Sponsors (5)
The bill raises national quality and clarity for continuous and private duty Medicaid nursing—potentially improving safety for vulnerable beneficiaries—while creating significant fiscal and provider-capacity pressures and uneven, state-dependent access that could limit the benefits in practice.
Medicaid beneficiaries who need multiple continuous hours or round-the-clock skilled nursing will be eligible to receive care from licensed nurses (RNs/LPNs), increasing clinical safety and quality of home and private duty nursing services.
States, providers, and plans will have clearer, standardized regulatory definitions and national quality measures for continuous/private duty skilled nursing, reducing interstate variation and regulatory confusion and making contracting and oversight more consistent.
The statute preserves stakeholder engagement and public process—by requiring a working group with beneficiaries, advocates, providers, and accrediting bodies plus notice-and-comment rulemaking—improving legitimacy and alignment of standards with patient needs.
State Medicaid programs and taxpayers may face materially higher costs to cover licensed-nurse requirements and expanded continuous skilled nursing, potentially straining state budgets, requiring offsets, or increasing local cost-sharing.
Medicaid beneficiaries—especially those with complex chronic needs, disabilities, or who are elderly—could face reduced access, delays, or service denials if states and providers cannot recruit enough licensed nurses or if providers cannot meet new standards.
Small providers, managed care plans, and home nursing agencies will incur administrative and compliance costs to implement new standards and quality measures, which could reduce provider capacity or raise program costs.
Based on analysis of 5 sections of legislative text.
Replaces 'private duty nursing' with 'continuous skilled nursing,' requires licensed nurses for complex continuous care, and directs HHS to set rules and quality measures.
Introduced December 10, 2025 by Michael A. Rulli · Last progress December 10, 2025
Changes Medicaid rules to replace the term “private duty nursing services” with “continuous skilled nursing services,” requires that complex-care Medicaid patients who need multiple continuous nursing hours per day be served by licensed nurses, and directs HHS to write new regulatory definitions and national quality standards. The bill sets deadlines for rulemaking and quality-measure updates, creates a stakeholder working group to develop standards, and tells HHS to notify states that these providers are not subject to Medicare home health agency conditions of participation.