Attorneys General from 20 states asked a federal judge to grant a temporary injunction halting implementation of changes to new rules affecting minimum nursing home staffing requirements announced by the Centers for Medicare and Medicaid Services (“CMS”) on April 22, 2024. 1
In his opinion, issued on January 16, 2025, Judge Strand, United States District Judge for the Northern District of Iowa, indicated that the plaintiffs failed to demonstrate a preliminary injunction is necessary and further stated that as the 24/7 registered nurse requirements and minimum hours-per-day requirements don’t take effect until May 2026, the alleged harm on Plaintiffs was too speculative to constitute irreparable harm, a requirement to secure a temporary injunction.
However, the litigation is still pending as the court considers whether the action taken by CMS is arbitrary and capricious. Judge Strand noted that the plaintiffs’ efforts would be best directed to arguing the merits of the matter as opposed to seeking to halt the implementation of the rule, stating: “the interests of justice will be best served by proceeding quickly to the dispositive motions stage of this case, thus allowing the parties to address the merits directly, rather than through the lens of a motion for a preliminary injunction”.
President Trump has nominated Dr. Mehmet Oz to lead CMS. There is no date set yet for the Senate confirmation hearing for Dr. Oz. However, President Trump has appointed Dr. Dorothy Fink as Acting Secretary of the Department of Health and Human Services (“HHS”). On January 21, 2025, Acting Secretary Fink ordered an immediate pause on issuing documents, regulations, and public communications. A link to the Memorandum is here: https://www.documentcloud.org/documents/25502931-acting-hhs-secretary-communications-memo-1-21-25/ The communication freeze is in place until February 1, 2025. Acting Secretary Fink indicates that “[t]he President’s appointees intend to review documents and communications expeditiously and return to a more regular process as soon as possible”.
Separately ordered by President Trump is a regulatory freeze, including new proposals for regulations, until such time as a department or agency head appointed or designated by President Trump reviews and approves all new proposed regulations. The regulatory freeze is in place for 60 days from January 20, 2025 and will allow the new administration time to determine its regulatory priorities and scope of forthcoming changes to regulations already in place.
Additionally, CMS implements a new rule requiring an RN to be onsite 24 hours a day/seven days a week and that such RN must be available to provide direct resident care.
Health care providers, including nursing facilities, should anticipate action to be forthcoming from the Trump Administration and we will be monitoring all actions which will impact healthcare providers and skilled nursing facilities.
[1] Under the new rule, CMS is requiring all nursing homes that receive federal funding through Medicare and Medicaid to provide a minimum of 3.48 hours of total direct nursing care to residents, of which .55 hours must be provided by a Registered Nurse and 2.45 hours to be provided by nurse aids. CMS clarifies that facilities are able to use any combination of nursing staff (RN, LPN, LVN, or nurse aides) to account for the additional .48 hours needed to comply with the new standards.
