The Centers for Medicare & Medicaid Services (CMS) has rescinded a key provision of its 2024 minimum staffing rule for long-term care facilities. An interim final rule issued December 2 removes the requirement that a registered nurse (RN) be on-site 24 hours a day, seven days a week, while retaining the existing federal standard of eight hours of RN coverage per day. The rule was published in the Federal Register on December 3, 2025, and will take effect on February 2, 2026.
The change follows a federal court ruling in Texas that struck down the 24/7 RN mandate, finding that it exceeded CMS’s statutory authority. CMS did not appeal, citing uncertainty stemming from the ruling and practical challenges of implementation. The rule’s broader staffing requirements, including minimum total nurse hours of 3.48 per resident per day—comprising at least 0.55 hours from RNs and 2.45 hours from nurse aides—are still in place.
CMS noted that the 24/7 RN requirement was only one part of its broader plan to improve nursing home care. The agency will continue providing guidance, training, and financial incentives to support workforce development in long-term care settings.
A federal moratorium prevents enforcement of the 2024 staffing standards—including both the 24/7 RN requirement and minimum nurse hours—until September 30, 2034. This effectively restores the previous staffing framework while maintaining federal nurse staffing standards established in law.
The full interim final rule is published in the Federal Register and can be accessed here.
Compliance Perspective
Issue
The CMS interim final rule removes the 24/7 RN staffing requirement for long-term care facilities while maintaining the federal standard of eight hours of RN coverage per day and minimum total nurse hours of 3.48 per resident per day. Facilities are expected to continue using facility assessments to ensure adequate staffing based on resident acuity and individual care needs. Adjusting policies, procedures, and monitoring practices to reflect these changes can help facilities maintain compliance and support resident safety.
Discussion Points
- Review staffing policies and procedures to ensure they align with current federal requirements and reflect facility-specific staffing needs. Consider consulting with your regulatory or compliance consultant to confirm that policies address both minimum requirements and resident-centered care expectations. Update procedures as needed and document changes.
- Train staff on updated staffing policies and expectations, including proper allocation of RN and nurse aide hours based on resident acuity. Reinforce clinical competencies and ensure staff are aware of any procedural adjustments resulting from the rule change. Med-Net Academy offers the course Sufficient Nurse Staffing, which helps staff determine whether the facility meets criteria for sufficient nursing staff, provides probing questions to guide assessment of staffing adequacy, and reviews CMS initiatives related to nurse staffing.
- Conduct periodic audits to verify that staffing levels meet current federal requirements and facility standards. Engage your consultant, if applicable, to assist with targeted mock surveys or focused reviews to identify potential gaps. Use audit findings to implement improvements and ensure ongoing regulatory compliance.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*