Sponsors (5)
The bill would improve and standardize coverage and quality for Medicaid beneficiaries needing continuous skilled nursing by requiring licensed nurses and national measures, but it risks substantial state and provider cost increases and potential access problems if workforce, funding, or state adoption fall short.
Medicaid beneficiaries who need round‑the‑clock or multiple‑hour continuous skilled nursing will be explicitly covered and receive care from licensed nurses (RNs/LPNs) when states adopt the revised service list, improving safety and continuity of care.
States, managed care plans, and providers will operate under a single national statutory/regulatory definition and set of quality measures for continuous skilled nursing, reducing state‑to‑state variation and improving oversight and measurable quality.
Providers, states, and beneficiaries will face less regulatory confusion because the bill clarifies that Medicaid private duty nursing is distinct from Medicare home health conditions and sets clearer expectations for service delivery, easing contracting and monitoring.
State Medicaid programs (and therefore state budgets and taxpayers) may face materially higher costs if requiring licensed nurses and expanded coverage increases provider wages or service utilization.
Medicaid beneficiaries could experience reduced or delayed access if states cannot recruit enough licensed nurses or if providers cannot meet new requirements, potentially disrupting care for people with complex needs.
Managed care plans, private duty nursing providers, and states will incur administrative and compliance costs to implement new national standards and quality measures, which could reduce provider capacity or be passed on via higher program costs.
Based on analysis of 5 sections of legislative text.
Replaces "private duty nursing services" with "continuous skilled nursing services" in Medicaid, requires HHS rulemaking, national quality standards, and HCBS measure updates.
Makes a targeted change to Medicaid law and rules to replace the term “private duty nursing services” with a new category called “continuous skilled nursing services,” requires HHS to define that term by regulation, and directs creation of national quality standards and updated HCBS quality measures for these services. The bill requires HHS to complete rulemaking and publish standards and measures on set timelines (mostly within 12–18 months) and notifies States that private duty nursing providers are not subject to Medicare home health agency conditions of participation.
Official title: 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.
Introduced December 10, 2025 by Michael A. Rulli · Last progress December 10, 2025