The Federal Nursing Home Staffing Mandate: Enacted in 2024, Repealed in 2025, and What It Means for Nurse Wages
By NurseCompensation Research Team · 2026-05-25 · 9 min read
CMS finalized minimum staffing requirements for nursing homes in April 2024, then repealed them in December 2025. Here is what happened, why it matters, and how it affects nursing pay in long-term care.
What Happened
In April 2024, the Centers for Medicare and Medicaid Services (CMS) issued a final rule requiring all Medicare- and Medicaid-certified nursing homes to meet minimum nurse staffing levels:
- Total nursing: 3.48 hours per resident day (HPRD)
- Registered Nurses: at least 0.55 HPRD
- Nurse Aides: at least 2.45 HPRD
- 24/7 RN requirement: A registered nurse on-site at all times
On December 2, 2025, CMS repealed the rule. The agency reinstated the prior standard: facilities must use the services of an RN for at least eight consecutive hours per day, seven days per week.
Why It Was Repealed
CMS cited three primary reasons:
- Workforce availability concerns, particularly in rural areas
- Legal challenges (the U.S. District Court for the Northern District of Texas had already vacated portions of the rule in April 2025)
- Industry feedback about implementation feasibility
What the Data Showed
Before repeal, research published in Health Affairs found that only 18% of U.S. nursing facilities met all three provisions of the 2024 rule. Specifically:
- 58% met the total nursing staffing standard
- 50% met the RN staffing requirement
- 28% met the nurse aide standard
Impact on Nursing Compensation
The staffing mandate, while active, was driving significant wage competition in long-term care:
During the mandate (2024-2025):
- Nursing home RN wages rose as facilities competed for limited staff
- Some facilities offered $5,000-$15,000 sign-on bonuses for RNs willing to work in SNFs
- Per diem rates for SNF nurses reached $45-$65/hour in competitive markets
After repeal:
- Wage pressure in long-term care is expected to moderate
- Facilities no longer face the same urgency to meet numerical thresholds
- Travel and agency utilization in SNFs may decrease, reducing premium pay opportunities
What This Means for Nurses Considering Long-Term Care
The repeal does not eliminate demand for nurses in nursing homes. The underlying demographics (aging population, 1.2 million current residents) remain unchanged. However, the regulatory urgency that was driving premium compensation has been removed.
Nurses currently working in or considering long-term care should:
- Expect wage growth to slow relative to 2024 levels
- Recognize that individual states may still maintain their own staffing standards (34 states had pre-existing requirements)
- Factor in that SNF work typically offers more predictable schedules than acute care
Sources: CMS Final Rule CMS-3442-F (April 2024), CMS Repeal Rule (December 2, 2025, Federal Register), Health Affairs research on state compliance rates, American Health Care Association statements.