On September 1, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting proposed rule. Under CMS’s proposal, nursing homes participating in Medicare and Medicaid would be required to meet specific nurse staffing levels that promote safe, high-quality care for residents. Nursing homes would need to provide residents with a minimum of 0.55 hours of care from a registered nurse per resident per day, and 2.45 hours of care from a nurse aide per resident per day, exceeding existing standards in nearly all states. CMS estimates approximately 75 percent of nursing homes would have to strengthen staffing in their facilities. As the long-term care sector continues to recover from the COVID-19 pandemic, the proposed standards take into consideration local realities in rural and underserved communities through staggered implementation and exemption processes. CMS specifically seeks comment on its proposed definition of “rural” for these exemptions. The proposed rule uses the Census definition of rural and urban, meaning that “rural” encompasses all population, housing, and territory not included within an urban area. See the Census Bureau for more information on urban area classification, including a high-resolution map of the urban areas based on the 2020 Census. Comments are due by November 6, 2023.