[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6592 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 6592
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 HOUSE OF REPRESENTATIVES
December 10, 2025
Mr. Rulli (for himself, Mr. Stanton, and Mr. Pappas) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
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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