How to meet CMS nursing home staffing requirements

The federal numeric staffing floor changed, but the scheduling work did not disappear. You still need a defensible facility assessment, the federal coverage that remains, your state's rules, and PBJ data that matches the hours people actually worked.

What still counts after the federal repeal

The 3.48 total HPRD floor and 24/7 RN requirement from the 2024 federal staffing rule are no longer the current numeric test after the February 2026 repeal.
Nursing homes still have to provide sufficient nursing staff for resident needs, complete the enhanced facility assessment, provide an RN for at least 8 consecutive hours a day 7 days a week, and have a full-time director of nursing.
PBJ submissions are due by 11:59 PM Eastern on the 45th calendar day after each federal fiscal quarter ends.Source: CMS PBJ staffing data submission
CMS counts hours paid to work by calendar day, deducts a 30-minute meal break from each full shift, and reports a 12-hour paid shift as 11.5 hours.Source: CMS PBJ Policy Manual

The real compliance chain

Meeting CMS requirements is a chain of evidence: the facility assessment describes resident needs, the schedule turns those needs into coverage, payroll shows what happened, and PBJ reports paid hours in CMS's format.

The 2026 repeal removed the federal HPRD floor and 24/7 RN requirement from the 2024 rule. It did not make staffing optional. Sufficient staffing, the facility assessment, statutory RN coverage, and a full-time director of nursing remain.

Start with the requirements that still bind

Use a written staffing matrix for each unit and shift. Keep the legal source beside the operational target. A state ratio is not the facility assessment, and neither replaces the federal RN coverage rule.

Layer	What to record	Check before publishing
Federal baseline	Sufficient staffing, assessment findings, RN coverage, full-time DON	Does each day have RN coverage? Does the plan reflect resident needs?
State requirement	State HPRD, ratio, staffing plan, or other applicable standard	Does it cover nursing facilities? Does it vary by shift or census?
Facility target	Role coverage by unit, shift, census band, and skill mix	Can the charge nurse see a gap before release?
Reporting record	Paid hours, job code, pay type, agency or contract status	Can each hour be traced to payroll or another auditable record?

Do not borrow numbers from another state or an old explainer. Mandatory-overtime scope varies by facility type.

Turn the assessment into a schedule someone can audit

Write the target in the same units your scheduler uses. If the assessment says the memory-care unit needs two RNs on days and one RN on nights, make those constraints visible instead of leaving them in a PDF.

Illustrative example, not a CMS minimum:

Shift	RN target	Scheduled	Result
7 a.m. to 3 p.m.	2	2	Meets the example target
3 p.m. to 11 p.m.	2	1	One RN gap
11 p.m. to 7 a.m.	1	1	Meets the example target

A daily headcount can show four RN shifts while the unit has an eight-hour gap. Check by shift and role. An extra aide does not cure an RN gap, and an agency RN still needs the correct PBJ mapping.

Decide before release whether each open line uses a float, per diem, voluntary extra work, or agency. A line open every week is a staffing-plan problem.

Handle overtime before it becomes the staffing plan

State mandatory-overtime restrictions are not a national rule, and facility scope varies sharply. Research confirms restrictions in 17 states, but only Pennsylvania, New Jersey, New York, and a narrower Washington rule clearly reach some nursing-home situations. Other listed states stop at hospitals, ambulatory surgery centers, or a defined employer category.

Where a rule applies, use last-resort coverage: check qualified people on duty, contact off-duty staff who agreed to extra work, use float or per diem coverage, then check an agency. Pennsylvania, New Jersey, and Missouri also require documentation. Chronic short staffing is not an unforeseeable emergency in the statutes reviewed.

Record the open shift, coverage attempts, qualification check, and final assignment.

Make the PBJ file agree with the schedule

PBJ is not a copy of the posted schedule. CMS expects hours paid to work by calendar day.

Scheduling event	PBJ treatment	Control to add
12-hour paid shift	Report 11.5 hours after the 30-minute meal-break deduction	Apply the deduction in the export
11 p.m. to 7 a.m. shift	Split hours across the two calendar dates at midnight	Test an overnight shift in export review
PTO, sick time, holiday, or off-unit orientation	Exclude non-work absence hours	Reconcile attendance and payroll
Agency or contract coverage	Include paid hours with the correct pay type and job title	Keep worker identity and role mapping consistent

Use the CMS nursing job codes deliberately. Code 7 is a direct-care RN. Code 9 is an LPN or LVN. Code 10 is a certified nurse aide, while code 11 is a nurse aide in training. The director of nursing is code 5 and should not be reported again under another title.

PBJ specification v4.10.0 caps an employee ID at 22.5 hours per day across job titles. A double shift can create a file error even when each assignment looks plausible. Flag it before export.

Quarterly deadlines are hard cutoffs. The federal fiscal calendar ends December 31, March 31, June 30, and September 30. Due dates are February 14, May 15, August 14, and November 14. The Final File Validation Report can take up to 24 hours, so reconcile before quarter close.

Use a four-way pre-publication check

Confirm the active facility-assessment targets by unit, census band, shift, and role.
Run the schedule through callouts, PTO, agency assignments, and overtime exposure.
Compare the posted schedule with attendance and payroll after the work.
Review PBJ codes, date splits, meal deductions, pay type, and the deadline.

Keep the assessment version and the reason for each material change with the schedule record. That is stronger evidence than a schedule that merely looks covered.

Where a compliant plan breaks

Using 3.48 HPRD or 24/7 RN coverage as though the repealed 2024 federal floor were still active can hide the state or facility-assessment target that now controls.
A daily headcount can look complete while one shift has an RN gap. Review coverage by unit, role, and shift.
A 12-hour shift is not 12 PBJ hours. CMS deducts 30 minutes from each full shift, and overnight work crosses two reporting dates.
Do not assume a mandatory-overtime law covers nursing homes because a summary lists the state. Facility scope differs, and chronic short staffing is not the emergency exception.

A scheduling layer for the numbers you actually use

Shiftd turns facility-assessment targets into schedule constraints, surfaces coverage gaps and overtime exposure before publication, and maps shifts to PBJ job codes. It keeps an audit record of schedule changes; it does not replace payroll, timekeeping, or clinical charting.

See Shiftd in action →

Questions DONs ask

Do I still need to schedule to 3.48 HPRD?

No. The 3.48 HPRD federal floor from the 2024 rule is no longer the current numeric test after the February 2026 repeal. Use the surviving federal requirements, your facility assessment, and the applicable state standard.

Does the repeal remove the facility assessment?

No. The facility assessment remains part of the staffing work. Use it to document the resident needs, services, and staffing plan behind each unit's coverage target.

Does PBJ count scheduled hours or paid hours?

Paid-to-work hours by calendar day. CMS excludes non-work absences and requires a 30-minute meal-break deduction from each full shift. A 12-hour paid shift reports as 11.5 hours.

When is the PBJ submission due?

By 11:59 PM Eastern on the 45th calendar day after the end of the federal fiscal quarter. The standard due dates are February 14, May 15, August 14, and November 14.

Can I use a state mandatory-overtime exception for a recurring vacancy?

Do not assume that you can. The reviewed statutes commonly require an unforeseeable emergency and reasonable efforts to find coverage, and several expressly say chronic short staffing is not an exception. Check the rule for your facility with counsel.