HHS Repeals Federal Nursing Home Staffing Rule Following Legal Challenge by LeadingAge Iowa

The U.S. Department of Health and Human Services (HHS) has formally repealed portions of the 2024 minimum staffing standards for long-term care facilities, originally issued by the Centers for Medicare & Medicaid Services (CMS). This decision follows a successful legal challenge by a coalition of states and providers, including LeadingAge Iowa. 

The 2024 rule would have required Medicare- and Medicaid-participating nursing homes to guarantee a minimum of 3.48 hours of direct nursing care per resident per day, including a set amount from registered nurses, and mandated that a registered nurse be on-site 24/7. LeadingAge Iowa advocated against these one-size-fits-all mandates that would disproportionately harm facilities in rural communities, where workforce shortages are already acute, and could jeopardize access to care. 

Earlier in 2025, the U.S. District Court for the Northern District of Iowa vacated the provisions requiring 24/7 RN staffing and the fixed hours-per-resident mandate, ruling that CMS lacked statutory authority to impose such rigid nationwide requirements. 

By withdrawing the staffing mandates, HHS has removed a significant regulatory burden, especially for providers serving rural communities. The repeal underscores a renewed federal emphasis on flexibility and local control in long-term care, and opens the door for more stakeholder engagement in future policy decisions. 

For LeadingAge Iowa and its members, this outcome safeguards the ability to continue serving older adults in communities across Iowa without facing unsustainable staffing obligations. LeadingAge Iowa remains committed to supporting its provider members, advocating for practical policies that protect access to high-quality care while helping providers navigate regulatory challenges. To read more, click here.