What Does the New Rule Require? 

In a QSO memo released June 18, 2024, CMS states that the assessment “must include an evaluation of diseases, conditions, physical or cognitive limitations of the resident population, acuity (the level of severity of residents’ illnesses, physical, mental, and cognitive limitations, and conditions) and any other pertinent information about the resident population as a whole that may affect the services the facility must provide.”

Furthermore, CMS states, operators must use the assessment to inform evidence-based staffing decisions, including necessary skills and competencies. The assessment should also help identify additional needs such as physical space, equipment, assisted technology, individual communication devices and other assets that might be needed to properly care for residents, according to the memo.

Revisions also expand the requirements for individuals who should have input into the assessment process to include:

• Nursing home leadership, including but not limited to, a member of the governing body and the medical director
• Management, including but not limited to, an administrator and the director of nursing
• Direct care staff, including RNs, LPNs/LVNs, and NAs, and other staff as applicable
• Residents, resident representatives, and family members

Here are additional key takeaways from the new rule:

• The facility assessment must use evidence-based, data-driven methods to plan for staffing and resources.
• Residents’ behavioral health needs must be accounted for along with cognitive, disease-specific, and physical needs.
• The assessment must reflect the resident population and address the facility’s resident capacity.
• The facility must develop a plan to maximize recruitment and retention of direct care staff.
• The assessment must address staffing levels needed for specific shifts (e.g., day, evening, night).
• The assessment must inform contingency planning for non-emergency events that nevertheless could impact resident care, such as staffing shortages.

10 Ways to Prepare

Here are ten actions to take now to prepare for enforcement of this new rule:

1. Review the current Facility Assessment with the team and identify areas that need updating and enhancement to address the rule changes.
2. Gather any existing documentation on staffing levels, plans, and recruitment efforts.
3. Establish a list of stakeholders who should provide input on facility risk assessments based on the rule’s revised guidance on who should be involved.
4. Evaluate current staffing levels and identify areas to plan for recruitment.  
5. Look at staff retention rates and identify ways to reduce turnover.
6. Review past survey findings to understand where proactive intervention might be needed.
7. Plan for compliance with acuity-based staffing:
          Consider what’s needed for making staffing decisions based on resident acuity considerations (e.g., access to information from EMRs
          Consider how to transform information from resident assessments into actionable staffing insights
8. Evaluate the likelihood of admitting resident populations that would require adjustments in facility resources (e.g., an influx of residents with disease-specific needs, residents with cultural dietary needs).
9. Evaluate current behavioral health services to determine if resident needs are being met and expand or enhance services as needed.
10. Watch for emerging updates in the form of FAQs and guidance documents from CMS.

Placing residents’ needs at the center of processes is really at the heart of CMS’ guidance and intentions. “While the facility assessment is intended to help facilities identify the appropriate amount of staff and resources needed, surveyors will continue to assess if facilities have sufficient nursing staff to meet residents’ needs,” CMS states. Keep this in mind as compliance efforts get underway.

Friends Services Alliance (FSA) is a national professional association of values-aligned organizations that serve seniors. Our support services include a team of Compliance experts who have supported organizations in developing and maintaining effective Compliance and Ethics Programs for more than 20 years.