HR-1303-119
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Michelle Fischbach (R-MN)
What it does
This bill would prohibit the Secretary of Health and Human Services from implementing, administering, or enforcing a May 2024 Centers for Medicare & Medicaid Services (CMS) rule that established minimum staffing standards for long-term care facilities (such as nursing homes) and required Medicaid payment transparency reporting. It would also block any "substantially similar" future regulation. The bill does not repeal the underlying statutory authority CMS used to issue the rule — it specifically targets this final rule and its enforcement.
Who benefits
Nursing home operators and long-term care facility owners who would avoid compliance costs associated with hiring additional staff. For-profit and nonprofit nursing home chains that argued the rule was financially unworkable. Rural nursing homes, which CMS itself acknowledged face the greatest difficulty recruiting qualified staff. Medicaid-dependent facilities operating on thin margins. Nursing home industry trade associations. States that opposed the federal staffing mandate as an intrusion on their regulatory authority.
Who is hurt
Nursing home residents — approximately 1.2 million Americans — who would not receive the staffing floor protections the 2024 rule was designed to provide. Certified Nursing Assistants (CNAs) and registered nurses who may have gained additional job opportunities under the rule. Resident family members and patient advocacy groups who supported the staffing minimums. Workers in facilities that currently fall below the rule's thresholds, who would lose a federal backstop for minimum care ratios. States that had aligned their own standards with the federal rule in anticipation of its implementation.
Supporters argue
Supporters argue that the 2024 CMS rule was an unprecedented federal overreach that would have forced hundreds of nursing homes — particularly in rural areas — to close or reduce beds due to an inability to recruit sufficient staff, leaving seniors with fewer care options. They contend that CMS's own analysis projected the rule would cost the industry approximately $6.8 billion annually and that roughly 79% of nursing homes were already out of compliance at the time of the rule's publication, making the mandate effectively unachievable. They argue that access to any care is more protective of seniors than a staffing standard that eliminates facilities entirely.
Opponents argue
Opponents argue that chronic understaffing in nursing homes is a well-documented cause of preventable resident harm, including infections, falls, and pressure ulcers, and that the 2024 rule set a modest floor — 3.48 total nurse staffing hours per resident per day — that most high-quality facilities already meet. They contend that blocking the rule removes the only federal mechanism to enforce a minimum standard of care for the nation's most vulnerable residents, and that industry cost projections have historically overstated compliance burdens to resist regulation. They further argue that the transparency reporting requirement, also blocked by this bill, is a basic accountability measure with no plausible justification for elimination.
Constitutional context
Congress has broad authority to set conditions on Medicare and Medicaid funding under the Taxing and Spending Clause (Art. I, §8, cl. 1), which it used to authorize CMS to regulate long-term care facilities. Post-Loper Bright v. Raimondo (2024), courts would independently assess whether CMS had clear statutory authority to issue the 2024 staffing rule rather than deferring to the agency's interpretation — making this bill's approach of a direct congressional prohibition an alternative path to the same outcome that litigation might achieve.
Checks and balances
Congress gains authority by stripping HHS/CMS of enforcement power over this rule; the executive branch loses regulatory discretion it exercised in 2024, and courts retain the ability to review whether the prohibition itself is consistent with existing Medicare and Medicaid statutes.
Historical precedent
Congress has previously used targeted legislative riders to block specific agency rules, including the 2016 Congressional Review Act resolution that overturned an OSHA silica rule, but no prior federal law has specifically blocked a CMS minimum staffing standard for nursing homes.