Federal Judge Strikes Down Biden-Era Rule

A federal judge struck down the Biden administration’s nursing home staffing rule requiring 24/7 registered nurse coverage, ruling the mandate exceeded the authority of the Centers for Medicare & Medicaid Services and contradicted Congressional intent.

Quick Takes

US District Judge Matthew Kacsmaryk ruled that CMS illegally replaced staffing requirements outlined by Congress with its own mandated ratios.
The rule would have required nursing homes to provide at least 3.48 nurse staffing hours per resident day and have registered nurses on-site 24/7.
Nursing home industry groups argued the mandate would have forced facility closures and displaced seniors due to existing workforce shortages.
The Biden administration intended the rule to prevent resident neglect and care delays, especially in light of the pandemic’s impact on nursing homes.
The ruling represents an ongoing tension between regulatory efforts to improve care standards and the practical challenges facing the nursing home industry.

Judge Rejects CMS Authority to Mandate Staffing Levels

US District Judge Matthew Kacsmaryk issued a summary judgment on April 7, striking down the former administration’s rule that would have required nursing homes to maintain specific staffing ratios. The ruling sided with nursing home industry groups, including the American Health Care Association, which argued that the Centers for Medicare & Medicaid Services (CMS) had overstepped its authority. Judge Kacsmaryk determined that CMS had illegally substituted its judgment for that of Congress, which had already established a framework for nursing home staffing based on resident-specific needs rather than blanket numerical requirements.

Federal judge blocks Biden nursing home staffing mandate https://t.co/WTFndbKnrc

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The contested rule would have required nursing homes to provide a minimum of 3.48 nursing staff hours per resident day and maintain registered nurse coverage 24 hours a day, seven days a week. In his ruling, Judge Kacsmaryk emphasized that CMS had set these requirements without properly considering the varying nursing needs of residents and established a baseline staffing requirement that did not align with statutory terms.

Industry Concerns Over Practical Implementation

Nursing home industry representatives celebrated the ruling as a necessary correction to what they viewed as an unrealistic mandate. They argued that implementing the staffing requirements amid existing workforce shortages would have devastating consequences for care facilities and the elderly residents they serve. The American Health Care Association, which led the legal challenge, maintained that the rule would have forced many nursing homes to close their doors, particularly in rural and underserved areas where hiring additional qualified staff would be nearly impossible.

Katie Smith Sloan of LeadingAge, another organization representing nonprofit nursing homes, criticized the mandate for addressing symptoms rather than underlying problems. She advocated for comprehensive solutions that would tackle funding shortfalls and workforce development issues instead of imposing staffing ratios that many facilities could not realistically meet. Industry leaders described the rule as a “20th Century solution,” calling for Congressional intervention to address the complex issues facing nursing home care.

Competing Priorities: Care Standards vs. Industry Realities

The ruling highlights the tension between efforts to improve care standards and the practical challenges of implementing those standards. The Biden administration developed the rule in response to concerns about resident neglect and inadequate care, issues that were starkly exposed during the pandemic when nursing homes experienced disproportionately high mortality rates. Administration officials argued that minimum staffing standards were necessary to ensure consistent quality of care and protect vulnerable residents.

Advocates for nursing home residents expressed disappointment with the ruling. Sam Brooks from the National Consumer Voice for Quality Long-Term Care argued that the staffing requirements would have significantly improved care quality for nursing home residents. Judge Kacsmaryk’s ruling, however, emphasized the legal boundaries of regulatory authority, stating that CMS “lacks authority to issue a regulation that replaces Congress’s preferred minimum hours with its own.”