December 8, 2025
The Centers for Medicare & Medicaid Services (CMS) has issued an interim final rule with comment period, reversing key components of the May 2024 Minimum Staffing Standards for Long-Term Care Facilities final rule. This action formally restores staffing requirements that were in place prior to the 2024 rule and confirms that CMS will not move forward with the previously proposed minimum staffing mandates.
The 2024 staffing rule had sought to establish minimum nurse staffing levels, including a 24/7 RN presence and specific “hours per resident day” (HPRD) targets. However, implementation of these requirements had already been paused for nine years under the One Big Beautiful Bill Act, which prevents enforcement until 2034. CMS stated, “While we considered retaining the rules without enforcement until the end of the moratorium in 2034, ultimately, we decided to remove these requirements to avoid unintended implementation challenges and confusion for LTC facilities.”
CMS explained its decision, noting that the previous quantitative minimum staffing standards “impose one-size-fits-all minimum requirements on all facilities across the country without accounting for differences in local labor supply, overall acuity of the facility’s resident population, or available resources. Rural and tribal community facilities currently face significant difficulties in recruiting and retaining staff; the current quantitative minimum staffing standards could put many of these facilities at an increased risk of closure, thus potentially decreasing access to health care in these communities.”
In addition, CMS considered stakeholder feedback in developing this interim final rule. The agency noted that long-term care facilities, particularly in rural and tribal areas, expressed concern that the previous staffing standards could increase the risk of facility closures.
Key Changes in the Interim Final Rule
§ 483.5 – Definition Removal: Deletes the HPRD definition, as it was only relevant to the now-repealed minimum staffing standards.
§ 483.35 – Nurse Staffing Requirements:
Eliminates the requirement for: (1) An RN onsite 24 hours a day, 7 days a week; (2) Minimum HPRD levels: 0.55 RN, 2.45 nurse aide, 3.48 total nursing
Reinstates the statutory staffing standard: (1) RN onsite for at least 8 consecutive hours per day, 7 days a week; (2) Full-time RN serving as director of nursing (unless a waiver is granted)
With this rule, CMS is formally reverting to the previous standards for LTC nurse staffing requirements, maintaining the long-standing 8-hour RN coverage and director of nursing requirement. Facilities will no longer be held to the fixed HPRD requirements or the 24/7 RN mandate.
The interim final rule comment period ends February 2, 2026.