CMS’ New Minimum Staffing Standards and Medicaid Institutional Payment Transparency Reporting Rule

According to the American Health Care Association, 87% of nursing homes face significant staffing shortages. To overhaul the landscape of long-term care (LTC) facilities and improve the quality of life for residents, the Centers for Medicare & Medicaid Services (CMS) rolled out new regulations in April 2024. The Minimum Staffing Standards for LTC Facilities and the Medicaid Institutional Payment Transparency Reporting rule aim to address longstanding concerns about staffing levels and financial transparency within the LTC industry. These regulations hold promise for enhancing care quality, but face significant criticism in the current state.

Minimum Staffing Standards for LTC Facilities

Under the new regulations, LTC facilities must meet minimum staffing requirements based on the acuity of their residents. Facilities will be required to have a minimum number of registered nurses (RNs) and licensed practical nurses (LPNs) on duty at all times, with additional staffing requirements for certified nursing assistants (CNAs) and other direct care staff. While this is a valuable step towards ensuring quality care, some critics argue the standards do not go far enough. They believe the minimum requirements may still fall short of what is necessary to provide optimal care, particularly for facilities with high-acuity residents. Additionally, concerns have been raised about the potential for facilities to adjust staffing levels during inspections to meet compliance, rather than maintaining consistent staffing levels throughout.

Medicaid Institutional Payment Transparency Reporting Rule

In addition to staffing standards, CMS has introduced the Medicaid Institutional Payment Transparency Reporting rule, which aims to increase transparency around Medicaid payments to LTC facilities. This rule requires facilities to report detailed information about their Medicaid revenues and expenses, including staffing costs. This information should allow CMS to improve accountability and oversight within the LTC industry. Transparent reporting can help identify disparities in funding, and highlight areas where additional resources may be needed to improve the quality of care. It also enables policymakers, researchers, and advocacy groups to better understand the financial landscape of LTC facilities, and advocate for necessary reforms and updates. Critics of the new rule worry the reporting requirements may place an undue burden on facilities already struggling with staffing and resources, particularly smaller, more rural, providers with more limited resources. There are also concerns about the potential for the reported data to be misinterpreted, or used inappropriately, to penalize facilities without considering contextual factors.

Impact on LTC Facilities and Residents

While the new regulations have the potential to drive positive change in the LTC industry, they also present challenges for facilities and residents alike. Compliance with minimum staffing standards and transparency reporting may require significant adjustments, in terms of staffing levels, resident populations, and administrative practices. Some facilities may struggle to meet these requirements, leading to limits on spaces for residents, potential disruptions in care delivery and additional financial strain; thus, making extended care even more expensive. Additionally, there is a risk that focusing solely on compliance with regulatory requirements may detract from broader efforts to improve care quality and resident outcomes. It is essential for stakeholders to maintain a holistic perspective and prioritize resident-centered care amid these new regulations.


As CMS moves forward with the implementation of minimum staffing standards and transparency reporting, it is crucial to address the criticisms and concerns raised by stakeholders. While addressing staffing shortages is a necessary step for CMS, collaborative efforts between policymakers, industry leaders, and advocacy groups are essential to ensure these regulations achieve their intended goals, and unintended consequences are accounted for as they arise. By fostering open dialogue and working together towards a shared vision of quality care, we can navigate challenges as they arise, and create a more resilient and responsive LTC system for the benefit of all.