{"id":57778,"date":"2025-04-21T16:02:00","date_gmt":"2025-04-21T16:02:00","guid":{"rendered":"https:\/\/www.dinsmore.com\/?post_type=publications&#038;p=57778"},"modified":"2025-12-31T15:57:43","modified_gmt":"2025-12-31T15:57:43","slug":"stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play","status":"publish","type":"publications","link":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/","title":{"rendered":"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/04\/Skilled-nursing-update-Header.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<p>On April 7, 2025, a Federal District Court in Texas vacated the controversial Centers for Medicare and Medicaid Services (\u201cCMS\u201d) proposal to require specific staffing requirements in skilled nursing facilities (\u201cSNFs\u201d).<a href=\"#_ftn1\" id=\"_ftnref1\">[1]<\/a> The court\u2019s decision has nationwide effect. The CMS proposal would have required SNFs to maintain a registered nurse (\u201cRN\u201d) ratio of 33 minutes per resident day (\u201cHPRD\u201d), two hours and 27 minutes for nurse aides and a 24\/7\/365 on-site RN requirement. Dinsmore has <a href=\"https:\/\/www.dinsmore.com\/publications\/proposed-cms-rules-would-impose-more-stringent-staffing-requirements-on-long-term-care-facilities\/\">reported previously<\/a> on the CMS Proposed Rule.<\/p>\n\n\n\n<p>Relying significantly on the Supreme Court\u2019s <em>Loper Bright<\/em> decision from 2024, the court determined that the CMS proposal overstepped the agency\u2019s authority and was inconsistent with Congress\u2019 legislative intent. For example, the Social Security Act states that a nursing facility must use the services of an RN for \u201cat least 8 consecutive hours a day, 7 days a week.\u201d<a href=\"#_ftn2\" id=\"_ftnref2\">[2]<\/a> The 24\/7\/365 on-site RN requirement in the CMS proposal is directly contradictory to the Social Security Act provisions. Further, the Social Security Act requires that SNFs provide \u201c24-hour licensed nursing services which are sufficient to meet the nursing needs of its residents.\u201d<a href=\"#_ftn3\" id=\"_ftnref3\">[3]<\/a> The specified HPRD requirements in the CMS proposal pose a direct conflict to the Social Security Act as well.<\/p>\n\n\n\n<p>The court\u2019s ruling is limited to the HPRD requirements and the 24\/7\/365 RN requirement in the CMS proposal. Despite the CMS proposal, states maintain the authority to impose more stringent staffing requirements on SNFs.<\/p>\n\n\n\n<p>If you have questions regarding the court\u2019s decision or CMS participation requirements for SNFs, please do not hesitate to contact your Dinsmore attorney.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><a href=\"#_ftnref1\" id=\"_ftn1\">[1]<\/a> <em>American Health Care Association, et al. v. Robert F. Kennedy, Jr, et al.<\/em> (Case No: 2:24-cv-00114-Z-BR).<\/p>\n\n\n\n<p><a href=\"#_ftnref2\" id=\"_ftn2\">[2]<\/a> 42 U.S.C. \u00a7 1396r(b)(4)(C)(i)(II).<\/p>\n\n\n\n<p><a href=\"#_ftnref3\" id=\"_ftn3\">[3]<\/a> 42 U.S.C. \u00a7 1396r(b)(4)(C)(i).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>On April 7, 2025, a Federal District Court in Texas vacated the controversial Centers for Medicare and Medicaid Services (\u201cCMS\u201d) proposal to require specific staffing requirements in skilled nursing facilities (\u201cSNFs\u201d).[1] The court\u2019s decision has nationwide effect. The CMS proposal would have required SNFs to maintain a registered nurse (\u201cRN\u201d) ratio of 33 minutes per\u2026<\/p>\n","protected":false},"author":8,"featured_media":0,"menu_order":0,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"tags":[],"publication-type":[12],"class_list":["post-57778","publications","type-publications","status-publish","format-standard","hentry","publication-type-legal-alerts"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.5 (Yoast SEO v26.9) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play - Dinsmore &amp; Shohl<\/title>\n<meta name=\"description\" content=\"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play Read insights and legal analysis from attorneys at Dinsmore &amp; Shohl LLP.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play\" \/>\n<meta property=\"og:description\" content=\"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play Read insights and legal analysis from attorneys at Dinsmore &amp; Shohl LLP.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/\" \/>\n<meta property=\"og:site_name\" content=\"Dinsmore &amp; Shohl\" \/>\n<meta property=\"article:modified_time\" content=\"2025-12-31T15:57:43+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/04\/Skilled-nursing-update-Header.jpg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/\",\"url\":\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/\",\"name\":\"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play - Dinsmore &amp; Shohl\",\"isPartOf\":{\"@id\":\"https:\/\/www.dinsmore.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/04\/Skilled-nursing-update-Header.jpg\",\"datePublished\":\"2025-04-21T16:02:00+00:00\",\"dateModified\":\"2025-12-31T15:57:43+00:00\",\"description\":\"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play Read insights and legal analysis from attorneys at Dinsmore & Shohl LLP.\",\"breadcrumb\":{\"@id\":\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#primaryimage\",\"url\":\"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/04\/Skilled-nursing-update-Header.jpg\",\"contentUrl\":\"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/04\/Skilled-nursing-update-Header.jpg\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.dinsmore.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.dinsmore.com\/#website\",\"url\":\"https:\/\/www.dinsmore.com\/\",\"name\":\"Dinsmore & Shohl\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/www.dinsmore.com\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.dinsmore.com\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.dinsmore.com\/#organization\",\"name\":\"Dinsmore & Shohl\",\"url\":\"https:\/\/www.dinsmore.com\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.dinsmore.com\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/12\/Dinsmore-Final-Logo-Navy.svg\",\"contentUrl\":\"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/12\/Dinsmore-Final-Logo-Navy.svg\",\"width\":413,\"height\":54,\"caption\":\"Dinsmore & Shohl\"},\"image\":{\"@id\":\"https:\/\/www.dinsmore.com\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play - Dinsmore &amp; Shohl","description":"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play Read insights and legal analysis from attorneys at Dinsmore & Shohl LLP.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/","og_locale":"en_US","og_type":"article","og_title":"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play","og_description":"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play Read insights and legal analysis from attorneys at Dinsmore & Shohl LLP.","og_url":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/","og_site_name":"Dinsmore &amp; Shohl","article_modified_time":"2025-12-31T15:57:43+00:00","og_image":[{"url":"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/04\/Skilled-nursing-update-Header.jpg","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/","url":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/","name":"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play - Dinsmore &amp; Shohl","isPartOf":{"@id":"https:\/\/www.dinsmore.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#primaryimage"},"image":{"@id":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#primaryimage"},"thumbnailUrl":"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/04\/Skilled-nursing-update-Header.jpg","datePublished":"2025-04-21T16:02:00+00:00","dateModified":"2025-12-31T15:57:43+00:00","description":"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play Read insights and legal analysis from attorneys at Dinsmore & Shohl LLP.","breadcrumb":{"@id":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#primaryimage","url":"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/04\/Skilled-nursing-update-Header.jpg","contentUrl":"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/04\/Skilled-nursing-update-Header.jpg"},{"@type":"BreadcrumbList","@id":"https:\/\/www.dinsmore.com\/publications\/stringent-federal-staffing-requirements-for-skilled-nursing-facilities-no-longer-in-play\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.dinsmore.com\/"},{"@type":"ListItem","position":2,"name":"Stringent Federal Staffing Requirements for Skilled Nursing Facilities No Longer in Play"}]},{"@type":"WebSite","@id":"https:\/\/www.dinsmore.com\/#website","url":"https:\/\/www.dinsmore.com\/","name":"Dinsmore & Shohl","description":"","publisher":{"@id":"https:\/\/www.dinsmore.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.dinsmore.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.dinsmore.com\/#organization","name":"Dinsmore & Shohl","url":"https:\/\/www.dinsmore.com\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.dinsmore.com\/#\/schema\/logo\/image\/","url":"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/12\/Dinsmore-Final-Logo-Navy.svg","contentUrl":"https:\/\/www.dinsmore.com\/wp-content\/uploads\/2025\/12\/Dinsmore-Final-Logo-Navy.svg","width":413,"height":54,"caption":"Dinsmore & Shohl"},"image":{"@id":"https:\/\/www.dinsmore.com\/#\/schema\/logo\/image\/"}}]}},"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.dinsmore.com\/wp-json\/wp\/v2\/publications\/57778","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.dinsmore.com\/wp-json\/wp\/v2\/publications"}],"about":[{"href":"https:\/\/www.dinsmore.com\/wp-json\/wp\/v2\/types\/publications"}],"author":[{"embeddable":true,"href":"https:\/\/www.dinsmore.com\/wp-json\/wp\/v2\/users\/8"}],"version-history":[{"count":5,"href":"https:\/\/www.dinsmore.com\/wp-json\/wp\/v2\/publications\/57778\/revisions"}],"predecessor-version":[{"id":65995,"href":"https:\/\/www.dinsmore.com\/wp-json\/wp\/v2\/publications\/57778\/revisions\/65995"}],"wp:attachment":[{"href":"https:\/\/www.dinsmore.com\/wp-json\/wp\/v2\/media?parent=57778"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.dinsmore.com\/wp-json\/wp\/v2\/tags?post=57778"},{"taxonomy":"publication-type","embeddable":true,"href":"https:\/\/www.dinsmore.com\/wp-json\/wp\/v2\/publication-type?post=57778"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}