NASHVILLE — A group of 20 attorneys general who asked the federal court to strike down a nursing home staffing rule has now asked the court for emergency relief.

The injunction will immediately halt the application and enforcement of the rule as the court considers written and oral arguments in the broader case.

Jon Lips, LeadingAge’s vice president of legal affairs, announced the latest development in the case at the group’s annual meeting here Sunday. The national organization LeadingAge is not involved in the lawsuit, but 17 of its affiliates representing 21 states signed on to the civil lawsuit, which was filed Oct. 8 in the U.S. District Court for the Northern District of Iowa.

“Plaintiffs in the Iowa case recently asked the court to issue an injunction that would prevent CMS from taking action to prepare for or implement the rule even if compliance with these requirements is not established outside of a facility evaluation,” Lips said in a packed hearing outlining recent federal policy developments. : “Until 2026 and beyond.”

“The Iowa case suggests that both providers and states are taking action now to prepare for the rule, which they should not.”

Attorneys general accused the Centers for Medicare and Medicaid Services of overstepping its regulatory authority by, among other things, tripling down on a longstanding congressional directive that a registered nurse be available eight hours a day, seven days a week. The new rule mandates an RN presence every hour of every day and 3.48 hours of daily nursing care for each resident.

Earlier this month, plaintiffs argued It was stated that the staffing rule, which was finalized in early May, exceeded CMS’s legal authority. The attorney general’s brief, led by Kris W. Kobach of Kansas, reiterated on Oct. 2 that the agency’s estimated $43 billion cost makes it an issue of great economic and political importance “unless Congress speaks clearly on this issue.” 22 motions for preliminary injunction and oral argument.

State provider groups describe the damage

The lawsuit now includes legal filings from LeadingAge chapter officials aimed at demonstrating the rule’s impact on nursing homes.

For example, Kari Thurlow, president and CEO of LeadingAge Minnesota, cautioned that even initial site evaluation provisions require significant staff time and financial investment. Despite this fact, providers worry that they will be cited for noncompliance due to CMS’ “lack of clear guidance.”

He expressed concern about the situation where the 5-star-rated Halstad Living Center has spent more than $10,000 on administrative costs to date; this figure was more than twice CMS’s estimated cost of compliance with the requirement in terms of staff time alone.

“These are for start-up costs and do not include any costs associated with accommodating ‘ongoing’ updates to the new facility assessment,” Thurlow wrote. “These vague and arbitrary definitions can result in providers being unfairly penalized through Civil Monetary Penalties during complaint investigations or annual surveys, despite acting in good faith.”

He called it an example of the rule’s “overly burdensome cost without benefiting residents.”

Costs cannot be recovered

The main argument also repeatedly touches on growing concerns about the costs of staffing necessary for compliance and efforts currently underway to recruit and maintain the nursing workforce. In Pennsylvania, for example, the annual cost of compliance is expected to average $689,000 per provider.

“LTCs that have not yet hired personnel to comply with the Final Rule will soon do so, and these costs will impose significant and, in many cases, impossible burdens on LTCs. These burdens are particularly harmful in rural areas where the necessary workforce is lacking or in other tight labor markets where LTC facilities compete with hospitals and other high-paying healthcare jobs for scarce healthcare professionals,” the attorney general wrote.

“Care homes will incur significant costs and may need to rely on temporary staffing agencies, which are significantly more expensive, sometimes several times the cost of a working staff member, and have a reputation for providing lower quality care by those less knowledgeable about care homes. less investment is being made in the well-being of residents. “These increased costs will likely lead to reduced services and closures in many nursing homes, ultimately reducing long-term care opportunities for seniors and forcing many people to move to facilities far from their families and friends.”

This was one of several ways in which AGs sought to plead irreparable harm; said providers may not be able to recoup money spent now if the staffing rule is ultimately defeated in this case or two others consolidated in the U.S. District. North Texas Court.

“Because the Final Rule is likely to be deemed illegal in many respects, this

“Because irreparable harm has been done to both corporate and State plaintiffs here, plaintiffs need injunctive relief,” they wrote. “In the absence of preliminary injunctive relief, Plaintiffs will suffer irreparable harm… LTC Plaintiffs and Corporate Plaintiffs representing LTCs suffer and will continue to be subject to sharply increased financial and administrative burdens that will be too great for many LTCs to bear and will result in reduced services and LTC closures.”

The plaintiffs said the court should not only pause enforcement of the rule in the states involved in the case, but also extend relief to all regulated nursing homes nationwide “pending a decision on the merits.”

“Anything less than a nationwide injunction would require organizational plaintiffs to monitor and report membership rolls to determine which LTCs are members to which the injunction applies,” the attorney general writes. “Meanwhile, other LTCs that are not members or residents of Plaintiff states will be forced to compete in an unequal market. “This Court should not allow such an unjust outcome.”