AHA Comments on Long-term Care Facility Minimum Staffing Proposed Rule

October 26, 2023

The Honorable Chiquita Brooks-LaSure
Administrator Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850

RE: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting, CMS-3442-P

Dear Administrator Brooks-LaSure,

On behalf of our nearly 5,000 member hospitals and health systems who work with long term care facilities to serve hundreds of thousands of patients each year, our professional membership groups and affiliates including the American Organization for Nursing Leadership, and our 2,425 post-acute care members, the American Hospital Association (AHA) appreciates the opportunity to provide comment on the proposed rule regarding minimum staffing standards for long-term care (LTC) facilities.

The AHA and its members are committed to safe staffing to ensure high quality, safe, equitable and patient-centered care in all health care settings, including LTC facilities. However, CMS’ proposal to implement mandatory nurse staffing levels is an overly simplistic approach to a complex issue that, if implemented, would have serious negative unintended consequences for not only nursing home patients and facilities, but the entire health care continuum.

We strongly agree with CMS that staffing is an integral part of delivering safe care. Yet, achieving safe staffing entails far more than simply meeting policymaker-set minimum thresholds or ratios. Indeed, CMS’ own commissioned analysis in support of this proposed rule asserted that there is “no obvious plateau at which quality and safety are maximized or ‘cliff’ below which quality and safety steeply decline.”1 That is because safe staffing is a complex, dynamic process centered around the needs of patients that accounts for their acuity, the experience and clinical expertise of the nurses and other health care professionals on the care team, and the technical capabilities of the facility.

View the detailed letter below.