II 

118TH CONGRESS 

2D SESSION S. 4122 

To amend title XIX of the Social Security Act to develop national quality 

standards for continuous skilled nursing services provided through Medicaid, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 15, 2024 

Mr. VANCE (for himself and Ms. HASSAN) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to develop 

national quality standards for continuous skilled nursing 

services provided through Medicaid, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Continuous Skilled 

5 Nursing Quality Improvement Act of 2024’’. 

6 SEC. 2. DEFINITIONS. 

7 In this Act: 


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1 (1) FULL-BENEFIT DUAL ELIGIBLE INDI2 VIDUAL.—The term ‘‘full-benefit dual eligible indi3 vidual’’ means an individual who is entitled to, or 

4 enrolled for, benefits under part A of title XVIII of 

5 the Social Security Act (42 U.S.C. 1395 et seq.), or 

6 enrolled for benefits under part B of title XVIII of 

7 such Act, and is eligible for medical assistance under 

8 the Medicaid program for full benefits under section 

9 1902(a)(10)(A) of such Act (42 U.S.C. 

10 1396a(a)(10)(A)) or 1902(a)(10)(C) of such Act (42 

11 U.S.C. 1396a(a)(10)(C)), by reason of section 

12 1902(f) of such Act (42 U.S.C. 1396a(f)), or under 

13 any other category of eligibility for medical assist14 ance for full benefits, as determined by the Sec15 retary. 

16 (2) MEDICAID BENEFICIARY.—The term ‘‘Med17 icaid beneficiary’’ means an individual who is eligible 

18 for, and enrolled in, a State Medicaid program. 

19 (3) MEDICAID PROGRAM.—The term ‘‘Medicaid 

20 program’’ means, with respect to a State, the State 

21 program under title XIX of the Social Security Act 

22 (42 U.S.C. 1396 et seq.) (including any waiver or 

23 demonstration under such title or under section 

24 1115 of such Act (42 U.S.C. 1315) relating to such 

25 title). 


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1 (4) PRIVATE DUTY NURSING SERVICES.—The 

2 term ‘‘private duty nursing services’’ has the mean3 ing given that term for purposes of section 

4 1905(a)(8) of the Social Security Act (42 U.S.C. 

5 1396d(a)(8)) (as in effect on the date of enactment 

6 of this Act). 

7 (5) SECRETARY.—The term ‘‘Secretary’’ means 

8 the Secretary of Health and Human Services. 

9 (6) STATE.—The term ‘‘State’’ has the mean10 ing given such term in section 1101(a) of the Social 

11 Security Act (42 U.S.C. 1301(a)) for purposes of 

12 title XIX of such Act (42 U.S.C. 1396 et seq.). 

13 SEC. 3. REDEFINING PRIVATE DUTY NURSING SERVICES 

14 PROVIDED THROUGH MEDICAID. 

15 (a) DEFINITION OF MEDICAL ASSISTANCE.— 

16 (1) IN GENERAL.—Section 1905(a)(8) of the 

17 Social Security Act (42 U.S. 1396d(a)(8)) is amend18 ed by striking ‘‘private duty nursing services;’’ and 

19 inserting ‘‘continuous skilled nursing services;’’. 

20 (2) EFFECTIVE DATE.—The amendment made 

21 by paragraph (1) takes effect on the date that is 18 

22 months after the date of enactment of this Act. 

23 (b) DEFINITION OF CONTINUOUS SKILLED NURSING

24 SERVICES.—Not later than 18 months after the date of 


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1 enactment of this Act, the Secretary, through notice and 

2 comment rulemaking, shall— 

3 (1) revise the definition of ‘‘private duty nurs4 ing services’’ in section 440.80 of title 42, Code of 

5 Federal Regulations, to be ‘‘continuous skilled nurs6 ing services’’; and 

7 (2) require that, a condition for Federal finan8 cial participation for a State’s furnishing medical as9 sistance for such services under the Medicaid pro10 gram to a complex-care patient who requires more 

11 than 2 continuous hours of nursing services per day, 

12 is that such services are provided by a licensed nurse 

13 (including a registered nurse or a licensed practical 

14 nurse). 

15 SEC. 4. DEVELOPMENT OF NATIONAL QUALITY STANDARDS 

16 FOR CONTINUOUS SKILLED NURSING SERV17 ICES PROVIDED THROUGH MEDICAID. 

18 (a) IN GENERAL.—Not later than 180 days after the 

19 date of enactment of this Act, the Secretary shall convene 

20 a working group that includes representatives of inde21 pendent and national providers of private duty nursing 

22 services under the Medicaid program, other private duty 

23 nursing agencies, full-benefit dual eligible individuals, 

24 Medicaid beneficiaries, patient advocacy groups, officials 

25 of State Medicaid programs, private duty nursing accredVerDate Sep 11 2014 20:02 Apr 24, 2024 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 iting bodies, and other relevant stakeholders, to develop 

2 and establish national quality standards for the purposes 

3 of improving the standard of care for private duty nursing 

4 services provided by States under the Medicaid program. 

5 (b) ENSURING CLINICALLY APPROPRIATE STAND6 ARDS.—The Secretary shall issue a letter to State Med7 icaid Directors stating that providers of private duty nurs8 ing services under the Medicaid program are not required 

9 to adhere to conditions of participation for home health 

10 agencies under title XVIII of the Social Security Act (42 

11 U.S.C. 1395 et seq.). 

12 (c) PUBLICATION OF NATIONAL STANDARDS.—Not 

13 later than 1 year after the date on which the working 

14 group described in subsection (a) is first convened, the 

15 Secretary shall publish the national quality standards de16 veloped by the working group for use by State Medicaid 

17 programs, managed care entities that enter into contracts 

18 with such programs, and providers of items and services 

19 under such programs. 

20 SEC. 5. MAINTAINING UP-TO-DATE CONTINUOUS SKILLED 

21 NURSING STANDARDS. 

22 (a) UPDATING HOME AND COMMUNITY-BASED

23 WAIVER SERVICES.—Not later than 18 months after the 

24 date of enactment of this Act, the Secretary, through no25 tice and comment rulemaking, shall revise the list of servVerDate Sep 11 2014 00:10 Apr 25, 2024 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 ices that are included as ‘‘home and community-based 

2 waiver services’’ under section 440.180(b) of title 42, Code 

3 of Federal Regulations, to include continuous skilled nurs4 ing care services, as defined for purposes of section 

5 1905(a)(8) of the Social Security Act (as amended by sec6 tion 3(a)) under section 440.80 of title 42, Code of Fed7 eral Regulations (as revised after the application of section 

8 3(b)). 

9 (b) UPDATING THE HOME AND COMMUNITY-BASED

10 SERVICES QUALITY MEASURE SET.— 

11 (1) IN GENERAL.—Not later than 1 year after 

12 the date of enactment of this Act, the Secretary 

13 shall update and publish the HCBS Quality Measure 

14 Set, described in the State Medicaid Director Letter 

15 #22–003 issued on July 21, 2022, to include core 

16 and supplemental quality measures for continuous 

17 skilled nursing services for use by State Medicaid 

18 programs, managed care entities that enter into con19 tracts with such programs, and providers of items 

20 and services under such programs. 

21 (2) REGULAR REVIEWS AND UPDATES.—The 

22 Secretary shall review and update the core set and 

23 supplemental set of continuous skilled nursing servVerDate Sep 11 2014 00:10 Apr 25, 2024 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 ices quality measures published under paragraph (1) 

2 not less frequently than every 8 years. 

Æ 


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