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On December 3, 2025, the Trump administration published an Interim Final Rule withdrawing Biden-era standards that established minimum staffing requirements for nursing homes under Medicare and Medicaid.
Background
The Centers for Medicare and Medicaid Services (CMS) under the Biden administration originally published the minimum staffing final rule, "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting," in May 2024. In an effort to address chronic understaffing at nursing homes and the quality of caregiving jobs, the rule required Medicare and Medicaid-certified facilities to maintain 24/7 onsite skilled nursing care for all residents and a minimum 3.47 "hours per resident day"—the total number of hours worked by each type of staff divided by the total number of residents—of staffing.
Those requirements sparked backlash from critics in the nursing home industry who argued that the rule would be burdensome, particularly for rural facilities that could not afford to hire additional staff. At the time, the Department of Health and Human Services (HHS) estimated that the nursing home industry would need to hire 12,000 registered nurses and more than 77,000 nursing aides to meet the mandated standards. Over 10 years, based on regulatory impact analysis calculations, HHS anticipated that the minimum staffing requirement would cost the industry $43 billion.
Prior to the implementation of the 2024 minimum staffing final rule, an analysis by the American Health Care Association (AHCA) and National Center for Assisted Living projected that, as of September 2023, 94 percent of facilities would not meet at least one of the proposed staffing requirements.
Accordingly, organizations filed complaints against HHS in two federal courts. In May 2024, the AHCA sued HHS in the U.S. District Court for the Northern District of Texas, seeking a judgment that the rule exceeded CMS' authority and was arbitrary and capricious in violation of the Administrative Procedures Act. The district court granted plaintiff's motion for summary judgment and vacated the rule. Similarly, in October 2024, 20 state attorneys general, joined by two nursing homes and additional nonprofit organizations representing aging services providers, filed a lawsuit asking the U.S. District Court for the Northern District of Iowa to enjoin the final rule on the basis that the rule exceeded statutory authority, was arbitrary and capricious, caused irreparable financial harm and violated the major questions doctrine. Like the Texas court, the Northern District for Iowa vacated the rule, finding that the rule exceeded statutory authority.
Those decisions signaled further trouble and waning support for the final rule. In July 2025, HR 1 delayed implementation of the rule for 10 years and—although the Trump administration initially filed a defense of the staffing rule in an appeal of the Northern District of Iowa's decision in the Eighth Circuit—in October 2025, the Trump administration voluntarily dismissed its appeal of the district court's decision to vacate the rule.
New Interim Final Rule
In a press release on December 2, HHS explained that it was taking action to officially retract the Biden administration's final rule after determining that it "disproportionately burdened facilities, especially those serving rural and Tribal communities, and jeopardized patient's access to care." In the new Interim Final Rule, CMS indicates that it took multiple factors into consideration in deciding to rescind the 2024 final rule:
- HR 1's prohibition on implementing, administering or enforcing the rule until 2034;
- Pushback from numerous organizations, including rural and tribal communities, who indicated that the 2024 minimum staffing final rule would lead to further shortages and significant financial burden; and
- The district court decisions in Iowa and Texas to vacate the final rule.
Although critics of the 2024 final rule, including leaders in the assisted living industry, welcomed HHS's Interim Final Rule, nursing home consumer groups, such as the National Consumer Voice for Quality Long-Term Care, expressed disappointment with the decision and argued that the Interim Final Rule and its accompanying press release repeated "debunked" information that rural facilities would be harmed by stricter staffing standards. The 2024 final rule, the consumer advocate group argued, included sufficient exceptions for nursing homes with "legitimate hiring challenges." Further, the group opined that it was troubling that the Interim Final Rule revokes the Biden administration's requirements without offering an alternative plan to address the staffing crisis in nursing homes.
The rule will go into effect on February 2, 2026, and the agency will receive public comment on the rule until that date. CMS determined that, under the Administrative Procedures Act, it could forgo the usual notice-and-comment rulemaking process because it found, for good cause, that those procedures would be impractical, unnecessary or contrary to the public interest.
Although the Interim Final Rule will go into effect before the agency has reviewed public comment, CMS says that it will consider comments "in deciding the next steps following this interim final rule."
For More Information
If you have any questions about this Alert, please contact Erin M. Duffy, Neville M. Bilimoria, Annie Blackman, any of the attorneys in our Health Law Practice Group or the attorney in the firm with whom you are regularly in contact.
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