119-s1920

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1920 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 1920

 To amend title XIX of the Social Security Act to develop national 
 quality standards for continuous skilled nursing services provided 
 through Medicaid, and for other purposes.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 May 22, 2025

 Mr. Tillis (for himself, Ms. Hassan, Mr. Sullivan, and Ms. Cortez 
Masto) introduced the following bill; which was read twice and referred 
 to the Committee on Finance

_______________________________________________________________________

 A BILL

 To amend title XIX of the Social Security Act to develop national 
 quality standards for continuous skilled nursing services provided 
 through Medicaid, and for other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Continuous Skilled Nursing Quality 
Improvement Act of 2025''.

SEC. 2. DEFINITIONS.

 In this Act:

    (1) Full-benefit dual eligible individual.--The term 
 ``full-benefit dual eligible individual'' means an individual 
 who is entitled to, or enrolled for, benefits under part A of 
 title XVIII of the Social Security Act (42 U.S.C. 1395 et 
 seq.), or enrolled for benefits under part B of title XVIII of 
 such Act, and is eligible for medical assistance under the 
 Medicaid program for full benefits under 

section 1902

    (a)

    (10)
        (A) of such Act (42 U.S.C. 1396a

    (a)

    (10)
        (A) ) or 1902

    (a)

    (10)
            (C) of 
 such Act (42 U.S.C. 1396a

    (a)

    (10)
            (C) ), by reason of 

section 1902

    (f) of such Act (42 U.S.C. 1396a

    (f) ), or under any other 
 category of eligibility for medical assistance for full 
 benefits, as determined by the Secretary.

    (2) Medicaid beneficiary.--The term ``Medicaid 
 beneficiary'' means an individual who is eligible for, and 
 enrolled in, a State Medicaid program.

    (3) Medicaid program.--The term ``Medicaid program'' means, 
 with respect to a State, the State program under title XIX of 
 the Social Security Act (42 U.S.C. 1396 et seq.) (including any 
 waiver or demonstration under such title or under 

section 1115 
 of such Act (42 U.S.C. 1315) relating to such title).

    (4) Private duty nursing services.--The term ``private duty 
 nursing services'' has the meaning given that term for purposes 
 of 

section 1905

    (a)

    (8) of the Social Security Act (42 U.S.C. 
 1396d

    (a)

    (8) ) (as in effect on the date of enactment of this 
 Act).

    (5) Secretary.--The term ``Secretary'' means the Secretary 
 of Health and Human Services.

    (6) State.--The term ``State'' has the meaning given such 
 term in 

section 1101

    (a) of the Social Security Act (42 U.S.C. 
 1301

    (a) ) for purposes of title XIX of such Act (42 U.S.C. 1396 
 et seq.).

SEC. 3. REDEFINING PRIVATE DUTY NURSING SERVICES PROVIDED THROUGH 
 MEDICAID.

    (a) Definition of Medical Assistance.--

    (1) In general.--

Section 1905

    (a)

    (8) of the Social Security 
 Act (42 U.S. 1396d

    (a)

    (8) ) is amended by striking ``private duty 
 nursing services;'' and inserting ``continuous skilled nursing 
 services;''.

    (2) Effective date.--The amendment made by paragraph

    (1) takes effect on the date that is 18 months after the date of 
 enactment of this Act.

    (b) Definition of Continuous Skilled Nursing Services.--Not later 
than 18 months after the date of enactment of this Act, the Secretary, 
through notice and comment rulemaking, shall--

    (1) revise the definition of ``private duty nursing 
 services'' in 

section 440.80 of title 42, Code of Federal 
 Regulations, to be ``continuous skilled nursing services''; and

    (2) require that such services under the Medicaid program 
 provided to complex-care patients who require multiple hours of 
 continuous nursing services per day, as determined by the 
 State, are provided by a licensed nurse, including a registered 
 nurse or a licensed practical nurse.

SEC. 4. DEVELOPMENT OF NATIONAL QUALITY STANDARDS FOR CONTINUOUS 
 SKILLED NURSING SERVICES PROVIDED THROUGH MEDICAID.

    (a) In General.--Not later than 180 days after the date of 
enactment of this Act, the Secretary shall convene a working group that 
includes representatives of independent and national providers of 
private duty nursing services under the Medicaid program, other private 
duty nursing agencies, associations representing providers of 
continuous skilled nursing services, full-benefit dual eligible 
individuals, Medicaid beneficiaries, patient advocacy groups, officials 
of State Medicaid programs, private duty nursing accrediting bodies, 
and other relevant stakeholders, to develop and establish national 
quality standards for the purposes of improving the standard of care 
for private duty nursing services provided by States under the Medicaid 
program.

    (b) Ensuring Clinically Appropriate Standards.--The Secretary shall 
issue a letter to State Medicaid Directors stating that providers of 
private duty nursing services under the Medicaid program are not 
required to adhere to conditions of participation for home health 
agencies under title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.).
            (c) Publication of National Standards.--Not later than 1 year after 
the date on which the working group described in subsection

    (a) is 
first convened, the Secretary, after providing a period of public 
notice and opportunity for comment, shall publish the national quality 
standards developed by the working group for use by State Medicaid 
programs, managed care entities that enter into contracts with such 
programs, and providers of items and services under such programs.

SEC. 5. MAINTAINING UP-TO-DATE CONTINUOUS SKILLED NURSING STANDARDS.

    (a) Updating Home and Community-Based Waiver Services.--Not later 
than 18 months after the date of enactment of this Act, the Secretary, 
through notice and comment rulemaking, shall revise the list of 
services that are included as ``home and community-based waiver 
services'' under 

section 440.180

    (b) of title 42, Code of Federal 
Regulations, to include continuous skilled nursing care services, as 
defined for purposes of 

section 1905

    (a)

    (8) of the Social Security Act 
(as amended by 

section 3

    (a) ) under 

section 440.80 of title 42, Code of 
Federal Regulations (as revised after the application of 

section 3

    (b) ).

    (b) Updating the Home and Community-Based Services Quality Measure 
Set.--

    (1) In general.--Not later than 1 year after the date of 
 enactment of this Act, the Secretary shall update and publish 
 the HCBS Quality Measure Set, described in the State Medicaid 
 Director Letter #22-003 issued on July 21, 2022, to include 
 core and supplemental quality measures for continuous skilled 
 nursing services for use by State Medicaid programs, managed 
 care entities that enter into contracts with such programs, and 
 providers of items and services under such programs.

    (2) Regular reviews and updates.--The Secretary shall 
 review and update the core set and supplemental set of 
 continuous skilled nursing services quality measures published 
 under paragraph

    (1) not less frequently than every 8 years. Any 
 such update shall include a period of public notice and 
 opportunity for comment.
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