Rhode Island General Laws Title 23. Health and Safety § 23-17.5-33. Minimum staffing level compliance and enforcement program

(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.

(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.

(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.

(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.

(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:

(1) Funds recovered through payment adjustments shall be allocated to:

(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.

(1) EOHHS shall conduct a financial and billing audit of any Medicaid-participating nursing home that, for four (4) consecutive quarters, has both:

(2) EOHHS shall initiate such audit within twelve (12) months following the end of the fourth consecutive quarter of non-compliance.

(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: