CMS Final Rule on Minimum Staffing Standards for Long-Term Care Facilities Struck Down

On April 7, 2025, the United States District Court for the Northern District of Texas vacated staffing requirements published in the Centers for Medicare & Medicaid Services (CMS) May 2024 Minimum Staffing Rule (the “Final Rule”). For long-term care facilities, this means the parts of the Final Rule mandating the 24 hours a day, 7 days a week registered nurse presence, and the hours per resident day (HPRD) requirements no longer apply.

The suit, filed by the American Health Care Association (AHCA) and others, challenged two provisions of the Final Rule: (1) the requirement a registered nurse be available to provide direct care 24 hours a day, 7 days a week (the “24/7 Requirement”); and (2) the hours per resident day (HPRD) requirements. The HPRD requirements mandated facilities have at least 3.48 hours per resident day for total nurse staffing by having a minimum of .55 hours per resident day for registered nurses, and a minimum of 2.45 hours per resident day for nurse aides. The Final Rule provided for staggered implementation dates over a period of 5 years based on location.

AHCA argued that CMS’ 24/7 Requirement replaced Congress’ mandate for “a registered professional nurse for at least 8 consecutive hours a day, 7 days a week,” absent Congressional permission. The Court agreed, ruling that CMS acted without authority in issuing the 24/7 Requirement and that in so doing, it amended Congress’ baseline.

The Court also ruled that CMS lacked authority to implement the HPRD requirements because Congress has stipulated nursing care standards must take a facility’s nursing needs into consideration, and the HPRD requirements failed to do so by setting a staffing requirement baseline.

While the Court has overturned the 24/7 and HPRD requirements, other provisions of the Final Rule remain in effect. CMS has 60 days to appeal the decision.