U.S. Sen. Kevin Cramer (R-ND) voiced his opposition to the federal staffing mandate in a September 24 speech delivered on the floor of the U.S. Senate. He also spoke on the dangers of administrative bureaucracy and the punitive nature of survey fines experienced by long-term care facilities. “In May, CMS issued this minimum staffing rule, which requires long-term care facilities to implement new staffing requirements,” said Sen. Cramer. “These are already institutions that are already woefully understaffed because of a lack of workforce. Most burdensome is the new requirement to have a Registered Nurse on site 24 hours a day, seven days a week, rather than the previous eight hours a day, seven days a week. Less than a quarter of North Dakota facilities meet this requirement, and among rural facilities, only 14 percent will meet that mandate.”

Sen. Cramer has pushed back against the nursing home staffing standard for nearly two years, sending a letter cosigned by 12 bipartisan Senate colleagues to CMS in January 2023. As a member of the Senate Veterans Affairs Committee, Sen. Cramer joined U.S. Senator Angus King (I-ME) in introducing a bill to require the Department of Veterans Affairs to submit a report regarding the proposed rule’s impact on the access of veterans to long-term care. The senators later requested the VA study the potentially harmful effects of the staffing rule on nursing homes. Sen. Cramer also joined U.S. Sen. James Lankford (R-OK) in cosponsoring H.J.Res.91, the Congressional Review Act resolution of disapproval to overturn the final rule issued by CMS.