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Minimum Staffing Rule & the Facility Assessment

Posted Jun 25, 20242 min Read

Regulatory & Clinical

The Centers for Medicare & Medicaid published final rules setting nurse staffing standards for nursing facilities on May 10, 2024. The final rule establishes three separate and independent nurse staffing requirements: 1) a facility assessment process 2) 3.48 hours per resident day (HPRD) of total nursing care (.55 HPRD registered nurse (RN), 2.45 HPRD nurse aide, and .48 of RN, nurse aide, or licensed practical nurse), and 3) RNs (Registered Nurses) 24 hours per day, seven days per week in every nursing facility.  

The facility assessment is not a new requirement for nursing facilities; however, it does change some of the requirements. The 2024 staffing rule moves the facility assessment requirement to its own regulatory provision 483.71 to emphasize the importance of the process and to complement the minimum numerical staffing standards. The rule requires each facility to conduct and document a facility-wide assessment to determine the resources (staff numbers, competencies, and skill sets) that are needed to care for residents during a 24-hour normal operations day and in cases of emergencies. The facility assessment must be reviewed annually or as necessary. The assessment calls for a multidisciplinary approach including participation of leadership, direct care staff, and, new at 483.71 (b)(1) iii, must also obtain and consider input received from residents, resident representatives, and family members. 

Other additions to the facility assessment process are requirements that a facility must use “evidence-based data-driven methos” to determine staffing needs of residents and that the assessment be consistent with and informed by individual resident assessments, such as the MDS (Minimum Data Set) as required under 483.20.  

AHCA/INCAL has developed the following resources:  

  • Facility Assessment Action Brief – provides a comprehensive overview of the updated rule and offers practical tips and steps for preparing for the assessment.  
  • Facility Assessment Check List – provides a guide as you work through the new assessment requirements.  
  • Proactive medical is in the process of updating the Facility Assessment Tool Kit now that the Surveyor Guidance has been released.  
  • QIO (Quality Improvement Organization) – Source will update the facility assessment resources; however, a specific date has not been promised.  


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