Direct answer
As of September 9, 2026, California skilled nursing facilities should not staff to the repealed federal 3.48 HPRD and 24/7 RN mandate, but they still must meet federal sufficient-staff rules and California Title 22’s 3.5 direct care hours and 2.4 CNA hours. ePeople helps operators compare both standards at shift level.
Key takeaways
- The Biden-era federal numeric minimums of 3.48 total HPRD, 0.55 RN HPRD, 2.45 nurse aide HPRD, and 24/7 onsite RN were repealed by HHS on December 2, 2025.
- California freestanding SNFs still must meet Title 22 and Health and Safety Code staffing floors of 3.5 direct care service hours per patient day, including at least 2.4 CNA hours per patient day.
- Federal participation requirements did not disappear: SNFs still need sufficient staff on a 24-hour basis, a licensed charge nurse on each tour, and an RN for at least 8 consecutive hours a day, 7 days a week, unless a waiver applies.
- California staffing audits remain documentation-heavy. CDPH can exclude non-delineated hours from the 3.5 and 2.4 calculation if records do not show who worked, when, and in what role.
- PBJ reporting still matters even after the federal repeal because CMS continues to publish staffing data, weekend staffing, turnover, and star-rating inputs on Care Compare.
Last updated: September 9, 2026.
California operators got a mixed signal when HHS repealed the federal staffing minimums on December 2, 2025. The repeal removed the federal numeric floor from the 2024 rule, but it did not erase older Medicare and Medicaid participation standards, and it did nothing to remove California’s separate staffing law. For a California skilled nursing facility, the practical question is not whether staffing minimums exist. It is which minimum controls which workflow on which day.
What changed federally after the 2025 repeal?
The short answer is that the national numeric floor from the April 22, 2024 CMS final rule is gone. That rule had set 3.48 total nursing hours per resident day, including 0.55 RN hours and 2.45 nurse aide hours, plus an onsite RN 24 hours a day, 7 days a week, with staggered implementation windows of 90 days, 2 years, and 3 years for non-rural facilities and up to 5 years for some rural requirements (CMS final rule fact sheet). HHS later announced that those staffing provisions were repealed on December 2, 2025 (HHS repeal announcement).
What federal staffing rules still apply to a California SNF?
The federal floor reverted to the longstanding participation standard under 42 CFR 483.35: sufficient nursing staff with the competencies to meet resident needs, licensed nurses on a 24-hour basis, a licensed charge nurse on each tour of duty, and an RN for at least 8 consecutive hours a day, 7 days a week, unless a waiver applies (42 CFR Part 483 published text). That means a California facility can no longer assume a federal 3.48 HPRD target, but it also cannot treat the repeal as permission to run thin if resident acuity and care plans call for more staffing.
What does California Title 22 require right now?
California still has a numeric state floor. Freestanding skilled nursing facilities generally must provide at least 3.5 direct care service hours per patient day, and at least 2.4 of those hours must be performed by certified nurse assistants. That requirement has applied since July 1, 2018, and CDPH continues to describe it as the statewide baseline for covered facilities (CDPH Title 22 72329.2; CDPH AFL 21-11). In other words, for most California operators, the repeal changed federal planning assumptions but did not lower the daily state staffing floor.
Federal floor after repeal vs California Title 22 daily staffing floor for SNFs
| Issue | Federal rule after 2025 repeal | California Title 22 / CDPH |
|---|---|---|
| Numeric minimum HPRD | No current federal numeric HPRD floor after repeal of the 2024 3.48 rule | 3.5 direct care service hours per patient day |
| CNA-specific minimum | No current federal CNA-specific HPRD floor after repeal of the 2.45 rule | 2.4 CNA hours per patient day |
| RN onsite requirement | RN at least 8 consecutive hours a day, 7 days a week; sufficient licensed nurses on a 24-hour basis; waivers may apply | No separate statewide 24/7 RN floor parallel to the repealed federal rule, but facility must still meet California licensing requirements and enough staff for resident needs |
| Charge nurse coverage | Licensed charge nurse on each tour of duty | State law does not replace the federal participation rule; operators should schedule to both |
| Who is covered | Medicare- and Medicaid-certified facilities under federal participation rules | Freestanding California SNFs subject to Title 22 section 72329.2 and related CDPH audit rules |
| Audit focus | Resident-need sufficiency, PBJ, Care Compare, survey citations such as F725 | Daily 3.5 and 2.4 compliance, timekeeping detail, census method, delineation of countable hours |
Which rule is stricter in practice?
For California freestanding SNFs, Title 22 is usually stricter because it gives surveyors and operators a clear daily number: 3.5 total direct care hours and 2.4 CNA hours. The federal standard is broader and more judgment-based. It can be stricter when acuity, behavior, wounds, or admissions volume make 3.5 mathematically insufficient, because the federal requirement still asks whether staffing was actually enough for the resident population and care plan, not just whether a state minimum was hit (CMS facility assessment guidance).
Does California let facilities waive the 2.4 CNA minimum?
Sometimes, but the waiver concept is narrower than many operators assume. CDPH states that facilities can seek a patient-needs waiver tied to the 2.4 CNA requirement while still meeting the overall 3.5 direct care service hour floor. The waiver is about individual patient needs, not general staffing convenience, and it does not erase the documentation burden (CDPH patient-needs waiver page). If your scheduler treats a waiver as a standing excuse for ordinary vacancies, that is the kind of mismatch that becomes painful in audit review.
What hours count toward California’s 3.5 and 2.4 calculations?
This is where comparison posts matter, because the calculation logic is different from the headline number. CDPH’s audit guidance says facilities must support the hours they count with payroll reports, timecards, role detail, and documentation that clearly delineates actual direct caregiver time. If hours are not appropriately documented, CDPH can exclude them from the 3.5 or 2.4 calculation (AFL 21-11). That means compliance is not just schedule design. It is schedule design plus role coding plus clean payroll evidence.
- 3.5 hours per patient day — minimum direct care service hours for covered California freestanding SNFs — CDPH / Title 22 — current
- 2.4 hours per patient day — minimum CNA portion of the California floor — CDPH / Title 22 — current
- 8 consecutive hours a day, 7 days a week — minimum federal RN service requirement that remains after repeal unless waived — 42 CFR 483.35 — current
- 45th calendar day after quarter end — PBJ submission deadline under CMS reporting rules — CMS PBJ page — current
- 22.5 hours per employee ID per day — PBJ edit limit CMS says users cannot exceed in current specifications — CMS PBJ update — February 6, 2026
How do PBJ and Care Compare still affect staffing decisions after the repeal?
The repeal did not turn off public staffing reporting. CMS still requires electronic PBJ submission based on payroll and other auditable data, and the first mandatory reporting period has been in effect since July 1, 2016. Quarterly submissions are due by the 45th calendar day after quarter end, and CMS continues to use staffing data in public reporting and ratings (CMS PBJ submission page). Medicare’s staffing resource also still points consumers to RN HPRD, total HPRD, weekend staffing, turnover, and administrator turnover on Care Compare (Medicare staffing resource).
How should a California operator staff weekends and high-acuity shifts?
Do not use the repeal as a reason to flatten weekend staffing to the bare California average. CMS has publicly posted weekend staffing and turnover measures since 2022, and those measures still shape how outsiders see a building’s consistency (CMS Care Compare update). In California, the better operating rule is to build to the state daily floor first, then layer resident-acuity coverage from the facility assessment workflow, and then confirm the PBJ output will match what payroll will actually show.
What does this comparison mean for budgeting and schedule design?
It means California buildings still need a numeric staffing engine even though the federal numeric rule was repealed. Federal law now asks, in effect, “Was staffing sufficient?” California still asks, “Did you hit 3.5 and 2.4 on this day, and can you prove it?” Those are related but different operating tests. ePeople is designed to help schedulers catch the unsafe middle zone: a plan that might pass a rough labor target yet fail California’s daily floor, PBJ optics, or acuity-driven sufficiency review. For a broader cost and coverage tradeoff, compare this issue with agency staffing vs. internal float pool for SNFs.
What should California SNFs audit every week now?
Audit five things weekly: daily hours against the 3.5 floor, CNA mix against 2.4, licensed coverage on every tour, RN coverage for each day of the week, and whether payroll coding will support the hours you plan to count. Then tie that review back to PPD compliance, F725 sufficient staffing, and PBJ submission controls. The facilities that get surprised are rarely the ones with no standards. They are the ones applying the wrong standard to the wrong dataset.
