from McKnights Long-Term Care News
The original sponsor of legislation to prevent a federal staffing mandate from taking effect said Wednesday she will still press for the bill’s passage, even after a judge vacated the rule this week.
Rep. Michelle Fischbach (R-MN) explained her plans to LeadingAge members gathered in Washington, DC, for a major lobbying event.
She said that US District Judge Matthew J. Kacsmaryk’s Monday ruling in favor of the American Health Care Association, LeadingAge and four Texas nursing homes was “awesome” and a “great step in the right direction.”
But Fischbach also said she expected the Department of Health and Human Services to appeal the rule within a designated 60-day window.
“You’re all familiar with the nursing staff ratio mandate proposed by the last administration and all the damage it would do to rural nursing homes,” she said. “So I’m going to go forward with the legislation because we need to make sure this rule is overturned.”
Fischbach first introduced the Protecting Rural Seniors Access to Care Act in 2023, about a month after the first version of the staffing rule was proposed by the Centers for Medicare & Medicaid Services. In late February 2025, at the start of the new Congress, she reintroduced the bill. Sens. Deb Fischer (R-NE) and James Lankford (R-OK) have also reintroduced their version of the bill.
Members of the Senate have suggested the mandate be eliminated to save the federal government $22 billion in costs, presumably for enforcement, over a decade. That makes Fischbach’s bill a key candidate for inclusion in a massive budget reconciliation package.
“You have to make sure that they remember that these things are affecting real people,” said Fischbach, a member of the House Ways and Means Committee that last year advanced the bill opposing the staffing mandate. “It’s really, really important you convey that message. This is about people. This is about our aging population. This is about people staying in their community.”
LeadingAge President and CEO Katie Smith Sloan said this particularly Lobby Day was especially important to the aging services sector “because so much is on the line.”
“We worry about the fate of Medicaid, affordable senior housing, tax-exempt bond financing, and funding for home-and community-based services, especially in rural areas,” she wrote in a blog Wednesday. “We continue to be challenged by the shortage of professional caregivers and troubled by disturbing misrepresentations of the role nonprofit organizations play in communities around our country. We cannot predict the outcomes of these and other debates currently taking place in Washington. However, we should all be very concerned that policymakers are even considering actions that we know will negatively affect the health and well-being of older adults.”
Uncertainty in DC and in court
Sloan called these “unprecedented, chaotic, fast-paced, and uncertain times” in Washington and for the sector. That’s valid about the staffing mandate, too.
Despite the judge vacating the rule in Texas, observers have told McKnight’s that provisions not explicitly argued against in that case — such as the rule’s Medicaid transparency changes — could stand. In a separate case being considered by the US District Court for Northern Iowa, a group of states attorneys general and LeadingAge affiliates have asked for relief from the entire rule.
The judge in the Iowa case has denied a temporary injunction, which is now on appeal to the Eighth Circuit Court of Appeals. But a District Court judge must also still rule on the merits, which could confirm or contradict the ruling in Texas.
The clearest relief for providers would be for CMS to rescind or refine the rule, or for Congress to block it.
Fischbach also has co-sponsored legislation to stop the nurse aide training lockout, which prevents those penalized over a certain threshold from training their own direct care staff. She added that “the focus needs to be shifted to education, recruitment and the retention of qualified staff.”
She said lawmakers are aware of and trying to address the need to address the workforce shortage, but a rule enacting one-size-fits-all staffing requirements “is not the solution.”
“Long-term care is a huge part of strong rural communities. We need to make sure those rural residents can receive care closer to relatives, their friends in the community they know. That’s so important to them as they age.”
