Health Law Daily Wrap Up, HEALTH CARE COMPLIANCE NEWS—20 states file suit against federal nursing home staffing rule, (Oct 15, 2024)
Multiple states are suing CMS over the federal nursing home staffing rule, arguing that it goes beyond the government’s authority and will put nursing homes out of business.
The attorney generals of Iowa, Kansas, and South Carolina are co-leading a lawsuit by states and nursing home industry groups against HHS Secretary Becerra and CMS to stop the nursing home staffing requirements rule. The rule requires more staff for patient care in nursing homes, also known as long-term care (LTC) facilities, over a two-to-five-year phase-in period. In the complaint, the rule is described as a “heavy-handed mandate” that goes beyond the authority of the federal government. The additional states or commonwealths joining the suit are Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kentucky, Missouri, Montana, Nebraska, Oklahoma, North Dakota, South Dakota, Utah, Virginia, and West Virginia. Texas filed suit earlier this year, as did additional nursing home groups. The final rule requires that the first phase of compliance begin May 10, 2026.
Arguments. The states and industry groups focus on two arguments—costs and the authority of the federal government. The complaint points to an outside study that predicts a rise in costs and a risk of nursing homes closing because of the rule. The study found:
Nursing homes will need to hire more than 100,000 additional full-time employees.
The final rule will cost nursing homes approximately $6.8 billion per year (higher than CMS’s estimate of $4 billion).
Ninety-four percent of current skilled nursing facilities will be out of compliance with at least one of the staffing requirements.
More than 285,000 nursing home beneficiaries (or one-fourth of total nursing home residents) will be at risk of losing care if nursing homes are unable to increase their workforce to meet these new standards.
In addition, according to the complaint, the final rule departs from the longstanding staffing requirements Congress put in place in two ways. First, the rule triples the statutory nursing home staff requirement—replacing Congress’s directive for an RN to be present for 8 hours per day, 7 days a week, with a new mandate to have an RN “onsite 24 hours per day, for 7 days a week.” Next, the final rule abandons the flexible statutory staffing standard that is “sufficient to meet the nursing needs” of each facility’s residents in favor of a national requirement that does not consider facility needs.
Earlier this year, the state of Texas and two nursing home trade groups also filed suit with similar arguments (see Texas sues over federal nursing home staffing rule, Aug. 22, 2024 and Nursing home trade groups file suit challenging new staffing requirements, May 28, 2024).
Final rule requirements. The minimum nursing staffing increases under the final rule are scheduled to be phased-in (seeNursing home staff increases, Medicaid transparency required under final rule, May 10, 2024) with the following timeline:
By May 10, 2026, facilities must meet a 3.48 hours per resident day total nurse staffing requirement and a 24/7 RN requirement (by May 10, 2027, for rural areas).
By May 10, 2027, facilities must meet a 0.55 RN and 2.45 nursing aid hours per resident day requirements (by May 10, 2029, for rural areas).
IndustryNews: NewsStory ComplianceNews CMSNews CoPNews LTCHNews PartANews PartBNews QualityNews SNFNews