Texas Attorney General Ken Paxton filed a lawsuit against federal agencies on Wednesday regarding the new minimum staffing rule for nursing homes. The lawsuit argues that the rule’s implementation without clear congressional authorization exceeds regulatory authority.
Key Arguments of the Lawsuit
Paxton’s lawsuit, filed in the Northern District of Texas, challenges the Centers for Medicare & Medicaid Services (CMS) staffing mandate on the grounds that it violates the Major Questions Doctrine established by the Supreme Court. This doctrine requires significant regulatory actions to have explicit authorization from Congress.
The lawsuit claims that the staffing rule is “arbitrary and capricious” and accuses CMS of relying on a “flawed study” to justify the rule. It also argues that CMS did not adequately address existing staffing shortages, making it nearly impossible for facilities to comply.
Impact on Texas Nursing Homes
According to the lawsuit, CMS’ assessment found that Texas skilled nursing facilities (SNFs) would need to recruit a large number of additional staff to meet the new requirements. Specifically, Texas facilities would need 2,579 more registered nurses (RNs) and 7,887 more certified nursing assistants (CNAs). The estimated cost for Texas facilities to meet the 24/7 RN requirement alone is about $84 million.
The lawsuit warns that these new requirements could lead to “enormous costs” for nursing homes and might force many long-term care facilities, especially in underserved areas, to shut down.
Paxton’s Criticism
Paxton criticized the rule in a statement to KXAN, a Texas news outlet. He argued that the rule, enacted by “Biden’s health bureaucrats,” could negatively impact rural care shortages by setting impractical hiring quotas. “This power grab could put much-needed care facilities out of business in some of the most underserved areas of our state,” Paxton said.
Defense of the Staffing Rule
In defense of the rule, Department of Health and Human Services (HHS) Secretary Xavier Becerra emphasized its goal of ensuring safe, high-quality care. “When facilities are understaffed, residents suffer,” Becerra stated. He added that comprehensive staffing reforms aim to improve working conditions, which could lead to higher wages and better staff retention.
Status of Related Lawsuits
The American Health Care Association (AHCA) also filed a lawsuit challenging the staffing mandate, and legal experts have indicated that it is well-framed and has a good chance of success, with a possible decision expected by early 2025. AHCA and several Texas-based operators have recently requested a briefing schedule from the court. According to court filings, a resolution could potentially come as early as January 2025.
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