Strikes existing subparagraph (C) of 1819(b)(4) and inserts new required nursing care provisions establishing 24-hour licensed nursing services, a minimum staffing requirement of at least 3.48 hours per resident day (or a higher number if specified by the report under new section 1128L(b)(2)), requirements for registered professional nurse services, a definition of 'hours per resident day', and an effective date 180 days after enactment.

Strikes existing subparagraph (C) of 1919(b)(4) and inserts new required nursing care provisions parallel to the amendments to 1819(b)(4)(C), establishing 24-hour licensed nursing services, a minimum staffing requirement of at least 3.48 hours per resident day (or a higher number if specified by the report under new section 1128L(b)(2)), requiring RN services, and referencing the effective date described in 1819(b)(4)(C)(iii).

Adds a new section 1128L to Title XI establishing requirements for a recurring study and reports recommending minimum staffing requirements for skilled nursing facilities and nursing facilities; directs the Secretary to designate an entity (ASPE, the Comptroller General, or MedPAC, in consultation with MACPAC) to conduct the study; prescribes consultation stakeholders and topics to be addressed; requires submission of the study report to the Secretary and a subsequent report from the Secretary to Congress; requires the Secretary to promulgate and update regulations based on the report(s); and provides for a $50,000,000 transfer from the Federal Hospital Insurance Trust Fund to the CMS Program Management Account for FY2027 to carry out the section.