In February 2026, the New York State Department of Health (DOH) issued its first set of civil penalty notices to 20 nursing homes for failure to comply with the State’s minimum staffing requirements. The penalties relate to one or more quarters beginning April 1, 2022 (Quarter 2 of 2022) through Quarter 4 of 2023, encompassing the first seven quarters of enforcement under the staffing mandate.
After consideration of statutory mitigating factors, the total penalties assessed against these 20 facilities amounted to $4,259,596 for the seven-quarter period. This reflects a reduction of approximately $2 Million from the maximum penalties that could have been imposed under the statute.
Based on our review of the first seven quarters of reported data, we estimate that approximately 80% of facilities statewide did not fully meet one or more components of the staffing mandate during this period.
Moreover, if maximum statutory penalties had been assessed for all facilities found noncompliant from 2022 Quarter 2 through 2025 Quarter 3, total recoupments could have reached approximately $114 Million underscoring the significant financial exposure associated with continued noncompliance.
Background of the Staffing Mandate
In April 2021, New York State enacted legislation establishing mandatory minimum staffing levels for nursing homes. Although the law was originally scheduled to take effect on January 1, 2022, implementation was delayed until April 1, 2022, due to statewide healthcare workforce shortages and the Governor’s declaration of a Statewide Disaster Emergency.
Pursuant to New York State Public Health Law § 2895-b (3), each nursing home must maintain minimum staffing levels measured in hours of care per resident, per day (HPRD), as follows:
- A minimum of 3.5 HPRD must be provided by certified nurse aides (CNA’s) and licensed nurses (Registered Nurses (RNs) or Licensed Practical Nurses (LPNs))
- Within that total, at least 2.2 HPRD must be provided by CNA’s; and
- At least 1.1 HPRD must be provided by RN’s/LPN’s
Compliance is measured on a quarterly basis using Payroll-Based Journal (PBJ) staffing data submitted to the Centers for Medicare & Medicaid Services (CMS).
Compliance & Redetermination Process
Between August 2023 and September 2025, the Department issued compliance notices covering the first seven quarters of enforcement (April 1, 2022, through December 31, 2023). Compliance notices have yet to be issued for subsequent quarters.
Within 10 business days of receiving a notice of noncompliance, facilities were allowed to submit a Request for Redetermination if they disagreed with the determination of noncompliance and/or a Penalty Reduction Application if they believed they met the mitigating factors described in 10 NYCRR 415.13(f)(2)(ii). Through this process, facilities may challenge the Department’s calculations and/or submit documentation supporting the application of mitigating factors.
Civil Penalty Structure
Where a facility fails to meet the minimum staffing standards for a given quarter, the Department may impose civil penalties of up to $2,000 per day for each day of noncompliance during that quarter.
Although the statutory maximum daily penalty remains $2,000 per day, the Department has revised its penalty calculation methodology. The current calculation establishes a three-part penalty structure that separately evaluates noncompliance within each of the three staffing mandated components. Penalties escalate with repeated occurrences of noncompliance within the same calendar year, thereby establishing a progressively more stringent enforcement model for facilities with recurring deficiencies. Additionally, penalties are assessed on a per day basis with a range of penalties based on the daily HPRD.
Mitigating Factors
In assessing penalties, the Department is required to consider statutory mitigating factors. Where a facility sufficiently demonstrates that a qualifying mitigating factor applies, the Department may reduce the assessed penalty. The mitigating factors considered by the Department include the following:
1. Extraordinary Circumstances
Facilities may seek mitigation for extraordinary circumstances that could not have been prevented, including natural disasters, statewide or national declared emergencies, or other catastrophic events. If approved, the period covered by the extraordinary circumstance is removed from the facility’s quarterly average HPRD calculation for penalty purposes.
2. Acute Labor Supply Shortages
Facilities located in areas determined by the Commissioner of Health to have an acute labor supply shortage may qualify for a reduction. To be eligible, a facility must first demonstrate that it implemented measures to ensure resident health and safety despite staffing challenges.
The facility must then provide comprehensive documentation evidencing meaningful efforts to recruit and retain nursing staff. Examples include, executed contracts with recruitment firms, job postings and recruitment materials, documentation of wage or benefit increases, retention initiatives or incentive programs, etc.
When assessing any penalty reduction, the Department evaluates these efforts under the following three categories:
1. Job enhancement initiatives
2. Recruiting efforts
3. Enhanced productivity strategies
The absence of sufficient documentation will likely result in minimal penalty reductions. A facility may receive up to a one-third (1/3) reduction in penalties for each category in which sufficient effort is demonstrated.
Important Update: In correspondence dated February 9, 2026, the Department revised the methodology used by the Commissioner to determine Acute Labor Shortage areas. The Department has indicated it will contact facilities that may now qualify for mitigation under the revised criteria.
3. Verifiable Union Dispute
A facility may also seek mitigation based on a verifiable labor dispute involving relevant nursing titles. If the Department accepts formal evidence of such a dispute, the period covered by the dispute may be excluded from the quarterly HPRD calculation when assessing penalties
Enforcement & Payment
The Public Health Law § 2895-b(2)(c) requires that the commissioner post the assessed penalties and mitigating factors at least thirty days prior to taking action.
Once civil penalties are formally assessed, if a facility fails to submit payment within the required timeframe, the matter will be referred to the Division of Legal Affairs Bureau of Administrative Hearings, who will initiate an administrative enforcement proceeding.
Key Takeaways
The issuance of these first penalty notices marks a significant escalation in enforcement of New York State’s nursing home staffing mandate. The magnitude of potential exposure, particularly if maximum penalties are applied over multiple quarters, highlights the importance of ongoing monitoring, comprehensive documentation of recruitment and retention efforts, and proactive compliance strategies.
As enforcement continues and methodologies evolve, facilities should closely evaluate their staffing data, assess potential mitigation eligibility, and prepare for continued regulatory scrutiny.
For further information on the Nursing Home Minimum Staffing including the recent DOH Presentation and updated FAQ’s, please refer to the NYS Department website for the Nursing Minimum Staffing and Direct Resident Care Spending.
And if you are concerned about your facility’s potential maximum penalty and need assistance estimating this for your facility, our team is available to help you navigate the process and better understand your potential exposure. Please do not hesitate to reach out to discuss your specific situation.
This material has been prepared for general, informational purposes only and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. Should you require any such advice, please contact us directly. The information contained herein does not create, and your review or use of the information does not constitute, an accountant-client relationship.
