As anticipated, litigation has started via various sources, in Federal courts, challenging CMS’ SNF “staffing mandate”. For specifics on the mandate and actual text, go here: https://rhislop3.com/2024/04/23/cms-final-snf-staffing-rule/
A big impetus behind the legal challenges to CMS mandate is the recent Supreme Court ruling known as the Chevron decision https://rhislop3.com/2024/07/01/scotus-chevron-decision-a-win-for-healthcare/ The decision overturns a longstanding doctrine that granted regulatory agencies, such as the Centers for Medicare & Medicaid Services, wide latitude in rulemaking for the organizations they oversee. One such rule heavily scrutinized by long-term care providers is the nursing home staffing mandate, presently engaged in litigation by multiple parties including the American Association for Health Care (trade association).
Ten days ago, the American Health Care Association, LeadingAge, and other plaintiffs formally requested a federal court to promptly rule in their favor regarding their opposition to a national nursing home staffing rule. The filing of a request for summary judgment in the US District Court for Northern Texas represents the most recent phase in a legal battle that is being waged predominantly through written submissions.
In defense of the staffing rule, CMS submitted in excess of 75,000 pages of documentation that it claims was used to create the staffing rule. CMS submits 75,000 pages to federal court to justify nursing home staffing mandate The submission of the administrative documentation marked the first major progress in the case since the American Health Care Association filed its challenge against the minimum staffing standard in late May. The Texas Health Care Association, three Texas providers, and LeadingAge are also involved in the lawsuit.
In a related event, during LeadingAge’s Annual Meeting and Convention, news broke that a suit filed by 20 attorneys general asking a federal court to strike down the nursing home staffing rule also has now asked the court for an immediate injunction. The civil suit was filed in US District Court for the Northern District of Iowa on Oct. 8.
The plaintiffs in the Iowa lawsuit have requested that the court grant an injunction to prevent CMS from proceeding with enforcement of the rule. This is despite the fact that compliance with the rule’s requirements, aside from the facility assessment, is not expected until 2026 or later.
The attorneys general have alleged that the Centers for Medicare & Medicaid Services exceeded their regulatory powers by, among other actions, tripling the duration of a longstanding congressional mandate that requires a registered nurse to be on duty for eight hours daily, seven days a week (this is the crux of the Chevron argument).
The primary argument opposing the mandate frequently highlights escalating worries about the expenses associated with increasing staff to adhere to it, alongside ongoing initiatives to recruit and retain a nursing workforce. For instance, in Pennsylvania, the anticipated average annual compliance cost is projected to be $689,000 for each provider. The cost and the burden are even greater for rural providers, if even attainable (meeting the standard).
Among the arguments presented by the Attorneys General was the assertion of irreparable harm, emphasizing that providers will not be able to recover the funds currently expended if the staffing rule is eventually overturned in this lawsuit or in the two other related cases consolidated in the US District Court for Northern Texas.
“Because the Final Rule is likely to be held unlawful on a host of grounds, and it causes irreparable harm to both organizational and State plaintiffs here, plaintiffs need injunctive relief,” they wrote. “Absent preliminary injunctive relief, Plaintiffs will suffer irreparable harm … The LTC Plaintiffs and the Organizational Plaintiffs that represent LTCs are suffering and will continue to suffer sharply increased financial and administrative burdens that will be too great for many LTCs to bear, leading to reduced services and LTC closures.”
The plaintiffs argued that the court should not only halt the rule’s implementation in the states involved in the lawsuit but also extend relief to all regulated nursing homes across the country.