HJRES-139-118
Ordered to be Reported by the Yeas and Nays: 21 - 18.
Sponsored by Michelle Fischbach (R-MN)
What it does
This joint resolution would use the Congressional Review Act (CRA) to nullify a rule issued by the Centers for Medicare & Medicaid Services (CMS) in 2024. That CMS rule set minimum staffing levels — including required hours of care per resident per day from registered nurses and nurse aides — for long-term care facilities that participate in Medicare and Medicaid. If this resolution passes both chambers and is signed into law, the CMS rule would be voided and could not be reissued in substantially the same form without new congressional authorization.
Who benefits
Nursing home operators and long-term care facility owners, particularly those in rural areas or regions with limited healthcare labor markets, who argue they cannot meet the staffing thresholds. For-profit and nonprofit nursing home chains that would face significant compliance costs under the CMS rule. States with fewer healthcare workers per capita, which would have more difficulty meeting the federal floor. Medicaid-participating facilities operating on thin margins who contend the rule would force closures or service reductions.
Who is hurt
The approximately 1.2 million residents currently living in Medicare- and Medicaid-certified nursing homes, who would not receive the minimum staffing protections the CMS rule was designed to provide. Family members and advocates of nursing home residents who sought stronger federal oversight of care quality. Registered nurses and certified nurse aides who may have gained additional employment opportunities under the staffing mandate. State Medicaid agencies that supported the rule as a quality-of-care floor.
Supporters argue
Supporters argue that the CMS staffing rule is an example of federal agency overreach that imposes an unworkable, one-size-fits-all mandate on a diverse industry. They contend that nursing homes — especially those in rural communities — face a severe workforce shortage that makes compliance with the specific hourly thresholds physically impossible, regardless of willingness or resources. Rather than improving care, supporters say, the rule would accelerate facility closures and reduce bed availability, leaving vulnerable seniors with fewer options. They also argue that Congress, not an executive agency, should set binding national standards of this magnitude, and that the rule's costs — estimated in the billions — were not adequately justified by CMS under the major questions doctrine, which requires clear congressional authorization for rules of vast economic and political significance.
Opponents argue
Opponents argue that nullifying the CMS rule would eliminate the first-ever federal minimum staffing standard for nursing homes, leaving residents in facilities with chronically low staffing levels that have been linked to higher rates of infections, falls, pressure ulcers, and preventable deaths. They contend that decades of voluntary compliance and state-level standards have proven insufficient to protect a highly vulnerable population that cannot easily advocate for itself. Opponents also argue that the workforce shortage cited by the industry is partly a product of low wages and poor working conditions — problems the rule was intended to address by creating market pressure to attract and retain staff. They further assert that CMS acted well within its statutory authority under the Social Security Act, which explicitly grants the agency power to set conditions of participation for Medicare and Medicaid facilities.
Constitutional context
The Congressional Review Act (5 U.S.C. ch. 8) gives Congress authority to disapprove agency rules by simple majority, grounded in Congress's broad power to define and limit executive agency authority. The underlying CMS rule rests on the Spending Clause (Art. I, §8) — conditions attached to Medicare and Medicaid funding — and the Commerce Clause. Key cases include NFIB v. Sebelius (2012), which affirmed Congress's broad Spending Clause authority to attach conditions to federal funds, and the major questions doctrine (West Virginia v. EPA, 2022), which requires agencies to show clear congressional authorization for rules of vast economic significance. Post-Loper Bright (2024), courts no longer defer to agency interpretations of ambiguous statutes, meaning CMS's statutory authority could face independent judicial scrutiny.
Checks and balances
This resolution would shift authority from the executive branch back to Congress. CMS, an executive agency under HHS, issued the staffing rule using its delegated rulemaking authority. If the CRA disapproval is enacted, Congress would effectively override that executive action and bar CMS from reissuing a substantially similar rule without new legislation — a significant legislative check on executive agency power. The resolution does not itself set staffing standards; it returns that policy space to Congress and the states.
Historical precedent
The Congressional Review Act has been used successfully to nullify agency rules, most notably in 2017 when Congress used it to void 14 Obama-era rules in rapid succession. No prior federal minimum staffing rule for nursing homes has existed, making this CMS rule — and this disapproval effort — without direct historical parallel in the long-term care context.