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Smith, McMorris Rodgers, Crapo Press Biden Administration to Withdraw Unworkable, Unrealistic Federal Nurse Staffing Mandate 

October 31, 2023

WASHINGTON – The Biden Administration recently proposed a one-size-fits-all federal nurse staffing mandate, despite overwhelming evidence that such a policy would be virtually impossible for the nation’s nursing homes to meet. 

In a letter to Health and Human Services (HHS) Secretary Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Brooks-LaSure, House Ways and Means Committee Chairman Jason Smith (MO-08), House Energy and Commerce Committee Chair Cathy McMorris Rodgers (WA-05), and Senate Finance Committee Ranking Member Mike Crapo (R-ID) call on the Administration to immediately withdraw the proposed rule and provide justification for its $40.6 billion unfunded mandate that could force many nursing homes to close, threatening resident access to direct care services.

From the letter:

“We write today to express our serious concerns regarding the Administration’s minimum nurse staffing standards proposed rule. This one-size-fits-all, unfunded mandate will jeopardize access to care for the 1.2 million Americans living in more than 15,000 certified nursing homes nationwide – especially those who reside in rural and underserved areas. Our nation’s nursing homes have weathered an unprecedented storm over the past three years. From government spending induced inflation to pandemic provider burnout, community access to long-term care services has been strained. Since January 2020, over 400 nursing homes closed their doors and approximately 190,000 nursing home employees left the workforce…Given this current landscape, the Administration’s proposal will only serve to further undermine patient access to skilled nursing care. As such, we strongly urge you to withdraw the rule and work with us on tailored solutions addressing the severe health care workforce shortages in our states,” write Chairman Smith, Chair Rodgers, and Ranking Member Crapo.

Under the Biden Administration’s proposal, nursing homes would have limited flexibility to distribute direct care staff and meet individual resident needs. Nursing homes face strong competition to recruit and retain trained workers, especially in rural areas. CMS data indicates that 79 percent of nursing facilities across the country would need to hire additional nursing staff in order to comply with the Biden Administration’s proposed mandate. While CMS argues that the total number of needed providers exist, many of these individuals are already practicing in another care setting or living in another geographic area.

From the letter:

“In applying a uniform, minimum staffing ratio to all facilities, regardless of size or case-mix, the proposed rule could incentivize some facilities to overstaff in order to meet arbitrary federal thresholds. This risks diverting qualified nurses away from small, rural and underserved facilities that also must hire additional employees, running counter to the stated intent of the proposal,” wrote Smith, Rodgers, and Crapo.

Even the final report, cited by the Biden Administration to justify proposing the new mandate, found no specified level of staffing could guarantee improved beneficiary outcomes.

From the letter:

“The Administration’s own study is clear that there is no significant correlation between any given staffing ratio and increased quality outcomes for residents,” wrote Smith, Rodgers, and Crapo. “[The] data call into question why the agency would place an unprecedented unfunded mandate on nursing facilities and the States while also acknowledging such a marginal expected increase in patient outcomes and quality.”


  • The Biden Administration’s proposed mandate will affect up to 1.2 million Americans living in 15,000 Medicare-certified nursing homes.
  • Since January 2020, more than 400 nursing homes have closed and approximately 190,000 nursing home workers have left the workforce.
  • CMS projects this unfunded mandate would cost more than $40 billion.
  • The mandate proposes increasing staffing levels to 0.55 nurse hours per resident day and 2.45 nurse aide per resident day.

Read the letter here.

READ: Biden Administration Mandates Threaten Already Troubled Health Care Access in Rural America

READ: Chairman Smith Seeks Solutions for Rural America’s Health Care Crisis During Community Roundtables in Missouri