Earlier this week, Hon. Matthew J. Kacsmaryk of the U.S. District Court for the Northern District of Texas vacated two key provisions of CMS’s 2024 nationwide staffing mandate, the requirements that skilled nursing facilities (SNFs) have a registered nurse onsite 24/7 and the onerous federal minimum staffing ratios. The court, in its ruling in American Health Care Association, et al., v. Robert F. Kennedy, Jr., et al. (Case No: 2:24-cv-00114-Z-BR), relied heavily on the Loper Bright case and found that CMS acted outside its authority by doing more than explaining the statutory scheme in its rule but instead trying to amend the statute through rulemaking. Other provisions of the Final Rule, including the enhanced requirements for completing Facility Assessments and the Medicaid transparency reporting, were not part of this challenge and remain in effect.

Although this order vacated portions of the Final Rule, California SNFs remain bound by the state requirements of 3.5 nursing hours per resident day, with a minimum of 2.4 hours performed by certified nurse aids.  

It remains to be seen whether CMS will file an appeal to the Fifth Circuit following this ruling or what its next steps will be regarding these provisions of the Final Rule. Regardless, this ruling in a case filed by AHCA, LeadingAge, the Texas Health Care Association, and four individual nursing homes, is a significant victory for the sector at this point. Interestingly, the provisions of the Final Rule remain under challenge in other jurisdictions, including the Northern District of Iowa, and there is proposed legislation to permanently override the CMS Final Rule pending in both the House and Senate. We will be keeping an eye on the status of the pending legislation as well as the federal cases.