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A much-anticipated final rule establishing nurse staffing standards at skilled nursing facilities is out, albeit with some extended timeframes to allow facilities to comply. While the current standards are focused on nursing staff only, APTA and other organizations are keeping an eye on the new rule in the event CMS considers applying staffing standards to other provider types in the SNF setting.

The final rule requires that any SNF that receives Medicare or Medicaid funding to employ sufficient nursing staff to provide at least 3.48 hours of daily care for each resident, with minimum allocations of 2.45 hours of nurse aide time and 0.55 hours of registered nurse time. In addition, SNFs will be required to have an RN on-site at all times and devote at least 80% of their Medicare payments to staff compensation.

The staffing standards rule is one of three final rules announced by CMS, all aimed at supporting the Biden administration's efforts to improve care in nursing homes. The other two rules are aimed at improving access to Medicaid services, particularly around home and community-based services, and for Medicaid beneficiaries in managed care plans. Of the final rules, the nurse staffing requirements are the focus of the most attention — the proposed version received more than 46,000 comments.

The requirements will be phased in over a three-year period for non-rural SNFs and over five years for SNFs in rural areas. Temporary hardship exemptions will also be offered.

APTA Health Policy and Payment Specialist Rachel Miller, MPH, thinks there are good reasons to keep an eye on the new rule, even though it doesn't directly regulate therapist staffing.

"APTA will be watching how this rule unfolds in terms of whether it leads to further efforts by CMS to establish more minimum staffing requirements," Miller said. "If CMS seems to be moving in this direction, we will be at the table for any discussions to ensure that whatever may be developed is patient-focused and adaptable."

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