June 16, 2025
A recent review by the Office of Inspector General (OIG) highlights gaps in how CMS supports state oversight of nursing home staffing. While CMS has provided new data tools to help states monitor staffing levels, including the Payroll Based Journal (PBJ) system, the report finds that crucial information is still missing.
The PBJ system, created to improve transparency and accountability, collects daily, auditable staffing data from nursing homes. However, CMS currently flags only facilities with zero registered nurse (RN) hours, overlooking those that fall below the required minimum of 8 RN hours per day but are not entirely unstaffed. This limits states' ability to effectively identify and address staffing shortfalls.
Additionally, CMS does not explain to states which aspect(s) of staffing pose a risk of being insufficient when it identifies nursing homes with a one-star staffing rating (the lowest rating on Care Compare, the public website for consumers). For example, states that were reviewed wanted to know specifically whether low staffing of nurse aides contributed to the potential insufficient staffing in nursing homes identified by CMS.
OIG recommendations include:
- CMS should inform states of nursing homes that appear from PBJ dta to violate the required number of daily RN staffing hours.
- CMS should provide states with additional nursing home staffing analysis and guidance to identify potential insufficient staffing.
CMS disagreed with the first recommendation and offered no clear stance on the second, stating only that it has already taken relevant action.
