The home health revenue cycle has experienced ongoing changes in recent years, and this year is no different. The Centers for Medicare & Medicaid Services (CMS) has announced more changes to nursing home staffing requirements, opening up opportunities for leadership to make strategic adjustments. These adjustments create downstream impacts on home health billing and home health care coding, increasing the value of optimized revenue cycle efficiency to adjust to the changes.
This update will help you stay on top of the home health staffing requirement change and adjust your revenue cycle strategy in the most effective way possible [1].
CMS Moves to Rescind Federal Nursing Home Staffing Requirements
CMS has started the process of withdrawing the federal staffing mandate for nursing homes [2]. While the rule’s specific contents remain unavailable to the public, it appears likely that CMS plans to officially withdraw a measure already largely dismantled through legislative and judicial channels.
The Biden administration initially advanced the staffing mandate in 2023, issuing a final rule last year. Providers submitted almost 50,000 comments when CMS initially proposed the mandate, demonstrating widespread opposition [3]. The nursing home sector responded with legal challenges, including litigation brought by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and LeadingAge. LeadingAge joined AHCA’s legal challenge last year, with around half of its state affiliates pursuing separate litigation alongside state attorneys general.
Earlier this year, a Texas judge delivered an additional blow to the rule, striking down critical provisions including the requirement for continuous registered nurse staffing and the minimum threshold of 3.48 hours per resident daily. The One Big Beautiful Bill Act (OBBBA) also imposed a 10-year moratorium on the mandate. Linda Couch, SVP of policy and advocacy at LeadingAge, views the repeal positively. “We are beyond eager to have the minimum staffing final rule repealed and are pleased to see apparent action under review at the Office of Management and Budget to do so quickly through an interim final rule. Because staff is critical to quality care, LeadingAge will continue to focus on the priority issue of expanding the aging services workforce.”
For revenue cycle professionals responsible for home health care billing operations, this development carries implications that will reverberate long-term.
The Rule Saw Significant Pushback From Providers
The rule’s primary requirements were scheduled to phase out within a year, with distinct timelines for RN staffing and total nursing hours. But extended compliance periods for rural facilities and available exemptions failed to address provider concerns about recruiting necessary staff. Some counties across the nation have only one licensed RN or none at all.
Home health providers also anticipated increased competition from hospitals and nursing homes for recruiting staff as they sought additional clinicians. This dynamic directly affects home health billing revenue capture, as unfilled positions delay service delivery and claim submissions.
The rule modified facility assessment requirements, attempting to establish hourly staffing standards as a baseline while requiring providers with high-acuity residents to furnish additional nursing care. Additionally, the rule would have triggered supplementary cost-reporting under the Medicaid Institutional Payment Transparency Reporting provisions, mandating states report the percentage of Medicaid payments allocated to direct care workers and support staff compensation.
Implications for Home-Based Care Providers
The Office of Management and Budget (OMB) received the rule for review on August 22. The specific timeline for the repeal is still unclear.
The announcement of the repeal is getting a positive response from the provider side. Katy Barnett, director of home care and hospice operations and policy at LeadingAge, comments. “The repeal is positive for home health agencies. LeadingAge has in comment letters repeatedly cited concerns about this staffing mandate’s impact on home health and hospice providers. The entire post-acute care sector needs a commitment from CMS to invest in attracting more staff to these professions, rather than implementation of rules creating competition between settings for limited staff.”
Still, the home health industry has avoided immediate impact because the main provisions weren’t scheduled to take effect until 2026. Mary Carr, vice president of regulatory affairs at the National Alliance for Care at Home sheds light on provider relief [4]. “Our fear was they were going to take people away. We were going to have a smaller staffing pool if skilled nursing facilities had to hire more nurse aides. We were concerned that it would impact us, but because these provisions weren’t even scheduled to take effect yet, we haven’t seen any impact.”
A Relief for the Revenue Cycle
For revenue cycle leaders overseeing home health care billing and home health care coding operations, this development offers some breathing room. Staffing stability directly correlates with claim accuracy and submission timeliness. When agencies struggle to fill clinical positions, home health billing processes suffer through delayed documentation, incomplete records, and compliance vulnerabilities that trigger denials.
In the face of this opportunity, revenue cycle leaders can step forward with renewed confidence. 3Gen Consulting offers proven expertise in home health billing and home health care coding. Whether you’re adapting your internal teams or seeking a partner to help you explore emerging opportunities in the face of reduced staffing requirements, we’re here to help. Contact us today to get started.
References
[1] CMS, “Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule (CMS 3442-F),” 22 April 2024. Available: https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0.
[2] T. Mullaney, “CMS Moves To Rescind Federal Nursing Home Staffing Mandate,” Skilled Nursing News, 2 September 2025. Available: https://skillednursingnews.com/2025/09/cms-moves-to-rescind-federal-nursing-home-staffing-mandate/.
[3] K. Marselas, “BREAKING: CMS intends to repeal nursing home staffing rule,” Haymarket Media, Inc., 2 September 2025. Available: https://www.mcknights.com/news/breaking-cms-intends-to-repeal-nursing-home-staffing-rule/.
[4] J. Famakinwa, “Home Health Industry Welcomes CMS’ Repeal Of Nursing Home Staffing Mandate,” Home Health Care News, 30 September 2025. Available: https://homehealthcarenews.com/2025/09/home-health-industry-welcomes-cms-repeal-of-nursing-home-staffing-mandate/.
