S. 1920: Continuous Skilled Nursing Quality Improvement Act of 2025

This bill, known as the Continuous Skilled Nursing Quality Improvement Act of 2025, aims to amend the Social Security Act to enhance the quality of continuous skilled nursing services provided through Medicaid. Here are the main components of the bill:

Definitions

The bill provides definitions for various terms, including:

• Full-benefit dual eligible individual: Someone eligible for both Medicare and Medicaid.
• Medicaid beneficiary: An individual enrolled in a State's Medicaid program.
• Private duty nursing services: Nursing services defined under the Social Security Act.
• Continuous skilled nursing services: This will replace the term "private duty nursing services" in the Medicaid context.

Redefining Private Duty Nursing Services

The bill mandates that:

• The term "private duty nursing services" will be changed to "continuous skilled nursing services" in the Medicaid framework.
• The Secretary of Health and Human Services is required to revise definitions and ensure that complex-care patients receive this care from licensed nurses.
• This change takes effect 18 months after the bill becomes law.

Development of National Quality Standards

Within 180 days after the bill is enacted, the Secretary must form a working group that includes various stakeholders to:

• Develop national quality standards for continuous skilled nursing services.
• Ensure that the standards improve the quality of care provided through Medicaid.

The Secretary will issue guidance regarding participation standards for nursing service providers under Medicaid.

Publication of National Standards

Within one year of the working group's establishment, the Secretary must publish the developed national quality standards for use by state Medicaid programs, managed care entities, and service providers.

Updating Standards and Services

The bill includes provisions for:

• Updating the definition of home and community-based waiver services to include continuous skilled nursing care.
• Updating the quality measures for these services, with new measures to be established within one year of enactment and reviewed every eight years.

Implications

Overall, this bill aims to improve the standards and accessibility of skilled nursing services for individuals on Medicaid, particularly those with complex medical needs, by establishing clearer definitions, quality measures, and a framework for ongoing oversight and improvement.

Relevant Companies

• HCA Healthcare Inc. (HCA) - As a large provider of healthcare services, changes in Medicaid policies regarding skilled nursing care could impact their operations and reimbursement strategies.
• Anthem, Inc. (ANTM) - As a major player in the Medicaid managed care space, revising quality standards and definitions could affect their service offerings and compliance costs.