Legal Victory for LeadingAge Missouri, State of Missouri, & All Nursing Homes: CMS Staffing Mandate Vacated
LA MO is pleased to share a significant win for nursing homes in Missouri and across the nation. On June 18, a federal judge in Iowa struck down the principal portions of CMS’ nursing home staffing mandate after LA MO, Missouri’s Attorney General, and other State Attorneys General and LeadingAge Affiliates filed a lawsuit challenging the constitutionality of the CMS rule. The Judge’s opinion and order are found here.
Last year, after LA MO met with Missouri Attorney General Andrew Bailey to encourage the State’s participation, and conferred with other State AGs and LeadingAge affiliates, the LA MO Board of Directors voted to join the collaborative litigation to support Missouri nursing homes. While we shared CMS’s goal of ensuring all nursing home residents receive quality care, we did not believe the staffing mandate was a viable solution. Rather, the mandate represented CMS overreach and placed an undue financial burden on states, providers, and Americans. In prosecuting a lawsuit, LA MO had two goals:
- To repeal harmful mandates on LA MO members and other nursing homes across the country before they went into effect. To reinforce our standing and substantive arguments for relief from the CMS Rule, we completed a “Declaration of Harm” – supported by LA MO members’ experience and data – to evidence how the mandate would harm our members if allowed to take effect.
- To ensure LA MO members would gain relief from any relief ordered if the Judge vacated the CMS Rule but limited relief narrowly to parties to the action.
The plaintiffs’ legal and evidential case was compelling. The Judge ruled CMS did not have statutory authority to impose two of the most burdensome requirements in the final staffing rule: the 24/7 registered nurse (RN) mandate and the minimum hours per resident day (HPRD) standards. These provisions would have imposed significant operational and financial strain on providers—especially in the face of ongoing workforce shortages. The Judge stated: “I have made a final determination that CMS lacked the authority to promulgate the HPRD requirements and 24/7 RN requirement… I find that the appropriate remedy in this context is to vacate the 24/7 RN and HPRD requirements. This vacatur applies writ large and is not limited to the plaintiffs in this case.” In layman’s language, the Judge ruled the staffing mandates cannot be enforced – for all nursing homes nationwide. However, the Judge upheld other parts of the CMS Rule, including the enhanced facility assessment and Medicaid payment reporting requirements.
An appeal of the decision must be filed within 60 days, and we will continue to keep you informed as the legal process unfolds. For now, this is a critical and hard-earned victory—and we thank all members for their continued engagement and support.
Missouri Immigrant Workforce Concerns?
Historically, LeadingAge Missouri members have required little assistance on immigration matters. That may change. Today, more than 800,000 immigrants and naturalized citizens comprise 28% of direct care employees in aging services and U.S. Immigration & Customs Enforcement (ICE) policies no long protect healthcare facilities. LA MO members appreciate that maintaining and growing their workforce is a constant challenge and immigration must be part of the solution. Which begs the question: Are LA MO members concerned about imminent expiration of Temporary Protected Status (TPS) for immigrant team members?
TPS is temporary immigration status conferred on nationals of designated countries experiencing problems that make it difficult or unsafe for them to return to their country. TPS protects these immigrants from deportation and allows them to work in the U.S. until TPS expires. TPS has been a lifeline for hundreds of thousands of workers from 17 designated countries. However, 11 of these country TPS designations have expired or will expire soon. By the end of September, the protected status for more than 500,000 immigrants – mostly from Haiti or Venezuela – expires.
LeadingAge has advocated to stop TPS expiration by highlighting the negative impact on our fragile long-term workforce. LeadingAge also supports legal action to stop deportations. While it is important to secure the U.S. border to address illegal immigration, it is also important to secure our aging services workforce through legal immigration.
LeadingAge built resources to assist members confronting TPS worker disruption and is partnering with the American Business Immigration Coalition to bring reason to TPS enforcement. To date, ABIC’s efforts focused on stopping deportation of non-criminal, long-time, highly valued immigrant workers in the agriculture and hospitality sectors, but through consultation with LeadingAge, ABIC is now expanding its efforts into healthcare.
Critical to resource development and deployment is knowing how many LeadingAge members are affected by the TPS expirations and where the immigrants live. If TPS expiration impacts your team members, please let us know so that we may capture data and refer resources. In addition, LeadingAge is looking for members willing to speak on the record about how developments related to the administration’s termination of TPS and humanitarian parole are impacting their staff. The communications team will coordinate interviews and be present for support.
LeadingAge Missouri Board Member Needed
The nomination process for 2026-2029 board service remains open. There are open Board seats for Organizational Members and Business Member “experts”. Meetings are in person four times per year. Interested? You may nominate yourself or others. Contact Bill Bates for more information and/or to submit an application.
Changes to the Pre-Admission Screening and Resident Review (PASRR) Level 2 Process
Level 1 applications that indicate a Level 2 evaluation are currently reviewed first by COMRU staff to determine if the applicant meets Nursing Facility Level of Care (LOC) before the application is sent to the DMH for a Level 2 evaluation by DMH’s contractor, Bock Associates. However, the Administrator for LTCR has advised LA MO that effective July 1, 2025, Level 1 applications that indicate a Level 2 evaluation, based on the responses on the application, will be sent to DMH for review and determination of whether a Level 2 evaluation is necessary. The LOC determination will be made after DMH makes the determination on the Level 2 evaluation. DHSS expects to complete the LOC within one business day of the DMH determination. The goal of these changes is to streamline the process and decrease review time for these applications.
This change will have no impact to individuals completing applications – there will be no changes to the application or to the submission process.
A good refresher on the conditions that indicate a Level 2 evaluation is found here. Please ensure a thorough review of the application and supporting documentation when making admission decisions. A new online application link will be provided on COMRU webpage (https://health.mo.gov/seniors/nursinghomes/pasrr.php) starting July 1, 2025.
Don’t Miss: Free July 16 Webinar on AI in Senior Living
Join LeadingAge on July 16 at 12 p.m. ET for AI in Senior Living: Expert Insights and Governance, a free learning event exploring how artificial intelligence is transforming senior living. Learn from Parasol Alliance CEO Amber Bardon as she shares expert insights on AI trends, ethical adoption, and strategies to enhance care, operations, and compliance. Learn more and register now.