Texas Judge Vacates Nursing Home Staffing Mandates
Judge Matthew Kacsmaryk of the U.S. District Court for the Northern District of Texas has issued a ruling to vacate the Biden Administration’s federal staffing mandate for nursing homes that was to be phased in starting in 2026.
“Today’s ruling from the Northern District of Texas is a victory for our nation’s seniors and their families,” said Clif Porter, president and CEO of the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL), in a statement. “This unrealistic staffing mandate threatened to close nursing homes and displace vulnerable seniors. The court decision not only upholds the rule of law and balance of powers, but it protects access to care for our aging population. We appreciate Judge Kacsmaryk’s careful and thoughtful review of this case.”
“The Court has confirmed that CMS does not have the authority to issue such staffing requirements—only Congress does. Therefore, we now call on Congress to act,” Porter continued. “In light of evolving care practices and our nation’s changing demographics, federal policymakers should not be dictating staffing hours but encouraging innovation and high-quality outcomes. The staffing mandate is a 20th Century solution that should be blocked by Congress once and for all.”
The requirement that has been set aside included a 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. Facilities may use any combination of nurse staff (RN, licensed practical nurse [LPN] and licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard. This means a facility with 100 residents would need at least two or three RNs and at least 10 or 11 nurse aides as well as two additional nurse staff (which could be registered nurses, licensed professional nurses, or nurse aides) per shift to meet the minimum staffing standards.
The National Consumer Voice for Quality Long-Term Care said the rule would save the lives of over 13,000 nursing home residents annually and raise the quality of care for hundreds of thousands of nursing home residents across the county.
CMS had said the standards take into consideration local realities in rural and underserved communities through staggered implementation and exemptions processes. CMS executives said the initiative is focused on improving the lives of over 1.2 million residents who reside in Medicare- and Medicaid-certified long-term care facilities.
But nursing home operators and associations saw the new rule as unworkable.
AHCA, joined by the Texas Health Care Association (THCA), LeadingAge, and several Texas long-term care facilities, filed a lawsuit in May of last year against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) for exceeding their statutory authority and arbitrarily and capriciously issuing the Minimum Staffing Standards for Long-Term Care Facilities final rule.
Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services, including nursing homes, issued a statement saying, “Our nonprofit, mission-driven members—many of whom have served their communities for decades—understand the true essence of caregiving. Our stance has always been clear: imposing mandates rather than addressing funding adequacy and workforce sufficiency is wrong-headed.”
It is unlikely that the Trump administration will appeal the ruling.
