On April 7, 2025, a Federal District Court in Texas vacated the controversial Centers for Medicare and Medicaid Services (“CMS”) proposal to require specific staffing requirements in skilled nursing facilities (“SNFs”).[1] The court’s decision has nationwide effect. The CMS proposal would have required SNFs to maintain a registered nurse (“RN”) ratio of 33 minutes per resident day (“HPRD”), two hours and 27 minutes for nurse aides and a 24/7/365 on-site RN requirement. Dinsmore has reported previously on the CMS Proposed Rule.
Relying significantly on the Supreme Court’s Loper Bright decision from 2024, the court determined that the CMS proposal overstepped the agency’s authority and was inconsistent with Congress’ legislative intent. For example, the Social Security Act states that a nursing facility must use the services of an RN for “at least 8 consecutive hours a day, 7 days a week.”[2] The 24/7/365 on-site RN requirement in the CMS proposal is directly contradictory to the Social Security Act provisions. Further, the Social Security Act requires that SNFs provide “24-hour licensed nursing services which are sufficient to meet the nursing needs of its residents.”[3] The specified HPRD requirements in the CMS proposal pose a direct conflict to the Social Security Act as well.
The court’s ruling is limited to the HPRD requirements and the 24/7/365 RN requirement in the CMS proposal. Despite the CMS proposal, states maintain the authority to impose more stringent staffing requirements on SNFs.
