Skilled Nursing Update: White House Creates Vision Board for Nursing Homes with Staffing Requirements, Ownership Transparency and Higher Fines


On March 1, 2022, President Biden outlined his plan to improve the quality of patient care, resident safety, regulations, fines, and transparency of skilled nursing ownership during his state of the art address. The union.

The day before, February 28, 2022, President Biden released a fact sheet titled “FACT SHEET: Protecting the Elderly and People with Disabilities by Improving the Safety and Quality of Care in Nursing Homes Nationwide (“White House Fact Sheet”) which outlines a set of reforms to be developed and implemented by the Department of Health and Human Services (“HHS”) that are designed to improve safety and quality of nursing home care, increase provider accountability for the care of nursing home residents, and make ownership of skilled nursing care more transparent.

The White House fact sheet detailed that more than 1.4 million people live in more than 15,500 Medicare and Medicaid-certified nursing homes. The White House fact sheet also says that over the past two years, more than 200,000 residents and staff at long-term care facilities have died from COVID.

The three main areas of White House fact sheet reform include:


Establish a minimum staffing requirement for nursing homes

CMS plans to come up with minimum staff adequacy standards that care homes must meet. CMS will conduct a new research study to determine the level and type of staff needed to provide safe, quality care and publish proposed rules within a year.

Adequately fund inspection activities

The White House wants to hold nursing homes accountable for their performance through the requirement for a robust compliance program. Elements of a strong program would include having adequate funding to conduct inspections and imposing meaningful penalties when deficiencies are found. President Biden will ask Congress to provide nearly $500 million to CMS, an increase of nearly 25%, to support health and safety inspections at nursing homes.

Increased scrutiny of more underperforming artists

CMS’s Special Focus Facility (“SFF”) program identifies the nation’s worst performing nursing homes for in-depth review with the goal of immediately improving the care they provide. The SFF program will be overhauled to improve care for affected residents more quickly, including changes that will make its requirements stricter and more impactful. CMS will also make changes that will allow the program to examine more installations by moving installations faster through the program. Facilities that fail to improve will face escalating enforcement action, including termination of Medicare and Medicaid participation.

Provide technical assistance to nursing homes to help them improve

CMS currently contracts with quality improvement organizations that help providers across the healthcare spectrum make meaningful improvements in the quality of care. CMS will ensure that improving home care nursing is a core mission for these organizations and will explore avenues to expand on-demand training and information sharing around best practices.

Improve nursing home care Compare

CMS plans to implement several initiatives to improve the CMS “Care Compare” website. Going forward, Care Compare will report whether a facility meets these minimum staffing requirements. CMS intends that the ratings more accurately reflect verifiable data, rather than self-reported data, and will hold care homes responsible for providing inaccurate information.

Make sure caregiver training is affordable

CMS intends to establish new requirements to ensure nursing trainees are informed of their potential entitlement to training reimbursement upon hiring.

Create a National Nursing Career Pathway Campaign

CMS, in conjunction with the Department of Labor, plans to work with external entities, including training intermediaries, registered apprenticeship programs, workforce management training programs and trade unions, to spearhead a national campaign to recruit, train, retain and transition workers into long-term care careers.

Continuation of COVID tests, vaccines and reminders

HHS will continue to support COVID testing as a key mitigation strategy for residents and staff. HHS will also continue to promote access to these vaccination clinics and efforts to encourage vaccinations through quality provider payment programs.

On-site infection prevention

CMS will clarify and increase standards for nursing homes on the level of staffing needed for on-site infection control employees.

Emergency Preparedness

CMS intends to review and consider changes to nursing home emergency preparedness requirements.

Reinforce protective measures against unnecessary drugs and treatments

CMS plans to launch a new effort to identify problematic diagnoses and refocus efforts to continue to reduce the inappropriate use of antipsychotic medications.


Strengthening the Skilled Nursing Facility (“SNF”) Value Based Purchasing (“VBP”) Program

The SNF-VBP program provides incentive funding to institutions based on their quality performance. CMS has begun measuring and publishing staff turnover and weekend staffing levels, metrics that correlate closely with the quality of care provided in a nursing home. CMS intends to offer further payment changes based on staff adequacy, resident experience and how providers retain staff.

Develop financial sanctions and other enforcement sanctions

President Biden has called on Congress to increase the dollar limit on financial penalties per instance for underperforming vendors from $21,000 to $1,000,000. CMS will expand the instances in which it takes enforcement action against poorly performing facilities based on desk reviews of data submissions, which will be conducted in addition to on-site inspections. In July 2021, CMS rolled back rules that reduced the amount of penalties for breaches by imposing only a one-time fine, instead of daily fines. CMS intends to review the possibility of making daily penalties the default penalty for non-compliance. CMS will also use data, predictive analytics and other information processing tools to improve the app.


Increase liability for chain owners of substandard facilities

President Biden has asked Congress to give CMS new authority to require minimum competency from businesses to participate in Medicare and Medicaid programs, allowing CMS to prohibit a person or entity from obtaining a Medicare provider agreement or Medicaid for a nursing home (new or existing) based on the Medicare compliance history of their other owned or operated facilities (previous or existing). President Biden also called on Congress to extend CMS’s enforcement authority to the property level, allowing CMS to impose enforcement actions on establishment owners and operators even after the facility closes. a facility, as well as owners or operators who provide substandard and non-compliant care in some facilities while owning others.

Transparency of ownership

CMS plans to create a new database that will track and identify owners and operators in all states to highlight past issues related to promoting the health and safety of residents. This registry will use information gathered through supplier registration and health and safety inspections to provide more information about potential owners and operators to states.

Improve transparency of facility ownership and finances

CMS will implement the Affordable Care Act’s requirements for transparency in nursing home ownership, including collecting and publicly reporting stronger data on business ownership and operations. CMS also plans to make this information easier to find on the Nursing Home Care Compare website.

Investigate the impact of private equity on skilled nursing

HHS will examine the role of private equity, real estate investment trusts and other investments in the retirement home industry.


  • These proposals to improve care and safety in nursing homes have not been published in regulations or in laws revised by Congress.
  • The proposals provide another tool to help improve care and identify possible areas of future application.
  • Nursing homes should always review and reconsider their policies and procedures as providers face increased regulation.

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