Tuesday morning brought the final nail in the coffin for an industry-opposed nursing home minimum staffing mandate launched under the Biden administration.
The requirements had been finalized by the Centers for Medicare and Medicaid Services (CMS) in April 2024 and were intended to begin a multiyear phase-in starting in 2026. Under that final rule, nursing homes receiving Medicare and Medicaid funding would have needed at least one registered nurse on-site 24 hours a day, plus other minimums, including a total nurse staffing standard of 3.48 hours per resident per day.
The Biden administration said at the time that the increases would increase care quality, a concern it said was at the forefront of more than 46,000 responses received during the rule’s public comment phase.
But the plan was fought every step of the way by long-term care industry groups and Republicans, who broadly argued that heightened requirements amid widespread workforce shortages would bring untenable costs and facility closures. A 2023 analysis from the American Health Care Association (AHCA) estimated the version of the requirements proposed at the time would force 102,000 additional nurse hires at a cost of $6.8 billion, 50% higher than the government’s cost estimate.
In April, lawsuits brought by AHCA and other trade organizations, as well as Texas Attorney General Ken Paxton, yielded a block from Judge Matthew Kacsmaryk of the U.S. District Court for the Northern District of Texas. More broadly, the summer’s One Big Beautiful Bill Act included a 10-year moratorium on the mandate.
CMS, which had initially appealed Kacsmaryk’s decision, pulled its legal opposition in September. Today, the Department of Health and Human Services (HHS) officially closed the book on the issue by repealing the relevant provisions of the 2024 final rule, citing its disproportionate burden on facilities serving rural and Tribal communities.
“Every American deserves access to compassionate, high-quality care,” CMS Administrator Mehmet Oz, M.D., said in a release. “At CMS, our mission is not only to improve outcomes, but to ensure those outcomes are achievable for all communities. We cannot meet that goal by ignoring the daily realities facing rural and underserved populations. This repeal is a step toward smarter, more practical solutions that truly work for the American people.”
The administration also framed the repeal as another step in its broader effort to unwind burdensome red tape, as directed under President Donald Trump’s 10:1 deregulation agenda.
“Safe, high-quality care is essential, but rigid, one-size-fits-all mandates fail patients,” HHS Secretary Robert F. Kennedy, Jr., said in Tuesday’s release. “This Administration will safeguard access to care by removing federal barriers—not by imposing requirements that limit patient choice.”