WASHINGTON – Minimum staffing requirements that North Dakota long-term care facilities had opposed when proposed under the Biden administration have been repealed under the Trump administration.

The U.S. Department of Health and Human Services has formally repealed the requirements, which affected nearly 1.2 million residents across the nation.

The 2024 rule required applicable nursing homes to provide residents with a minimum of 3.48 hours of nursing care per day, including at least 0.55 hours from a registered nurse per resident per day, and 2.45 hours from a nurse aide per resident per day. It mandated each facility have a registered nurse onsite 24/7.

U.S. Sen. Kevin Cramer, R-ND, said he led multiple efforts, including bipartisan legislation, to push back against the rule, culminating in the passage of the Working Families Tax Cut Act, which included a 10-year moratorium on enforcement of the staffing mandate.

“Rolling back the burdensome, Biden-era staffing mandate is a major win for patients, providers, and every rural community depending on accessible, local long-term care,” Cramer said.

“Our rural long-term care providers already face a range of challenges, and this staffing mandate from the Biden administration only added to their burden,” Sen. John Hoeven, R-ND, said. “This one-size-fits-all approach would have actually reduced access to long-term care in rural areas by forcing providers to shut down when they were unable to comply.”

In a public comment before the rule was finalized, the North Dakota Long Term Care Association, North Dakota Hospital Association, North Dakota Medical Association, North Dakota Nurses Association and the Quality Health Associates of North Dakota outlined their concerns.

They noted more than 500 nursing homes have closed since 2020, often due to the inability to hire qualified staff. They also noted Centers for Medicare & Medicaid Services estimated the staffing rule would cost $4 billion annually, roughly $300,000 per facility.

“North Dakota has always had one of the highest staff to resident ratios in the country. We are most concerned about the proposed 24/7 RN requirement. The number of RNs needed to fulfill this standard just simply do not exist. This mandate may force more nursing homes, many of which already operate on tight budgets, to close their doors, reducing access to care. North Dakota has had more nursing home closures in the last few years than ever before, largely due to staffing issues,” they collectively stated.

“The formal repeal of the mandate is a long-awaited decision that acknowledges the ongoing workforce challenges facing providers and restores essential flexibility for facilities to staff in a way that best supports resident-centered care,” said Nikki Wegner, president of the North Dakota Long Term Care Association.