CMS repeals 2024 nursing home staffing mandate

On December 3, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a significant policy reversal by repealing the 2024 federal minimum staffing requirements for long-term care (LTC) facilities. This interim final rule rescinds the quantitative standards that mandated continuous registered nurse (RN) coverage and specific hours per resident per day (HPRD) from May 2024, reverting LTC facilities to previous staffing criteria.

Staffing standards rollback and implications

The 2024 rule had required LTC providers to maintain at least one RN onsite 24 hours a day, seven days a week. It also set minimum daily staffing levels of 0.55 RN hours, 2.45 nurse aide hours, and 3.48 total nursing hours per resident. With the repeal, these mandates are no longer enforceable. Instead, facilities will follow the former statutory standard requiring an RN onsite for a minimum of eight consecutive hours daily without any automatic round-the-clock staffing obligation, unless waived.

This rollback responds to a federal statute enacted earlier in 2025 prohibiting CMS from enforcing the more stringent 2024 staffing rules until September 30, 2034. CMS and the Department of Health and Human Services (HHS) cited concerns that a uniform, inflexible staffing model overlooks variations in facility size, location, and workforce availability—particularly in rural and tribal settings. The agencies warned that strict enforcement could lead to facility closures, ultimately decreasing access to care for vulnerable populations.

Remaining regulatory requirements and sector impact

CMS clarified that other provisions from the 2024 regulation remain intact. These include enhanced facility assessments and certain transparency measures, especially those related to Medicaid institutional payment disclosures. LTC providers must continue adherence to these non-staffing elements to maintain compliance.

The staffing repeal presents a dual impact. Advocates who viewed the original minimum staffing rule as essential to improving resident safety and care quality regard this as a setback. Research and advocacy groups have linked higher staffing ratios with reductions in adverse events for residents. Conversely, LTC operators—particularly those contending with staffing shortages and limited funding in less populated regions—may find relief in the renewed flexibility. The rollback reduces the regulatory burden amid ongoing workforce challenges.

Looking forward

This policy reversal marks a pivotal moment in federal LTC regulation, reaffirming the balance CMS seeks between safeguarding care standards and ensuring operational feasibility for providers. Stakeholders should anticipate continued monitoring of staff-related policies, as workforce dynamics and legislative actions evolve. Facilities should also remain vigilant about compliance with ongoing transparency and assessment requirements.