A federal judge in Texas has blocked a nursing home staffing rule mandated by the Biden administration last year.
In May 2024, a month after the final rule was released, the American Health Care Association, the Texas Health Care Association, Arbrook Plaza, Booker Hospital District, and Harbor Lakes Nursing and Rehabilitation Center brought a lawsuit in federal court in the Northern District of Texas.
The final rule imposing minimum staffing requirements on nursing homes exceeded statutory authority, the plaintiffs said.
On April 7, Judge Matthew J. Kacsmaryk agreed.
"Though rooted in laudable goals, the final rule still must be consistent with Congress's statutes," Kacsmaryk ruled. "To allow otherwise permits agencies to amend statutes though they lack legislative power. Separation of powers demands more than praiseworthy intent."
The ruling listed nursing home "failures" of "inadequate staffing levels, poor infection control, failures in oversight and regulation and deficiencies that result in actual patient harm."
Kacsmaryk said: "Though the final rule attempts to remedy chronic nursing home deficiencies, it does so deficiently. It requires nursing homes participating in Medicare or Medicaid to have a registered nurse on staff at least twenty-four hours a day, although Congress set the baseline at eight hours a day."
While these deficiencies deserve an effectual response, any regulatory response must be consistent with Congress's legislation governing nursing homes, Kacsmaryk said.
The rule attempted to require every participant nursing home to achieve minimum staffing hours based on a facility's number of residents, although Congress mandated consideration of a facility's individual nursing needs, the ruling said.
The court granted the plaintiffs' motion for summary judgment and denied the defendants' cross motion for summary judgment.
WHY THIS MATTERS
The Centers for Medicare and Medicaid Services' final rule required nursing homes participating in Medicare and Medicaid programs to provide residents with a minimum total of 3.48 hours of nursing care per day, which included at least 0.55 hours of care from a registered nurse per resident per day, and 2.45 hours of care from a nurse aide per resident per day.
Nursing homes were required to have a registered nurse on site 24 hours per day, seven days per week.
The American Hospital Association said the final rule was "onerous," given nursing homes already face staffing challenges.
EVP Stacey Hughes said at the time, "This final rule could lead nursing homes to reduce capacity or close outright, including those that are otherwise high performers on quality and safety metrics."
In April 2024, when the rule was released, CMS said it had developed a $75 million national nursing home staffing campaign to increase the number of nurses.
THE LARGER TREND
The Biden administration initiated the rule after the government found that more than 40% of Americans killed during the COVID-19 pandemic lived in nursing homes.
An estimated 62,000 nursing home residents died of COVID-19, as of September 2020. An estimated 1.2 million residents receive care in Medicare- and Medicaid-certified nursing homes.
CMS said it received and considered more than 46,000 public comments on the rule from various stakeholders, including residents and their family members, workers, advocates and the industry.
Many of these comments highlighted how – without sufficient staff – residents did not receive necessary care, including baths or trips to the bathroom, and experienced preventable safety events, such as pressure ulcers and falls, CMS said.
Email the writer: SMorse@himss.org