Special “Your Top-Line” Edition on Proposed Minimum Staffing

Programs and Resources; Workforce
​​On Friday, September 8 a special edition of the 2023-Q3 Your Top-Line was published on LTC Trend Tracker​. On the front page, it contains detailed information on how your center performs relative to the proposed federal minimum staffing requirements using the latest Payroll-Based Journal (PBJ) data from 2023-Q1. If your center does not meet one of the three proposed requirements of 2.45 nursing aide hours per resident day (HPRD), 0.55 registered nurse (RN) HPRD, or RN on site 24 hours a day for 7 days a week, the Top-Line shows how many additional hours and full time equivalent (FTE) nurses would be needed.

Registered LTC Trend Tracker users will have received an email on Friday, September 8 with their center's Top-Line. The Top-Line can also be accessed within LTC Trend Tracker. If you have not yet registered for LTC Trend Tracker, you can do so here.

Members are encouraged to submit comments to CMS about the proposed requirements using the information in the Top-Line alongside sharing your experience and perspective. Comments are due by November 6.

Frequently Asked Questions (FAQs) Regarding Minimum Staffing Top-Line:

  • What job positions are included in the nurse aide and registered nurse calculations and proposed requirements?
    • CMS is looking for feedback on what job positions to include, and we encourage you to tell CMS to allow for maximum flexibility in who counts.
    • For the Top-Line calculations, we used the same job codes as Five-Star. For nurse aides that is certified nurse aides (job code 10), nurse aids in training (code 11) and medication aides/technicians (code 12). For RN, we included RN director of nursing (code 5), RN with administrative duties (code 6) and RNs (code 7)
  • Is there no proposed requirements for Licensed Practical/Vocational Nurses (LPN/LVN)?
    • There is not. We encourage you to tell CMS how important LPN/LVNs are and how they should be included as counting towards the RN requirements.
  • For the calculated hours needed on the Top-Line, what timeframe is that for? How are FTEs calculated from hours needed?
    • The hours needed data represents the hours needed in a quarter. To calculate FTEs, we assumed one FTE could report 37.5 hours per week to PBJ. Thus, one FTE provides 487.5 hours a quarter or 1,950 hours per year.
  • When will the next quarter of PBJ data be released?
    • The next release of PBJ data for 2023-Q2 is expected on Oct 27 by CMS. We will update LTC Trend Tracker with that data as soon as possible after it is released.
  • How is CMS defining rural and urban?
    • CMS proposed using the 2020 U.S. Census definition of rural and urban, which defines urban as a territory with at least 2,000 housing units or a population of at least 5,000. Any area that is not urban is considered rural. CMS is looking for comments on whether they should use another definition.
    • In the Top-Line, your center was geocoded to x- and y-coordinates using the address listed on CMS Care Compare then mapped to identify whether it is within a U.S. Census defined urban area. Mass batch geocoding is not always 100% accurate. You can verify your urban/rural designation with the Rural Health Information Hub or the U.S. Census Geocoder, if you have multiple buildings and addresses to check.   
  • Where can I find out more information about the proposed minimum staffing rule requirements?