The federal nursing home staffing standard was repealed

In 2024 the federal government set a minimum staffing level for nursing homes for the first time. Courts vacated it, Congress blocked it, and CMS repealed it effective February 2, 2026. NursingHomeGrade still grades facilities against it. This page explains what the rule required, how it died, what actually applies now, and why we kept the benchmark.

What the 2024 rule required

The CMS final rule "Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting," published May 2024, would have required every Medicare- or Medicaid-certified nursing facility to provide, at minimum:

• 0.55 registered nurse (RN) hours per resident per day.
• 2.45 nurse aide hours per resident per day.
• 3.48 total nurse staffing hours per resident per day, inclusive of the two figures above.
• An RN on site 24 hours a day, 7 days a week, replacing the older 8-hour requirement.

The requirements were to phase in over three years for urban facilities and five years for rural facilities, with the total-hours and 24/7 RN provisions arriving before the individual RN and aide thresholds. Facilities could apply for hardship exemptions tied to local workforce availability. The rule also imposed a new, enforceable facility assessment process and required daily posting of actual staffing levels.

How it died

• April 2025 — Northern District of Texas. In litigation brought by the nursing home industry, the court vacated the rule in full, holding that CMS had exceeded its statutory authority in setting numeric staffing minimums Congress had not authorized.
• June 2025 — Northern District of Iowa. A second court vacated the 24/7 RN requirement and the minimum hours-per-resident-day provisions on similar grounds.
• July 4, 2025 — Public Law 119-21. Congress imposed a moratorium barring CMS from implementing or enforcing the staffing minimums through September 30, 2034.
• December 3, 2025 — CMS interim final rule. CMS published "Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities" in the Federal Register, formally removing the hours-per-resident-day requirements and the 24/7 RN requirement from the regulations.
• February 2, 2026 — repeal effective. The pre-2024 staffing rules are the operative federal requirement.

What federal law actually requires now

The reinstated standard is the one that governed nursing homes before 2024: a facility must have a registered nurse on duty at least 8 consecutive hours a day, 7 days a week, and must employ a full-time director of nursing. Both are subject to waiver where a facility can demonstrate it is unable to recruit staff and the state agency approves.

This is materially weaker than what was repealed, and not merely by degree. The 2024 rule scaled with the number of residents; the current rule does not scale at all. A 120-bed facility and a 30-bed facility satisfy it identically — one RN, one third of the day. For the 120-bed facility that works out to roughly 0.07 RN hours per resident per day if the RN works no other shift, against the 0.55 the repealed rule would have required. For the remaining 16 hours of the day, federal law requires no registered nurse in the building at all. The current requirement is a staffing floor for the facility, not a care standard for the resident.

What still applies

The repeal was not total. These obligations survive and remain enforceable:

• Sufficient staffing (42 CFR 483.35). Facilities must have sufficient nursing staff with the appropriate competencies to assure resident safety and attain each resident's highest practicable well-being. This is a qualitative standard with no number attached, which is precisely why the 2024 rule was written.
• Facility assessment requirements. The enhanced assessment process introduced by the 2024 rule — requiring facilities to evaluate resident acuity and determine the staffing needed to meet it — remains in effect.
• Daily staffing posting. Facilities must continue to post actual daily nurse staffing levels where residents and visitors can see them.
• Payroll-based journal reporting. Facilities still submit verified daily staffing data to CMS, which is what makes the figures on this site possible.

Why we still grade against 0.55

CMS did not arrive at 0.55 RN hours arbitrarily. It came out of a commissioned staffing study and decades of research linking registered nurse hours to pressure ulcers, avoidable hospitalizations, infection rates, and mortality. The rule was struck down on questions of administrative authority and blocked on questions of cost and workforce supply. Nothing in the litigation, the statute, or the repeal notice found that residents need less nursing care than the evidence indicated. A staffing level does not stop being the level residents need because the agency that identified it lost the authority to require it. We report the current legal requirement honestly wherever we cite it, and we grade against the benchmark.

Sources: Federal Register, "Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities" (published December 3, 2025); American Health Care Association v. Becerra, U.S. District Court for the Northern District of Texas (decided April 2025); the multistate challenge decided by the U.S. District Court for the Northern District of Iowa (June 2025); Public Law 119-21 (2025); 42 CFR 483.35.

How many facilities fall below 0.55 today

These figures are computed from the current CMS data in our database each time this page is requested. Facilities that do not report RN staffing hours are excluded from both the count and the denominator.

6,440 of 14,308 reporting nursing facilities nationally (45.0%) staff below 0.55 RN hours per resident per day — the level the repealed 2024 rule would have required.