New Lawsuit Filed in Opposition to Federal Nursing Home Staffing Mandate

• A new lawsuit has been filed against the Centers for Medicare and Medicaid Services’ (CMS) final ruling on minimum staffing requirements for nursing homes.
• Filed in Texas, the suit alleges that CMS violated the Administrative Procedure Act — the same argument made in the first lawsuit, which also originated in Texas.
• As the litigation makes its way through the courts, the new mandate has begun its phased rollout. 

A second lawsuit is making its way through the courts, continuing the push back on federally mandated nursing home staffing requirements.

Texas Attorney General Ken Paxton, who filed the suit, alleged that the Centers for Medicare and Medicaid Services (CMS) ruling violates the Major Questions Doctrine and called it a “power grab.”

“We are taking the federal government to court over this rule that could worsen rural care shortages by shutting down facilities due to new hiring quotas that are impossible to fill,” Paxton stated in a news release, echoing arguments from other opponents of the ruling.

The CMS final ruling, issued in April, set minimum staffing requirements for nursing homes that receive Medicare and Medicaid funding. Its phased implementation began last month as the courts sort out litigation and facilities continue to grapple with staff shortages.

What’s in the New Lawsuit?

The new lawsuit makes similar arguments to one filed in May in the same district court — that CMS violated the Administrative Procedure Act.

Paxton alleged that the ruling “removes the historic flexibility” of nursing home leadership to determine appropriate staffing levels for their own facilities, according to the court filing.

“Whatever benefits increased staffing may theoretically provide, CMS has not explained at all how setting these levels will improve quality of life for long-term care residents,” the lawsuit states.

Yet, researchers from the University of Pennsylvania determined nearly 13,000 lives could be saved annually through the ruling’s implementation.

The suit also alleged that CMS did not consider concerns from Texas about a lack of staff or human resources to comply with the ruling, but a federal nursing home staffing campaign is expected to include more than $75 million to assist states with recruitment.

How Did we Get Here?

The White House issued, in April, its ruling on nursing home staffing, which requires nursing homes that receive federal funding maintain a staffing ratio of 3.48 hours per resident per day (HPRD) of total staffing. Phased implementation began in August, with most facilities being required to meet a May 2026 deadline to bring total staffing levels to the new requirements.

The American Health Care Assocation filed a lawsuit in May, alleging that the mandate violates the Administrative Procedures Act.

Last month, Skilled Nursing News reported that a resolution to the months-long lawsuit could be reached in early 2025 if a proposed schedule from AHCA and other industry organizations is accepted.

Two joint resolutions that disapprove of the CMS ruling (H.J.Res.139 and S.J.Res.91) also are making their way through Congress. 

Has the Industry Response Changed?

A chief concern among those who oppose the minimum staffing mandate is securing enough workers to meet the requirements. A KFF analysis found that 19% of facilities meet all requirements in the ruling, but nearly 60% “would meet the interim requirement of an overall requirement of 3.48 HPRD.”

Mark Parkinson, AHCA/NCAL president and CEO, told SNN that it’s “not hyperbole” to call access to care a national crisis, noting that nursing homes are closing at a faster rate than they’re opening.

Speaking to PBS News Hour, KFF Senior Correspondent Jordan Rau said backlash from some stakeholders is occurring because of the cost to meet the staffing standards.

“It’s going to be extremely expensive to hire those people, and a lot of people don’t want to take these jobs right now,” Rau said. “I mean, if you’re a nursing aide, the average pay is about $19 an hour. People don’t want to do that. It’s a very, very difficult job. So in some places they’ll have to increase the wages. So the industry claims that they can’t afford it, and so they’ve resisted it, both politically, they’ve gone to Congress, and they’re looking to block and overturn the rule, and also legally and going to the courts.”

Melissa Batchelor, Ph.D., RN, and Diana J. Mason, Ph.D., RN, who both work at the George Washington University School of Nursing, questioned in a July editorial for STAT News why the industry is trying to reverse the ruling “in a way that would ensure that no administration can ever set minimum staffing standards.”

However, Barry Port, the chief executive officer of Ensign, believes the mandate will be struck down in the aftermath of Chevron ruling. He told SNN that the attorney who brought the Chevron case to the court also is representing AHCA in its suit.

The Bottom Line

A second lawsuit has been filed in opposition to the Centers for Medicare and Medicaid nursing home staffing mandate. It makes the same argument as the first — that the mandate violates the Administrative Procedure Act. While the legal action makes its way through the courts, nursing homes are beginning to implement a phased rollout of the CMS ruling. However, costs and availability of workers remain a point of contention. 

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