Department of Health and Human Services, Centers for Medicare & Medicaid Services: Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities

B-337945

December 17, 2025

The Honorable Mike Crapo
Chairman
The Honorable Ron Wyden
Ranking Member
Committee on Finance
United States Senate

The Honorable Brett Guthrie
Chairman
The Honorable Frank Pallone, Jr.
Ranking Member
Committee on Energy and Commerce
House of Representatives

The Honorable Jason Smith
Chairman
The Honorable Richard Neal
Ranking Member
Committee on Ways and Means
House of Representatives

Subject: Department of Health and Human Services, Centers for Medicare & Medicaid Services: Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities

Pursuant to section 801(a)(2)(A) of title 5, United States Code, this is our report on a major rule promulgated by the Department of Health and Human Services, Centers for Medicare & Medicaid Services (collectively, CMS) titled “Medicare and Medicaid Programs; Repeal of Minimum Staffing Standards for Long-Term Care Facilities” (RIN: 0938-AV25). We received the rule on December 4, 2025. It was published in the Federal Register on December 3, 2025. 90 Fed. Reg. 55687. The effective date of the rule is February 2, 2026.

According to CMS, this rule repeals provisions of a rule titled, Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. CMS stated that this action was taken in view of changes made by law, which precludes CMS from implementing, administering, or enforcing certain provisions of the rule until September 30, 2034. See generally, Pub. L. No. 119-21, § 71111, 139 Stat. 298 (July 4, 2025).

The Congressional Review Act (CRA) requires a 60-day delay in the effective date of a major rule from the date of publication in the Federal Register or receipt of the rule by Congress, whichever is later.  5 U.S.C. § 801(a)(3)(A).  The 60-day delay in effective date does not apply, however, if the agency finds for good cause that notice and public procedure thereon are impracticable, unnecessary, or contrary to the public interest, and the agency incorporates the finding and a brief statement of its reasons in the rule.  See 5 U.S.C. §§ 553(b)(4)(B), 808(2). Here, although CMS did not specifically mention CRA's 60-day delay in effective date requirement, CMS found good cause to waive notice-and-comment procedures and incorporated a brief statement of reasons. 

Specifically, CMS determined that good cause exists under 5 U.S.C. § 553(b)(B) and 42 U.S.C. § 1395hh(b)(2) to dispense with notice-and-comment requirements.  CMS explained that the regulations at issue are unenforceable until 2034 pursuant to section 71111 of Public Law 119-21, that portions of the rule have been vacated by federal courts, and that no regulated entities or members of the public currently rely on them.  CMS stated that maintaining such unenforceable provisions in the Code of Federal Regulations would be confusing and impracticable, potentially leading to misunderstandings among long-term care facilities, regulators, and the public.  CMS stated that immediate repeal avoids this risk, ensures regulatory clarity, and prevents prolonged uncertainty.  CMS also stated that it concluded that delaying repeal for a comment period or until 2034 would be unnecessary and contrary to the public interest.

Enclosed is our assessment of CMS's compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule. If you have any questions about this report or wish to contact GAO officials responsible for the evaluation work relating to the subject matter of the rule, please contact me at (202) 512-8156.

Shirley A. Jones
Managing Associate General Counsel

Enclosure

cc: Calvin E. Dukes II
Regulations Coordinator
Department of Health and Human Services

ENCLOSURE

REPORT UNDER 5 U.S.C. § 801(a)(2)(A) ON A MAJOR RULE
ISSUED BY THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES,
CENTERS FOR MEDICARE & MEDICAID SERVICES
TITLED
“MEDICARE AND MEDICAID PROGRAMS; REPEAL OF MINIMUM STAFFING STANDARDS FOR LONG-TERM CARE FACILITIES”
(RIN: 0938-AV25)

(i) Cost-benefit analysis

The Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (collectively, CMS) prepared an analysis of the costs and benefits of this rule. 90 Fed. Reg. 55687, 55696 (Dec. 3, 2024). CMS estimates that removing the requirements for 24/7 registered nurse coverage and the minimum nurse staffing levels will result in significant savings. Id. CMS stated that these savings are reflected in annualized monetized benefits of approximately $5,412 million at a 3 percent discount rate and $5,282 million at a 7 percent discount rate, over the period 2025 through 2034. Id. CMS also estimates increased Medicare spending, and regulatory review costs of $716,357. Id. Further, CMS estimates the annualized monetized costs to be $321 million at a 3 percent discount rate and $314 million at a 7 percent discount rate, over the same period. Id.

(ii) Agency actions relevant to the Regulatory Flexibility Act (RFA), 5 U.S.C. §§ 603–605, 607, and 609

The Secretary of HHS has certified that this rule will not have a significant economic impact on a substantial number of small entities. 90 Fed. Reg. at 55696. In addition, the Secretary has certified that the rule will not have a significant impact on the operations of a substantial number of small rural hospitals. Id.

(iii) Agency actions relevant to sections 202–205 of the Unfunded Mandates Reform Act of 1995, 2 U.S.C. §§ 1532–1535

CMS determined that this rule does not mandate any requirements for state, local, or tribal governments, or for the private sector. 90 Fed. Reg. at 55696.

(iv) Other relevant information or requirements under acts and executive orders

Administrative Procedure Act, 5 U.S.C. §§ 551 et seq.

CMS waived the notice-and-comment procedures upon finding good cause to do so. 90 Fed. Reg. 55689–90. Specifically, CMS determined that good cause exists under 5 U.S.C. § 553(b)(B) and 42 U.S.C. § 1395hh(b)(2) to dispense with notice-and-comment requirements. Id. CMS explained that the regulations at issue are unenforceable until 2034 pursuant to section 71111 of Public Law 119-21, that portions of the rule have been vacated by federal courts, and that no regulated entities or members of the public currently rely on them. Id. CMS stated that maintaining such unenforceable provisions in the Code of Federal Regulations would be confusing and impracticable, potentially leading to misunderstandings among long-term care facilities, regulators, and the public. Id. CMS stated that immediate repeal avoids this risk, ensures regulatory clarity, and prevents prolonged uncertainty. Id. CMS also stated that it concluded that delaying repeal for a comment period or until 2034 would be unnecessary and contrary to the public interest. Id.

Paperwork Reduction Act (PRA), 44 U.S.C. §§ 3501–3520

CMS determined that this rule contains information collection requirements under the Act, but the rule does not impose new information collection requirements. 90 Fed. Reg. at 55690. Instead, the rule revises an information collection requirement already established. Id.

Statutory authorization for the rule

CMS promulgated this rule pursuant to sections 1302, 1320a-7, 1395i-3, and 1396r of title 42, United States Code, and section 71111 of Public Law 119-21 (July 4, 2025).

Executive Order No. 12866 (Regulatory Planning and Review)

CMS stated that this rule is significant per section 3(f)(1) of the Order, as amended, and was reviewed by the Office of Management and Budget. 90 Fed. Reg. at 55691.

Executive Order No. 13132 (Federalism)

CMS determined that this rule will not have a substantial direct effect on state or local governments, preempt states, or otherwise have federalism implications. 90 Fed. Reg. at 55696.