New Nursing Home Regulations: 2022 CMS Staffing Guidelines

Nurse handing a nursing home resident a meal

The Centers for Medicare & Medicaid (CMS) recently launched changes to its Nursing Home Five-Star Quality Rating System. This has given many post-acute leaders reason to pay even closer attention to CMS guidelines for 2022, especially since this appears to be just the beginning of some significant changes from the agency.

The announcement opens the door to multiple questions around nursing home staffing requirements by state for 2022. The short answer is that these requirements are still up to each state, but there are a lot of interesting recent happenings coming down from CMS. Here’s a look at new nursing home regulations, 2022 CMS guidelines, and what it all means for your facility.

The Enhanced Rating System Has Launched

The Five-Star Quality Rating System was originally created to help healthcare consumers, families, and caregivers make more informed comparisons and ask better questions about the topics in nursing home care that are most pressing to them. The Biden-Harris Administration has sought to build on these efforts to improve nursing home quality and the care residents receive.

The latest enhancements leverage data on weekend staffing rates (for nurses and turnover among nurses and administrators), integrating this information to increase transparency. CMS Administrator Chiquita Brooks-LaSure emphasizes the fact that staffing levels and turnover, which now includes temporary staff, can have a substantial impact on the health outcomes and quality of care that people living in nursing homes receive.

The emphasis on turnover comes from CMS research, which finds that higher turnover is associated with a lower quality of care. For example, nurses who have worked longer at a facility are more familiar with residents and administrators who have longer tenures are able to create stable leadership and more consistent protocols and policies.

A Staffing Study, an RFI, and New Rules for 2023

It’s important to keep in mind that these changes aren’t happening in a vacuum. In late August 2022, CMS proposed new minimum staffing requirements to ensure that each facility is maintaining staff who are properly trained and are able to provide the quality of care their residents need. To accomplish this, CMS launched a multi-faceted effort to determine minimum levels and types of staffing needed to maintain safety and care quality. This initiative has included a Request for Information (RFI) and a new study.

The RFI happened in early 2022 and was part of the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule. The promised rule making on minimum staffing requirements will be issued in Spring of 2023.

Results of the RFI

Public comments on the RFI closed on June 10, 2022, with CMS receiving over 3,000 comments from parties ranging from long-term care ombudsmen, providers, resident advocates, nursing home staff and administrators, caretakers, and labor unions.

Nursing home resident advocates and industry associations provided ranging views on new nursing home regulations in 2022. Advocacy groups and families of residents generally favored establishing minimum staffing requirements. Family and caretakers also voiced concerns about residents not receiving adequate care because of chronic understaffing.

Some commenters suggested a move away from a minimum staffing requirement and instead implementing an acuity staffing model per shift. Other commenters recommended a staff to patient ratio as an alternative. Advocacy groups also stated that acuity should stand as a primary determinant in the establishment of minimum staffing standards.

What Will the Study Look Like?

The study has been designed to supplement, and not replace, prior studies and it’s been set on an accelerated timeline. It will involve both quantitative and qualitative elements that will inform the staffing proposal, to include:

  • Interviews
  • Observation data
  • Surveys
  • Minimum Data Set (MDS)
  • Medicare Payroll-based Journal (PBJ) data
  • Literature reviews
  • Site visits (across 15 states)
  • Cost analyses

New Nursing Home Regulations: 2022 and Beyond

As nursing home leaders consider how to move forward with the 2022 CMS guidelines, it’s also important to be prepared for what CMS may require in the future.

While turnover is being tracked, keep in mind that there is pressure on CMS to focus on patient outcomes as a defining metric. This means that nursing home administrators have an opportunity to balance their staffing strategy against CMS requirements and patient outcomes.

Here are two ways to set your facility up for success right now, both for patient care and future compliance.

1. Use State Staffing Requirements as a Guide

While you await upcoming CMS guidance on minimum staffing requirements, you can always look to current nursing home staffing requirements by state (2022 state-by-state update).

2. Broaden Your Staffing Methods

Also, know that there is ample room between permanent staff and per-diem options. Look for ways to incorporate block booking, contract, and float pool approaches to staffing that will help you achieve the positive patient outcomes and consistency for your residents that CMS is interested in.

Is Your Staffing Strategy Ready for New Nursing Home Regulations?

The 2022 CMS Guidelines set in motion a clearer path toward minimum staffing requirements. Learn how to prepare your facility with a cost-effective staffing strategy that not only aligns with CMS’s approach, but also promotes patient care and retention.






Megan is a business writer with over 15 years of experience in healthcare enterprise technology. She holds an MBA and B.S. in Healthcare Administration. She now keeps an ongoing eye on the latest developments and successes in healthcare admin technology and the people who use it to build a better world for providers, patients, and their care communities.


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