Last week, the Centers for Medicare & Medicaid Services (CMS) repealed staffing requirements established in a 2024 rule. The rule would have required nursing homes to be staffed to a minimum level of 3.48 hours per resident day, divided among various categories, and to have a registered nurse 24 hours per day, 7 days per week. Nursing homes were given several years to bring their staffing into compliance.
Critically, these guardrails were intended to be a floor. As CMS stated at the time, many facilities would likely need to go beyond them to ensure patient safety.
Many facilities would likely need to go beyond these guardrails to ensure patient safety.
The rule’s implementation and enforcement was delayed under the Republican reconciliation bill (H.R. 1). By repealing it entirely, the interim final rule released last week goes much further.
The original staffing rule arose out of the significant need for nursing home reform and improvement brought to light during the COVID-19 pandemic. Researchers projected it would save approximately 13,000 lives a year.
Lawmakers, Advocates Voice Concerns
The response to the rule’s rescission among advocates and democratic lawmakers has been critical. Senator Ron Wyden, ranking Democrat on the Senate Finance Committee, said that “[S]eniors are going to be less safe in nursing homes” as a result of the administration’s actions. And the non-profit the National Consumer Voice for Quality Long-Term Care “strongly condemns” the change.
The National Consumer Voice for Quality Long-Term Care “strongly condemns” the change.
The repeal of the staffing standards does not, however, eliminate the enhanced facility assessment process, a distinct and independent staffing requirement set out in the 2024 final rule that addresses resident acuity and requires facilities to staff to meet the actual needs of their residents. This portion of the 2024 rule was unaffected by H.R. 1 and was recently the subject of a letter from Senate Democrats asking CMS to clarify which parts of the rule were still in effect.
The interim final rule rescinding the staffing requirements goes into effect Feb 2, 2026.
