State Associations' Comments on Minimum Staffing Standards Proposed Rule

On November 6, 2023, ADvancing States, the National Association of Medicaid Directors (NAMD), and the National Association of State Directors of Developmental Disabilities (NASDDDS) submitted joint comments to CMS on the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Notice of Proposed Rulemaking (CMS-3442-P).

Our associations support the intent of the proposed rule to establish nurse staffing requirements to ensure nursing homes are held accountable for the provision of safe and high-quality care. However, we have concerns regarding potential unintended consequences for Medicaid home and community-based services (HCBS).

Notably, the proposed rule would require increased transparency regarding Medicaid payments compensating direct care workers, but it does not include a minimum percentage for compensation to direct care workers (DCWs). This differs from the payment adequacy provisions in the proposed Ensuring Access to Medicaid Services Notice of Proposed Rulemaking (CMS-2442-P), which would require states to ensure 80 percent of HCBS rates are directed toward DCW compensation. We express concerns that this disparate approach to DCW compensation in institutional versus HCBS settings may have the unintended consequence of incentivizing providers to deliver institutional services rather than HCBS. We recommend CMS coordinate internally and with other federal agencies to ensure alignment of requirements affecting the direct care workforce across proposed rules, to ensure quality service delivery and avoid unintended negative consequences for HCBS delivery systems.

Click here to read the full letter.

Alert date: 
Wednesday, November 8, 2023