Among the myriad executive orders signed by President Donald Trump on Inauguration Day Monday was one that freezes new regulations. A welcome relief for nursing home providers, the executive order reflects the new Republican administration’s overall preference for less regulation.

However, it is worth noting that this executive order will not derail the staffing mandate – certainly not in the long term – since the freeze lasts only 60 days, presumably until some of Trump’s nominees for various cabinet positions are confirmed.

That said, the freeze on new regulations could have implications for newly introduced survey procedures, which were set to become effective in late February, as well as for transparency of ownership requirements, experts said.

A slew of regulations thought to burden skilled nursing providers, including additions to the survey process, which CMS issued as part of a 900-page document, will now be on pause as will the transparency requirements, sector experts said.

“The prior Administration’s view of how they wanted to regulate the industry …. is part and parcel of the type of thing [the Trump administration] is trying to put a stop to so they can take a deeper look and get their nominations cleared through the Senate,” Steve LaForte, Cascadia Healthcare’s chief legal officer and executive vice president of corporate affairs, told Skilled Nursing News.

The industry is currently overburdened by regulation, and some of the rules need to be rolled back – something this executive order on day one of the Trump administration has generated hope for, Leah Klusch, executive director of the Alliance Training Center, told SNN.

“We have a new administration with new executive orders that are immediately implemented. So it’s a whole different ballgame,” she said.

However, the minimum staffing rule remains insulated from President Trump’s executive order, not only because the mandate has been in effect since June 21 of last year, but also because portions of the rule, such as the facility assessments, were implemented beginning August 8, experts said.

“The freeze doesn’t apply to the staffing rule because it is beyond any of the contingencies in the enumerations of the freeze,” LaForte said. “[This] maintains the necessity of the [main] lawsuit.”

And that is why legal experts also shared that if the industry wants to defeat the mandate, a legal victory over the lawsuit brought on by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), LeadingAge and several Texas providers, is also important.

“The AHCA lawsuit remains very relevant. The element of the executive order [that freezes federal regulation] … may not apply to the rule as it appears already ‘effective’ and any suspension appears discretionary as to rules published but not yet effective,” Mark Reagan, managing shareholder at Hooper Lundy & Bookman, told SNN. “Further, the manner in which [the executive order] is written, its review and application appears to be discretionary in that the language says ‘consider postponing for 60 days.’”

Specifically, the executive order states that in addition to considering postponing the effective date of any published or issued rules published in the Federal Register for 60 days, in order to review potential questions of fact, law, and policy, a comment period can follow during this time.

There remain several options to eliminate the minimum staffing rule, Reagan noted, including through the litigation that’s underway as well as via Congressional action that will invalidate the regulation, or if the Centers for Medicare and Medicaid Services (CMS) itself repeals it.

President Trump has tapped Dr. Mehmet Oz to become the next CMS chief, pending confirmation, for which a timeline has not been established as yet.

“While the nursing home staffing rule does not fall under the president’s executive order on a regulatory freeze, we are hopeful that the rule’s repeal is on his 100-days to-do list,” Linda Couch, SVP of policy and advocacy at LeadingAge, said in an emailed statement to SNN. “We do know, from press reports, that the rule’s repeal is on Congress’s list for budget reconciliation options.”

Beyond a stop to the staffing mandate, successful confirmation of various Trump nominees could alleviate the burdens of various other regulations impacting the nursing home sector under Trump, experts noted.

“The transparency requirements are going to be kicked down the road,” LaForte said. “If they come into effect, I think that they’re going to come into effect in a watered-down way.”

In issuing the executive order, Trump said executive departments and agencies will not propose nor issue a rule “in any form, including submission to the Office of the Federal Register (OFR), until a department or agency head appointed by the President after January 20, 2025, has reviewed and approved it. This authority may be delegated to another presidential appointee as allowed by law, with the Office of Management and Budget (OMB) director retaining the ability to exempt any rule deemed necessary for ’emergency situations or other urgent circumstances, including rules subject to statutory or judicial deadlines that require prompt action.’” 

What to expect in the first half of 2025

In the first 100 days of the new administration, besides the staffing mandate, AHCA/NCAL is focused on key legislation.

“We’re closely watching the budget reconciliation process because that’s where Congress intends to pursue many legislative priorities. We’re optimistic that we’ll be able to create some victories for long-term and post-acute care through this process, such as repealing the staffing mandate which would not only protect access to care but help save the government money,” Michael Bassett, Senior Vice President of Government Relations at AHCA/NCAL, said in an emailed statement to SNN. “Reconciliation may not happen in the first 100 days, but there will definitely be movement in this first part of the year.”

Also of interest is the confirmation of Trump’s nominees for key HHS positions including Robert F. Kennedy Jr., who has been chosen as HHS Secretary, and Jim O’Neill who is being tapped for Deputy Secretary.

Meanwhile, Oz, a medical doctor, known to be a supporter of Medicare Advantage in the past, will likely be confirmed as the administrator of CMS, experts said.

The nomination of Oz, Klusch said, is a win for the nursing home sector because his policies will be rooted in medical “practice” unlike his predecessor, Chiquita Brooks-LaSure, whose expertise lay in community health policy. The timeline for Oz’s confirmation is unknown at this time, but given that Brooks-LaSure wasn’t confirmed until May, it may be a while before a new head of the CMS is ushered in.

Officials at AHCA/NCAL said they’d like to see minimal delays to the confirmations.

“The U.S. Senate will hold hearings for each appointee, and then we’ll see if they proceed for a vote before the entire body. We are encouraging Senate leadership to swiftly consider the appointments impacting our sector, including Secretary of HHS and CMS Administrator. It is vital that we have a seamless transition to maintain access and continuity of care,” said Bassett.

Other Trump nominees in health care include Marty Makary, a surgeon and critic of overprescribing, who is nominated to lead the Food and Drug Administration (FDA), and David Weldon, who has a background in health policy, for directorship of Centers for Disease Control and Prevention (CDC). Meanwhile, Jay Bhattacharya, a health policy expert and critic of pandemic management, is selected to lead the National Institutes of Health (NIH). And finally, Janette Nesheiwat, known for her work in preventive medicine and public health, is nominated as Surgeon General.

Sector will be ‘recipient’ not driver of policy

For some sector experts, the nursing home sector won’t be at the center of any of the Trump Administration’s policies initially, but will instead be influenced by policies, such as those concerning immigration and taxes.

“[Policy changes under Trump] will have a huge impact on our sector, but we’re not going to drive that. We’re going to be the recipients of that,” said Bob Kramer, founder and fellow at Nexus Insights, and co-founder, former CEO and now a strategic advisor at the National Investment Center for Seniors Housing & Care (NIC).

Given the clashes between MAGA Republicans and figures like Elon Musk regarding immigration, it could mean that exemptions are made for skilled workers, including nurses, he said. That said, an immigration policy ignoring non-skilled workers, including those in construction, could also have a negative impact on nursing homes, given more and more extreme weather events where the workers have been helpful in rebuilding efforts, Kramer told SNN.

“If you deport everybody and have very strict immigration controls, and let’s say, only have exceptions for highly skilled workers – that will drive up construction costs, and it will also make labor more expensive,” he said. ”We are competing in a broader market. We’re not just competing as skilled nursing or senior living providers.”