The CMS final rule outlines the following requirements around staffing:

• Total nurse staffing standard of 3.48 hours per resident day
  • RN hours per resident day = 0.55 hours
  • Direct nurse aid hours per resident day = 2.45 hours
  • Any nurse staff (RN/LPN/LVN/AIDE) hours per resident day = 0.48 hours
• Must have an RN on site 24 hours a day, seven days a week to provide skilled nursing care.
• Limited possible exemptions for facilities that may qualify (ie rural location, or unique workforce challenges being identified) after completing a CMS Facility survey.
• Facilities must utilize their new facility assessment tools to determine if more hours than the minimum standard needs to be set based on factors specific to that facility’s resident criteria.
• States must report compensation for workers – percent of Medicaid payments that are spent on compensation for care workers and support staff delivering patient care.

Facility Assessment Requirements:
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• Include behavioral health needs while care planning for residents.
• Look at each resident’s specific needs rather than aa general resident population.
• Nursing home leadership must provide input – including but not limited to administrator, DON, medical director, direct care staff.
• Include feedback from residents and family members.
• Develop a staffing plan to maximize staff retention and recruitment.

CMS Implementation Plan:
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• Staggered implementation timeline of the minimum staffing and the 24/7 RN requirements based on geographic locations –
  • Phase 1 – facilities must meet the facility assessment requirements within 90 days (July 2024)
  • Phase 2 – facility must meet the 3.48 HPRD and the 24/7 RN requirements within 2 hours (by April 2026)
  • Phase 3 – facilities must meet the specific breakdown of HPRD to meet the 0.55 RN and 2.45 Nurse Aide HPRD requirements (April 2027)

Nationwide Drug Shortages Record High
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During the first quarter of 2024 alone there have been over 320 drug shortages, a ten-year record high. Most of these shortages are older generic products, with half being injectable medications. The generic medications can only compete with pricing, so likely a supply vs demand issue played a role in these shortages. The generic shortages do not affect the drug companies, because the cost to produce these medications is so low which is why there is not real drive to address the shortages quickly.

Many clinics and hospitals are completely out of certain medications causing disruptions in patient care. The FDA is looking at different tools that can be utilized to increase supply, including an expedited review of a supplement. Many of the shortages began years ago but were exacerbated by COVID-19 and we are now seeing the effects of the pandemic on supply. HHS will be looking at wholesalers and drug purchasing to identify disruptions in the supply chain.They are seeing how corporate control of drugs affects the end user, the patient.