A repeal of the nursing home staffing mandate could have been among several provisions in the Republicans’ “One Big, Beautiful Bill” that would have been subject to a 60-vote threshold if it were to remain in the bill by the time the Senate took a vote on it this week. However, the 10-year moratorium on the mandate has been placed back in.

Given their narrow majority in the Senate, Republicans are aiming to fast-track the spending bill using the budget reconciliation process, which allows passage by a simple majority but also imposes stricter conditions.

A section in the budget reconciliation bill related to nursing home staffing was attempting to repeal parts of the nursing home staffing regulations and transparency policies, and would have prohibited the Secretary of the Department of Health and Human Services (HHS) from implementing, administering or enforcing any part of the final nursing home staffing rule, which requires a registered nurse be onsite 24/7 and implements staffing standards in nursing homes until 2034.

However, the bill’s provision on the staffing mandate has been updated to restore the decade-long moratorium on it with language that aligns with the House bill, sources said.

“The Senate Parliamentarian approved the language currently in the bill that puts a 10-year moratorium on the staffing mandate, so it does not require 60 votes. The language appears to be the same as the House-passed version,” Pete Van Runkle told Skilled Nursing News.

Senate Parliamentarian Elizabeth MacDonough ruled last week that the staffing mandate’s repeal and several other provisions in President Trump’s GOP spending bill violated the Byrd Rule and could not be included in the bill.

Other disqualified items included restrictions on Medicaid, penalties for disclosing taxpayer information, deregulation of gun silencers, student aid for certain non-citizen immigrants, and a ban on funding gender-affirming care through Medicaid and CHIP.

Meanwhile, certain provisions were redrafted to address the Parliamentarian’s guidance and are no longer subject to a 60-vote threshold and include the proposed measures on provider taxes.

The redrafted provision on provider taxes softens the impact on nursing homes by exempting nursing and intermediate care facilities from the gradual reduction in the provider tax “hold harmless” threshold. Beginning in 2028, this threshold will decrease by 0.5% annually for other provider classes in expansion states, reaching a limit of 3.5% by 2032.

However, the provision still prohibits all states from increasing provider tax rates or expanding the tax base, meaning states cannot use provider taxes to raise additional Medicaid funding. While nursing homes are shielded from the phased threshold cuts, they could still be indirectly affected if overall state Medicaid funding shrinks due to the broader limits, putting pressure on reimbursement rates and services.

Cutting provider taxes in the “Big Beautiful Bill” would reduce a key source of Medicaid funding that many states rely on to support health care services, including nursing homes. Without the ability to raise or expand provider taxes, states would face budget shortfalls, likely leading to reduced Medicaid payments to nursing homes. This could result in staffing cuts, fewer services, or even closures—directly impacting care for elderly and disabled residents who depend on Medicaid for long-term support.

“We have been successful in removing parts of this bill that hurt families and workers, but the process is not over, and Democrats are continuing to make the case against every provision in this Big, Beautiful Betrayal of a bill that violates Senate rules,” said ranking member of the Senate Finance committee, Jeff Merkley (D-Ore.). “We cannot let Republicans succeed in betraying middle-class families across this country.”

Along with this snag, Medicaid cuts in the bill are a major sticking point as well. After the Senate vote concludes and if the bill manages to pass narrowly given the thin Republican majority, the bill will be sent back to the House before it is signed off by President Donald Trump – who has favored doing so ahead of the Fourth of July weekend.

Several House Republicans – who expect to vote on it by Wednesday based on several news reports – may oppose the bill if those cuts remain, even if it passes the Senate.

And a study from Brown University researchers and shared by Senate Democrats stated that the bill’s Medicaid cuts could potentially impact 579 nursing homes, if implemented.