On April 7, 2025, United States District Judge Mathew J. Kacsmaryk of the United States District Court for the Northern District of Texas struck down two Center for Medicare and Medicaid Services (“CMS”) staffing provisions for nursing homes promulgated by the Biden Administration in 2024. District Judge Kacsmaryk reasoned CMS overstepped its authority by essentially “revising” clearly delineated staffing requirements set by Congress when it issued the two provisions.
The two voided provisions from the case include the “24/7 Requirement” and the “HPRD Requirements.” The “24/7 Requirement” mandates that a “facility must have a registered nurse (“RN”) onsite 24 hours per day, for 7 days a week that is available to provide direct resident care.” See 42 C.F.R. § 483.35(c)(1) (2024). The “HPRD Requirements” set out three minimum staffing standards for facilities. First, the “facility must meet or exceed a minimum of 3.48 hours per resident day for total nurse staffing. Id. § 483.35(b)(1). Second, to do so, a facility must have a “minimum of 0.55 hours per resident day for registered nurses.” Id. § 483.35(b)(1)(i). Third, a facility must have a “minimum of 2.45 hours per resident day for nurse aides.” Id. § 483.35(B)(1)(ii).
In the 25-page opinion, Judge Kacsmaryk reasoned CMS’ “24/7 Requirement” impermissibly expands the [42 U.S.C. § 1396r(b)(4)(C)(i)(II)’s] 8 hour- minimum registered professional nurse requirement to a 24-hour requirement. While the defendants in the case argued that the words “at least” in the statute were only meant to set a baseline, Judge Kacsmaryk did not find the agency possessed the authority to demand more from nursing facilities. Doing so, in Kacsmaryk’s opinion would permit CMS to “rewrite clear statutory terms to suit its own sense of how the statute should operate.” (citing In Re Benjamin, 932 F. 3d 293, 300 (5th Cir. 2019)).
Judge Kacsmaryk struck down the “HPRD Requirements” on similar grounds, noting the statute does not present a “fill up the details scenario.” Rather, Congress requires nursing homes to “provide 24-hour licensed nursing services which are sufficient to meet the nursing needs of its residents.” See 42 U.S.C. § 1396(b)(4)(C)(i). Because the statute goes on to reveal factors that nursing home must consider in making this determination, Judge Kacsmaryk found the HPRD’s blanket three-fold requirements usurped Congress’ will of the consideration of those enumerated factors.
While nursing home industry groups have cause for excitement, facilities should still prepare to meet the standards set out by CMS beginning in May 2026 as higher courts could overturn the ruling. Attorneys in Sandberg Phoenix’s long-term care team are carefully monitoring cases challenging the CMS provisions and will advise our clients based on the most recent developments.
