Nursing Home Minimum Staffing and Direct Resident Care Spending
Nursing Home Minimum Staffing
Nursing Homes are required by New York State Public Health Law and Regulations to meet minimum staffing standards. These minimum standards require every nursing home to maintain daily staffing hours equal to 3.5 hours of care per resident per day by a certified nurse aide, licensed practical nurse, or registered nurse. Of the 3.5 hours required, at least 2.2 hours of care per resident per day must be provided by a CNA and at least 1.1 hours of care per resident per day must be provided by a licensed nurse.
Compliance with the minimum nursing staff requirements is determined on a quarterly basis using the most recent data available from the federal Centers for Medicare and Medicaid Services (CMS) Payroll Based Journal (PBJ). Nursing homes that fail to adhere to the minimum staffing standards are subject to civil penalties.
The Department of Health will impose a penalty of up to $2,000 per day for each day in a quarter that a facility fails to comply with the minimum nursing staff requirements. The Department of Health may impose a range of penalties, and the penalty may be less than $2,000 per day if the facility can demonstrate, to the satisfaction of the Department, that one or more of the mitigating factors below prevented compliance:
- Extraordinary circumstances such as natural disaster, catastrophic event or a national or state declared emergency;
- The facility is located in a region in which the Commissioner of Health determines an acute labor supply shortage of certified nurse aides, licensed practical nurses, or registered nurses existed during the quarter; or
- A verifiable union dispute exists between the facility and employed or contracted nurse aides, licensed practical nurses, or registered nurses that resulted in a labor shortage at the facility during the quarter.
Initial Notice of Noncompliance
The Department will issue notices of noncompliance when review of the CMS PBJ for the quarter indicated that a nursing home was noncompliant with the minimum nursing staff requirements established under Public Health Law § 2895-b and 10 NYCRR 415.13.
- If the provider believes the nursing home can demonstrate mitigating or aggravating factors set forth in regulation 10 NYCRR 415.13, they may apply for a reduction in penalties using the web-based Penalty Reduction Application available through a link in the notice of noncompliance.
- If the provider disagrees with the determination of noncompliance, they must complete and submit the web-based Request for Redetermination available through a link in the notice of noncompliance. Redetermination requests must include the Request for Redetermination – Employee Detail Attachment (XLS).
- Penalty reduction and redetermination requests must be submitted within 10 business days.
Determinations of an Acute Labor Supply Shortage
On a quarterly basis, the Commissioner in consultation with the NYS Department of Labor will issue a determination as to whether an acute labor supply shortage of nurse aides, certified nurse aides, licensed practical nurses, or registered nurses existed in any Metropolitan or Nonmetropolitan Area of New York State for the previous quarter, as such areas are defined by the federal Bureau of Labor Statistics.
- November 15, 2023 Nursing Home Staffing Standards Webinar
- July 6, 2023 Nursing Home Staffing Standards Webinar