In a win for aging services providers, a Texas court has vacated CMS regulations setting minimum staffing standards for nursing homes. 

 In an opinion and order issued April 7, United States District Court Judge Matthew J. Kacsmaryk struck down the minimum nursing home staffing requirements established by the Centers for Medicare and Medicaid Services (CMS) in a May 2024 rule.  

LeadingAge is a co-plaintiff in this lawsuit, and we celebrate the outcome. “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,” said LeadingAge President and CEO Katie Smith Sloan in a statement. This “ruling is a victory that strengthens our resolve and propels our ongoing advocacy on behalf of our 5,500 members across the country.”

Our lawsuit (AHCA, LeadingAge et al. v. Kennedy, Jr., No. 2:24-cv-00114 (N.D. TX)) specifically challenged the requirements that nursing homes must (i) meet or exceed a minimum of 3.48 hours per resident day (HPRD) for total nurse staffing, including a minimum of 0.55 HPRD for registered nurses, and a minimum of 2.45 HPRD for nurse aides; and (ii) have a registered nurse onsite to provide care 24 hours per day, 7 days a week. 

After considering the legal arguments presented by the respective parties and the relevant law, the court ruled in our favor, granting the plaintiffs’ motion for summary judgment and denying the government’s cross motion for summary judgment. 

In his decision, Judge Kacsmaryk wrote that the staffing provisions are not consistent with Congress’ legislation governing nursing homes. 

First, Congress previously enacted statutory language that requires each Medicare or Medicaid nursing home “to use the services of a registered professional nurse for at least 8 consecutive hours a day, 7 days a week.” CMS lacks authority “to issue a regulation that replaces Congress’s preferred minimum hours with its own,” the Judge explains, and “[t]hat is exactly what the 24/7 Requirement does.” The opinion and order further states: “Congress did not grant statutory amendment authority nor stay silent on the base number of hours a nursing home must use an RN’s services. It answered eight. Congress reserved to itself that decision.” 

Second, Congress enacted statutory language that requires nursing homes to “provide 24-hour licensed nursing services which are sufficient to meet the nursing needs of its residents.”  On this issue, the judge found that CMS lacks the authority to mandate hours per-resident-day ratios for all facilities – to set a baseline staffing requirement for all – that does not consider the “nursing needs” of a facility’s residents, as the statute provides. 

For those reasons, as the opinion and order articulate in more detail, Judge Kacsmaryk vacated the challenged CMS staffing requirements with nationwide effect. 

The CMS final staffing rule also established an enhanced facility assessment requirement for nursing homes and directed states to collect and report on the percentage of Medicaid payments spent on compensation for direct care workers, and support staff in nursing facilities and intermediate care facilities for individuals with intellectual disabilities. Those parts of the final rule were not at issue in this case and are not affected by the court’s ruling. 

 The U.S. Department of Health and Human Services (HHS) has the right to appeal the decision to the United States Court of Appeals for the Fifth Circuit. If HHS wishes to appeal, it must do so within 60 days, and we will follow this issue very closely. 

  by Jonathan Lips