States, nonprofits sue over nursing home staffing rule: 10 things to know

Twenty states and 19 nonprofit organizations have filed a lawsuit against the HHS and CMS over a nursing home staffing level mandate, according to court documents reviewed by Becker's.

CMS issued the mandate in April as part of a Medicare and Medicaid minimum staffing standards final rule, which aims to improve nursing home care by implementing minimum staffing level requirements. 

Here are 10 things to know about the lawsuit:

1. The lawsuit was filed Oct. 8 in the U.S. District Court for the Northern District of Iowa.
   
   
2. The plaintiffs are:
   
   
   • Alabama, Alaska, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Utah, Virginia and West Virginia
     
     
   • Affiliates of the nonprofit aging services provider LeadingAge from Colorado, Delaware, Iowa, Kansas, Maryland, Michigan, Minnesota, Missouri, Nebraska, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, Southeast (Florida, Alabama, Mississippi, and Louisiana), Tennessee and Virginia
     
     
   • The South Dakota Association of Healthcare Organizations
     
     
   • Atchison, Kan.-based nursing homes Dooley Center and Wesley Towers
     
     
3. The defendants are: HHS, CMS, HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure
   
   
4. The final rule requires long-term care facilities to have a registered nurse on site for 24 hours per day, seven days a week as opposed to the current requirement of eight hours per day, seven days a week.
   
   
5. The final rule also requires total nurse staffing of at least 3.48 hours per resident day, registered nurse staffing of at least .55 hours per resident day and nurse aide staffing of at least 2.45 hours per resident day.
   
   
6. Facilities are to implement the staffing level requirements in three phases over a three-year period, according to CMS. 
   
   
7. In the lawsuit, the plaintiffs say the final rule "poses an existential threat to the nursing home industry as many nursing homes that are already struggling will have no choice but to go out of business."
   
   
8. The plaintiffs are requesting the court "vacate, set aside and permanently enjoin" the CMS staffing standards final rule.
   
   
9. CMS estimates the total cost of implementing the minimum staffing requirements over the next 10 years will be $43 billion.
   
   
10. Texas Attorney General Ken Paxton in August filed a similar lawsuit against the Biden administration over the staffing mandate.