The Centers for Medicare & Medicaid Services has officially repealed the federal minimum staffing requirements for nursing homes, ending a contentious two-year regulatory battle that pitted patient advocates against industry groups. The final rule, published in the Federal Register on December 3, 2025, eliminates the 3.48 hours per resident day (HPRD) staffing floor and the 24/7 registered nurse requirement that were finalized in April 2024.
Background on the Mandate
The original 2024 rule established the first-ever federal minimum staffing standards for nursing homes, requiring facilities to provide at least 0.55 RN hours per resident day, 2.45 nurse aide hours per resident day, and a registered nurse on-site around the clock. CMS estimated the rule would have affected approximately 75% of nursing homes and required the sector to hire an additional 102,000 workers.
The rule faced immediate legal challenges from industry groups and state attorneys general, with opponents arguing it was financially infeasible given existing workforce shortages and Medicaid reimbursement constraints. In July 2025, Congress passed Public Law 119-21, which prohibited CMS from implementing or enforcing the staffing standards through September 30, 2034.
HHS Rationale
In rescinding the rule, HHS stated that the staffing mandate “imposed disproportionate burdens on facilities, especially those serving rural and Tribal communities, and jeopardized patients’ access to care.” The agency cited workforce data showing that many facilities, particularly in rural areas, would have been unable to meet the staffing floors regardless of financial resources due to labor market constraints.
HHS also pointed to analysis suggesting that strict enforcement could have triggered facility closures, reducing overall access to nursing home care. The department estimated that 1,900 facilities nationwide were at “high risk” of closure under the mandate.
Industry Reaction
The American Health Care Association called the repeal “a victory for common sense and patient access,” noting that the original rule failed to account for the nationwide healthcare workforce shortage. AHCA President Mark Parkinson stated, “We have always supported staffing levels that ensure quality care, but arbitrary federal mandates disconnected from labor market realities would have done more harm than good.”
The nursing home industry had argued that compliance would cost an estimated $6.8 billion annually, costs that could not be absorbed given Medicaid rates that already fail to cover the cost of care in most states.
Advocate Response
Patient advocacy groups condemned the repeal. The National Consumer Voice for Quality Long-Term Care called the decision “a devastating blow to the 1.2 million Americans living in nursing homes.” The organization noted that the original rule was estimated to save 13,000 lives annually.
Senator Ron Wyden (D-OR) issued a statement calling the repeal “a gift to the nursing home industry at the expense of vulnerable seniors and people with disabilities.” Several Democratic lawmakers have vowed to pursue legislative reinstatement of staffing standards.
What This Means for Facilities
With the federal mandate repealed, staffing requirements revert to the pre-2024 framework, which requires only “sufficient nursing staff” to meet resident needs without specifying numeric minimums. State-level staffing requirements, which vary widely, remain in effect. Facilities in states like California and New York with existing state mandates will continue to face those requirements.
CMS has indicated it will continue to monitor staffing levels through Payroll-Based Journal data and may cite facilities for quality deficiencies if inadequate staffing leads to care failures, but there will be no standalone staffing citations based on numeric thresholds.