HHS Officially Rescinds Nursing Home Minimum Staffing Rule

 The Trump administration on Tuesday rescinded a Biden-era rule that required a minimum number of healthcare staff in nursing homes.

The Department of Health and Human Services (HHS) said Tuesday in a press release it is taking the action "after determining the final rule imposed by the Biden administration disproportionately burdened facilities, especially those serving rural and tribal communities, and jeopardized [patients'] access to care."

"Today's decision to repeal these provisions, in alignment with the One Big Beautiful Bill Act, underscores HHS's commitment to practical, sustainable approaches to improving nursing home care, and allows for further opportunity for engagement with community and tribal stakeholders," the release stated.

"Safe, high-quality care is essential, but rigid, one-size-fits-all mandates fail patients," HHS Secretary Robert F. Kennedy Jr. said in the release. "This administration will safeguard access to care by removing federal barriers -- not by imposing requirements that limit patient choice."

Mehmet Oz, MD, MBA, administrator of the Centers for Medicare & Medicaid Services (CMS) said in the release that "At CMS, our mission is not only to improve outcomes, but to ensure those outcomes are achievable for all communities. We cannot meet that goal by ignoring the daily realities facing rural and underserved populations. This repeal is a step toward smarter, more practical solutions that truly work for the American people."

The rule, enacted in May 2024 by the Biden administration, required nursing homes that participate in federal programs such as Medicare and Medicaid to meet a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care, according to a CMS fact sheet. Facilities could use any combination of nurse staff (RNs, licensed practical nurses [LPNs] and licensed vocational nurses, or nurse aides) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard, the agency said. The rule also required nursing homes to have an RN on site 24 hours a day, 7 days a week, to provide skilled nursing care.

CMS gave nursing homes 2 years to comply with some parts of the rule and 3 years for other parts; rural facilities were given extra time. However, Republicans and nursing home organizations pushed back on the rule, saying it would force some nursing homes to close. Two large nursing home provider organizations sued over the regulations; a federal court judge ruled in their favor and struck down several of the rule's key provisions. In addition, the One Big Beautiful Bill Act delayed implementation of the rule for 10 years. Tuesday's announcement was not a surprise, because HHS in August had sent the proposed rescission to the Office of Management and Budget for review.

Nursing home and hospital groups praised the rule's rescission. "The CMS staffing mandate repeal is a much-needed recognition of the very real barriers that our nursing home members navigate in recruiting and retaining staff," Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit aging services providers, said in a statement. "We will continue to engage with federal policymakers and advocate for meaningful investments in the long-term care workforce and the advancement of smart policies to realize the necessary numbers of trained and qualified nurse aides, registered nurses, licensed practical nurses, and other [nursing home] caregivers."

The American Hospital Association (AHA) also applauded the move. "The AHA applauds CMS's repeal of the misguided minimum staffing requirements for long-term care facilities," Stacey Hughes, the AHA's executive vice president for government relations and public policy, said in a statement. "The AHA has repeatedly raised concerns that the requirements could exacerbate workforce shortages, lead to facility closures, and jeopardize access to care, especially in rural and underserved communities that often do not have the workforce levels to support these requirements."

But nursing home consumer groups felt otherwise. "We were very disappointed by CMS's announcement today," Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care, a patient advocacy group, wrote in an email to MedPage Today. "Even though it claimed the rescission was in part due to congressional and judicial developments, it repeated the often-debunked lines from the nursing home industry that there are not enough staff and that rural facilities will be harmed. Both of these claims are not true."

"The rule had numerous opportunities for exceptions, meaning that nursing homes with legitimate hiring challenges would be exempted from compliance," he continued. "Further, there was no evidence rural facilities would have a harder time complying [than] non-rural facilities.... The real problem is that nursing homes treat workers poorly and cannot retain them."

"Most disheartening was that CMS offered no plan to address the staffing crisis in nursing homes," Brooks added. "Instead, it is returning to the status quo, which results ... in residents suffering and dying because nursing homes are not staffed adequately."

https://www.medpagetoday.com/geriatrics/generalgeriatrics/118802