CMS has repealed a core provision of its 2024 minimum staffing rule for long-term care facilities, citing recent federal court rulings and concerns over implementation.
In an interim final rule published Dec. 2, the agency withdrew the requirement that long-term care facilities maintain a registered nurse on site 24 hours a day, seven days a week. The current federal requirement, which calls for RN staffing for eight hours per day, seven days a week, will remain in place.
The reversal comes months after a Texas federal judge vacated the provision, ruling that the 24/7 staffing requirement exceeded CMS’ authority. The agency did not appeal the decision, citing uncertainty caused by the ruling and challenges associated with implementation.
The original rule also included minimum nurse staffing levels of 3.48 hours per resident per day, including at least 0.55 hours from registered nurses and 2.45 hours from nurse aides. Those requirements remain in place for now, though legal and political challenges continue.
Industry groups that opposed the original mandate have welcomed the rollback.
“Today’s decision to repeal the one-size-fits-all staffing requirement in long-term care facilities is a good day for patients’ access to care,” Charlene MacDonald, executive vice president of public affairs at the Federation of American Hospitals, said in a statement shared with Becker’s. “This repeal rightfully reflects the reality that long-term care facilities are facing challenging workforce shortages. Rolling back this regulatory burden recognizes flexible staffing coupled with innovation improves the quality of care, reduces staff burnout and keeps facilities’ doors open.”
The American Hospital Association echoed those sentiments. In a Dec. 2 statement, Stacey Hughes, executive vice president for government relations and public policy, said the AHA “applauds” CMS’ repeal of the RN staffing requirement.
“The AHA has repeatedly raised concerns that the requirements could exacerbate workforce shortages, lead to facility closures and jeopardize access to care, especially in rural and underserved communities,” Ms. Hughes said. “Safe staffing… has always been about clinical judgment and flexibility to meet continually evolving patient needs rather than meeting arbitrary, one-size-fits-all numbers set by regulation.”
The staffing rule, announced in 2023 and finalized in 2024, was slated to roll out in three phases over three years, beginning in 2026. It quickly became a flashpoint for debate, with critics arguing that the requirements were unrealistic amid a national shortage of healthcare workers, particularly RNs.
In its interim final rule, CMS emphasized that the 24/7 RN requirement was only one part of a broader strategy to improve nursing home care and said it will continue offering technical assistance, training and financial incentives to support workforce development in long-term care settings.
Click here to read the 31-page interim final rule.
