In a major victory for nursing homes and long-term care industry advocates, on Monday, April 7, 2025, Judge Matthew J. Kacsmaryk of the US District Court for Northern Texas struck down a Centers for Medicare & Medicaid Services (“CMS”) rule mandating certain staffing standards for nursing homes participating in Medicare and Medicaid (the “Rule”). Under the Rule, among other updates, nursing homes would have been required to maintain a registered nurse (RN) on staff 24/7 and to provide specific, minimum hours of direct care by RNs and nurse aids per resident, per day.
Critics of these requirements have opined since the Rule’s proposal that it would significantly burden nursing homes, particularly those in rural areas, without realizing a comparable benefit in terms of care quality. Many critics and industry advocates have argued that understaffing among nursing facilities is the result of a widespread nursing shortage, and that mandating staffing levels in the midst of this shortage will only burden facilities that already face significant obstacles in remaining solvent and continuing to operate.
The subject lawsuit involved allegations by the American Health Care Association, a national trade group representing nursing homes, that CMS had violated the Administrative Procedures Act in issuing the Rule, arguing that the Rule was “arbitrary and capricious.” In striking down the Rule, Judge Kacsmaryk made note of a CMS research study from June 2023 that concluded there was no “clear evidence basis for setting a minimum staffing level,” a conclusion that has been cited by critics since the Rule’s introduction to argue that the Rule is disconnected from its stated purposes regarding care quality. Judge Kacsmaryk ultimately found that, “Congress mandated consideration of a facility’s individual nursing needs” with respect to rules mandating staffing levels and that, because the Rule represented a “blanket mandate” that did not take such individual needs into account, it should be vacated as an unlawful breach of separation of powers doctrine.
What this Means for Providers
Although nursing home providers that participate in Medicare/Medicaid may be able to breathe a sigh of relief in the immediate term, they are still encouraged to monitor for further updates. Technically, the Trump administration has not signaled an intent to abandon efforts to litigate this matter further, leaving open a possibility (albeit potentially slim) that this case could be appealed to the United States Supreme Court. More importantly, providers are still subject to rules requiring them to staff according to resident needs (for example, under 42 C.F.R. § 483.35(a)). Further, individual states may implement higher standards of staffing in connection with facility licensure than those established by CMS. Consequently, extensive RN/nurse aid coverage may be necessary regardless of whether the minimum thresholds proposed by CMS under the Rule will no longer be effective.
