Continuous Skilled Nursing Quality Improvement Act of 2025
- Bill Number
- S. 1920
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-05-22: Read twice and referred to the Committee on Finance.
- Last Updated
- 2025-12-17T07:00:41Z
AI-Generated Summary
Purpose of the Legislation
The Continuous Skilled Nursing Quality Improvement Act of 2025 aims to enhance the quality and standardization of skilled nursing services provided to Medicaid beneficiaries who need ongoing, intensive care at home. It redefines existing terms in Medicaid law to better reflect "continuous skilled nursing services" and establishes national guidelines to improve care delivery, particularly for patients with complex medical needs.
Key Provisions
- Redefinition of Services (Section 3): Changes the term "private duty nursing services" in Medicaid law to "continuous skilled nursing services." This applies to care for patients requiring multiple hours of nursing per day. The Secretary of Health and Human Services (HHS) must update federal regulations within 18 months to require that such services be delivered by licensed nurses (e.g., registered nurses or licensed practical nurses).
- Development of National Quality Standards (Section 4): Within 180 days of enactment, HHS must form a working group with diverse stakeholders (e.g., nursing providers, patient advocates, state officials) to create national quality standards for these services. HHS will issue guidance clarifying that these providers do not need to follow rules for home health agencies under Medicare. The standards must be published within one year after public comment for use by states, managed care organizations, and providers.
- Updates to Home and Community-Based Services (Section 5): Within 18 months, HHS must revise federal rules to explicitly include continuous skilled nursing in "home and community-based waiver services" (programs allowing Medicaid to cover long-term care outside institutions). Additionally, within one year, HHS must update the Home and Community-Based Services (HCBS) Quality Measure Set—a list of performance metrics for states—to include measures for these nursing services. These measures will be reviewed and updated at least every eight years with public input.
Significant Changes to Existing Law
- Renames and expands the scope of "private duty nursing services" under Section 1905(a)(8) of the Social Security Act (the law governing Medicaid), shifting focus from episodic care to continuous, skilled care for complex patients.
- Introduces mandatory use of licensed nurses for intensive services, which was not explicitly required before.
- Adds continuous skilled nursing to the list of allowable services in home and community-based waivers (under 42 CFR 440.180), making it easier for states to cover these without special approvals.
- Creates new national standards and quality measures outside existing Medicare home health rules, providing a tailored framework for Medicaid while ensuring periodic updates to keep standards current.
Potential Impacts
- On Government Agencies: HHS will face new administrative duties, including rulemaking, convening groups, and publishing standards, potentially increasing workload but promoting consistency across states. State Medicaid programs may need to align their policies, possibly leading to more uniform reporting and oversight.
- On Citizens: Medicaid beneficiaries, especially those with chronic or complex conditions (e.g., full-benefit dual eligibles who qualify for both Medicare and full Medicaid benefits), could receive higher-quality, more accessible home-based nursing, reducing reliance on hospitals or nursing homes and improving independence.
- On International Relations: No direct impacts, as this is a domestic health policy focused on U.S. Medicaid programs.
- Overall, the law could lower long-term healthcare costs by emphasizing preventive home care, though initial implementation might require state-level adjustments.
Main Stakeholders Affected
- Medicaid Beneficiaries: Particularly full-benefit dual eligibles and those needing continuous care, who stand to gain from improved service quality and access.
- Healthcare Providers: Private duty nursing agencies, licensed nurses, and home care organizations, which must adapt to new standards and licensing requirements.
- State Governments: Medicaid program administrators, who will implement the standards and update waivers, potentially affecting budgeting and service delivery.
- Advocacy and Industry Groups: Patient advocates, nursing associations, and accrediting bodies involved in the working group and public comment processes.
- Federal Government: HHS, responsible for oversight, rulemaking, and enforcement.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicaid's framework under Title XIX of the Social Security Act by promoting evidence-based standards without mandating state adoption, preserving federalism (states' flexibility in program design). The use of notice-and-comment rulemaking ensures transparency and legal compliance under the Administrative Procedure Act.
- Constitutional: No apparent challenges; it aligns with Congress's spending power to set conditions for federal Medicaid funds and supports equal protection by standardizing care for vulnerable populations.
- Political: Bipartisan sponsorship (introduced by Senators Tillis, Hassan, Sullivan, and Cortez Masto) suggests broad support for improving home-based care amid rising demand for long-term services. It could influence future debates on Medicaid expansion or workforce shortages in nursing, emphasizing quality over cost-cutting.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (3)
Sen. Hassan, Margaret Wood [D-NH], Sen. Sullivan, Dan [R-AK], Sen. Cortez Masto, Catherine [D-NV]
Recent Actions
- 2025-05-22: Read twice and referred to the Committee on Finance.
- 2025-05-22: Introduced in Senate
Bill Versions
- Continuous Skilled Nursing Quality Improvement Act of 2025 — issued 2025-05-22 — PDF (7 pages)