More Minnesota-specific data released on impact of proposed staffing rule

By Patti Cullen, CAE  |  October 6, 2023  |  SNF/NF providers

Commissioned by AHCA/NCAL, professional services firm CLA (CliftonLarsonAllen LLP) analyzed the impact of President Biden’s proposed rule to establish federal staffing minimums on nursing facilities. As you know, the proposed rule would require specific nursing facility staff to spend a minimum number of hours with each resident—2.45 nurse aide hours per resident per day (HPRD) and 0.55 registered nurse (RN) HPRD—as well as have a RN on site 24 hours a day. Utilizing Payroll-Based Journal (PBJ) data and hourly rates from Medicare cost reports, CLA estimated the additional staff necessary to meet the staffing requirement, as well as the costs associated with the additional staff. The following is among CLA’s findings nationally:
  • Nursing facilities would need to hire an estimated 102,154 additional full-time employees (80,077 nurse aides and 22,077 RNs)
  • The proposed mandate would cost nursing facilities approximately $6.8 billion per year—higher than the $4 billion per year estimate from the Centers for Medicare and Medicaid Services (CMS)
  • 94% of nursing facilities are currently not meeting at least one of the three proposed staffing requirements: the 2.45 nurse aide HPRD, the 0.55 RN HPRD, and the 24/7 RN
  • Of the 94%, 36% of facilities are not meeting all three requirements; 34% are not meeting two of the requirements; and 24% are not meeting one of the requirements
  • Nursing facilities that did not meet at least one of the requirements were more likely to have a majority of their residents relying on Medicaid (56% average Medicaid census) compared to facilities that met the criteria (43%)
  • If nursing facilities are unable to increase their workforce to meet these new requirements, more than 280,000 nursing facility residents or nearly one-quarter of all residents, could be impacted by census reductions

The overall workforce and financial impact of the staffing mandate varies by state. Here is what the report finds for Minnesota:




According to the American Health Care Association, as of October 3, Minnesota has generated 110 comments through their Action Alert system—we can do better than that!!

On October 19, 2023, we are scheduling a “day of action” where we want all of our members who have not yet submitted their comments to CMS to do so—we are hosting a webinar at 3:00 CT starting with Mark Parkinson and Matt Smyth from the American Health Care Association (AHCA) explaining the importance of your involvement and the key messages you should be sure to share. Following their presentation, Association staff will field questions, offer talking point assistance, and be your overall cheerleaders to get your teams excited about providing their stories. Register here!

If you don’t want to wait until then, act now—go to the AHCA/NCAL action center page where you can compose your message and send it directly to CMS. Ask your staff to do this as well so there are multiple comments from your community.  


Patti Cullen, CAE
Patti Cullen, CAE  |  President/CEO  |   pcullen@careproviders.org  |  952-851-2487