The nursing-facility minimum staffing rule is paused through FY2034
A practical playbook for HCBS & LTSS leaders (mapped to workforce, compliance, client support, and advocacy)
Congress’s One Big Beautiful Bill Act (Public Law 119-21) delays federal implementation of key pieces of CMS’s nursing-facility staffing rule until FY2035—i.e., through September 30, 2034. The paused elements include the 24/7 RN requirement and the minimum 3.48 hours per resident day (HPRD) staffing standard, as well as state Medicaid institutional payment transparency reporting tied to nursing facilities and ICF/IIDs.
Quick refresher on the rule that’s on ice: CMS’s 2024 final rule set the 3.48 HPRD total nursing minimum, with at least 0.55 RN HPRD and 2.45 nurse-aide HPRD, plus an RN on duty 24/7.
Important nuance: OBBB pauses specified provisions (the staffing minimums and the Medicaid institutional payment-reporting requirement). Other portions—like updated facility assessment requirements—took effect in 2024 and were not rolled back by statute. (GovInfo, KFF)
What this means (plain English)
Near-term staffing pressure from SNFs eases, but demand for direct care talent remains intense across settings.
Cross-continuum partnerships can pivot: with 24/7 RN and 3.48 HPRD on hold, many SNFs will emphasize retention and targeted staffing versus rapid headcount expansion—opening doors to collaborate on shared pipelines that also benefit HCBS.
Policy attention shifts to states: some may advance state-level staffing standards or incentives even while the federal provisions are paused.
Transparency reporting for institutional LTSS is delayed by statute; keep an eye on how states approach data collection voluntarily or via other authorities.
Priority actions by lane
1) Workforce development
Goal: Convert the pause into pipeline momentum that strengthens community supports.
Co-design talent pipelines with SNFs and health systems (paid practicums, “earn-while-you-learn” tracks). Use the breathing room to build companion → personal care → advanced dementia/behavioral health career ladders that raise competence and retention across the continuum.
Stand up micro-credentials (2–4 hrs) in dementia care, safe mobility, infection control, and respectful care conversations—skills SNFs also prize—so trainees can move between settings as needs shift.
Leverage state and federal training dollars unrelated to the paused provisions (e.g., workforce boards, community-college partnerships) and document outcomes you can bring to Medicaid rate discussions.
2) Compliance adherence
Goal: Stay aligned with what is still live and be “audit-ready” when the pause lifts.
Do not ignore the rule entirely. CMS’s final rule remains on the books; specific provisions are delayed to FY2035. Keep staff aware of the baseline standards (3.48 HPRD; 0.55 RN; 2.45 NA; 24/7 RN) and your state’s current expectations.
Facility assessment updates (a separate piece of the rule) took effect in 2024; ensure your partners in SNFs—and your own internal policies where relevant—reflect current assessment practices (inputs from staff and resident representatives; acuity-aligned plans).
Data discipline now = smoother reactivation later. If you operate across settings, keep capturing labor hours, skill mix, and vacancy/turnover the same way you would if staffing standards were active; it’s easier to scale up when timelines change.
3) Client support
Goal: Protect safe transitions and continuity—without adding burden to families.
Tighten warm handoffs with SNFs: shared checklists for ADLs, mobility, and behavioral supports; earlier introductions between your care team and the resident/family to reduce readmissions.
Set expectations transparently: the pause does not guarantee more staff at facilities; encourage families to bring specific questions about care plans and escalation pathways. Consider a one-page “Preparing for a safe transition” handout.
Use the pause to stabilize at home and in the community: offer caregiver coaching, safety checks, and respite where covered to reduce avoidable returns to the hospital or facility.
4) Advocacy
Goal: Shape state-level policy and keep momentum on quality—without blunt mandates that ignore workforce realities.
Ask your state:
Will the state pursue targeted staffing supports (scholarships, tuition, transport, housing stipends) during the federal pause?
How will the state monitor outcomes (falls, pressure injuries, ED transfers) to ensure quality doesn’t slip while federal enforcement is paused?
What’s the plan to publish staffing-and-quality dashboards that inform consumers and providers?
Bring solutions, not just concerns: propose shared training consortia, standardized clinical rotations, and data elements that demonstrate how stronger HCBS capacity reduces institutional strain and improves outcomes.
Timeline you can bring to meetings
May–June 2024: CMS staffing rule published; effective June 21, 2024 (with phased implementation in the original rule).
July 4, 2025: OBBB enacted; Sec. 71111 delays implementation of the 24/7 RN, 3.48 HPRD standard, and Medicaid institutional payment transparency reporting until FY2035.
Through Sept 30, 2034 (FY2034): Pause in effect; watch for state choices and any CMS guidance clarifying scope. (Some non-staffing pieces—e.g., updated facility assessments—remain operative.)
Metrics to track (and share with state partners)
Time-to-fill and 90-day retention for direct care roles (by credential).
Avoidable ED visit rate and 30-day readmission rate for members transitioning between SNF and community.
Training throughput: completions of micro-credentials aligned to dementia, mobility, and safety.
Cross-continuum pipeline outputs: number of apprenticeships, supervised practicums, and joint hires placed.
Bottom line
The federal staffing floor for nursing facilities is on hold until FY2035, but the imperative to deliver safe, person-centered care is not. HCBS and LTSS leaders can use this window to: (1) expand workforce pipelines that stabilize care across settings, (2) shore up compliance for elements still in force, (3) strengthen client supports that reduce crisis utilization, and (4) drive state-level solutions that lift quality while acknowledging the labor market we actually have.
References
Congress.gov. (2025). H.R. 1—One Big Beautiful Bill Act (Public Law No. 119-21), Sec. 71111 (delays to minimum staffing rule and Medicaid institutional payment transparency reporting until FY2035). Retrieved August 21, 2025, from the Library of Congress website. (Congress.gov)
Centers for Medicare & Medicaid Services. (2024, Apr 22). Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting (Fact sheet). (CMS)
Federal Register / GovInfo. (2024, May 10). Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting (89 FR 40876) [Final rule]. (GovInfo)
Federal Register / GovInfo. (2024, Jun 24). Minimum Staffing Standards…; Correction (89 FR 52392). (Clarifies effective date and technical corrections.) (GovInfo)
KFF. (2024, May 21). A closer look at the final nursing facility rule and which facilities might meet new staffing requirements. (Phasing and facility-assessment details.) (KFF)
