The original sponsor of the law to prevent federal staffing from taking effect said Wednesday that it plans to force the bill to pass even after a judge overturned the rules this week.
Rep. Michelle Fishbach (R-MN) explained her plans to the leading members who gathered in Washington, DC for a major lobbying event.
She said Monday that US District Judge Matthew J. Caxmalick's ruling in favour of the American Medical Association, Reading Age and four Texas Nursing Facilities was “great” and “a big step in the right direction.”
However, Fishbach also said he expects the Department of Health and Human Services to appeal the rules within the designated 60-day window.
“You're all familiar with the mission of nursing staff proportions proposed by the last administration and all the damage it would have to do to rural nursing homes,” she said. “So we're going to go ahead with the law because we need to make sure that this rule is overturned.”
Fischbach introduced the Protected Rural Seniors Access Act in 2023, about a month after the initial version of staffing rules was proposed by the Centers for Medicare and Medicaid Services. In late February 2025, she reintroduced the bill at the start of a new parliament. Deb Fischer (R-NE) and James Lankford (R-OK) also reintroduced versions of the bill.
For more than a decade, the senator has proposed to eliminate orders that would save the federal government $22 billion in expenses, perhaps for enforcement. This makes Fischbach's bill an important candidate for inclusion in a large budget settlement package.
“We need to make sure we remember that these things are affecting people in real life,” said Fischbach, a member of the House Ways and Means committee, which last year advanced a bill against staffing mandate. “It's really, really important for you to convey that message. It's about people. It's about our ageing population. It's about people who stay in their community.”
Leading President and CEO Katie Smith Sloan said this lobby day is particularly important for the aging services sector.
“We are concerned about the fate of funding for Medicaid, affordable senior housing, tax-free bond financing, and community-based services, especially in rural areas,” she wrote in her blog Wednesday. “We are constantly being challenged by the shortage of professional caregivers and are plagued by preventing nonprofit organizations from misrepresenting the role they play in our country's communities. We cannot predict the outcome of these and other debates currently taking place in Washington.
Uncertainty in DC and courts
Sloan called these “unprecedented, chaotic, fast-paced, uncertain times” for Washington and the sector. It is also effective for staffing duties.
Despite the judges leaving rules open in Texas, observers told McKnight that in that case provisions that were not expressly discussed in that case could withstand, such as changes to Medicaid transparency in the rules. In another case, the state attorney general and a group of leading affiliates seeking relief from the entire rules as it is being considered by the U.S. Northern Iowa District Court.
An Iowa judge has denied the temporary injunction and is now appealing to the 8th Circuit Court of Appeals. However, district court judges must still govern merits that may confirm or contradict Texas' judgment.
The clearest relief for providers is that CMS will either revoke or improve the rules, or Congress will block them.
Fischbach also has co-sponsored laws to stop training lockouts for nurse aides. She added that “focus needs to be shifted to education, recruitment and retention of qualified staff.”
She said lawmakers are aware of the need for and are trying to deal with the labor shortage, but the rules that enact the requirements for all staff “is not a solution.”
“Long-term care is a big part of a strong rural community, and we need to ensure that rural residents receive close care to relatives, friends in the community they know.
