CMS’s unrealistic and contentious ‘Final Mandate’ governing nursing home staffing policies has been vacated by a US District Court judge.
A year ago, with the blessings of the Biden administration, the Centers for Medicare & Medicaid Services (CMS) finalized a staffing mandate that threw healthcare entities and nursing home owners into a frenzy. Fast forward to April 7, 2025, and a US District Court vacated the onerous federal mandate that held nursing home and healthcare facilities in a chokehold. The ruling concluded that CMS had exceeded its statutory authority by imposing federal staffing minimums at nursing homes—an important win for regulatory balance.
The mandate called for a minimum of 3.48 hours per resident per day (HPRD) of total staffing, allocating specific hourly requirements for registered nurses (RN) and nurse aides. It would have been phased in over three years, with rural communities getting an additional two-year grace period. But even with this phased-in approach, many in the industry argued that the requirements were logistically and financially impossible to meet.
Industry leaders fought the mandate tooth and nail. They maintained that they hadn’t yet recovered from the trials of COVID and were already burdened with severe, country-wide staffing shortages, specifically for nurses and support staff. They argued that the mandate’s staffing standards were unfeasible and threatened to shut down nursing homes and displace hundreds of thousands of residents in the process.
The American Health Care Association and the National Center for Assisted Living, an industry group, released an analysis citing the potential need to hire an estimated 102,000 nurses and nursing aides across the industry should they be forced to comply with the staffing regulations. To add insult to injury, the mandate did not provide financial support for recruitment or training for any of this potential additional staff—essentially mandating the impossible without offering a single tool to get it done.
“This unrealistic staffing mandate threatened to close nursing homes and displace vulnerable seniors.”
Clif Porter, CEO of the American Health Care Association/National Center for Assisted Living
US District Court Judge Matthew Kacsmaryk, a Trump appointee, stated in his ruling that, while the policy was “rooted in laudable goals, the Final Rule still must be consistent with Congress’s statutes.” This was a charitable statement as the staffing mandate was never broadly supported—even among healthcare advocates or lawmakers on either side of the aisle.
It faced bipartisan opposition in Congress back in 2023, with bills in both chambers trying to block the rule. Nearly 100 House members wrote to then-Health Secretary Xavier Becerra, urging him to reconsider the proposed rule. Lawmakers from rural states were especially opposed, as meeting the mandate’s minimum staffing requirements would have been particularly challenging, if not impossible, in underserved areas.
It’s a major victory for seniors, their families, and certainly for us in rural America. I think this decision safeguards access to care. I also think it paves the way for a more thoughtful approach, one that enhances quality, supports caregivers and ensures the sustainability of rural providers.
Good Samaritan Society, President and CEO Nate Schema
With a Republican majority in both chambers of Congress and some rural Democrats’ disagreement with the rule, it is unlikely that the staffing mandate will be reinstated through legislation anytime soon. But, in today’s highly litigious environment, there are proponents of the staffing rule—including unions, consumer groups, and some prominent Democrats in Congress—that may urge the Health and Human Services (HHS) to appeal the court’s decision or explore alternative regulatory approaches.
For now though, many in the healthcare industry are relieved. The termination of the staffing mandate acknowledges their realities on the ground and validates the issues they are struggling with. Providers are already under immense pressure, balancing the rising costs of care, workforce shortages, and the expectation of delivering high-quality services. This ruling brings some breathing room to healthcare entities that have been doing their best to stay viable while maintaining integrity and quality standards of care.
This material has been prepared for informational purposes only, and is not intended to provide or be relied upon for legal or tax advice. If you have any specific legal or tax questions regarding this content or related issues, please consult with your professional legal or tax advisor.
