The Enhancing Skilled Nursing Facilities Act (HB7106) amends Titles XVIII and XIX of the Social Security Act to streamline care delivery in skilled nursing facilities and nursing facilities. It broadens who can supervise and certify services, expands the set of professionals who can administer Part B, and updates residents’ rights to reflect a larger team of clinicians working in accordance with State law.
The bill is designed to reduce bottlenecks in care delivery by authorizing non-physician clinicians to participate more fully in SNF care, subject to state-specific scope-of-practice rules.
At a Glance
What It Does
Medicare and Medicaid provisions are updated to allow nurse practitioners, physician assistants, and clinical nurse specialists to supervise, certify, and deliver core SNF services where State law permits.
Who It Affects
Skilled nursing facilities, nursing facilities, providers operating under Medicare and Medicaid, state licensing bodies, and residents receiving SNF care.
Why It Matters
By expanding the clinician pool, the bill aims to reduce care delays, improve access to on-site medical oversight, and align federal program rules with state scope‑of‑practice variations.
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What This Bill Actually Does
The bill makes a series of targeted changes to how care is delivered in skilled nursing facilities under Medicare and Medicaid. Key Medicare changes include allowing non-physician clinicians who operate under State law — nurse practitioners, physician assistants, and clinical nurse specialists — to participate in certification of post-hospital extended care services, to supervise SNF services, and to be involved in the administration of Part B.
It also broadens the definition of who can supervise and participate in the provision of services and who can assist with residents’ rights, adding non-physician clinicians to those roles where appropriate. On the Medicaid side, HB7106 updates SNF and intermediate care facility service certifications to permit the same non-physician professionals to certify services, and it clarifies supervision and record-keeping requirements.
The overarching effect is to grant facilities flexibility to deploy a broader care team while maintaining alignment with state-law practice rules. The bill does not specify funding implications, leaving cost considerations to be addressed in implementation.
The Five Things You Need to Know
The bill allows certification of post-hospital extended care services under Medicare to be carried out by a nurse practitioner, physician assistant, or clinical nurse specialist working in accordance with State law.
SNF supervision provisions are broadened to permit supervision by a nurse practitioner or physician assistant, or clinical nurse specialist, in accordance with State law.
Administration of Part B is expanded to include nurse practitioners and physician assistants, expanding the set of approved providers.
Resident rights are updated to recognize nurse practitioners, physician assistants, and clinical nurse specialists as authorized supervising clinicians.
Medicaid SNF/ICF certification processes are updated to allow physicians, or NP/PA/CNS working in accordance with State law, to certify skilled nursing facility services.
Section-by-Section Breakdown
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Medicare certification for post-hospital extended care services
This provision amends section 1814(a)(2) to replace a restrictive phrase with language that permits care certifications to be performed by professionals working in accordance with State law. The change broadens who may certify post-hospital extended care services, enabling qualified non-physician clinicians to participate in the certification process where allowed by state rules.
SNF supervision expanded to non-physician clinicians
Section 1819(b)(6)(A) is amended to change the supervision header and to insert an allowance for supervision by a nurse practitioner or physician assistant, in addition to physicians, in accordance with State law. This broadens who can supervise resident care in SNFs, potentially improving on-site medical oversight and response times.
Part B administration broadened
The bill adds nurse practitioners and physician assistants to the personnel who can participate in the administration of Part B, by inserting those roles after references to physicians and by clarifying supervision relationships. This expands the set of qualified providers responsible for Part B activities, aligning with a broader care team.
Provision of medical and other health services
Section 1861(s)(2)(K)(ii) is amended to permit a broader set of clinicians (NPs, PAs, CNS) to provide or collaborate on services, replacing narrower existing language. The change increases the practical availability of qualified clinicians for on-site care in SNF settings.
Scope of services updates
Section 1819(b)(2)(B) is amended to add that NP, PA, or CNS working in accordance with State law may participate in the delivery of attending physician services. This expands the workforce capable of meeting residents’ care needs within SNFs.
Residents’ rights enhancements
Section 1819(c) is amended to insert non-physician clinicians (NPs, PAs, CNS) into the framework for residents’ rights. The changes ensure these clinicians can act within their state-authorized roles to support residents’ care plans and rights without requiring physician-only oversight.
Medicaid SNF/ICF certification changes
The Medicaid provision (section 1902(a)(44)) is revised to broaden who may certify SNF and intermediate care facility services. It allows physicians, or NPs, PAs, or CNS acting in accordance with State law, to certify these services, reflecting a more flexible, team-based approach in Medicaid programs.
Nursing facility supervision and records
Section 1919(b)(6)(A) is amended to require that resident care be provided under the supervision of a physician or NP or PA (or, at state option, a CNS). It also maintains the requirement that clinical records be maintained, supporting continuity of care and regulatory compliance.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Residents in SNFs and their families gain faster access to care and more on-site clinical oversight from a broader clinician workforce.
- SNFs and nursing facilities gain operational flexibility and potential staffing efficiency by expanding the pool of qualified supervisors and certifiers.
- Nurse practitioners, physician assistants, and clinical nurse specialists gain expanded roles and clearer pathways to contribute to SNF care.
- Medical directors and other clinical leadership within SNFs can leverage team-based care to improve service delivery.
- State Medicaid agencies may experience streamlined certification processes aligned with state scope-of-practice rules.
Who Bears the Cost
- Facilities may incur upfront costs to train staff and adjust procedures to integrate NP/PA/CNS into certification and supervision workflows.
- Potential transitional costs for states to harmonize practice rules with federal changes and ensure consistent implementation across providers.
- Physician practices that previously held exclusive supervisory authority may face shifts in supervision dynamics and compensation structures.
- Regulatory and credentialing bodies may need to update oversight processes to reflect expanded roles.
- Federal and state governments could incur administrative costs associated with implementing and monitoring new certification and supervision requirements.
Key Issues
The Core Tension
The central dilemma is whether expanding non-physician supervision and certification will improve care access and efficiency without compromising quality or increasing administrative burden, given that state scope-of-practice rules vary and federal funding remains unsettled.
This act introduces meaningful change to who can supervise and certify SNF services, but its success hinges on state-level scope-of-practice variations and the readiness of facilities to adopt team-based care models. Because the changes expressly require “in accordance with State law,” effectiveness will depend on each state’s own licensure and practice rules, which can differ significantly.
The bill also increases the set of clinicians involved in care delivery and certification, which could raise upfront training and compliance costs for facilities and payers, even as it promises to improve access and efficiency over time. Finally, while it expands the workforce contributing to SNF care, the bill does not specify funding or reimbursement adjustments, leaving questions about budgetary impact and payer incentives to separate deliberations.
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