LeadingAge National Government News: June 25, 2025

June 20 brought good news in the lawsuit filed by LeadingAge state affiliates and state Attorneys General (“Plaintiffs”) challenging the CMS nursing home minimum staffing rule. In an opinion and order dated June 18, U.S. District Court Judge Leonard Strand struck down the 24/7 RN requirement and the hours per resident day (HPRD) requirements, finding that CMS did not have the statutory authority to create the requirements and granting the Plantiffs’ Motion for Summary Judgment with respect to these specific provisions.  

The Plaintiffs had also urged the court to strike down the enhanced facility assessment (EFA) requirement, and the directive for states to collect data and report on the percentage of Medicaid payments spent on compensation for direct care workers, which the CMS final rule also included. In part, they argued that the EFA and Medicaid reporting requirements are not severable from the specific staffing standards, that all of the components of the final rule serve to impose unlawful staffing standards and so cannot stand.  

On these issues, however, Judge Strand sided with the government and declined to invalidate the provisions. In summary Judge Strand wrote: “I have made a final determination that CMS lacked the authority to promulgate the HPRD requirements and 24/7 RN requirement. … Because I have found that the Final Rule is severable …, 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.” 

Any appeal of the Judge’s Order must be filed within 60 days. 

Senate Majority Leader John Thune (R-SD) is still hoping to bring the Senate’s version of the budget reconciliation bill to the floor by the end of the week of June 23 or over the weekend— the latest is that he is targeting Friday, June 27 but this is a perpetually moving target as negotiations continue. House Speaker Mike Johnson (R-LA) has informed House members that they should expect that next week’s scheduled Congressional recess may well be canceled in order to facilitate passage of the legislation. 

President Trump also continues to push for the aggressive timeline — he posted on Truth Social that he wants to be able to sign the bill on July 4th. A few notes on the state of play: 

• We are still awaiting the new text of the Senate reconciliation package to be put on the floor at end of the week of June 23 (assuming that timeline sticks). 
• Starting late the week of June 16, Republicans and Democrats have been arguing before the Senate Parliamentarian regarding whether certain provisions within the Senate’s bill comply with budget reconciliation rules (aka the Byrd Rule). The Democratic staff of the Senate Budget Committee has been posting regarding provisions that are ruled out of order — meaning they would need 60 votes to pass. Some of these provisions may drop out of the bill. Others, Senate Republicans may try to fix — for example, a provision that shifted costs for the Supplemental Nutrition Assistance Program (SNAP) to states was ruled noncompliant with the Byrd Rule but Senator John Boozman (R-AR) has indicated that the Senate Agriculture Committee, which he chairs, has fixed the issue and this provision will remain (it is expected Democrats will challenge it again). We await news about the results of the challenges to the bill’s health or tax provisions. 
• On June 23, there was discussion of adding a proposal to the Senate package that would have reduced the expansion FMAP (currently at 90% in all states that expanded Medicaid) to the state’s traditional FMAP for all new enrollees into the expansion. Thank you to those who activated quickly to weigh in with your Senators about the detriments of this proposal. We are hearing that this proposal, championed by Senator Rick Scott (R-FL), does not have the support needed to be included in the legislation but we will not know for sure until we see the next round of text. 
• One reported sticking point in the healthcare title of the bill is around provider taxes. Manatt put out a blog on June 23 that highlights which states are most hurt by the changes to the provider tax policy between the House and Senate. Senators Josh Hawley (R-MO) and Susan Collins (R-ME) are supposedly working on a rural hospital (some reports say rural nursing homes are also included) provider relief fund to try to counterbalance the impact of the Senate’s provider tax policy. These Senators, along with others like Senator Thom Tillis (R-NC) and Jerry Moran (R-KS) have also expressed concern about the policy itself. Senators Bill Cassidy (R-LA), Hawley, and Tillis have also reportedly raised concerns that the Senate’s provider tax provision cannot pass the House; Leader Thune appears to have indicated that he is going to push forward with the Senate version and put the House in a take it or leave it position. We will see if that strategy evolves and also if any of the Senators expressing concerns ultimately are willing to vote No, which may change Leader Thune’s calculus.  
• 16 House Republicans sent a letter on June 24 to Leader Thune and Speaker Johnson regarding their concerns about the Medicaid provisions in the Senate bill. That letter can be found here. 
• On June 20, LeadingAge submitted a response to Ranking Member Sanders’ request for information on the impacts of H.R. 1: One Big Beautiful Bill on health care providers. We highlighted potential impacts to nursing homes, HCBS providers, and housing. LeadingAge’s response can be found here. 

The Centers for Medicare & Medicaid Services (CMS) released memo QSO-25-20-NH on June 18 announcing several changes to Nursing Home Care Compare. Beginning with the July quarterly refresh, CMS will use only two standard survey cycles to compute health inspection ratings, rather than the last three standard surveys. The past three years of complaint surveys will continue to be calculated, and weights have been adjusted so that the most recent standard survey and the past 12 months of complaints will account for 75% of the health inspection rating and the second most recent standard survey and complaint surveys occurring in the past two and three years will account for 25% of the health inspection score.  

Also beginning with the July refresh, CMS will begin displaying performance data for affiliated entities on nursing homes’ profile pages, and COVID vaccination metrics will be removed from providers’ main profile pages. LeadingAge notes, however, the removal of these metrics appears only to apply to the metrics on the main profile pages that were updated monthly based on the most recent National Healthcare Safety Network (NHSN) data. There has been no indication that CMS will be removing the vaccination coverage measures from the Quality Measures domain, and removal of these measures from the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) would require regulatory action.  

Lastly, beginning with the October quarterly refresh, CMS will make adjustments to the long-stay antipsychotics measure to utilize data from Medicare and Medicaid cost reports in addition to data from the Minimum Data Set (MDS) assessment. The addition of this data is anticipated to result in increased rates of reported antipsychotic usage. 

Between June 18 and June 23, the U.S. Department of Labor has submitted a dozen proposed regulations for review by the White House Office of Management and Budget’s Office of Information and Regulatory Affairs. We don’t know the specifics of these proposals, but the covered topics include the following, among others: Apprenticeship Programs, Reducing Equal Employment Opportunity Regulatory Burden; Updates to Respiratory Protection Standard Medical Evaluation Requirements; Rescinding Unnecessary Notice and Comment Procedures, and Application of the Fair Labor Standards Act to Domestic Service. We expect the proposed rules to emerge on a cascading basis in the coming weeks. LeadingAge will closely monitor these developments and report details as they emerge. 

The Centers for Medicare and Medicaid Services (CMS) issued a fraudulent phishing alert. The alert details a scheme targeting Medicare providers where scammers impersonate CMS and send phishing fax requests. The phishing fax requests medical records and other documentation indicating the targeted provider is being audited. CMS reminds providers that CMS does not initiate audits by requesting medical records via fax. If you are targeted by suspicious activity, including this kind of phish, providers should work with their Review contractor to understand if a request is verifiable. 

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