Federal Judge Blocks Nursing Home Staffing Rule

In April 2024, the Centers for Medicare and Medicaid Services (CMS) mandated increases in nursing home staffing. The Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting rule outlined how much time nurses must spend caring for residents. While Congress previously required only eight hours a day of registered nursing care, the Final Rule mandated that at least one registered nurse be on staff round-the-clock. As a result, many facilities needed to hire more nurses to comply with CMS’ rule.

Controversy followed the Biden-era mandate. While some saw the Final Rule as an important step toward keeping residents safe, others questioned its practical effect on facilities already struggling to fill staffing vacancies.

In a recent lawsuit, challengers characterized the rule as overreaching. A district judge found that CMS lacked the legislative power to make the rule.

Lawsuit Details

Last June, the American Health Care Association, which represents 15,000 nursing homes across the United States, Texas Health Care Association, and other nursing home-affiliated organizations sued the secretary of the United States Department of Health and Human Services and the administrator of the CMS.

They argued that the Final Rule contradicted Congress’ intent and standing legislation. The plaintiffs also asserted that the requirements were impossible to meet, harming those in need by closing facility doors.

Judge’s Conclusions

In an opinion filed on April 7, 2025, U.S. District Judge Matthew Kacsmaryk threw out CMS’ rule. He addressed whether CMS had the authority to issue the Final Rule and concluded that it did not.

His opinion identified several problems with the Final Rule relating to the separation of powers issue.

• The 24-hour-a-day registered nurse requirement contradicts Congress’ baseline requirement of eight hours a day.
• The rule fails to account for the facility’s individual nursing needs, per Congress’ directive. The bright-line rule contrasts Congress’ flexible standard considering the facility’s needs.

Ultimately, the district court determined that CMS’ “praiseworthy” intent to address nursing home problems was not enough to allow the rule to stand.

As this decision may be appealed, it remains to be seen whether it will stand.