§ 23-17.5-33. Minimum staffing level compliance and enforcement program.
(a) Retroactive application.
(1) All fines or penalties incurred prior to January 1, 2026, are hereby forgiven, and
any enforcement actions, including fines and penalties, shall commence only for violations
occurring on or after January 1, 2026.
(b) Compliance determination.
(1) Compliance shall be determined quarterly by comparing staffing data from the Centers
for Medicare and Medicaid Services' (CMS) payroll-based journal and the facility's
daily census, as self-reported to the department.
(2) Discrepancies between job titles and payroll-based journal entries shall be addressed
by departmental regulations.
(c) Staffing level compliance payment adjustments.
(1) Facilities failing to meet minimum staffing requirements shall face a fine in the
following quarter valued at three percent (3%) of the total of Medicaid reimbursements,
calculated based on the most recent financial period.
(d) Corrective action plan.
(1) Facilities found non-compliant will receive a thirty-day (30) corrective notice.
(2) If compliance is not achieved within thirty (30) days, payment reductions shall be
enforced.
(e) Waiver provision.
(1) The department shall waive fines for facilities that demonstrate high-quality care.
To qualify for a waiver, a facility must meet at least one of the following criteria:
(i) Substantial compliance: During the last three (3) consecutive survey cycles, the facility
received no substandard quality of care/immediate jeopardy deficiencies and was not
placed under compliance orders, temporary management, or quality monitoring; or
(ii) Acuity criterion: A facility is considered to serve a lower-acuity resident population
if its Nursing Case-Mix Index ranks in the lowest twenty-five percent (25%) of all
Medicaid-participating nursing homes. The lowest twenty-five percent (25%) is determined
by multiplying the current total number of Medicaid-participating nursing homes by
twenty-five hundredths (0.25) and rounding up to the nearest whole number; or
(iii) If the facility achieved compliance for at least seventy-five percent (75%) of operating
days in the quarter.
(f) Recovered funds.
(1) Funds recovered through payment adjustments shall be allocated to:
(i) Workforce development programs aimed at enhancing the recruitment, training, and retention
of direct care staff; and
(ii) Compliance assistance programs designed to provide technical support to underperforming
facilities.
(g) Implementation and oversight.
(1) The department shall issue regulations to implement these provisions, with a transition
period of six (6) months provided to allow facilities to meet the new requirements.
(2) The department shall provide public reports on facility compliance, staffing levels,
and payment adjustments on a quarterly basis.
(3) Nursing home facilities shall provide a list of all licensed staff, including name,
license, and home addresses, to the department upon renewal of the nursing home operator
license or when there is a change in effective control of the nursing home facility.
Failure to provide the required list within thirty (30) days of the renewal or change
in effective control shall result in a direct monetary fine of up to one thousand
dollars ($1,000) per day.
(h) Audit requirements.
(1) EOHHS shall conduct a financial and billing audit of any Medicaid�participating nursing
home that, for four (4) consecutive quarters, has both:
(i) Failed to meet the state safe-staffing standard; and
(ii) Not qualified for a waiver under subsection (e) of this section.
(2) EOHHS shall initiate such audit within twelve (12) months following the end of the
fourth consecutive quarter of non-compliance.
(i) Public reporting.
(1) Within thirty (30) days after completing any audit under subsection (f)(1), EOHHS
shall publish on its website a report that includes, for each audited facility:
(i) The quarter(s) audited;
(ii) Key audit findings and any identified overpayments; and
(iii) Amounts recovered and corrective actions taken.