The Vast Majority of Nursing Facilities Will Need to Hire More Staff to Comply with the Final Federal Rule When Fully Implemented, Unless They Qualify for an Exemption

Based on a new KFF analysis, fewer than 1 in 5 (19%) nursing facilities currently meet the minimum staffing standards set out in the final requirements of the federal rule released today by the Centers for Medicare and Medicaid Services (CMS).

CMS adopted staffing standards that are similar to the staffing requirements in the rule proposed last year, which included minimum staff levels of 0.55 registered nurses and 2.45 nurse aide hours per resident day. The final requirements of the rule maintain these staff levels, and add an overall staffing requirement of 3.48 hours per resident day. The rule also requires a registered nurse on staff 24 hours per day, 7 days per week.

Nearly 60% of facilities currently meet the overall staffing requirement of 3.48 hours per resident day, which has been set as the interim requirement in the rule. Fewer facilities (19%) would meet the final requirements that include minimums for registered nurses and nurse aides, which will be applied when the rule is fully implemented.

This analysis does not estimate which facilities would qualify for an exemption or how staffing levels will change between now and when the staffing standards take effect. Urban and rural facilities have different timelines to come into compliance with the rule, which this analysis also does not take into account.