As Congress Unveils Spending Bill, HHS’ Becerra Defends $130.7B 2025 Budget, Nursing Home Staffing Mandate

Congressional leaders released on Thursday bipartisan fiscal appropriations bills for 2024 totaling $1.2 trillion in funding, including for health care.

Ahead of it, two House panels grilled the Department of Health and Human Services’ (HHS) Secretary Xavier Becerra on Wednesday during hearings on White House’s fiscal 2025 budget proposal for the department.

Becerra addressed lawmaker’s questions related to the HHS’ fiscal 2025 discretionary spending request, which stands at $130.7 billion, at his hearings before the Labor-HHS-Education Appropriations Subcommittee and the Ways and Means Committee.


The department’s budget request includes provisions to strengthen nursing home oversight, transparency, and enforcement of penalties, validation of Care Compare date.

The HHS FY 2025 budget request also includes investments of $492 million to improve oversight of nursing homes and other healthcare facilities, and $15 million to advance health equity while data updates to Care Compare are noted as neutral.

At the hearings, a concern raised by lawmakers was related to closures of nursing homes, with Republican Congressman Jason Smith from Missouri demanding assurance that no nursing home would shut down as a result of the federal government’s minimum staffing proposal.


In his response, Becerra pivoted to stressing quality of care at nursing homes, citing nursing homes’ devastating death rate during the Covid-19 pandemic.

“Something’s going on. And we can’t just close our eyes to it,” Becerra said. “We have to make sure that if we’re going to leave our loved one in a nursing home, there is a nurse that is available to provide care. And these standards simply say that.”

The Centers for Medicare & Medicaid Services’ (CMS) staffing proposal, released last September, is under review at the Office of Budget and Management (OMD).

​​The CMS staffing rule calls for Medicare- and Medicaid-certified nursing homes to provide a staffing equivalent of 3 hours per resident per day (PRPD), with 0.55 hours of care from registered nurses (RNs) and 2.45 hours of care from nurse aides. Non-rural nursing homes will have 3 years and rural nursing homes have 5 years to meet these standards. The rule also calls for facilities to have an RN on staff 24 hours a day, daily.

As for the fiscal appropriations bill for 2024, lawmakers unveiled increases for mental health and Alzheimer’s research.

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