A study meant to underpin a new federal nursing home staffing minimum will last about seven months and end in December, a Centers for Medicare & Medicaid Services official said Thursday.
That confirmation came during an Open Door Forum conference call Thursday, and amid a fierce, ongoing debate how mandated staffing levels can be equitably determined at all.
The CMS call came nearly a week after the agency issued its final 2023 pay rule. In it, CMS acknowledged there had been a “significant response” to its request for information on establishing mandatory minimum staffing levels.
Policy analyst Cameron Ingram told attendees the study launched in May, and agency officials are working to evaluate more than 3,000 comments on the proposed staffing rule. She said the comments typically pitted the concerns of consumer groups against those of nursing home providers, who have expressed concern about the ability to recruit and pay additional frontline workers.
Commeters, she said, recommended several potential models for developing a stuffing rule, including:
- Using an acuity-staffing model per shift, rather than a broad minimum
- Implementing a hybrid approach using facility assessment requirements and a staffing benchmark to determine additional staffing needs above a standard level
- Establishing minimums for residents with lowest-care needs, assessed using the MDS
Some submissions expressed concern that acuity-based standards “may be more susceptible to gaming,” Ingram said.
Commenters also asked the agency to consider how factors including ownership, proportion of Medicaid beds, size and market competition, could affect a nursing home’s ability to meet staffing minimums.
“Most commenters,” she said, were in support of creating avenues for competitive wages for nursing home staff to address issues of recruitment and retention. Industry commenters, Ingram added, also asked for a delayed or phased-in approach to any eventual rule given current labor challenges.
“While there are clear differences of opinion among stakeholders on establishing minimum staffing standards, it is CMS’ goal to use information along with the findings of the research staffing study, to strike a balance between positions all in the interest of ensuring safe and quality care for residents.”
Asked whether CMS would address reimbursement when it issues its staffing rule, Ingram declined comment until the study’s conclusion. Administrator Chiquita Brooks-LaSure has previously said funding “is part of” a staffing solution.
Also on Thursday’s call, officials outlined the first steps for providers in an upcoming switch to a new data system capturing key, facility-level data. Starting Aug. 15 and progressing by region through the fall, every provider will be asked to appoint a security official responsible for granting employees and vendors access to the Internet Quality Improvement and Evaluation System, or iQIES.
iQIES will replace Certification and Survey Provider Enhanced Reports, or CASPER. The original quality data system, used by providers and surveyors, is more than 20 years old.