The bill redefines private duty nursing services as continuous skilled nursing services under Medicaid and sets an 18-month window for the change to take effect. It then directs the Secretary to convene a broad, multi-stakeholder working group to develop national quality standards for continuous skilled nursing in the Medicaid program and to publish those standards after a notice-and-comment period.
Finally, SB1920 requires updates to home- and community-based waiver services and the HCBS quality measure set to reflect continuous skilled nursing, with defined timelines for ongoing review.
The change aims to raise care quality for Medicaid beneficiaries who require complex, lengthy nursing support by standardizing service definitions and oversight. It also foregrounds a structured process for stakeholder input, state implementation, and regular updates to measurement tools to keep pace with clinical and organizational advances.
The bill does not compel adherence to established Title XVIII home health conditions of participation, but it creates a parallel national standard framework intended for Medicaid programs, managed care entities, and providers.
At a Glance
What It Does
Not later than 18 months after enactment, the bill redefines private duty nursing as continuous skilled nursing for Medicaid. It also directs the Secretary to revise the CFR definition and establish licensing requirements for complex-care patients. A working group will craft national quality standards and publish them after public notice and comment.
Who It Affects
State Medicaid programs, private duty nursing agencies, licensed nurses, managed care entities contracting with Medicaid, and Medicaid beneficiaries (including dual eligibles) who rely on private duty nursing services.
Why It Matters
Creates a uniform, nationwide set of quality standards for continuous skilled nursing, reducing variation in care across states and improving accountability, while enabling ongoing measurement and improvement through updated HCBS measures.
More articles like this one.
A weekly email with all the latest developments on this topic.
What This Bill Actually Does
The Continuous Skilled Nursing Quality Improvement Act would redefine the core service funded through Medicaid from ‘private duty nursing’ to ‘continuous skilled nursing.’ This change is not immediate but takes effect 18 months after enactment, giving states and providers time to adjust. The bill directs the Secretary to publish a clarified, regulated definition of continuous skilled nursing through rulemaking, including licensing requirements for complex-care patients when hours of care occur daily.
In tandem, the Secretary must convene a diverse national working group within 180 days to develop national quality standards for these services and publish them within a year after the group’s first meeting, after a period of public notice and comment. State Medicaid programs, managed care entities, and providers would then use the standards to guide care and contracting.
Beyond standards, SB1920 requires updates to home- and community-based waiver services to include continuous skilled nursing care under the relevant CFR provisions and to expand the HCBS Quality Measure Set to cover core and supplemental measures for continuous skilled nursing. The Secretary must ensure regular review and updating of these measures, not less than every eight years, with public input each time.
Importantly, while the bill directs public doctors and agencies to align with these new measurements, it preserves a separate framework for Title XVIII home health CoPs, clarifying that Medicaid-private duty nursing is not bound by those CoPs. The overall aim is to elevate care quality, standardize practice across states, and embed ongoing measurement to monitor impact and drive improvements.
The Five Things You Need to Know
The bill redefines “private duty nursing services” as “continuous skilled nursing services” under Medicaid, with an 18-month effective date.
The Secretary must revise the CFR definition and impose licensing requirements for complex-care patients receiving continuous skilled nursing in Medicaid.
A nationwide working group, including providers, beneficiaries, and state officials, will establish national quality standards for continuous skilled nursing and publish them after a notice-and-comment period.
The HCBS waiver services list will be updated to include continuous skilled nursing care, and the HCBS quality measure set will be expanded accordingly, with periodic updates every eight years.
The Secretary will issue a guidance letter to State Medicaid Directors stating that Title XVIII home health CoPs do not apply to private duty nursing under Medicaid, preserving distinct regulatory pathways.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Definitions of key terms
This section codifies the core terms the bill relies on—most notably “full-benefit dual eligible individuals,” “Medicaid beneficiary,” “Medicaid program,” and “private duty nursing services”—and then sets the stage for redefining the latter as “continuous skilled nursing services.” It also clarifies the roles of the Secretary and State in applying these definitions, ensuring the policy has a clear federal-state interface for administration under Title XIX.
Redefinition of private duty nursing as continuous skilled nursing
Section 3(a) substitutes the phrase “private duty nursing services” with “continuous skilled nursing services” in the Medicaid medical assistance definition. Section 3(b) establishes an 18-month clock from enactment for this redefinition to take effect and directs the rulemaking process to operationalize the change, including licensing requirements for complex-care patients receiving such services.
Development of national quality standards for continuous skilled nursing
Section 4(a) instructs the Secretary to convene a working group within 180 days that includes private duty nursing providers, beneficiaries, state officials, accrediting bodies, and other stakeholders to develop national quality standards. Section 4(b) clarifies that providers are not required to meet conditions of participation for home health agencies under Title XVIII. Section 4(c) requires the Secretary to publish the standards within a year after the working group’s first meeting, following public notice and comment.
Maintaining up-to-date continuous skilled nursing standards
Section 5(a) directs rulemaking to update the list of home- and community-based waiver services to include continuous skilled nursing care, aligned with the amended section 1905(a)(8). Section 5(b) requires the update and publication of the HCBS Quality Measure Set to include continuous skilled nursing measures, with regular reviews not less frequently than every eight years, including a period for public notice and comment.
This bill is one of many.
Codify tracks hundreds of bills on Healthcare across all five countries.
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
- Full-benefit dual eligible individuals who rely on long, continuous nursing care, gaining clearer standards and quality expectations.
- Medicaid beneficiaries broadly, including those not dual-eligible, who will benefit from standardized care quality and performance measures across states.
- Private duty nursing agencies and nurses that meet the new standards, gaining clearer licensing expectations and a recognized quality framework.
- State Medicaid programs and State officials, who will have a unified set of standards and measures to guide program administration and contracting.
- Accrediting bodies and professional associations that align with national standards and accreditation processes.
Who Bears the Cost
- Private duty nursing providers may incur costs to hire licensed staff, expand hours of operation for complex-care patients, and achieve compliance with the new standards.
- State Medicaid programs will incur administrative costs to implement the new standards, revise program guidance, and adapt to updated CFR references.
- Managed care entities contracting with Medicaid may face contract modifications and data-reporting burdens to align with the new quality measures.
- Home- and community-based waiver programs may need additional resources to expand services to include continuous skilled nursing and to track enhanced quality measures.
- Private accrediting bodies and professional associations may incur costs to update accreditation criteria and certification processes to reflect the national standards.
Key Issues
The Core Tension
The central dilemma is whether national quality standards for continuous skilled nursing will meaningfully improve patient outcomes without imposing prohibitive costs or access barriers for states, providers, and beneficiaries, especially in low-resource settings.
The bill promises stronger, nationwide quality standards for a high-need population, but it also creates potential implementation challenges. States could face upfront administrative costs to align benefits, licensing, and measurement systems with the new definitions.
Providers may confront staffing and training pressures to deliver continuous skilled nursing hours per day for complex-care patients, potentially affecting access if supply cannot meet demand in under-resourced areas. While the legislation carves out a separate CoP framework for Title XVIII, the separation may yield governance and oversight complexities as states implement Medicaid-driven standards alongside existing Medicare-related requirements.
Data collection, reporting, and ongoing review will be essential to demonstrate value and inform future updates, but they will also require robust data infrastructure that some programs may lack.
Try it yourself.
Ask a question in plain English, or pick a topic below. Results in seconds.