In Surprise Move, DHHS Appeals District Court Decision to Strike Down Long Term Care Staffing Mandates

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On April 7, 2025, U.S. District Judge Matthew J. Kacsmaryk of the Northern District of Texas struck down the Biden administration’s final rule related to federally imposed minimum staffing requirements for long term care facilities (“Final Rule”).[i]  The hope then was that the Trump administration would be unlikely to appeal the District Court’s decision, providing relief for nursing home operators.[ii]   However, on June 2, 2025, the Department of Health and Human Services (DHHS) notified the District Court it is appealing Judge Kacsmaryk’s decision to the Fifth Circuit Court of Appeals. [iii]

The Final Rule was highly unpopular with the nursing home industry as it sought to mandate minimum levels of nursing staff, require a 24/7 RN on-site requirement, and implement new requirements related to facility staffing assessments while not providing any related funding to support the new requirements.[iv]  At the time, the American Health Care Association’s (AHCA) CEO, Mark Parkinson, agreed that the Final Rule “may be well intentioned” but that it would “threaten[] to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors' access to care.”[v] 

The President and CEO of LeadingAge[vi] issued a statement on June 3, 2025 regarding the HHS appeal, stating:  “It is unfortunate that more time and taxpayer dollars must be wasted debating this unrealistic regulation when ultimately, our legal arguments will prevail. From the start, the rule has been an unnecessary distraction from the real task at hand: strengthening the long-term care workforce. . . ”[vii]

Cliff Porter, the President and CEO of AHCA/NCAL, echoed the sentiment that the goal is to strengthen the long-term care workforce.  On April 7, 2025, while calling the Final Rule an “unrealistic staffing mandate,” Mr. Porter continued to call on Congress for assistance in creating “a variety of workforce solutions that would help build a pipeline of new caregivers, attract them to long term care, and develop their skills and career.”[viii]  

As the DHHS appeal works its way through the Fifth Circuit Court of Appeals, both sides are likely to vigorously defend their positions and a final decision could lean either way.  In the meantime, the current Congressional budget includes a section titled “Preventing wasteful spending” that would impose a moratorium on the implementation of the Final Rule.[ix]  If the budget section is enacted, it would prevent the Final Rule from being implemented until January 1, 2035.

In summary, the fate of the Final Rule is in flux as DHHS’ appeal keeps the Final Rule in play.  However, relief from the staffing mandates may come in the form of a Congressional moratorium on implementation of the Final Rule and/or the Fifth Circuit Court of Appeals may uphold the District Court’s decision to strike down the Final Rule.

If you need assistance with navigating nursing home surveys or another long term care or post-acute care issue, please reach out to Maynard Nexsen for assistance. 

_{[i] See previous article on the District Court’s decision to strike down the Long Term Care Mandates at https://www.maynardnexsen.com/publication-federal-judge-strikes-down-long-term-care-staffing-mandates-nursing-home-industry-cheers-while-also-signaling-a-continuing-need-for-workforce-solutions; see CMS fact-sheet at: https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0}

_{[ii] Court tosses Biden nursing home staffing standard}

_{[iii] See Defendants’ Notice of Appeal, American Health Care Association, et al. v. Robert Kennedy, Jr., et al., Case No: 2:24-cv-00114-Z-BR, Doc. 103.}

_{[iv] The AHCA’s analysis of the staffing mandate is available at https://www.ahcancal.org/Data-and-Research/Pages/Staffing-Mandate-Analysis.aspx and https://www.ahcancal.org/Workforce-and-Career/Pages/Staffing-Mandate.aspx.}

_{[v] Nursing Homes React to Staffing Mandate Final Rule (ahcancal.org)}

_{[vi] LeadingAge is an advocacy group of a membership of nonprofit ageing services providers and other mission-driven organizations serving older adults.  https://leadingage.org/about-us/}

_{[vii] https://leadingage.org/leadingage-reax-department-of-health-and-human-services-appeal-of-u-s-district-courts-april-7-2025-nursing-home-staffing-mandate-ruling/}

_{[viii] AHCA Applauds Court Vacating the Federal Staffing Mandate}

_{[ix] https://www.govtrack.us/congress/bills/119/hr1/text at Subpart B, Sec. 44121.}