CMS announces increased nursing home staffing oversight, changes to PBJ manual

The Centers for Medicare & Medicaid Services (CMS) on Nov. 30 announced actions that will increase nursing home oversight and improve transparency relative to facilities maintaining sufficient staffing levels to ensure high-quality care. These actions include sharing data with states when potential issues arise regarding staffing levels and the availability of onsite registered nurses; clarifying how facilities should report hours and deduct time for staff meal breaks; and providing facilities with new tools to help ensure their resident census is accurate.

CMS also announced the release of new payroll-based staffing data outlining updates to the Payroll Based Journal (PBJ) Policy Manual. A memo states CMS will inform state survey agencies of facilities with potential staffing issues. Using the new PBJ data, CMS will identify facilities with low staffing on the weekends and facilities with several days in a quarter without a RN onsite.

CMS will provide a list of facilities with potential issues to support survey activities for evaluating sufficient staffing and improving resident health and safety. States will now be required to conduct at least 50 percent of the required off-hours survey using the list provided by CMS. In addition, CMS will identify facilities with a high risk of noncompliance in the RN staffing requirements. Survey teams, conducting an annual survey or complaint survey, will investigate the requirement of a RN seven days a week, eight hours a day. If a surveyor confirms there is noncompliance and the requirement is not met, the facility will be cited under deficiency F-tag 727.

Within this memo, CMS reported updates to the PBJ Policy Manual and FAQ document expanding guidance to deducting time for meal breaks and adding language to instruct facilities to use a reasonable methodology to allocate universal care worker hours. The memo also defines two reports for providers to help ensure dates are submitted timely and accurately. The two reports are the MDS Census Summary Report and the MDS Census Detail Report.

LeadingAge will continue to monitor the impact using the PBJ data and members are encouraged to report concerns or challenges with PBJ. Over the last few months, LeadingAge has heard from members regarding the enforcement and requirement of the meal break policy and the use of universal care workers. LeadingAge currently has a bi-weekly call with CMS regarding the challenges with these two areas.