Direct answer
As of September 11, 2026, California SNFs should not staff to the repealed federal 3.48 HPRD and 24/7 RN rule. They still must meet 42 CFR 483.35, Title 22’s 3.5 and 2.4 hour floors, and, if licensed for 100 or more beds, an RN awake and on duty at all times. 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The Biden-era federal numeric minimums of 3.48 total HPRD, 0.55 RN HPRD, 2.45 nurse aide HPRD, and 24/7 onsite RN were repealed by HHS on December 2, 2025.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 42 CFR 483.35 still requires an RN for 8 consecutive hours a day, 7 days a week, unless waived. That block is daily RN availability, not a named day shift.
- California Title 22 section 72329 is stricter for many buildings: 100 or more licensed beds need an RN awake and on duty at all times, in addition to the DON. The trigger is licensed capacity, not census.
- PBJ reporting still matters after the federal repeal because CMS continues to publish staffing data, weekend staffing, turnover, and star-rating inputs on Care Compare.
Last updated: September 11, 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California operators got a mixed signal when HHS repealed the federal staffing minimums on December 2, 2025.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 HHS later announced that those staffing provisions were repealed on December 2, 2025 (HHS repeal announcement).
The comparison is not theoretical volume. Williams, Zheng & White found weekend total nurse staffing 17% lower and RN staffing 38% lower across 15,650 U.S. SNFs (2019). Gandhi found mean annual RN turnover of about 44% in 13,631 facilities (2022). Those rates still matter after the federal numeric-floor repeal because PBJ and Care Compare keep publishing them. ePeople compares the remaining California and federal tests; it does not create the underlying turnover.
What federal staffing rules still apply to a California SNF?
The federal floor reverted to 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). Those eight hours are a consecutive daily coverage block, not a named 7 a.m. to 3 p.m. day shift. Other licensed nurses can cover the rest of the day if resident need and California rules allow it.
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 | 22 CCR 72329: 59 or fewer licensed beds need an RN or LVN awake 24/7; 60–99 need that licensed nurse plus a separate DON; 100 or more licensed beds need an RN awake 24/7 plus a separate DON |
| 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 sections 72329 and 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, licensed-bed RN or LVN on-duty proof, timekeeping detail, census method, delineation of countable hours |
Does California still require an RN 24/7 after the federal repeal?
Yes, for a skilled nursing facility licensed for 100 or more beds. Title 22 section 72329 requires at least one registered nurse awake and on duty in the facility at all times, day and night, in addition to the director of nursing (22 CCR 72329). Smaller SNFs need an RN or LVN awake 24/7 and still need the federal eight-hour RN block unless a waiver applies. The trigger is licensed beds, not today’s census. Do not apply Chapter 8 ICF/DD staffing in section 76355 to a licensed SNF.
California Title 22 licensed-nurse on-duty rules for SNFs by licensed bed capacity
| Licensed beds | On-duty licensed nurse | Director of nursing |
|---|---|---|
| 59 or fewer | At least one RN or LVN awake and on duty at all times, day and night | DON must be an RN and work 8 hours on the day shift, 5 days a week; section 72329 does not require that nurse to be in addition to the DON |
| 60 to 99 | At least one RN or LVN awake and on duty at all times, day and night, in addition to the DON | DON cannot have charge nurse responsibilities |
| 100 or more | At least one RN awake and on duty at all times, day and night, in addition to the DON | DON cannot have charge nurse responsibilities |
Does the Director of Nursing count as the required RN?
Not by title alone. Title 22 section 72327 says the DON must be a registered nurse and must be employed eight hours a day on the day shift, five days a week (22 CCR 72327). That office coverage is not the same as the on-duty RN. In a SNF licensed for 60 or more beds, the on-duty licensed nurse must be in addition to the DON, and the DON cannot serve as charge nurse. RN availability, RN HPRD, and DON hours are three different tests.
Which rule is stricter in practice?
For California freestanding SNFs, Title 22 is usually stricter on hours because it gives a daily number: 3.5 total direct care hours and 2.4 CNA hours. It is also stricter on RN coverage in buildings licensed for 100 or more beds, which need an RN 24/7, not the federal eight-hour block. The federal standard can still be stricter when acuity makes 3.5 mathematically insufficient, because 42 CFR 483.35 asks whether staffing met resident need and the care plan (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?
An RN hour does not automatically count toward California’s 3.5 floor. CDPH counts documented direct caregiver time, not every paid licensed hour. RN or LVN time counts only when the nurse is performing countable nursing services and the record shows who worked, in what role, and for how long (AFL 21-11). DON hours have separate credit rules by licensed-bed size, and infection-preventionist time does not count. If hours are not delineated, CDPH can exclude them from the 3.5 or 2.4 calculation.
- 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
- 100 licensed beds — California Title 22 trigger for an RN awake and on duty at all times, in addition to the DON — 22 CCR 72329 — 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 posted weekend staffing and turnover measures since 2022 (CMS Care Compare update). Build to the state daily floor first, keep the licensed-bed RN or LVN on-duty rule on Saturday night, then confirm the PBJ file will match payroll. A 100-bed license still needs an RN awake overnight on the weekend.
What does this comparison mean for budgeting and schedule design?
It means California buildings still need a numeric staffing engine and a licensed-bed RN check even though the federal numeric rule was repealed. Federal law asks whether staffing was sufficient and whether the eight-hour RN block was filled. California asks whether you hit 3.5 and 2.4, and whether the on-duty RN or LVN rule for your licensed capacity was met. ePeople is designed to help schedulers catch a plan that might pass a labor target yet miss the 100-bed RN 24/7 rule, PBJ optics, or acuity review. For a cost and coverage tradeoff, compare agency staffing vs. an internal float pool.
What should California SNFs audit every week now?
Audit six things weekly: daily hours against the 3.5 floor, CNA mix against 2.4, the licensed-bed RN or LVN on-duty rule, federal RN coverage for each day of the week, licensed charge-nurse coverage on every tour, 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 the ones applying the federal eight-hour RN rule to a 100-bed California license.
