Bipartisan Bill to Strengthen Medicaid Continuous Skilled Nursing Introduced in the U.S. House

Last week, a bipartisan coalition in the U.S. House of Representatives introduced House Resolution 6592, the Continuous Skilled Nursing Quality Improvement Act of 2025, marking a critical next step in modernizing Medicaid’s continuous skilled nursing benefit.

This week, a bipartisan coalition in the U.S. House of Representatives introduced House Resolution 6592, the Continuous Skilled Nursing Quality Improvement Act of 2025, marking a critical next step in modernizing Medicaid’s continuous skilled nursing benefit.
 
Led by Representatives Michael Rulli (R-OH-6), Greg Stanton (D-AZ-4), and Chris Pappas (D-NH-1), the bill serves as the House companion to Senate Bill 1920, which was introduced earlier this year by Senator Thom Tillis (R-NC) and Senator Maggie Hassan (D-NH).
 
The House introduction expands bipartisan momentum behind a long-overdue update to Medicaid’s approach to continuous skilled (private duty) nursing, an essential service for individuals with significant and complex medical needs, particularly medically fragile children.
 
“This bill is a game-changer for Medicaid patients who depend on skilled nursing at home,” said Jason Lee, President & CEO of the Home Care Association of America in a press release. “Modernizing outdated policies and establishing national quality standards are essential steps in ensuring families receive consistent, high-quality care.”
 
What the Continuous Skilled Nursing Quality Improvement Act Does
 
The Continuous Skilled Nursing Quality Improvement Act of 2025 directs the Department of Health and Human Services (HHS) to work collaboratively with providers, state Medicaid agencies, and patient advocates to establish national quality standards for continuous skilled nursing services. These updates will improve oversight, ensure consistent quality, and reduce unnecessary administrative barriers.
 
The bill includes:

• Terminology Modernization: Updates the definition of private duty nursing to “continuous skilled nursing services” to reflect the needs of patients requiring extended skilled nursing care.
• National Quality Standards: Requires HHS to convene a working group to develop national standards for continuous skilled nursing services.
• Medicaid Coverage Clarity: Ensures Medicaid providers are not subject to Medicare home health agency participation conditions, reducing regulatory burdens and improving access to care.
• Home and Community-Based Services Inclusion: Expands Medicaid’s home and community-based services (HCBS) waiver program to include continuous skilled nursing care.
• Quality Measure Updates: Directs HHS to update and maintain quality measures for Medicaid-covered skilled nursing services.

The House introduction of the Continuous Skilled Nursing Quality Improvement Act represents a meaningful advance toward modernizing Medicaid’s CSN benefit and improving access to in-home skilled nursing services across the country.
 
HCAOA will continue advocating in both chambers of Congress as this legislation moves forward and will provide ongoing updates for members.

The HCAOA Advocacy Fund powers the full scope of our federal and state policy work: helping us retain skilled lobbyists, respond quickly to emerging issues, strengthen coalitions, and elevate home care priorities nationwide. Member support ensures we have the resources to stay engaged in every state and on Capitol Hill as we work to advance policies that support providers, caregivers, and the families they serve.