Fiscal impact reports (FIRs) are prepared by the Legislative Finance Committee (LFC) for standing finance
committees of the Legislature. LFC does not assume responsibility for the accuracy of these reports if they
are used for other purposes.
F I S C A L I M P A C T R E P O R T
SPONSOR Chávez
/Duhigg/Ferrary/Thomson
LAST UPDATED
ORIGINAL DATE 01/24/2025
SHORT TITLE Nursing Staff-To-Patient Ratios in Hospitals
BILL
NUMBER House Bill 72/ec
ANALYST Rommel
REVENUE*
(dollars in thousands)
Type FY25 FY26 FY27 FY28 FY29
Recurring or
Nonrecurring
Fund
Affected
Penalty
Assessment
$0 $0
Indeterminate
but minimal
gain
Indeterminate
but minimal
gain
Indeterminate
but minimal
gain
Recurring General Fund
Parentheses ( ) indicate revenue decreases.
*Amounts reflect most recent analysis of this legislation.
ESTIMATED ADDITIONAL OPERATING BUDGET IMPACT*
(dollars in thousands)
Agency/Program
FY25 FY26 FY27
3 Year
Total Cost
Recurring or
Nonrecurring
Fund
Affected
HCA
Indeterminate
but minimal
Up to $1,007.5 Up to $1,007.5 Up to $2,015.0 Recurring General Fund
Total
Indeterminate
but minimal
Up to $1,007.5 Up to $1,007.5 Up to $2,015.0 Recurring General Fund
Parentheses ( ) indicate expenditure decreases.
*Amounts reflect most recent analysis of this legislation.
Sources of Information
LFC Files
Agency Analysis Received From
New Mexico Board of Nursing (BON) Health Care Authority (HCA) Department of Health (DOH)
SUMMARY
Synopsis of House Bill 72
House Bill 72 (HB72) amends the Public Health Act to create a hospital staffing advisory
committee to advise the Health Care Authority (HCA) in setting minimum staffing ratios for
nursing units in the state’s hospitals. HB72 requires hospitals to employ sufficient staff to meet
the ratios and to adopt rules on the training of direct patient care personnel. Hospitals are
prohibited from assigning unlicensed personnel to perform duties that require a licensed nurse or House Bill 72/ec – Page 2
require specialized knowledge, but licensed and registered nurses could work within their scope
of practice. HCA is charged with enforcing the minimum staffing ratios, by court action if
necessary. HCA may also waive minimum staffing ratios for rural general acute care hospitals as
needed to increase operational efficiency. HB72 further creates a framework for penalty
assessments and, in the case of multiple violations of staffing ratio requirements, the submission
of a corrective action plan by the hospital to the HCA.
This bill contains an emergency clause and would become effective immediately on signature by
the governor.
FISCAL IMPLICATIONS
HCA’s Division of Health Improvement estimates that it will need 16.5 additional FTE at an
annual cost of approximately $1 million to support the implementation of HB72, including
administrative staff, staff to survey hospitals for compliance with the act, and staff to intake
complaints related to violations of the minimum staffing ratios. HCA derived this estimate based
on an assumption of 200 complaints per year; costs may ultimately be lower than $1 million if
the number of actual complaints is lower.
HCA estimates no fiscal impact for fiscal year 2025. However, this bill contains an emergency
clause and, if signed by the governor, would come into effect within the last three months FY25,
requiring HCA to bear at least some costs in that year. Legislative Finance Committee (LFC)
staff assume that HCA would bear an indeterminate but minimal cost to implement HB57 in
FY25.
HB87 empowers the HCA to levy civil penalties against hospitals it finds to have violated the
minimum staffing standards. LFC staff estimate that HCA would not derive significant revenue
from these penalties.
SIGNIFICANT ISSUES
Healthcare providers in New Mexico and throughout the United States are experiencing nursing
shortages. The 2024 New Mexico Healthcare Workforce Committee Report indicates that with
no redistribution of the current workforce, an additional 5,353 registered nurses would be needed
for all New Mexico counties to meet the national benchmark (92 nurses per 10,000 population)
1
.
High patient-staff ratios likely contribute to unsafe conditions for patients and burnout for nurses.
The Board of Nursing (BON) documents considerable evidence in the medical/nursing literature
that attests to high ratios leading to burnout. BON also points to one preliminary study indicating
that better staffing ratios could result in cost savings for hospitals.
2
Hospitals may serve very different populations and thus need different staffing ratios to provide
quality care. The federal Centers for Medicare and Medicaid Services (CMS) publishes
1
https://digitalrepository.unm.edu/nmhc_workforce/13/
2
Lasater, K. B., Aiken, L. H., Sloane, D., French, R., M. B., Alexander, M., & McHugh, M. D. (2021). Patient
outcomes and cost saving associated with hospital safe nurse staffing legislation: an observational study. BMJ Open,
11:e052899. doi: 10.1136/bmjopen-2021-052899. House Bill 72/ec – Page 3
requirements for participation in Medicare and Medicaid that dictate adequate staffing but do not
dictate specific ratios.
3
In accordance with CMS rules, the hospital director of nursing is
responsible for nurse staffing levels and determining the type and number of nursing staff
necessary to provide nursing care for all areas of the hospital. Determining appropriate staffing
for any given unit or facility considers many variables including patient complexity and needs,
the experience, education, qualifications, skills and competency of available staff, shift-to-shift
variables, and patient turnover. The staffing committee created in HB72 is not in conflict with
the CMS guidelines.
BON notes there may be unintended effects of prohibiting an unlicensed assistive person (UAP)
from the scope of practice outlined in Section 4-C of the bill (page 8, lines 2-21). BON points out
that many of these procedures have, under direct supervision, been performed by UAPs in the
past. They further note that “Non-traditional health profession students benefit from pipeline and
pathway programs through stacked credential approaches to traditional college. This exclusion of
UAP roles may interrupt or negatively impact that option.”
ADMINISTRATIVE IMPLICATIONS
The bill requires rule promulgation and establishment of the staffing ratio committee by July 1,
2026. HB72’s emergency clause would allow HCA to begin the work directed by the bill upon
signature by the Governor.
HCA notes the following administrative implications:
Monitoring compliance with HB72 would be a new and additional workload. Currently,
the Division of Health Improvement surveys hospitals either upon initial licensure of the
hospital, when directed to do so by CMS, or when a state complaint is received. The
Division of Health Improvement would need additional staff to monitor compliance with
all requirements of HB72 and investigate complaints. Funds would be needed for salary
and benefits, as well as rent, supplies, equipment, communication, travel, cars, copying,
and information technology for new staff. Contract funds would also be needed to cover
the costs of fair hearings for contested civil monetary penalties and other sanctions
imposed by the Division of Health Improvement to enforce the provisions of the Act.
Additional attorney time would be needed to participate in or respond to court filings for
injunctive relief.
CONFLICT, DUPLICATION, COMPANIONSHIP, RELATIONSHIP
HB72 is related to HB145 from the 2024 legislative session and HB236 from the 2023 legislative
session. HB72 adds new material regarding mandatory training and orientation of staff and the
authorization of penalties and removes provisions allowing for per-diem and mileage
reimbursement for members of the staffing committee.
3
Code of Federal Regulations 42 CFR 482.23(b) House Bill 72/ec – Page 4
OTHER SUBSTANT IVE ISSUES
A growing body of research indicates that enhanced nurse-to-patient ratios can have a positive
impact on quality of care and patient outcomes.
4
California and Massachusetts require specific
ratios within certain hospital units. Other states require public reporting of staffing ratios by
hospitals. Other states have created nurse-driven staffing committees convened at the hospital
level.
On April 22, 2024, CMS issued the Minimum Staffing Standards for Long-Term Care Facilities
and Medicaid Institutional Payment Transparency Reporting final rule. CMS is finalizing a total
nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55
HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Long-term
care facilities may use any combination of nurse staff (RN, licensed practical nurse and licensed
vocational nurse, or nurse aide) to account for the additional 0.48 HPRD needed to comply with
the total nurse staffing standard.
HR/rl/SL2/sgs
4
Health Serv Res. 2021 Mar 15;56(5):885–907. doi: 10.1111/1475-6773.13647