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DHS warns CMS staffing rule will strain rural nursing homes, asks for flexibility
Summary
Secretary Arkoosh told the appropriations panel that a CMS staffing rule that would require a registered nurse on site 24/7 will be difficult for rural nursing facilities to meet and that the federal implementation has been delayed about two years, though not eliminated.
Department of Human Services Secretary Dr. Valerie Arkoosh told the House Appropriations Committee that a CMS rule requiring a registered nurse to be present 24/7 at nursing facilities will be challenging for many rural providers and that DHS submitted public comment to CMS seeking additional consideration for rural communities.
Why it matters: Nursing workforce shortages and geographic disparities mean some facilities will struggle to meet prescriptive staffing rules. Arkoosh said the federal requirement includes a 24/7 RN standard and — while CMS delayed the RN component for roughly two years after public comment — the requirement still exists and could present “an enormous challenge, particularly in our rural communities.”
Lawmakers asked what happens if facilities cannot meet the standard. Arkoosh said the federal process typically begins with corrective action plans and could eventually affect licensing; she also said CMS included an exemption process but that details were limited. The secretary pointed to administration proposals — including loan-repayment incentives targeted to rural health workers — designed to increase workforce capacity.
Ending: DHS said it is monitoring implementation timelines, submitted comments to CMS to highlight rural impacts, and proposed state-level incentives to recruit and retain nurses and clinicians in underserved areas. The department recommended staged, targeted supports to give rural providers time to comply if the federal rule takes effect.
