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On July 16, 2015, the Centers for Medicare & Medicaid Services (CMS) published proposed rules to revise the Requirements of Participation (RoPs) for nursing facilities that participate in Medicare or Medicaid, or both.[1]  Since most nursing facilities participate in both programs, the federal regulations set the standards of care for facilities.  The current RoPs, which implement the 1987 Nursing Home Reform Law,[2] have been in effect for 25 years.  In response to numerous requests, CMS reopened the 60-day comment period and allowed comments to be submitted by October 14.

Although the Center supports some of the proposed changes (such as the new requirement that a baseline care plan be developed within 48 hours of a resident’s admission), we believe that the proposed rules missed an important opportunity for improving care for residents.  The absence of a sufficient number of professional nurses is recognized as a key cause of poor care outcomes for residents.  Unfortunately, CMS proposes essentially the status quo on nurse staffing, authorizing facilities to determine how many nurses to employ.  The Center urged CMS to mandate explicit nurse staffing standards, including registered nurses 24 hours per day.  The Center’s comments are available at

[1] 80 Fed. Reg. 41267 (July 16, 2015).  See Center for Medicare Advocacy, “Proposed Requirements of Participation for Nursing Facilities Do Not Strengthen Standards for Residents” (Alert, July 16, 2015).
[2] 42 U.S.C. §§1395i-3(a)-(h), 1396r(a)-(h), Medicare and Medicaid, respectively.






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