December 9, 2025

The President’s Message is published in the MHA Weekly News Report, a member only publication of the Montana Hospital Association. To subscribe, click here.

Last week, the Centers for Medicare & Medicaid Services (CMS) announced a major policy reversal, formally repealing the federal minimum nurse staffing standards it adopted in 2024. These now-rescinded requirements would have imposed strict hourly staffing thresholds—including 3.48 hours of nursing care per resident day and 24/7 onsite RN coverage—on all Medicare- and Medicaid-certified nursing homes.

Instead, CMS has returned to its long-standing staffing framework, requiring access to an RN for at least eight consecutive hours daily, seven days a week, and maintaining the requirement for a full-time RN director of nursing except where a waiver applies. The strengthened facility assessment requirements from the 2024 rule, however, remain in place.

From the outset, MHA strongly opposed CMS’s proposed minimum staffing standards, submitting detailed comments, engaging with Montana’s congressional delegation, and joining national partners to communicate the impacts on rural providers and the seniors they serve.

MHA Vice President Heather O’Hara, MSN, RN, led our advocacy on this issue. With her extensive experience in both patient care and nursing leadership roles, as well as insights from her clinical peers across the state, Heather was able to articulate the real-world implications of well-intentioned but ill-conceived standards like these. Her advocacy emphasized that Montana’s long-term care sector is already in crisis, with at least 11 nursing home closures in the past few years alone. Imposing staffing mandates amid workforce shortages would have pushed many remaining facilities to the brink, reducing access to care and forcing seniors farther from home.

CMS’ reversal aligns with the 10-year moratorium on federal staffing mandates that was included in the budget reconciliation bill, H.R. 1, enacted by Congress this past July. This congressional action acknowledges what our association has consistently raised with federal policymakers: one-size-fits-all staffing ratios are unworkable in rural states and will accelerate nursing home closures rather than improve care.

We thank Montana’s congressional delegation—Senator Steve Daines, Senator Tim Sheehy, Representative Ryan Zinke and Representative Troy Downing—all of whom understood and supported repeal of these unrealistic and counterproductive standards.

CMS’s repeal provides welcome and necessary relief, but our advocacy continues. We remain committed to ensuring federal policy reflects the realities of rural healthcare and protects access to safe, high-quality long-term care for Montana’s seniors.