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January 2025 Post Acute Care Litigation Update

Sydney C. Scott

January 2025 Post Acute Care Litigation Update
skaman306 via Getty Images

The Northern Districts of Iowa and Texas are each handling cases challenging recently finalized staffing requirement regulations for long-term care facilities (LTCs). 

Dubbed by the state government and trade association plaintiffs as a “one-size-fits-all” approach, the LTC final regulations impose two mandatory staffing requirements: (1) shifting from an 8/7 registered nurse (RN) requirement to a 24/7 RN requirement; and (2) increasing the requirements of RN hours per resident day (HPRD). Additionally, the Final Rule introduces an “enhanced facility assessment” (EFA), a compliance measure requiring LTCs to ensure satisfactory staff and resident involvement. Plaintiffs claim each of these requirements are outside the scope of CMS’s statutory authority and constitute arbitrary and capricious agency action under the Administrative Procedure Act.

Defendants claim the LTC final regulations are consistent with agency authority, arguing that CMS’s authority to establish regulatory regimes for Medicaid and Medicare programs for LTCs extends to regulating the LTCs’ workforce. Relatedly, Defendants assert the requirements reflect the agency’s protection of LTC residents' health and safety. Additionally, Defendants justify the reasoning for the regulations by referencing the 2022 Abt Study, literature gathered post COVID-19, and the claim that the efforts to update staffing requirements have been ongoing for years. Defendants assert the completion of these updated studies and the accumulated literature now make such revisions possible.

The Northern District of Texas has received cross-motions for summary judgment and is expected to rule on the motions soon. Meanwhile, in the Northern District of Iowa, Judge Leonard T. Strand denied Plaintiffs’ motion for a preliminary injunction, citing Plaintiffs’ failure to demonstrate the necessary grounds to justify such relief. Judge Strand stated resolving the merits of the case would best serve justice. Dispositive motions are due by March 3, 2025.