Trump Administration Repeals Misguided, Biden-Era Minimum Staffing Requirements for Long-Term Care Facilities

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WASHINGTON, D.C. - The U.S. Department of Health and Human Services (HHS) formally repealed Biden-era minimum staffing requirements for long-term care facilities (LTC), which affected nearly 1.2 million residents across the nation. The rule exacerbated workforce shortages and significantly harmed access to care in rural communities. Reversal of the mandates demonstrates a commitment to "practical, sustainable approaches to improving nursing home care, and allows for further opportunity for engagement with community and Tribal stakeholders," according to HHS.

The 2024 rule required applicable nursing homes to provide residents with a minimum total of 3.48 hours of nursing care per day, including at least 0.55 hours from a registered nurse per resident per day, and 2.45 hours from a nurse aide per resident per day. It mandated each facility have a registered nurse onsite 24/7. HHS said these measures disproportionately burdened rural and underserved communities already grappling with critical health care workforce shortages.

U.S. Senator Kevin Cramer (R-ND) raised concerns over the harmful impact of the Centers for Medicare & Medicaid Services' (CMS) staffing ratio for rural communities and North Dakota families. He led multiple efforts, including bipartisan legislation, to push back against the rule, culminating in the passage of the Working Families Tax Cut Act which included a 10-year moratorium on enforcement of the staffing mandate.

He applauded the Trump administration's announcement this week saying, "rural America deserves solutions, not red tape."

"Rolling back the burdensome, Biden-era staffing mandate is a major win for patients, providers, and every rural community depending on accessible, local long-term care," said Cramer. "Congress mandated a 10-year moratorium of this debilitating rule in the Working Families Tax Cut Act, and now the administration has finished the job. Thank you, President Trump, Secretary Kennedy, and Administrator Oz, for prioritizing patients over bureaucracy."

In a public comment before the rule was finalized, the North Dakota Long Term Care Association, North Dakota Hospital Association, North Dakota Medical Association, North Dakota Nurses Association, and the Quality Health Associates of North Dakota outlined their concerns.

The organizations highlighted CMS' misunderstanding of nursing facilities' operational realities and disclosed more than 500 nursing homes have closed since 2020, often due to the inability to hire qualified staff. They also noted CMS estimated the staffing rule would cost $4 billion annually, roughly $300,000 per facility.

The groups said, "North Dakota has always had one of the highest staff to resident ratios in the country. We are most concerned about the proposed 24/7 RN requirement. The number of RNs needed to fulfill this standard just simply do not exist. This mandate may force more nursing homes, many of which already operate on tight budgets, to close their doors, reducing access to care. North Dakota has had more nursing home closures in the last few years than ever before, largely due to staffing issues."

They concluded, "the mandate's strict penalties and limited flexibility in addressing temporary staffing shortages demonstrate a lack of understanding of the operational realities of nursing homes."

Nikki Wegner, President of the North Dakota Long Term Care Association, reacted to the Trump administration's revocation of the rule, "The formal repeal of the mandate is a long-awaited decision that acknowledges the ongoing workforce challenges facing providers and restores essential flexibility for facilities to staff in a way that best supports resident-centered care. This outcome reflects years of persistent advocacy by long term care providers, caregivers, residents, families, and partners across the country. We want to extend special thanks to Senator Cramer for his tireless leadership on this issue and to Senator Hoeven and Congresswoman Fedorchak for their steadfast support and advocacy."

Cramer met with CMS Administrator Dr. Mehmet Oz in July to discuss the reforms needed to improve care for North Dakotans. He delivered a floor speech highlighting dangers of the rule and sent a letter to CMS requesting the agency avoid one-size-fits-all staffing mandates for nursing homes. In the letter, Cramer and his colleagues said staffing mandates are not the only solution and a "one-size-fits-all staffing mandate would undermine access to care for patients, particularly in rural communities." In June 2023, he questioned CMS officials at a hearing about the mandate's impact on already stressed staffing challenges.

In March 2024, Cramer and U.S. Senator Angus King (I-ME) joined forces tointroduce the VA Report on Proposed CMS Staffing Ratios Act to require the Department of Veterans Affairs to submit a report regarding the proposed rule's impact on veterans access to LTC services. Cramer cosponsored U.S. Senator James Lankford's (R-OK) bipartisan Congressional Review Act resolution of disapproval to overturn the final rule issued by CMS.