On June 9, 2025, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) posted a report stating that the Centers for Medicare & Medicaid Services (CMS) did not provide states with sufficient information to effectively oversee minimum nursing home staffing requirements.
The report stated that CMS did not identify all nursing homes with fewer than eight registered nurse (RN) hours, instead targeting only those with zero RN hours. It also found that CMS did not effectively explain to states which aspect(s) of staffing pose a risk for insufficient staffing when identifying nursing homes with a one-star staffing rating—the lowest rating on Care Compare, the public website for consumers.
According to the OIG, the evaluation assesses the early experiences of states in leveraging new data and guidance provided by CMS to identify staffing deficiencies.
CMS previously implemented the Payroll Based Journal (PBJ) system to give consumers more accurate information about nursing home staffing. The PBJ system requires nursing homes to submit auditable daily data on hours worked by different types of staff. In response to earlier OIG recommendations, CMS began sharing selected PBJ data and related guidance with state survey agencies for use during inspections.
Although states reported that PBJ data has been helpful, the OIG concluded that CMS did not provide enough information for states to fully enforce the minimum requirement of eight RN hours per day or the broader requirement to ensure sufficient staffing to meet residents’ needs. Specifically:
- CMS does not identify all nursing homes with fewer than 8 RN hours per day. Instead, CMS targets nursing homes with zero RN hours. The OIG noted that states could better target their oversight if CMS identified all nursing homes that had more than zero but fewer than 8 hours of RN coverage.
- CMS does not explain to states which aspect(s) of staffing pose a risk for insufficient staffing when it identifies nursing homes with a one-star staffing rating. For example, the OIG noted that states wanted to know whether low staffing of nurse aides contributed to the potential insufficient staffing in these nursing homes.
The OIG recommended that CMS (1) notify states of nursing homes that appear to fall short of the required daily RN hours based on PBJ data, and (2) provide states with additional staffing analysis and guidance to help identify insufficient staffing.
CMS did not concur with the first recommendation and neither concurred nor nonconcurred with the second, stating that it has already implemented it.
Access the OIG report here.
Compliance Perspective
Issue
Skilled nursing facilities (SNFs) are required to provide a minimum of 8 hours of RN coverage daily and maintain staffing levels sufficient to meet residents’ needs. However, an OIG report posted on June 9, 2025, found that CMS does not identify all nursing homes with fewer than 8 RN hours per day and only flags those with zero RN hours. Additionally, CMS does not clearly inform states which staffing components contribute to a one-star staffing rating. Without clear identification and guidance, SNFs may not receive timely oversight or support, increasing the risk of noncompliance with staffing requirements and potentially compromising resident care.
Discussion Points
- Review policies and procedures to ensure they address the requirement for at least 8 hours of RN coverage each day, as well as the requirement to provide sufficient staffing to meet residents’ needs. Make sure there is a system in place to track and monitor daily RN hours and identify any days that fall below the minimum.
- Educate staff responsible for staffing and scheduling on federal staffing requirements and how low staffing levels may affect the facility’s star rating. Ensure staff understand how to accurately report staffing data and are aware of the importance of maintaining consistent RN and aide coverage.
- Conduct regular audits of staffing records, including PBJ data, to ensure RN hours meet the daily minimum and that staffing levels overall are adequate. Use audit results to address gaps and support compliance efforts.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*