/>iOn Monday, April 7, the U.S. District Court for the Northern District of Texas vacated CMS’s recently adopted rule imposing minimum staffing requirements for long-term care facilities participating in Medicaid or Medicare. On April 22, 2024, CMS announced this final rule (the “Final Rule” or “CMS-3442F”), which sought to “significantly reduce the risk of residents receiving unsafe and low-quality care within LTC facilities.”[1] Specifically, the Final Rule would have required nursing homes to provide at least 3.48 hours per resident day of total nurse staffing and required each nursing home to maintain a registered nurse onsite 24 hours a day, 7 days a week – triple Congress’s original directive of 8 hours, 7 days a week.
Although the Final Rule included hardship exemptions and staggered implementation of its requirements, it nevertheless sparked significant controversy – with CMS receiving over 46,000 comments when it was proposed in 2023. Many nursing home residents and their families supported the Rule’s adoption as a necessary response to long-standing concerns over poor facility conditions, neglected residents, and inadequate care. Conversely many in the nursing home industry argued that the Final Rule would increase costs for facilities such that many nursing homes would be forced to shut down, concluding that the Final Rule would ultimately harm patients, particularly those in rural areas, by causing workforce shortages and significantly limiting patients’ access to care.
Accordingly, in June of 2024 the American Health Care Association, LeadingAge, Texas Health Care Association, and other industry advocates sued CMS to block the Final Rule. In its April 7 ruling, the Court acknowledged the failures plaguing nursing homes, which it described as including “inadequate staffing levels, poor infection control, failures in oversight and regulation, and deficiencies that result in actual patient harm.” However, the Court also noted that the Final Rule’s requirement that a registered nurse be onsite 24/7 exceeded the statutory baseline set by Congress. Regarding the minimum nurse staffing requirements, the Court concluded that the Final Rule’s blanket requirement effectively replaced the more flexible standard adopted by Congress. Ultimately the Court struck down nearly all of the Final Rule on the basis that CMS exceeded its authority in its adoption, stating:
Though rooted in laudable goals, the Final Rule still must be consistent with Congress’s statutes. To allow otherwise permits agencies to amend statutes though they lack legislative power. Separation of powers demands more than praiseworthy intent.
In essence, the Court explained that future regulatory solutions related to nursing home minimum staffing requirements will need to come from Congress. CMS has not yet indicated whether it will appeal the Court’s ruling. Thus, for the time being, nursing homes are relieved from the Final Rule’s staffing requirements.
