’s response is a blanket staffing mandate, currently unfunded and without any supporting workforce development programs. This one-size-fits-all regulation is counterproductive and in no way addresses the underlying issue of our persistent workforce challenges. To truly solve our labor crisis, we must start with the core need: proactive measures that will support workforce recruitment and retention.”

Referring to immigration as one potential fix, Parksinson called on lawmakers to support the DIGNITY Act, which includes elements to improve visa processing, and the Healthcare Workforce Resilience Act, which would recapture unused visas from previous fiscal years for nurses and their families.

He also called for “proper Medicaid funding and fully funded regulations” to give facilities the resources they need to recruit and retain caregivers, and legislation that would allow new training resources for nursing homes. 

“The biggest challenge is that in today’s labor market, the workers simply aren’t there,” Parksinson wrote. “A staffing mandate will not create applicants. And when nursing homes cannot meet this impossible standard, they will have to reduce the number of residents they serve or close entirely, exacerbating the current access to care crisis we’re already seeing unfold.”