(April 11, 2025) – Court Vacates Nursing Home Staffing Rule
The American Health Care Association successfully defeated a Centers for Medicare & Medicaid Services rule mandating nurse staffing levels for long-term care facilities. The challenged provisions required the presence of a registered nurse 24 hours per day, seven days a week, and mandated minimum staffing ratios for RNs and nurse’s aides based on hours per resident day.
The court rejected the 24/7 requirement as exceeding the agency's authority, as federal statute requires an RN be present only eight hours per day. It also invalidated the minimum staffing ratios because they imposed a rigid staffing structure that was not based on any assessment of residents’ needs or a facility's case mix, in contravention of federal law. Accordingly, the court vacated those provisions of the rule, found at 42 C.F.R. Section 483.35(b)(1) and 483.35(c). All remaining provisions of the rule remain in effect.
U.S. Senate Advances Amendment to House Budget Resolution
The U.S. Senate passed an amendment to the previously passed House Concurrent Resolution that would establish the congressional budget for the federal fiscal year 2025 while setting appropriate budget levels for FFYs 2026 through 2034. Although the Senate advanced an amendment, differences must be resolved before enactment.
Of note, the Senate amendment continues to include $880 billion in funding reductions for programs under the jurisdiction of the House Committee on Energy and Commerce.
CMS Issues Contract Year 2026 Policy and Technical Changes to Medicare Advantage, Medicare Part D and PACE Programs
The Centers for Medicare & Medicaid Services released a final rule for contract year 2026 that includes policy and technical changes to Medicare Advantage, the Medicare prescription drug benefit program, the Medicare Cost Plan Program and Programs for All-Inclusive Care for the Elderly. The rule includes the following:
- Restrictions to Medicare plans' ability to reopen and modify a previously approved inpatient hospital decision based on information gathering after the approval
- Codifying existing guidance that requires plans to give a provider notice of a coverage decision, including notices to the beneficiary
- Modifications to existing regulations to clarify that an enrollee’s liability to pay for a service cannot be determined until a Medicare Advantage organization makes a decision on a contracted provider’s claim for payment
- Medicare Advantage Risk Adjustment Updates
- Vaccine cost-sharing revisions that prohibit cost sharing for an adult vaccine recommended by the Advisory Committee on Immunization Practices and under Medicare Part D
- Insulin cost-sharing revisions
Before You Go ...
The Food and Drug Administration is
warning consumers about nitrous oxide — commonly used as an anesthetic for surgical and dental procedures that briefly disrupts oxygen flow to the brain — being sold in colorful canisters with different flavors in gas stations and convenient stores. The
FDA warning states that inhaling the gas for its euphoric effects can cause dangerously low blood pressure, leading to loss of consciousness and injuries.