Kansas, et al. v. Becerra (CMS staffing rule challenge)

Docket number: 1:24-cv-00110 (N.D. Iowa)

The Hamilton Lincoln Law Institute (HLLI) filed a lawsuit challenging the legality of a federal regulation by the Centers for Medicare & Medicaid Services (CMS) that threatens the health, safety, and well-being of millions of nursing home patients across the county. Representing two non-profit nursing homes and 21 LeadingAge state affiliates, which are membership associations that represent hundreds of not-for-profit aging services providers across the country, HLLI joined 20 State Attorneys General, led by Kansas, Iowa, and South Carolina in the legal challenge.

In April, CMS promulgated the regulation “Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting” requiring all federally funded nursing homes to meet one-size-fits-all staffing requirements, including 24/7 RN care and enhanced facility assessments that will require nursing homes to hire more than 100,000 additional full-time employees and cost them approximately $6.8 billion per year, while providing no funding to support the necessary hires. The requirements are inconsistent with statutory law and Congress’s decision to establish a flexible staffing standard that recognizes the wide variation in nursing home residents’ needs and surrounding communities. CMS took a question of major importance, imposing billions of dollars of compliance costs on the nursing home industry, out of the hands of Congress without identifying statutory authority for doing so, insteading relying solely on a “miscellaneous” rulemaking provision allowing the Secretary of Health and Human Services to impose such other requirements as necessary to the general health and safety of residents. Nearly 300,000 nursing home beneficiaries—one-fourth of total nursing home residents—will be at risk of losing necessary care as a result of the rule.

HLLI represents LeadingAge South Carolina, LeadingAge Kansas, and LeadingAge Iowa in the suit, along with LeadingAge state affiliates from 18 additional states (Alabama, Colorado, Delaware, Florida, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, and Virginia) and non-profit nursing homes Dooley Center and Wesley Towers. In addition to the States of Kansas, Iowa, and South Carolina, the other State plaintiffs are Alabama, Alaska, Arkansas, Florida, Georgia, Idaho, Indiana, Kentucky, Missouri, Montana, Nebraska, Oklahoma, North Dakota, South Dakota, Utah, Virginia, and West Virginia. The plaintiffs filed their complaint in the Northern District of Iowa.

On October 22, 2024, plaintiffs filed a motion to preliminarily enjoin the rule. On November 27, plaintiffs filed their reply in support of a preliminary injunction and the court heard argument on the motion on December 5.

Case Documents