HHS Rescinds Skilled Nursing Facilities Mandate: Is This a Win for Nursing Homes?
The U.S. Department of Health and Human Services (HHS) has officially rescinded the controversial skilled nursing facilities staffing mandate, a move that has sent ripples throughout the healthcare industry. This decision, impacting numerous nursing homes across the nation, particularly those in rural and tribal communities, raises a critical question: HHS Rescinds Skilled Nursing Facilities Mandate: Is This a Win for Nursing Homes?
The Backstory: The Skilled Nursing Facilities Staffing Mandate
In May 2024, the Biden administration finalized a rule mandating minimum staffing levels for nursing homes participating in Medicare and Medicaid programs. This rule required facilities to provide a minimum of 3.48 hours of nursing care per resident per day (HPRD), including at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Additionally, the mandate stipulated that a registered nurse be present on-site 24 hours a day, seven days a week.
The Centers for Medicare & Medicaid Services (CMS) argued that these measures were essential to improve the quality of care in nursing homes, addressing concerns highlighted by over 46,000 public comments received during the rule’s development. However, the mandate faced fierce opposition from long-term care industry groups and Republicans, who warned of untenable costs and potential facility closures due to widespread workforce shortages.
HHS Pulls the Plug: The Rescission
On December 2, 2025, HHS announced the repeal of key provisions of the 2024 final rule. This decision, championed by the Trump administration, effectively eliminates the 24/7 on-site RN requirement and the specific minimum number of nursing hours per resident per day. The facility assessment requirements adopted in the 2024 final rule will remain in place.
HHS Secretary Robert F. Kennedy Jr. stated, “Safe, high-quality care is essential, but rigid, one-size-fits-all mandates fail patients. This Administration will safeguard access to care by removing federal barriers—not by imposing requirements that limit patient choice.” CMS Administrator Dr. Mehmet Oz echoed this sentiment, emphasizing the need for practical solutions that work for all communities, including rural and underserved populations.
Why Rescind the Mandate? The Rationale
HHS justified the rescission by citing several factors:
- Disproportionate Burden on Rural and Tribal Communities: The agency determined that the mandate would disproportionately burden facilities serving rural and tribal communities, which already face severe healthcare workforce shortages. According to the most recent CMS Nursing Home Staffing Dashboard (2025 update), more than 60 percent of rural facilities reported “severe difficulty” hiring RNs, compared with 32 percent of suburban facilities. In several Tribal regions, vacancy rates for certified nursing assistants (CNAs) exceeded 40 percent.
- Risk of Facility Closures and Reduced Access to Care: HHS expressed concern that the mandate could lead to facility closures and reduced access to care, particularly in areas with limited long -term care options. Implementing a numerical staffing threshold could drive nursing homes to further reduce capacity or close in order to meet the requirements. Fewer nursing home beds could adversely impact hospital patients who are denied the specialized care they are prescribed when they must stay, sometimes months, in hospital beds awaiting discharge to post-acute care settings. This could become especially dire in rural and underserved communities.
- Inadequate Consultation with Tribal Communities: Tribal leaders argued that the 2024 rule did not include meaningful consultation, despite its significant effect on Indian Health Service long-term care programs. HHS pledged that future regulatory changes affecting Tribal health services will undergo full government-to-government consultation.
- Financial Strain on Facilities: The agency pointed to the projected financial burden on facilities already operating with thin margins, with estimates suggesting the mandate would cost the industry billions of dollars annually.
A Win for Nursing Homes? The Industry Perspective
The nursing home industry has largely applauded the HHS decision. The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) have been vocal opponents of the mandate, arguing that it was unrealistic and threatened to close nursing homes and displace vulnerable residents.
Clif Porter, president and CEO of AHCA/NCAL, called the HHS move a “victory for our nation’s seniors and their families.” He stated that the rescission recognizes the very real barriers that nursing homes navigate in recruiting and retaining staff.
Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit aging services providers, echoed this sentiment, emphasizing the need for meaningful investments in the long-term care workforce and the advancement of smart policies to realize the necessary numbers of trained and qualified nurse aides, registered nurses, licensed practical nurses, and other [nursing home] caregivers.
Concerns and Criticisms: The Other Side of the Coin
While the nursing home industry celebrates the rescission, patient advocacy groups and some lawmakers have expressed strong concerns. They argue that the mandate was a crucial step toward improving the quality of care in nursing homes and protecting vulnerable residents from neglect and abuse.
The National Consumer Voice for Quality Long-Term Care described the staffing requirements as “the most significant increase in protections for nursing home residents in decades.” The group said it “strongly condemns” the health department dropping the rule. “The minimum staffing rule was estimated to save 13,000 lives annually and enhance the quality of care and life for nursing home residents,” the group said.
Richard Mollot, executive director of the Long Term Care Community Coalition, expressed disappointment, stating that the rescission would exacerbate workforce shortages at area eldercare facilities. “But it at least set a floor that would have improved life for many,” Mollot said. “This is particularly true for residents in New York nursing homes, which persistently have some of the lowest staffing levels in the nation.”
The Impact on Patient Care and Potential Injuries
The rescission of the skilled nursing facilities mandate raises concerns about potential impacts on patient care and the risk of injuries. Understaffing in nursing homes has been linked to various issues, including:
- Increased Risk of Falls: Insufficient staff can lead to inadequate supervision and assistance, increasing the risk of falls and related injuries.
- Medication Errors: Overworked and understaffed nurses may be more prone to making medication errors, which can have serious consequences for residents.
- Pressure Ulcers (Bedsores): Lack of staff can result in residents not being repositioned frequently enough, leading to the development of pressure ulcers.
- Infections: Inadequate staffing can compromise infection control measures, increasing the risk of infections spreading among residents.
- Neglect and Abuse: In extreme cases, understaffing can contribute to neglect and even abuse of residents.
If a nursing home resident suffers an injury due to understaffing or inadequate care, they may have grounds to file a personal injury claim against the facility. These claims can help recover compensation for medical expenses, pain and suffering, and other damages.
The Road Ahead: What’s Next?
While the federal mandate has been rescinded, it’s important to note that state regulations setting minimum staffing at nursing homes may still be in place. For example, New York State requires nursing homes to devote at least 3.5 hours of medical care to residents daily, including a minimum of 1.1 hours from a licensed nurse and 2.2 hours from nurses’ aides.
CMS will continue monitoring staffing, quality metrics, infection-control performance, and resident outcomes. Facilities still must:
- Maintain adequate staffing to meet resident needs.
- Comply with state-level staffing requirements.
- Report staffing levels through the Payroll-Based Journal (PBJ) system.
The HHS has opened a 60-day comment period, with all comments due by February 2, 2026. CMS says that it will consider comments “in deciding the next steps following this interim final rule.”
Conclusion: A Complex Issue with No Easy Answers
The HHS decision to rescind the skilled nursing facilities mandate is a complex issue with no easy answers. While the nursing home industry argues that the mandate was burdensome and unrealistic, patient advocates worry about the potential impact on the quality of care and resident safety.
Ultimately, the question of whether this rescission is a “win” for nursing homes depends on how facilities respond. If they prioritize resident care and invest in attracting and retaining qualified staff, it could be a positive development. However, if they use the rescission as an opportunity to cut costs and further reduce staffing levels, the consequences for residents could be dire.