H.R. 7106 — Enhancing Skilled Nursing Facilities Act

This section revises Medicare and Medicaid requirements in skilled nursing facilities (SNFs) and nursing facilities—SNFs provide post-hospital skilled nursing and rehabilitation services under Medicare Part A (42 U.S.C. 1395f et seq.), while nursing facilities provide long-term care under Medicaid (42 U.S.C. 1396r)—to authorize nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) working in accordance with state law to perform functions previously limited to physicians. For Medicare (amending 42 U.S.C. 1395f(a)(2), 1395i-3(b)(2)(B) and (b)(6)(A) and (c), 1395u(b)(2)(C), and 1395x(s)(2)(K)(ii)): (1) authorizes NPs, CNSs, or PAs working in accordance with state law (replacing prior requirements for no direct/indirect employment relationship with the facility and collaboration with a physician) to certify and recertify post-hospital extended care services in SNFs; (2) requires supervision of resident health care by a physician, NP, or PA in accordance with state law (previously physician supervision only); (3) authorizes NPs or PAs (without prior supervision or collaboration requirements) to administer or order Part B services; (4) clarifies services that NPs, CNSs, or PAs working in accordance with state law may provide as the attending provider and for periodic exams and care reviews; and (5) expands residents' rights to choose NPs, PAs, or CNSs working in accordance with state law for medical care. For Medicaid (amending 42 U.S.C. 1396a(a)(44) and 1396r(b)(6)(A)): (1) authorizes NPs, PAs, or CNSs working in accordance with state law (previously physicians only) to certify and recertify SNF services (intermediate care facility services remain physician-certified); and (2) requires supervision of resident health care by a physician, NP, or PA (or, at state option, CNS).