Continuous Skilled Nursing Quality Improvement Act of 2025
Sponsored By: Representative Rulli
Introduced
Summary
National quality standards for continuous skilled nursing under Medicaid. This bill would redefine private duty nursing as continuous skilled nursing and set national clinical and licensing expectations for that care within Medicaid and Home and Community-Based Services (HCBS).
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- Families and Medicaid beneficiaries: Complex-care patients would have a clarified pathway to licensed continuous skilled nursing led by registered or licensed practical nurses, with the new definition taking effect about 18 months after enactment.
- Providers and States: The Secretary would convene a stakeholder working group within 180 days to draft standards, and would tell State Medicaid Directors that these providers are not subject to Medicare home health agency participation rules.
- Measurement and program updates: States, managed care plans, and providers would use national standards published after public notice and comment, with HCBS waiver services updated within 18 months and the HCBS quality measure set updated within 1 year and reviewed at least every 8 years.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 3 benefits, 0 costs, 1 mixed.
Medicaid moves to continuous skilled nursing
If enacted, Medicaid would replace “private duty nursing” with “continuous skilled nursing.” The change would take effect 18 months after enactment. HHS would update federal rules by that time and add continuous skilled nursing to home- and community-based waiver services. The bill would also define key terms, including who counts as a Medicaid beneficiary and a full-benefit dual eligible.
National standards for Medicaid home nursing
If enacted, HHS would convene a group of states, providers, patients, and advocates within 180 days. Within one year after the first meeting, the Secretary would publish national quality standards after public comment. States, managed care plans, and providers would use them for continuous skilled nursing. Separately, within one year of enactment, HHS would add quality measures for these services to the HCBS set and review them at least every 8 years.
Licensed nurses for complex-care patients
If enacted, HHS would set a rule within 18 months for certain patients. If your State decides you need multiple hours of continuous nursing each day, your care would have to be delivered by a licensed nurse (RN or LPN). This could improve safety but might make staffing harder in some areas.
Medicaid nursing not bound by Medicare rules
If enacted, HHS would send a letter to State Medicaid Directors. It would state that Medicaid private duty/continuous skilled nursing providers do not have to follow Medicare home health agency participation rules. This clarifies compliance for states and providers and does not change household payments.
Sponsors & CoSponsors
Sponsor
Rulli
OH • R
Cosponsors
Stanton
AZ • D
Sponsored 12/10/2025
Pappas
NH • D
Sponsored 12/10/2025
Gottheimer
NJ • D
Sponsored 1/7/2026
Taylor
OH • R
Sponsored 2/3/2026
Roll Call Votes
No roll call votes available for this bill.
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