Texas Sues Biden Administration Over Nursing Home Staffing Mandate

An article from

Dive Brief:

• Texas has sued the Biden administration over its rule setting minimum staffing levels in nursing homes in the latest legal challenge against the mandate, which is highly unpopular with the industry.
• In a lawsuit filed Wednesday in a Texas district court, Attorney General Ken Paxton urged the judge to vacate the regulation, arguing Medicare overstepped its authority in setting staffing levels without a specific directive from Congress.
• “The new requirements remove the historic flexibility of a nursing home to determine what is ‘sufficient to meet the nursing needs of its residents,’” the complaint reads. “Instead, the CMS Final Rule now imposes a one-size-fits-all rule that directly contravenes Congress’s stated flexible directive with rigid, inflexible requirements.”

Dive Insight:

The CMS finalized the rule in question earlier this year. The rule requires all nursing homes that receive federal funding through Medicare and Medicaid to have a registered nurse onsite for 24 hours a day, seven days a week. Nursing homes must also provide at least 3.48 hours of care per resident each day. At least 0.55 hours of that care must be provided by registered nurses.

The rule — which will start taking effect in 2026 — was meant to safeguard quality of care at nursing homes after a raft of concerning reports about deficient services during the COVID-19 pandemic. Research has shown that higher staffing levels contribute to better health outcomes for patients.

However, the Biden administration was slammed by nursing home operators for creating one-size-fits-all staffing standards, regardless of specific facilities’ needs. The industry also cited high costs of coming into line with the rule — compliance will cost nursing homes an estimated $43 billion over the next decade, according to government data — and difficulties finding enough caregiver to meet the rules’ requirements.

Texas’ new lawsuit against the HHS and CMS doubles down on those complaints, arguing that nursing homes across the state will be forced to shut down as a result of the regulation. The litigation cites a legal theory called the Major Questions Doctrine which holds agencies are not allowed to issue economically significant regulations without clear direction from Congress.

“This power grab by [President] Biden’s health bureaucrats could put much-needed care facilities out of business in some of the most underserved areas of our state,” Paxton said in a statement. “We are taking the federal government to court over this rule that could worsen rural care shortages by shutting down facilities due to new hiring quotas that are impossible to fill.”

The suit was filed in the Northern District Court of Texas, which is overseen by Judge Matthew Kacsmaryk. Kacsmaryk is a popular judge for plaintiffs looking to overturn government regulations — the Trump appointee has a history of conservative-leaning rulings, including in healthcare. Kacsmaryk suspended Food and Drug Administration approval of the abortion pill mifepristone last year.

The American Health Care Association, an association representing long-term and post-acute care providers, filed its lawsuit looking to overturn the nursing home staffing mandate in the same district this spring.