MACPAC Responds to CMS on Staffing Levels (SNF)

The Medicaid and CHIP Payment and Access Commission (MACPAC) responded to the Centers for Medicare & Medicaid (CMS) Request For Information (RFI) regarding establishing minimum staffing ratios for nursing facilities. In the RFI, CMS requested information from stakeholders to learn more about what facility factors should be considered when establishing staffing standards and what can be learned from states’ experiences with minimum staffing requirements. In their letter, MACPAC noted they intend to examine how Medicaid payments may be structured to improve staffing for Medicaid residents and will present their findings within the coming year.

Also noted in their response:

• There is a known link between staffing levels and quality of care; facilities that serve a higher share of Medicaid residents have lower staffing rates compared to other facilities.
• In 2019, nearly half of the facilities serving the highest share of Medicaid beneficiaries had 1-2 star ratings.
• There is considerable state variation in staffing star ratings suggesting state policies impact ratings
• States can develop Medicaid payments to incentivize facilities to spend more of their revenue on staff, such as wage pass-through payment policies requiring specified portions of Medicaid rates to be spent on staff wages.
• Medicaid Value Based Purchasing (VBP) incentive payments to providers related to staffing measure performances have mixed outcomes and there is little existing data to support its effectiveness.