On April 7, 2025, a federal judge struck down the Centers for Medicaid & Medicare Services (CMS) federal nursing home Minimum Staffing Mandate implemented in May 2024 (Final Rule). Aimed at improving quality of care, the Final Rule required 3.48 hours per resident day of patient care, but most notably required that nursing homes have a Registered Nurse (RN) on site 24/7. While praising the intent of the Final Rule and acknowledging that nursing home quality issues “deserve an effectual response”, the Court found that CMS lacks legislative authority to promulgate a Final Rule that is inconsistent with federal statute.
The Plaintiffs, which included the American Health Care Association (AHCA), argued against the Final Rule on the basis that minimum staffing standards were already established by Congress in federal statute. The Court agreed, citing the recent U.S. Supreme Court decision Loper Bright[1], which overturned the landmark Chevron[2] decision which had afforded federal agencies a large degree of deference. The Court stated that a regulatory response has to align with the federal statute enacted by Congress and CMS lacks the legislative power to implement an inconsistent rule, stating “[s]eparation of powers demands more than praiseworthy intent.” While the Secretary of CMS has discretion to impose conditions on a nursing home’s participation in Medicare and Medicaid as they find necessary in the interest of health and safety, the Court noted that CMS cannot impose a requirement (such as the 24/7 RN requirement) that “plainly changes” a federal statute, as the Final Rule would do.
The Court’s decision comes at a pivotal time with major restructuring at CMS and uncertainty about Medicaid funding. The future of CMS’s revised Long-Term Care Surveyor Guidance (Revised Guidance) set to take effect in April 2025 is now unknown. The Revised Guidance, among other things, would require surveyors to focus heavily on the Final Rule requirements, assessing compliance based upon Payroll-Based Journal (PBJ) data, patient acuity and complexity, facility odors, etc.
What we do know is that the Court’s decision to strike down the Final Rule does not mean that facilities should abandon the idea of providing more staff to meet higher acuity residents. In fact, the Court noted that the current minimum staffing federal statute addresses this already, requiring that the nursing care standard consider “the nursing needs of [a facility’s] residents”, rather than conform to a one-size-fits-all approach as the Final Rule provided.
It is important to remember that several states have implemented their own minimum staffing mandates, so while the Court struck down the Final Rule, nursing homes may still have state mandates to comply with. Here at Garfunkel Wild, we are staying apprised of the regulatory developments for nursing homes to ensure they remain compliant.
Should you have any questions regarding the above, please contact the author, the Garfunkel Wild attorney with whom you regularly work, or email us at [email protected].
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[1] Loper Bright Enterprises v. Raimondo, 144 S. Ct. 2244, 2247, 219 L. Ed. 2d 832 (2024).
[2] Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc. (467 U.S. 837 (1984)).