For SNFs, the move eliminates immediate compliance obligations around 24/7 RN coverage and nurse staffing hour thresholds. However facility assessments and Medicaid reporting requirements remain in effect.
Surveyors will also continue scrutinizing PBJ data, making consistent staffing documentation as important as ever.
Federal nursing home staffing rule lives on as HHS pursues new appeal
Federal judges in Texas and Iowa this spring rejected provisions of the Centers for Medicare & Medicaid Services rule requiring 24/7 registered nurse coverage and daily nurse staffing minimums. And Congress on July 1 voted to delay possible enforcement of the rule until fall 2034, saving an estimated $22 billion as part of a much broader reconciliation bill.
But Justice Department attorneys working on behalf of HHS have advanced an existing appeal and filed another since the bill’s July 4 signing, keeping their legal fight for the 2024 staffing rule very much alive.
Justice Department attorneys working on behalf of HHS have advanced an existing appeal and filed another since the bill’s July 4 signing, keeping their legal fight for the 2024 staffing rule very much alive.
— McKnight’s Long-Term Care News, August 28, 2025
Staffing mandate knockout embodies ‘evolution’ to new rule-making era
Last week’s completion of a one-two punch to the Biden administration’s nursing home staffing mandate is a clear indicator that high-profile rulings by the US Supreme Court may increasingly shape the provider regulatory landscape for years to come.
A US District Judge in Iowa, like a peer in a separate case in Texas two months earlier, ruled Wednesday that the Centers for Medicare & Medicaid Services had overreached in trying to mandate 24/7 registered nurse presence and other staffing levels in skilled nursing facilities.
— McKnight’s Long-Term Care News, June 23, 2025
Staffing mandate has ‘one foot in the grave’ after judge tosses nurse requirements
“That’s not to say that [the Department of Health and Human Services] will necessarily discontinue its legal defense of the mandate. But it’s hard to see how the staffing mandate survives given these legal setbacks,” said Bentley, managing director in ATI’s Care Continuum Strategy & Solutions Practice.
“This is yet another major blow to the staffing mandate. So, not sure if the mandate is officially dead, but it’s clearly got one foot in the grave.”
— McKnight’s Long-Term Care News, June 22, 2025
Unrealistic staffing rules get a reality check
It turns out, you can’t regulate your way out of a workforce shortage. That’s the message the Centers for Medicare & Medicaid Services just got from a federal judge in Iowa, who did what many skilled care operators had been hoping for: He hit pause on the most unrealistic parts of the staffing mandate.
— McKnight’s Long-Term Care News, June 22, 2025
Stiff-arming the staffing mandate
Even if some future court action or legislative repeal fully negates the staffing rule, it must be remembered that regulations will still say that nursing homes must provide “sufficient and competent staffing.”
Surveyors will still be scrutinizing Payroll-Based Journal data and using it to determine who gets taken to the wood shed and who doesn’t. State inspectors will be able to interpret compliance with as much, or more, discretion than ever before.
— McKnight’s Long-Term Care News, June 20, 2025
BREAKING: Federal judge vacates 24/7 RN and nurse-hour demands in staffing mandate
The ruling gives nursing home operators another significant court victory in their drive to have the first-ever federal nursing home staffing mandate struck down or at least mitigated. It comes after a similar lawsuit filed by the American Health Care Association in Texas also wound up with the staffing mandate being tossed on essentially the same grounds in April.
US District Judge Leonard T. Strand of the US District Court for Northern Iowa, ruled that the staffing requirements exceeded the legal authority of the Centers for Medicare & Medicaid Services.
— McKnight’s Long-Term Care News, June 20, 2025
Iowa Court Vacates 24/7 RN Rule, Staffing Hours in Biden-Era Nursing Home Staffing Mandate
In the latest litigation over the federal staffing mandate, Judge Leonard T. Strand for the Northern District of Iowa vacated crucial aspects of the rule earlier this week, namely that a registered nurse (RN) needs to be on-site 24 hours a day, seven days a week.
The court vacated “the most egregious and costly aspects of the final rule,” Craig Conley, shareholder at law firm Baker Donelson, told Skilled Nursing News, referring to the HPRD and 24/7 RN requirements.
— Skilled Nursing News, June 20, 2025
