Federal Judge Strikes Down CMS Nursing Home Staffing Requirements

The long-term care (LTC) sector is breathing a collective sigh of relief following the ruling from a federal judge tossing out the Centers for Medicare & Medicaid Services (CMS) controversial staffing minimums.

The ruling from Judge Matthew J. Kacsmaryk of the U.S District Court for Northern Texas states:

“Society has a duty to care for its elderly. Nursing homes play a necessary role. But failures plague them… These deficiencies deserve an effectual response. But any regulatory response must be consistent with Congress’s legislation governing nursing homes. The Final Rule’s challenged provisions are not.”

The CMS minimum staffing standards for long-term care facilities have been beset by criticisms and lawsuits since the agency finalized them in April 2024.

In addition to having a registered nurse (RN) onsite 24 hours a day, seven days a week, the final rule required LTC facilities to maintain total nurse staffing of 3.48 hours per resident day (HPRD). This total must include at least 0.55 HPRD of direct RN care and 2.45 HPRD of direct nurse aid care.

Questions remain about other components of the Final Rule, including enhanced facility-wide assessments that require LTC facilities to:

• Use evidence-based methods when planning care for residents, including consideration for residents with behavioral health needs.
• Assess specific residents’ needs and adjust based on significant changes in the resident population.
• Include input from nursing home leadership (e.g., the medical director), management (e.g., director of nursing), and direct care staff (e.g., RNs). The facility must also solicit and consider input from residents, resident representatives, and family members.
• Develop a plan to maximize recruitment and retention of staff.

The enhanced facility-wide assessment requirements took effect 90 days after the final rule publication. 

What to Do Now

Your state’s nursing home association is a valuable resource for updates and guidance as compliance requirements continue to shift. As your advocates, they can provide direction and assistance in maintaining compliance with state and federal rules and requirements.

Although the federal staffing minimums are off the table for now, each LTC facility should take time to analyze staffing levels in the context of resident needs and current federal and state-level rules. Contact your CRI advisor for help assessing your facility’s readiness to meet state and federal staffing benchmarks and other regulatory requirements.