Continuous Skilled Nursing Quality Improvement Act of 2025

This bill updates how Medicaid supports people who need many hours of nursing care each day at home. It changes the term “private duty nursing” to “continuous skilled nursing” and requires that complex-care patients who need multiple hours per day get care from a licensed nurse, such as an RN or LPN . The federal health agency must bring together patients, states, and providers to create national quality standards, then publish those standards for states and health plans to use . It also clarifies that these nursing providers do not have to follow Medicare’s home health agency rules, which may not fit this kind of care .

The bill adds continuous skilled nursing to home and community-based waiver services and sets up new quality measures that states and health plans must consider and update over time .

• Who is affected | What changes | When
• Patients on Medicaid who need many hours of daily nursing care; families; nursing agencies; state Medicaid programs | “Private duty nursing” becomes “continuous skilled nursing” under Medicaid; care for complex cases must be given by licensed nurses | Term change takes effect 18 months after enactment; nurse requirement set in the same timeline through rulemaking
• Patients, states, and providers | A national working group creates and the agency publishes quality standards for this care | Group convened within 180 days; standards published within 1 year after the group first meets
• States and managed care plans | Add continuous skilled nursing to HCBS waivers and include new quality measures, with updates at least every 8 years | HCBS list updated within 18 months; quality measure set updated within 1 year and reviewed regularly