Federal judge strikes down critical elements of the Biden-era nursing home staffing mandate, dealing a major blow to CMS’s regulatory agenda
A federal judge has struck down critical elements of the Biden-era nursing home staffing mandate, dealing a major blow to CMS’s regulatory agenda.
What the Court Ruled
In a summary judgment issued by U.S. District Court judges in Texas and Iowa, two key provisions of the Department of Health & Human Services’ 2024 rule were struck down:
- The requirement that nursing homes maintain a registered nurse on-site 24/7
- The mandate for a minimum of 3.48 total nursing hours per resident per day.
Both judges determined that CMS overstepped its authority: current federal law only requires eight consecutive hours of RN coverage daily and allows flexibility to meet resident needs.
Responses from the Industry
The decision was celebrated by advocates for nursing home operators, with the American Health Care Association (AHCA) calling it a “protection against unrealistic mandates that could harm seniors,” and praising its relief for rural and smaller providers.
Meanwhile, consumer advocates warned of potential negative consequences. The National Consumer Voice noted that the rule would have prevented thousands of pressure ulcers and hospitalizations, lamenting its loss while pledging to continue their advocacy.
Next Steps in Legal and Regulatory Review
- CMS has appealed the Texas ruling to the Fifth Circuit Court of Appeals, requesting reinstatement of the staffing provisions.
- In April, another federal judge in Iowa temporarily halted the mandate’s implementation while reviewing the case merits. However, other parts of the rule—such as facility assessment updates and Medicaid transparency—remain in effect.
- Meanwhile, the 2025 federal budget reconciliation bill includes language that could impose a ten-year moratorium on CMS’s nursing home staffing mandates.
What This Means for Providers and Residents
For Providers:
This ruling provides immediate flexibility in staffing models—especially important for rural and small facilities that struggled to comply. However, uncertainty remains as appeals continue, and legislative intervention is possible.
For Residents:
The eliminated mandates were designed to enhance resident safety and reduce adverse outcomes. Consumer voice groups emphasize that there are trade-offs in rescinding requirements linked to improved care quality.
Bottom line:
Health care providers and policymakers are watching closely. The Fifth Circuit's decision on appeal and potential Congressional action in the coming months will determine the final scope and structure of federal nursing home staffing standards.
Sources
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