The formal comment period for the Centers for Medicare & Medicaid Services’ controversial new staffing mandate closed on November 6, and the official responses from long-term care leaders have been strong.

In September, CMS proposed the first-ever federal staffing minimums for U.S. nursing homes, which would require at least 3.0 hours of direct care per patient day by registered nurses and nurse aides. Providers argue that this rule would have catastrophic consequences for already struggling facilities, costing upwards of $4 billion each year and ultimately reducing patients’ access to care.

Since issuing the proposal, CMS has received over 40,000 public comments from concerned stakeholders, including several major associations that represent nursing homes around the country.

LeadingAge President and CEO Katie Smith Sloan said in a press release, “The proposal will fail because it does not consider two major issues: the ongoing workforce crisis and the proposal’s astronomical implementation costs.”

According to cost estimates conducted by LeadingAge, in order to comply with the regulation, providers and states that reimburse for Medicaid-covered care would spend more than $7 billion annually.

In its letter to CMS, the American Hospital Association took issue with the “static and ineffective” requirements of .55 hours per resident day for registered nurses and 2.45 for nurse aides.

“A simple mandate of a base number of RN and NA hours per resident day emphasizes staff roles and responsibilities of yesterday rather than what current and emerging practices may show is most effective and safe for the patient,” wrote Stacey Hughes, executive vice president of the AHA.

Many state leaders have voiced their opposition as well. Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, cautioned that adopting the proposal would lead to “a dramatic loss of high-quality nursing facilities.” Instead, he urged CMS to introduce “creative workforce policies to address nursing shortages, attract competent and dedicated caregivers to our sector, and support the development of career pathways in long-term care.”

CMS must now review the thousands of comments before making its final decision on the mandate — a lengthy process that may take up to a year. In the meantime, long-term care providers across the nation are bracing for the sweeping changes that may lie ahead.

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