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The U.S. District Court for the Northern District of Iowa  components of the Centers for Medicare & Medicaid Services’ minimum nurse staffing rule. The rule would have required nursing homes to have an RN onsite all the time and prescribe a minimum total nurse staffing hours per resident day. The court maintained the rule’s enhanced facility assessment and Medicaid reporting requirements. District Court Judge Leonard Strand said CMS did not have the authority to mandate rigid staffing requirements for long-term care facilities. A Texas district court also  the minimum staffing mandate in April. AONL and the American Hospital Association oppose the staffing mandate; the AHA criticized the policy in a  in October 2024. (AHA News , 6/20/25)