Nursing home industry sues Biden administration over staffing rule

An industry lawsuit is urging a federal court to overturn the Biden administration’s new mandatory minimum staffing requirements on nursing homes, arguing the federal Medicare agency exceeded its authority. 

The complaint argues Congress never gave the Centers for Medicare and Medicaid Services (CMS) the authority “to impose such onerous and unachievable mandates on practically every nursing home in the country,” so the rules are a violation of the Administrative Procedure Act. 

It was filed last week in the Northern District of Texas by the American Health Care Association (AHCA), its Texas counterpart and the operators of three nursing homes in the state. 

“Setting one-size-fits-all staffing requirements that will require some four-fifths of the nation’s nursing homes to hire additional personnel, even though almost no state has deemed those higher levels necessary … is the height of arbitrary and capricious agency action,” the complaint stated.    

The lawsuit argues the requirements will force facilities to close or downsize, displacing tens of thousands of residents and “forcing countless other seniors and family members to wait longer, search farther, and pay more for the care they need.” 

Under the requirements unveiled last month, all nursing homes that receive federal funding through Medicare and Medicaid will need to have a registered nurse on staff 24 hours per day, seven days per week and provide at least 3.48 hours of nursing care per resident per day. 

The rules will cost nursing homes $43 billion over the next decade, according to estimates from the Department of Health and Human Services (HHS).   

The requirements of the rule will be introduced in phases, with longer timeframes for rural communities. Limited, temporary exemptions will be available for both the 24/7 registered nurse requirement and the underlying staffing standards for nursing homes in workforce shortage areas that demonstrate a good faith effort to hire.   

Nonrural facilities must meet the requirements by May 2027, and rural facilities have five years, until May 2029. 

But according to the lawsuit, the staffing requirements “flunk basic principles of administrative law at every turn.” 

“We had hoped it would not come to this; we repeatedly sought to work with the Administration on more productive ways to boost the nursing home workforce,” Mark Parkinson, President and CEO of AHCA, said in a statement.  

Notably, the lawsuit was filed in federal court in Amarillo, Texas. Texas is a popular venue for groups looking to get favorable rulings against the Biden administration, and the district court in Amarillo has only one judge, Matthew Kacsmaryk. 

Kacsmaryk, an appointee of former President Trump, is the same judge who suspended approval of the abortion pill mifepristone and has ruled against the Biden administration on several other issues, including immigration and LGBTQ protections.