CMS Rescinds Biden-Era Nursing Home Minimum Staffing Mandate

The Centers for Medicare and Medicaid Services (CMS) announced an Interim Final Rule on December 3, 2025, which rescinds the Biden administration's 2024 minimum staffing standards for nursing homes under Medicare and Medicaid. The original rule, published in May 2024, mandated 24/7 onsite skilled nursing care and a minimum of 3.47 staffing hours per resident per day, aiming to address chronic understaffing and improve care quality but was met with significant opposition from the nursing home industry. Critics argued that the rule would impose undue financial and operational burdens, particularly on rural nursing facilities, with projected industry costs reaching $43 billion over ten years and requiring the hiring of tens of thousands of additional nursing staff. Legal challenges quickly followed, with two federal courts vacating the rule, stating it exceeded CMS's statutory authority and was arbitrary. These rulings, coupled with legislative delay through HR 1 in 2025, signaled a strong pushback against the staffing mandates. The Trump administration eventually dismissed its appeal defending the rule in October 2025. In the new Interim Final Rule, CMS justified the rescission by citing the disproportionate burdens the 2024 standards placed on facilities in rural and Tribal communities. Reaction to the rescission has been mixed. Industry leaders in assisted living welcomed the Interim Final Rule, while nursing home consumer advocacy groups criticized it, maintaining that the original standards included adequate exceptions and expressing concerns about the lack of a replacement plan to address staffing shortages. CMS will accept public comments on the Interim Final Rule through February 2, 2026, despite the rule taking immediate effect on that date. The agency has indicated that it will consider feedback received to determine future regulatory steps. This regulatory reversal highlights the ongoing tension between improving care quality in long-term care settings and the operational challenges faced by providers, especially in underserved areas. It underscores the evolving landscape of healthcare regulation affecting Medicare and Medicaid providers and the complexities of balancing regulatory compliance, industry capacity, and patient access to care. Stakeholders should monitor further CMS actions as the agency evaluates public input and potential alternative strategies to address staffing issues in nursing homes.