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A federal judge in Texas blocked nursing home staffing rules mandated by the Biden administration last year.
In May 2024, a month after the final rule was released, the American Medical Association, the Texas Health Care Association, the Arbrook Plaza, Booker Hospital District, and the Harbor Lakes Nursing and Rehabilitation Center filed lawsuits in federal court in the Northern District of Texas.
The plaintiff said the final rules imposing minimum staffing requirements on nursing homes exceeded the statutory authority.
On April 7th, Judge Matthew J. Cuxmalick agreed.
“Though rooted in a commendable goal, the final rules still need to be consistent with Congressional law,” Kaxmalick ruled. “Otherwise, they lack legislative authority to allow agencies to amend the law. The separation of power demands more than admirable intentions.”
The ruling party listed nursing home “failures” of “inadequate staffing levels, poor infection control, failed monitoring and regulation, and failures in flaws that cause actual patient harm.”
Kacsmaryk said: “The final rule seeks to remedy the defects in chronic nursing homes, but it is highly flawed. Nursing facilities participating in Medicare or Medicaid must have registered nurses on staff at least 24 hours a day.
These flaws deserve an effective response, but the regulatory response must be consistent with legislation in the legislature that governs the council's nursing homes, Kaxmalick said.
The rules sought to require all participant nursing homes to achieve minimum staffing hours based on the number of facilities, but required council to consider the facility's individual nursing needs.
The court granted the plaintiff's motion for summary judgment and rejected the defendant's mutual claim for summary judgment.
Why is this important?
The final rules for the Centers for Medicare and Medicaid Services required residents to provide nursing facilities participating in the Medicare and Medicaid programs with a minimum of 3.48 hours of nursing care per day, including at least 0.55 hours of care from registered nurses per resident per day, and 2.45 hours of care from nurses per resident per day.
Nursing facilities required registered nurses to serve as registered nurses on the site 24 hours a day, seven days a week.
The American Hospital Association said the final rule is “funny” given that nursing homes already face staffing challenges.
“This final rule could either acquire nursing homes and reduce capacity, including high performance on quality and safety indicators, or be completely intimate,” EVP Stacey Hughes said at the time.
In April 2024, when the rules were released, CMS said it had developed a $75 million national nursing home staff campaign to increase the number of nurses.
Bigger trends
The Biden administration launched the rules after the government discovered that more than 40% of Americans killed during the Covid-19 pandemic lived in nursing homes.
An estimated 62,000 nursing home residents have died of Covid-19 as of September 2020. An estimated 1.2 million residents are in care at Medicare and Medicaid-certified nursing homes.
CMS said it received and considered more than 46,000 public comments on the rules from a variety of stakeholders, including residents and their families, workers, advocates and the industry.
Many of these comments highlighted that without adequate staff, residents were not receiving the necessary care, such as trips to the bathroom or toilet, and experienced preventable safety events such as pressure ulcers and waterfalls.
Email the writer: smorse@himss.org
