Texas Attorney General Ken Paxton filed a lawsuit on Wednesday against federal agencies over the minimum staffing rule for nursing homes, claiming the rule’s implementation without clear congressional authorization constitutes an overreach of regulatory power.
The Texas lawsuit argues that the Centers for Medicare & Medicaid Services’ (CMS) staffing mandate violates the Major Questions Doctrine established by the Supreme Court. The doctrine requires that significant regulatory actions by government agencies must have authorization from Congress.
Filed in the Northern District of Texas – the same district as the American Health Care Association’s (AHCA) lawsuit – Paxton’s lawsuit uses similar language as well in arguing that the rule is “arbitrary and capricious.”
The lawsuit further alleges that CMS relied on a “flawed study” to justify the rule and failed to adequately address the existing staffing shortages that would make compliance nearly impossible.
The filing references CMS’ own assessment, which found that Texas skilled nursing facilities (SNFs) would need to recruit the highest number of additional registered nurses (RNs) among all states, resulting in an increase of 2,579 RNs and 7,887 certified nursing assistants (CNAs). CMS has acknowledged that Texas facilities would face costs of approximately $84 million to meet the 24/7 RN requirement alone.
This will put “enormous costs” on nursing homes, and could lead to the shutdown of numerous long-term care facilities, particularly in underserved areas, the lawsuit alleges.
“This power grab by Biden’s health bureaucrats could put much-needed care facilities out of business in some of the most underserved areas of our state,” Paxton said in a statement to a Texas news outlet, KXAN. He criticized the rule for potentially worsening rural care shortages arguing that the new hiring quotas are impractical given the current staffing situation.
The Department of Health and Human Services (HHS) Secretary Xavier Becerra defended the rule when it was proposed, emphasizing its goal of providing safe, high-quality care.
“When facilities are understaffed, residents suffer,” Becerra had said. “Comprehensive staffing reforms can improve working conditions, leading to higher wages and better retention for this dedicated workforce.”
As for AHCA’s lawsuit, legal experts told Skilled Nursing News that it is strong, framed well and likely to succeed, with a decision possible by early 2025. And recently, AHCA and several Texas-based operators formally filed a joint motion for a briefing schedule. Court filings lay out a possible schedule that suggests a resolution may come as early as January.
