Regardless of optimism that the CMS Minimum Staffing Mandate will be overturned either legislatively or legally, the Facility Assessment requirement portion of the mandate for skilled nursing facilities is still due by August 8, 2024. To comply with the new mandatory staffing rules, the first thing providers will need to do is update their facility assessments for all buildings by the August 8 deadline. CMS’ Quality, Safety, & Oversight Group (QSOG) memo QSO-24-13-NH, issued on June 18, 2024, provides detailed guidelines on what surveyors will inspect. Here’s our summary:
- Population Assessment: This must reflect current resident needs and be adjusted if new needs arise. This area has been part of the facility assessment requirement all along.
- Capacity: Include bed count, unit details, and any staffing constraints. This is an area that many providers miss.
- Staffing Models: Specify the shifts (days, evenings, nights, weekends), skills, and competencies required.
- Regulatory Updates: An F838 tag will be used for citations related to facility assessments to help ensure quality care standards are met. Please note that with any quality care and professional standards you identify within the assessment, deficiencies can be cited in potentially eight different areas.
- Evidence-Based Data: Use data-driven methods to assess resident variations. This is an area that is currently murky and will need clarification. The guidelines seem to imply that behavioral health needs to be incorporated with the use of your Minimum Data Set (MDS) to identify diagnoses and categorize resident needs presumably. It likely also will include consideration of cultural and religious needs.
- Staff Involvement: Specific personnel, e.g., administrator, medical director, must participate in facility assessments, as well as direct care staff, including RNs, LPNs, CNAs, and representatives (if applicable). This would include individuals such as union stewards, etc.
- Resident Input: Solicit feedback through surveys, suggestion boxes, or notices, among other methods. The main thing is to enable alignment between the facility, your process, all residents, resident representatives, and family members.
- Training Needs: Staff training should align with resident demographics and needs.
- Unit-Specific Staffing: Detail staffing plans for different resident care units.
- Recruitment & Retention Plan: Outline strategies to attract and keep direct care staff. This is a new piece, and we’re unsure how surveyors will review it. More clarification is needed, but it certainly could include areas to demonstrate efforts made, such as dollars spent on advertising, the depth of your onboarding program, etc. It is important to show an intentional effort is being made.
- Contingency Planning: Prepare for staffing disruptions without activating emergency plans.
- Contractor Services: Aim to ensure continuity of services during emergencies. While providers don’t have much control over these individuals, some types of documentation should be in place to demonstrate your contractors are engaged in the plan somehow.
- Annual & As-Necessary Updates: Regularly update assessments based on changes in resident population or care needs.
Overall, the focus is on compliance with regulatory components, not assessment quality. However, systemic care concerns identified during surveys will prompt a review of the facility assessment.
While the ultimate disposition of the staffing regulation remains uncertain (especially with the recent SCOTUS decision on the Chevron doctrine), most of these facility assessment provisions make sense for providers to adopt regardless of any regulatory requirements. The facility assessment is a key driver of provider programs and services, and having more specificity may help drive better management decisions regarding resource utilization.
For help with your Facility Assessment or aligned strategies for implementing your facility assessment, contact your advisor at Forvis Mazars today.