Minimum Staffing Rule

The Facility Assessment required as of August 8, 2024 was at § 483.70(e) is now moved to § 483.71.

Question: Do therapists and assistants have anything to do with the facility assessment?

Answer: Yes, therapists and assistants count as services provided which are required to be part of the facility assessment. Contracted services also count towards the requirement.

Please also note the definition of direct care staff for the Minimum Staffing Rule is different than the one used for PBJ purposes.

Section from the CFR:

Additional details to enhance our understanding of the requirements:

• Requires each LTC facility to conduct and document a facility-wide assessment to determine what resources are necessary to care for its resident population competently during both day-to-day operations and emergencies.
• The assessment must address or include an evaluation of the resident population, the facility’s resources, and a facility-based and community-based risk assessment that utilizes the all-hazards approach.
• Requires an Annual Update

Goals:

• Advanced equitable, safe, and quality care sufficient to meet the nursing needs of all residents and greater consistency across facilities.
• Facility assessment allows the staff to provide meaningful input regarding the facility’s operations, which has the potential to lead to a better working environment that complements retention and hiring efforts.
• Facilities are tasked with developing their facility assessments to determine the personnel needed to meet residents’ needs.

Definitions of Direct Care Workers and Support Staff

At § 442.43(a)(2), for the purposes of the proposed reporting provision at § 442.43(b), we proposed to define direct care workers to include: nurses (registered nurses, licensed practical nurses, nurse practitioners, or clinical nurse specialists) who provide nursing services to Medicaid-eligible individuals receiving nursing facility and ICF/IID services; certified nurse aides who provide such services under the supervision of one of the foregoing nurse provider types; licensed physical therapists, occupational therapists, speech-language pathologists, and respiratory therapists; certified physical therapy assistants, occupational therapy assistants, speech-language therapy assistants, and respiratory therapy assistants or technicians; social workers; personal care aides; medication assistants, aides, and technicians; feeding assistants; activities staff; and other individuals who are paid to provide clinical services, behavioral supports, active treatment (as defined at § 483.440), or address activities of daily living (such as those described in § 483.24(b), which includes activities related to mobility, personal hygiene, eating, elimination, and communication), for individuals receiving Medicaid-covered nursing facility and ICF/IID services.

Our proposed definition of direct care worker differs from the definition of direct care staff in LTC facilities at § 483.70(q)(1), which was established for the PBJ reporting program at § 483.70(q).