The short version: CMS removed the 2024 requirements for a registered nurse on site 24/7 and for 3.48 total nurse staffing hours per resident per day, effective February 2, 2026. What remains is the older, qualitative framework: sufficient nursing staff on a 24-hour basis, an RN for at least 8 consecutive hours a day, a full-time director of nursing (unless waived), and a facility assessment. Texas adds its own rule on top. For a Texas skilled nursing facility, the federal numeric floor is gone, but the duty to staff to resident needs is not.

What the 2024 rule required

The final rule published in the Federal Register on May 10, 2024 (FR Doc. 2024-08273) set three numeric nurse staffing standards for Medicare- and Medicaid-certified long-term care facilities, along with a requirement that an RN be on site around the clock:

  • An RN on site 24 hours a day, 7 days a week.
  • 3.48 total nurse staffing hours per resident per day.
  • 0.55 RN hours and 2.45 nurse aide hours per resident per day, within that total.

The rule was written to phase in over several years, which is why many administrators spent 2024 and 2025 modeling what it would mean for their building rather than hiring to it. Those numbers are the ones that no longer apply.

How the standards came apart

Three separate things happened, and they are easy to blur together:

  • Courts. Two federal district courts vacated the minimum staffing standards and the 24/7 RN requirement: American Health Care Association v. Kennedy (N.D. Texas, 777 F. Supp. 3d 691, 2025) and Kansas v. Kennedy (N.D. Iowa, June 18, 2025), according to Manatt Health's summary.
  • Congress. Section 71111 of Public Law 119-21, signed July 4, 2025, prohibits CMS from implementing, administering or enforcing the staffing standards until September 30, 2034, per the text of the CMS interim final rule.
  • CMS. The agency issued the interim final rule (CMS-3442-IFC, 90 FR 55687), published December 3, 2025 and effective February 2, 2026, which removes the 24/7 RN requirement, the three hours-per-resident-day minimums and the related definition from 42 CFR 483.5 and 483.35.

CMS's stated reasoning, as summarized by Manatt, is that one-size-fits-all minimums ignore local labor supply, resident acuity and available resources, and could contribute to closures in rural areas.

What still applies at the federal level

The interim final rule restored the pre-2024 RN and director of nursing language rather than leaving a gap. Per the Federal Register text, these requirements remain:

  • Sufficient staff (42 CFR 483.35). Sufficient numbers of nursing personnel, with appropriate competencies, on a 24-hour basis.
  • RN coverage. A registered nurse for at least 8 consecutive hours a day, 7 days a week.
  • Director of nursing. A full-time DON, except when waived.
  • Facility assessment (42 CFR 483.71). The sufficient-staff language points back to the facility assessment, which is where census, acuity and the skill mix you need are supposed to be worked out.
  • Medicaid payment transparency reporting. LeadingAge and Manatt both report this part of the 2024 rule remains in effect.

LeadingAge also reports that CMS has said it will use comments on the interim final rule to inform future rulemaking. Treat the current rule as the present state of the law, not a permanent settlement.

What Texas requires on top

Texas nursing facility licensure rules are separate from the federal conditions of participation. 26 TAC § 554.1001 (text via Cornell LII) includes these staffing provisions:

  • Sufficient licensed nurses and other nursing personnel, including nurse aides, on a 24-hour basis to care for all residents according to their care plans. Staffing is tied to resident assessments, care plans and the facility assessment.
  • A licensed nurse designated as charge nurse on each shift, unless waived. The rule says "licensed nurse," so the charge role is not limited to RNs.
  • An RN for at least 8 consecutive hours a day, 7 days a week, unless waived.
  • An RN as director of nursing, full-time at 40 hours per week, unless waived. The DON may serve as charge nurse only when average daily occupancy is 60 or fewer residents.
  • Waivers are available when a facility shows diligent recruitment and the state determines resident health and safety will not be endangered, with annual review. A written waiver request to HHSC is required if staffing falls below the requirements for 30 or more days in any 45-day period.
  • Daily posting of facility name, date and census, and at the start of each shift the hours and times worked by RNs, LVNs and CNAs.

The Cornell page notes its most recent amendment as effective January 2, 2022 and that state rules are updated quarterly. Confirm the current text in the official Texas Administrative Code, and confirm anything waiver-related with HHSC, before relying on this summary.

What this means for coverage planning

This section is our reading of the rules above, not legal advice.

The practical effect of the repeal is that no federal formula tells a building how many aide and nurse hours it owes per resident. The number that matters is the one your own facility assessment supports. A 90-bed building with a high-acuity short-stay unit and a 90-bed building that is mostly long-stay residents can reasonably land in different places, and the requirement is that the staffing is sufficient for the residents you actually have.

Three places where Texas buildings tend to feel the difference in practice:

  • The RN and DON gap. The 8-hour RN requirement and a full-time DON are still binding. When the DON role is vacant or the only RN calls out, that is a coverage problem with a regulatory consequence, not just a scheduling one.
  • Charge nurse on every shift. Nights and weekends need a designated licensed nurse. An LVN can fill that role under the Texas rule, which makes LVN availability on off-shifts a real planning variable.
  • Aide coverage that follows census. With no per-resident floor, CNA hours are set by your assessment and care plans. Census swings and new admissions are what usually expose a thin CNA schedule.

What to have ready when you request agency staff

Hearthstone & Co. staffs RN, LVN and CNA roles as our core, and can also place allied and other medical staff. Whichever agency you use, a request that is specific gets matched faster. Before you call:

  • The role and license level for each open shift (RN, LVN or CNA), and whether the charge nurse role is attached.
  • Shift times and the dates or recurring pattern, including nights and weekends.
  • Current census and any acuity factors that affect the skill mix (for example, wound care, IV therapy or memory care).
  • Your orientation requirements for first-time agency staff, the EHR and badge access steps, and who meets them at the start of the shift.
  • Whether the need is a one-off, a per diem pattern or a longer vacancy, so the right arrangement can be proposed.

On the verification side, ask any agency how it checks licenses and exclusion status. Our guides on verifying a Texas nursing license and OIG and SAM exclusion screening walk through what that looks like, and the staffing agency vetting scorecard lists what to ask.

For our SNF-specific page, see nursing home staffing in Houston. Role pages: CNA, LVN and RN staffing. For shift-pattern options, read about per diem nurse staffing, and for tactics on closing gaps see reducing nurse staffing gaps in SNFs.

Frequently asked questions

Did CMS repeal the nursing home minimum staffing rule?

Yes. CMS issued an interim final rule, published in the Federal Register on December 3, 2025 (90 FR 55687) and effective February 2, 2026, that removed the 2024 requirements for a registered nurse on site 24 hours a day, 7 days a week and for minimum nurse staffing of 3.48 hours per resident per day. Congress had separately barred CMS from implementing or enforcing those standards until September 30, 2034, and two federal district courts had already vacated them.

Does a Texas nursing facility still need an RN on site?

Yes, but not around the clock under the federal rule. The federal requirement restored by the repeal is a registered nurse for at least 8 consecutive hours a day, 7 days a week, plus a full-time director of nursing unless waived. Texas rule 26 TAC 554.1001 contains the same 8-hour RN requirement and a full-time, 40-hour-per-week RN director of nursing, subject to waivers, and also requires a designated licensed charge nurse on each shift.

What federal staffing requirements remain after the repeal?

Facilities must still have sufficient nursing staff, with the appropriate competencies, on a 24-hour basis, and must still complete a facility assessment under 42 CFR 483.71. Medicaid payment transparency reporting also remains in effect. The sufficient-staff requirement refers back to the facility assessment, so census and resident acuity continue to drive how many nurses and aides a facility needs on each shift.

Does the repeal mean nursing homes need fewer CNAs, LVNs and RNs?

Not by itself. The repeal removed a federal numeric floor. It did not remove the requirement to staff to resident needs, and Texas still requires sufficient licensed nurses and nurse aides on a 24-hour basis based on resident assessments, care plans and the facility assessment. How many staff a given building needs depends on its census, acuity and shift pattern.

Sources

Reviewed against these sources on October 24, 2026. Regulations change; verify against the official Federal Register and Texas Administrative Code before acting.

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