H.R. 6592 — Continuous Skilled Nursing Quality Improvement Act of 2025

This section establishes definitions for terms used in the Act. Such terms include (1) full-benefit dual eligible individual, meaning an individual entitled to or enrolled for Medicare benefits under part A or part B of title XVIII of the Social Security Act who is eligible for full-scope Medicaid benefits under specified categories; (2) Medicaid beneficiary, meaning an individual eligible for and enrolled in a state Medicaid program; (3) Medicaid program, meaning a state program under title XIX of the Social Security Act, including related waivers or demonstrations; (4) private duty nursing services, having the meaning given in section 1905(a)(8) of such Act as in effect on the date of enactment; (5) Secretary, meaning the Secretary of Health and Human Services; and (6) State, having the meaning given in section 1101(a) of such Act for title XIX purposes.

This section revises the Medicaid definition of private duty nursing services—typically skilled nursing care provided in the home to medically complex children under age 21 (i.e., as an alternative to institutional care)—to “continuous skilled nursing services,” effective 18 months after enactment. It (1) amends section 1905(a)(8) of the Social Security Act to make this change in statute; and (2) directs the Secretary of Health and Human Services, through notice-and-comment rulemaking completed no later than 18 months after enactment, to revise the regulatory definition in 42 CFR 440.80 accordingly and to require that such services for complex-care patients needing multiple hours of continuous nursing per day—as determined by the state—are provided by a licensed nurse, including a registered nurse or licensed practical nurse.

This section directs the Secretary of Health and Human Services (HHS), within 180 days of enactment, to convene a working group—including representatives of private duty nursing providers and agencies, associations for continuous skilled nursing services, full-benefit dual eligible individuals, Medicaid beneficiaries, patient advocacy groups, state Medicaid officials, accrediting bodies, and other stakeholders—to develop national quality standards for private duty nursing services (i.e., continuous skilled nursing) under Medicaid. The section further requires HHS to issue a letter to state Medicaid directors clarifying that such providers are not subject to Medicare home health agency conditions of participation; and, within one year of convening the working group and after public comment, to publish the standards for use by state Medicaid programs, managed care entities, and providers. (As background, private duty nursing services under Medicaid support beneficiaries—often children with complex medical conditions or dual eligibles—requiring around-the-clock skilled nursing distinct from Medicare's episodic home health services.)

This section directs the Secretary of Health and Human Services (1) not later than 18 months after enactment to revise regulations at 42 CFR 440.180(b) to include continuous skilled nursing care services—defined under 42 CFR 440.80 and Medicaid section 1905(a)(8)—as home and community-based services (HCBS) waiver services; and (2) not later than one year after enactment to update the HCBS Quality Measure Set (per CMS State Medicaid Director Letter #22-003) to incorporate core and supplemental quality measures for such services applicable to state Medicaid programs, managed care plans, and providers, with reviews and updates at least every eight years including public comment periods. (As background, HCBS waivers under Medicaid section 1915(c) enable states to provide long-term services and supports in community settings as alternatives to institutional care.)