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Biden Administration’s SNF Minimum Staffing Ratio

TAKE ACTION NOW! The Biden Administration’s SNF Minimum Staffing Ratio proposed rule is unfounded, unfunded, and unrealistic! 

On September 1, 2023, the Biden Administration finally released the Centers for Medicare and Medicaid Services (CMS) proposed rule to mandate staffing ratios in skilled nursing facilities.  In short, the rule would require SNFs to meet certain hours per resident per day (.55 RN HPRD + 2.45 Nurse Aid HPRD) and have a nurse on staff 24/7.  The definition of what staff can count toward the rule is very narrow (LPNs, therapists, social workers, etc…are EXCLUDED), there is NO FUNDING (the Biden Administration admits it will cost an additional $40B over 10 years (that’s approximately $300k per SNF/yr!), the waivers are impossible to get and are time limited, the effective date phase in period is shorter than appears (for nearly 80% of the SNFs, they must have a nurse 24/7 in just 2 years), and the penalties for non-compliance are severe. On top of all of this is the fact that this rule is being released during the midst of a historic and on-going labor crisis in the long term care sector and the needed staff just isn’t there to meet these requirements. 

The formal comment period has begun and you have until November 6 to submit your comments opposing this very concerning rule. AHCA/NCAL has set a goal of 10,000 individual and unique comments. To submit yours, you can follow the instructions on this link:  Action Center (  Please encourage everyone you know (colleagues, residents, family members, vendors, neighbors, etc…) to do the same. Other health care providers (hospitals, senior living, home health, etc…) should be equally concerned because if the rule goes through as is, staff will very likely be pulled from other health care providers into SNFs to meet the rule’s requirements. Thus, everyone from all sides of the health care continuum should get involved as it will impact many directly and indirectly beyond the SNF world.

For more information, please contact Scott Tittle, Head of Government Relations and External Affairs at VIUM Capital at You can also watch a recent AHCA/NCAL webinar on the provisions of the rule and some helpful hints on how to submit comments formally to CMS.

For AHCA/NCAL members who wish to listen to the recent webinar, you can find it here: 

For everyone else, we’ve provided the webinar power point presentation here for your review.

Please submit your comments now before the comments period closes and encourage everyone you know to do the same! 

What Others Are Saying:,-Health-Care-Advocates-Add-To-Growing-List-Of-Voices-Sounding-.aspx,-Lawmakers-Express-Serious-Concerns-Over-Biden-Administration’s-Proposed-Staffing-.aspx

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