Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities

<RULE> DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Centers for Medicare & Medicaid Services</SUBAGY> <CFR>42 CFR Part 483</CFR> <DEPDOC>[CMS-3442-IFC]</DEPDOC> <RIN>RIN 0938-AV25</RIN> <SUBJECT>Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). <HD SOURCE="HED">ACTION:</HD> Interim final rule with comment period. <SUM> <HD SOURCE="HED">SUMMARY:</HD> This interim final rule with comment period repeals provisions of the final rule titled “Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting.” This action is taken in view of changes made by by public law, which precludes HHS from implementing, administering, or enforcing certain provisions of the final rule until September 30, 2034. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> These regulations are effective on February 2, 2026. <E T="03">Comment date:</E> To be assured consideration, comments must be received at one of the addresses provided below, by February 2, 2026. </EFFDATE> <HD SOURCE="HED">ADDRESSES:</HD> In commenting, please refer to file code CMS-3442-IFC. Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed): 1. <E T="03">Electronically.</E> You may submit electronic comments on this regulation to <E T="03">http://www.regulations.gov.</E> Follow the “Submit a comment” instructions. 2. <E T="03">By regular mail.</E> You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-3442-IFC, P.O. Box 8016, Baltimore, MD 21244-8016. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. <E T="03">By express or overnight mail.</E> You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-3442-IFC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. For information on viewing public comments, see the beginning of the <E T="02">SUPPLEMENTARY INFORMATION</E> section. <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> The Clinical Standard Group's Long Term Care Team at <E T="03">HealthandSafetyInquiries@cms.hhs.gov.</E> </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <E T="03">Inspection of Public Comments:</E> All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following website as soon as possible after they have been received: <E T="03">http://www.regulations.gov.</E> Follow the search instructions on that website to view public comments. CMS will not post on <E T="03">Regulations.gov</E> public comments that make threats to individuals or institutions or suggest that the commenter will take actions to harm an individual. CMS continues to encourage individuals not to submit duplicative comments. We will post acceptable comments from multiple unique commenters even if the content is identical or nearly identical to other comments. <HD SOURCE="HD1">I. Background</HD> In the May 10, 2024 <E T="04">Federal Register</E> (89 FR 40876), the Centers for Medicare & Medicaid Services (CMS), published a final rule titled “Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting” (hereinafter referred to as 2024 Minimum Staffing final rule). This rule, among other items, established minimum staffing standards for long-term care facilities participating in Medicare and Medicaid programs. The standards were informed by data and literature available in 2022 and 2023. On July 4, 2025, Public Law 119-21 was signed into law. Section 71111 of Public Law 119-21 prohibits CMS from implementing, administering, or enforcing the minimum staffing standards set forth in § 483.5, definitions related to staffing requirements, and § 483.35, requirements for a registered nurse (RN) to be onsite 24 hours, 7 days per week and that each facility provides a minimum of 0.55 RN, 2.45 nurse aide (NA), and 3.48 total nurse staffing hours per resident day (HPRD), for a specified time period. This legislative action effectively suspends implementation of these provisions until September 30, 2034. <HD SOURCE="HD1">II. Basis for Repeal</HD> <HD SOURCE="HD2">A. Legislative Moratorium</HD> Section 71111 of Public Law 119-21 precludes CMS from implementing, administering, or enforcing the minimum staffing standards established in the 2024 Minimum Staffing final rule (89 FR 40876) until after September 30, 2034. This prohibition renders portions of §§ 483.5 and 483.35 unenforceable and unimplementable during the period before October 1, 2034. Congress has thus effectively suspended these provisions for that period. We believe that this prohibition warrants restoration of the previous version of the Code of Federal Regulations (CFR). Without such revisions, the regulations would lack nurse staffing standard that implements the minimum requirements for long-term care facilities set forth in sections 1819(b)(4)(C)(i) and 1919(b)(4)(C)(i) of the Act. <HD SOURCE="HD2">B. Policy Considerations</HD> HHS and CMS are committed to protecting the health and safety of residents in long-term care facilities. Following the publication of the final rule, interested parties continue to express their concerns over the establishment of the quantitative minimum staffing standards, requiring a RN to be onsite 24 hours, 7 days per week and that each facility provides a minimum of 0.55 RN, 2.45 NA, and 3.48 total nurse staffing HPRD. LTC facilities, particularly those within rural and tribal communities, raised significant concerns that these standards, even with a comprehensive exemption process in place, could increase the risk of facility closure, thus potentially decreasing access to healthcare. Rural and tribal communities face a specific challenge of geographic isolation, making it difficult to recruit nurses and for patients to access care. <SU>1</SU> <FTREF/> LTC facilities continue to note hiring challenges due to the existing labor supply and available resources despite their best efforts to meet these requirements. The National Indian Health Board stated that the 2024 final rule would be catastrophic for keeping facilities open and meeting the trust and treaty obligations in healthcare because of the difficulty of staffing in Indian Country. Further, they noted that LTC facility closures like this in tribal communities do not just remove jobs but break cultural bonds and remove elders from their communities. <FTNT> <SU>1</SU>  Taylor, Noelle, et al. “Promising Practices to Address Healthcare Needs Voiced by Local Native Americans.” <E T="03">DigitalCommons@USU,</E> 2025, <E T="03">digitalcommons.usu.edu/tcjournal/vol2/iss1/4/.</E> Accessed September 18, 2025. </FTNT> Likewise, multiple sources have described the current and projected shortages, including the International Council of Nurses (ICN) report calling for the worldwide shortage of nurses to be treated as a global health emergency. The report, titled <E T="03">Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness</E> , <SU>2</SU> <FTREF/> details the impact that the pandemic had on the world's nursing workforce, nurse burnout, and access to care. The National Center for Workforce Analysis (NCHWA)  <SU>3</SU> <FTREF/> projects nationwide nursing shortages, including a shortage of 295,800 nurses nationwide, with larger shortages of nurses in nonmetropolitan areas including rural and tribal communities. In addition, according to a <E T="03">Health Workforce Analysis</E> published by the Health Resources and Services Administration (HRSA), authorities project just 63,720 people working as full-time RNs in 2030. Lastly, the American Association of Colleges of Nursing predicts that RN shortages will continue over the next decade and beyond, with a 13 percent deficit in the total number of RNs in nonmetropolitan areas predicted to be needed in the United States by 2037, and a 5 percent deficit of RNs predicted for metropolitan areas of the country. <SU>4</SU> <FTREF/> <FTNT> <SU>2</SU>  Buchan, James, and Howard Catton. <E T="03">RECOVER to REBUILD INVESTING in the NURSING WORKFORCE for HEALTH SYSTEM EFFECTIVENESS International Council of Nurses the Global Voice of Nursing.</E> 2023. </FTNT> <FTNT> <SU>3</SU>  McGhee, Moira. “A Crisis by the Numbers: Nursing Shortages in 2025 by State.” <E T="03">Yahoo Finance,</E> Vivian Health, February 24, 2025, <E T="03">finance.yahoo.com/news/crisis-numbers-nursing-shortages-2025-163000209.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAACgfnz8Zi44P6ei-zweMuE0reqyIi9N19l_UIZVnmeFi0iHKKbYKSrtXhK23rJ6yZQ9Ny2dDkmXAlJropGQI2grGod8aHqswrTZBa0eiYk6EEyW9usg5XEYExAWFSvEP24uxek-T5cxKAvfjFgVRWHFZDR98zsEBIafohInLbBiH.</E> Accessed September 5, 2025. </FTNT> <FTNT> <SU>4</SU>  American Association of Colleges of Nursing. “Nursing Shortages Fact Sheet.” American Association of Colleges of Nursing, 2024, <E T="03">www.aacnnursing.org/news-data/fact-sheets/nursing-shortage.</E> </FTNT> Furthermore, two district courts have vacated at the summary judgment stage the minimum staffing p ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 65k characters. 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