Minimum Nursing Requirements and Standards for Nursing Homes Receives Letter from Congressman

Congressman Greg Pence (R-IN), along with Rep. Brett Guthrie (R-KY), Rep. Vern Buchanan (R-FL), Rep. Michelle Fischbach (R-MN), Rep. Jared Golden (D-ME), and Rep. Chris Pappas (D-NH), led 91 of their colleagues on a bipartisan letter to Department of Health and Human Services (HHS) Secretary Xavier Becerra.

In the letter, the lawmakers expressed their concerns with the Centers for Medicare and Medicaid Services’ (CMS) proposed rule that was issued on September 1, 2023, at the direction of the Biden White House. This rule would establish minimum staffing requirements and standards for nursing homes, which would inevitably result in limited access to care for seniors, mandatory increases in state Medicaid budgets, and most consequentially lead to widespread nursing home closures.

“At a time when nursing homes are already experiencing healthcare worker shortages and financial hardships, CMS and the Biden Administration should not be implementing a regulation that would only exacerbate this issue. If implemented, facilities throughout the country will have no choice but to deny access to our nation’s seniors who need nursing home care, especially in rural communities, like many of the ones I represent in Indiana’s sixth congressional district,” said Congressman Pence. “This one-size-fits-all regulatory requirement will result in many negative consequences, and I strongly urge Secretary Becerra to reconsider this proposal.”

“I am pleased join with Representatives Pence, Fischbach, Golden, and Pappas to express our serious concern about the Centers for Medicare and Medicaid’s (CMS) proposed rule, which would lead to significant reductions in care for long-term care residents, especially in rural communities. We must ensure that we have a strong pipeline of long-term care, but instead of working with Congress to address long-standing health care workforce issues; CMS’ one-size-fits-all unfunded mandate makes it more challenging to find qualified workers further restricting access to these essential health care services. On the contrary, my bipartisan Building America’s Health Care Workforce Act would help bolster America’s nursing home workforce by extending a pathway for temporary nurse aides to become Certified Nursing Assistants. With the workforce shortages already affecting nursing homes across the country, seniors cannot afford yet another top-down mandate from the Biden administration,” said Congressman Guthrie.

“I am again encouraging the administration to reconsider its rule that could force nursing homes in rural Minnesota to close their doors,” said Congresswoman Fischbach. “Further closures of facilities in rural areas would leave seniors with little to no options for care. That is unacceptable. Instead, this letter outlines specific ways CMS can work with stakeholders to improve care and encourage recruitment and retention of qualified staff.”

“I remain committed to supporting access to high quality care for individuals residing in nursing home facilities. However, these proposed requirements could devastate access to long-term care for New Hampshire’s seniors,” said Congressman Pappas. “Instead of burdening nursing homes with new regulations during an ongoing workforce shortage, we should be focused on providing long-term care facilities with the resources and funding to stay open, recruit and retain a strong workforce, and provide residents with the best care possible. Granite Staters, especially those in rural areas, deserve access to long-term care in their communities, and I urge CMS to re-evaluate these regulations to prevent the closure of nursing homes across the country.”

“There are workforce shortages all across rural America and healthcare workers are no exception. I’m committed to working with my colleagues to find ways to prevent otherwise avoidable closures of nursing homes in Maine,” said Congressman Golden.


In September, CMS issued a proposed rule establishing minimum staffing requirements and standards for nursing homes. Highlighted in the proposed rule is that, according to the Bureau of Labor Statistics, “there are roughly 235,900 fewer health care staff working in nursing homes and other long-term care facilities compared to March of 2020.” Nursing homes around the country would need to hire nearly 13,000 registered nurses and 76,000 nursing assistants. Safety thresholds could increase a modest 1% while costing between $1.5 to $6.8 billion to fully implement. Noncompliance with CMS’ proposed minimum staffing requirements would lead to citations for noncompliance with Medicare Conditions of Participation, potentially resulting in a variety of enforcement actions, including imposition of Civil Monetary Penalties, denial of payments for new admissions, and even termination from the Medicare program.

Many organizations, including the American Health Care Association, National Rural Health Association, National Association of State Veterans Homes, Lutheran Services in America, Council for Health and Human Services Ministries, and LeadingAge, are supportive of this letter.

To read the letter, click here.

In addition to the letter, Reps. Pence and Fischbach have introduced H.R. 5796, the Protecting Rural Seniors Access to Care Act, to prevent CMS from implementing this rule until it can prove it will not result in the closure of skilled nursing facilities, will not harm patient access, and will not make workforce shortage issues worse.