Enhancing Skilled Nursing Facilities Act

Bill Number

H.R. 7106

Origin Chamber

House

Congress

119th Congress, Session 2

Policy Area

Health

Status

Introduced

Latest Action

2026-01-15: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Last Updated

2026-01-20T14:35:19Z

AI-Generated Summary

Purpose

The Enhancing Skilled Nursing Facilities Act (H.R. 7106) aims to streamline the delivery of care in skilled nursing facilities (SNFs) and nursing facilities under the Medicare and Medicaid programs. It expands the roles of non-physician healthcare providers—such as nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs)—to perform certain supervisory, certification, and care-related functions, as long as they comply with state laws. This reduces reliance on physicians alone, potentially making care more efficient and accessible.

Key Provisions

The bill amends multiple sections of the Social Security Act (Titles XVIII for Medicare and XIX for Medicaid) to incorporate NPs, PAs, and CNSs into care processes.

Medicare Amendments (Title XVIII)

• Certification of Post-Hospital Extended Care Services (Section 1814(a)(2)): Simplifies certification requirements by allowing providers working under state law to certify services, removing prior restrictions tied to physician involvement.
• Supervision in SNFs (Section 1819(b)(6)(A)): Changes the header from "Physician supervision" to "Supervision" and allows NPs or PAs to supervise resident care under state law.
• Administration of Part B Services (Section 1842(b)(2)(C)): Expands billing and service administration to include NPs and PAs directly, without requiring physician supervision or collaboration.
• Provision of Medical and Health Services (Section 1861(s)(2)(K)(ii)): Permits NPs and CNSs to provide certain services independently or in collaboration with physicians, as defined in the Act.
• Scope of Services (Section 1819(b)(2)(B)): Allows the attending provider to be an NP, PA, or CNS under state law for overseeing resident care plans.
• Residents' Rights (Section 1819(c)): Updates rights protections to include consultations and decisions involving NPs, PAs, or CNSs under state law, alongside physicians.

Medicaid Amendments (Title XIX)

• Certification of SNF and Intermediate Care Facility Services (Section 1902(a)(44)): For SNFs, allows NPs, PAs, or CNSs (under state law) to certify and recertify services, in addition to physicians; for intermediate care facilities, retains physician certification.
• Supervision and Clinical Records in Nursing Facilities (Section 1919(b)(6)(A)): Requires resident care to be supervised by a physician, NP, or PA (with states optionally including CNSs), replacing prior physician-only mandates.

Significant Changes to Existing Law

• Expansion of Provider Roles: Previously, many functions (e.g., certification, supervision, and service provision) were limited to physicians or required their direct oversight. The bill shifts to "in accordance with state law," enabling NPs, PAs, and CNSs to take on these roles more independently, aligning with varying state scopes of practice.
• Removal of Collaboration Requirements: Eliminates mandates for NPs or PAs to work under physician supervision or collaboration in specific Medicare contexts, promoting flexibility.
• Uniform Application Across Programs: Harmonizes rules between Medicare SNFs and Medicaid nursing facilities, while distinguishing intermediate care facilities to maintain some physician involvement.

Potential Impacts

• On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) may see reduced administrative burdens in oversight and certification processes, potentially lowering costs. States could gain flexibility in implementing care standards but might need to update licensing laws.
• On Citizens: Medicare and Medicaid beneficiaries (often elderly or disabled individuals in long-term care) could experience faster access to care, shorter wait times for certifications, and more options in rural or underserved areas where physicians are scarce. This might improve quality of life but could raise concerns if provider qualifications vary by state.
• On International Relations: No direct impacts, as the bill focuses on domestic healthcare programs.

Main Stakeholders Affected

• Healthcare Facilities: SNFs and nursing facilities benefit from streamlined operations and reduced physician dependency.
• Healthcare Providers: NPs, PAs, and CNSs gain expanded authority and opportunities; physicians may see a shift in workload but retain core roles.
• Beneficiaries: Elderly, disabled, or low-income individuals relying on Medicare/Medicaid for long-term care.
• Government Entities: CMS, state Medicaid agencies, and Congress, which oversee program implementation and funding.
• Professional Associations: Groups representing nurses, physicians, and facility operators, who may influence or adapt to state law changes.

Notable Legal, Constitutional, or Political Implications

• Legal Implications: Reinforces federal deference to state laws on provider scopes of practice, potentially reducing litigation over certification validity. It maintains patient protections (e.g., residents' rights) while broadening access, without altering core eligibility or payment structures.
• Constitutional Implications: No apparent conflicts with federalism, as the bill explicitly ties changes to state law compliance; it upholds equal protection by standardizing care access without discrimination.
• Political Implications: Supports bipartisan efforts to address healthcare workforce shortages, particularly in aging populations, but could spark debates on provider autonomy versus physician oversight. Passage might encourage similar expansions in other federal health programs, influencing future policy on team-based care.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Kiggans, Jennifer A. [R-VA-2]

Cosponsors (1)

Rep. Dingell, Debbie [D-MI-6]

Recent Actions

• 2026-01-15: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2026-01-15: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2026-01-15: Introduced in House
• 2026-01-15: Introduced in House

Bill Versions

• Enhancing Skilled Nursing Facilities Act — issued 2026-01-15 — PDF (6 pages)