Judge strikes down controversial Biden mandate to increase nursing home staffing

By Tami Luhby, CNN
(CNN) — A federal judge in Texas on Monday nixed a controversial Biden administration rule that would have required nursing homes to boost their nursing staff in coming years.
US District Court Judge Matthew Kacsmaryk noted that staffing and other deficiencies at nursing homes “deserve an effectual response. But any regulatory response must be consistent with Congress’s legislation governing nursing homes.”
“Though rooted in laudable goals, the Final Rule still must be consistent with Congress’s statutes,” wrote Kacsmaryk, an appointee of President Donald Trump.
The Biden administration finalized the first-ever minimum staffing regulation for nursing homes last April. The mandate, which would have required facilities to hire more registered nurses and nurse aides, was quickly challenged in court by nursing home operators and their trade associations. Nursing homes already struggle to fill open positions, they said.
“This unrealistic staffing mandate threatened to close nursing homes and displace vulnerable seniors,” Clif Porter, CEO of American Health Care Association/National Center for Assisted Living, one of the plaintiffs in the lawsuit, said in a statement.
Meeting the proposed mandate would have required nursing homes to hire more than 100,000 additional nurses and nurse aides at an annual cost of $6.8 billion, according to the association’s 2023 analysis.
Nursing home trade groups have pushed Congress to improve funding for nursing home care, which is mainly provided through Medicaid. The staffing rule, they noted, did not provide any support for recruitment and training of nursing staff.
“Our stance has always been clear: imposing mandates rather than addressing funding adequacy and workforce sufficiency is wrong-headed,” Katie Smith Sloan, CEO of LeadingAge, which represents nonprofit providers of aging services and was also a plaintiff in the lawsuit, said in a statement.
The staffing mandate had also raised bipartisan concerns in Congress. A bipartisan Senate bill and similar legislation introduced by House Republicans would have prohibited the Department of Health and Human Services from finalizing the proposed rule. Nearly a hundred House members from both parties wrote a letter to then-Health Secretary Xavier Becerra expressing their concerns with the proposed rule, particularly that it could lead to widespread nursing home closures.
The rule called for all nursing homes that receive Medicare and Medicaid funding to provide a total of at least 3.48 hours of nursing care per resident per day. Plus, nursing homes would have had to have a registered nurse onsite at all times. The mandate would have been phased in over three years, with rural communities having up to five years.
Some 75% of nursing homes would have had to hire staff, HHS said when it finalized the rule.
The agency declined to comment about the judge’s decision.
This story has been updated with additional developments.
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