Texas sues Biden administration over nursing home staffing rule

Texas is suing the Biden administration over a new policy that mandates minimum staffing levels in nursing homes, arguing the federal Medicare agency exceeded its authority.  

In a lawsuit filed Wednesday in the Northern District of Texas, state Attorney General Ken Paxton (R) said the rule should be vacated and the administration should be permanently blocked from enforcing it. 

“This power grab by [President] Biden’s health bureaucrats could put much-needed care facilities out of business in some of the most underserved areas of our state,” Paxton said in a statement. “We are taking the federal government to court over this rule that could worsen rural care shortages by shutting down facilities due to new hiring quotas that are impossible to fill.” 

The complaint argues Congress has repeatedly refused to change nursing home staffing requirements, and the Centers for Medicare and Medicaid Services does not have the authority to override what Congress intended. 

“The new requirements remove the historic flexibility of a nursing home to determine what is ‘sufficient to meet the nursing needs of its residents.’ Instead, the CMS Final Rule now imposes a one-size-fits-all rule that directly contravenes Congress’s stated flexible directive with rigid, inflexible requirements,” the complaint states. 

Under the requirements unveiled earlier this year, all nursing homes that receive federal funding through Medicare and Medicaid will need to have a registered nurse on staff 24 hours per day, seven days per week and provide at least 3.48 hours of nursing care per resident per day.  

The rules will cost nursing homes $43 billion over the next decade, according to estimates from the Department of Health and Human Services. 

The requirements of the rule will be introduced in phases, with longer time frames for rural communities. Limited, temporary exemptions will be available for both the 24/7 registered nurse requirement and the underlying staffing standards for nursing homes in workforce shortage areas that demonstrate a good faith effort to hire.

Nonrural facilities must meet the requirements by May 2027, and rural facilities have five years, until May 2029.

But according to Texas, the policy could cause rural nursing homes to shut down and would force nursing homes in the state “overnight to hire more than 10,000 personnel with highly specific qualifications — more personnel than are currently available in the labor market within the State and specific service areas.”

The lawsuit was filed in federal court in Amarillo, Texas, which has only one judge, Matthew Kacsmaryk.  

The industry group American Health Care Association filed a similar lawsuit in the same district in May.

Kacsmaryk, an appointee of former President Trump, is the same judge who suspended approval of the abortion pill mifepristone and has ruled against the Biden administration on several other issues, including immigration and LGBTQ protections.