[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4122 Introduced in Senate (IS)]

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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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Continuous Skilled Nursing Quality 
Improvement Act of 2024''.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Full-benefit dual eligible individual.--The term 
        ``full-benefit dual eligible individual'' means an individual 
        who is entitled to, or enrolled for, benefits under part A of 
        title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.), or enrolled for benefits under part B of title XVIII of 
        such Act, and is eligible for medical assistance under the 
        Medicaid program for full benefits under section 1902(a)(10)(A) 
        of such Act (42 U.S.C. 1396a(a)(10)(A)) or 1902(a)(10)(C) of 
        such Act (42 U.S.C. 1396a(a)(10)(C)), by reason of section 
        1902(f) of such Act (42 U.S.C. 1396a(f)), or under any other 
        category of eligibility for medical assistance for full 
        benefits, as determined by the Secretary.
            (2) Medicaid beneficiary.--The term ``Medicaid 
        beneficiary'' means an individual who is eligible for, and 
        enrolled in, a State Medicaid program.
            (3) Medicaid program.--The term ``Medicaid program'' means, 
        with respect to a State, the State program under title XIX of 
        the Social Security Act (42 U.S.C. 1396 et seq.) (including any 
        waiver or demonstration under such title or under section 1115 
        of such Act (42 U.S.C. 1315) relating to such title).
            (4) Private duty nursing services.--The term ``private duty 
        nursing services'' has the meaning given that term for purposes 
        of section 1905(a)(8) of the Social Security Act (42 U.S.C. 
        1396d(a)(8)) (as in effect on the date of enactment of this 
        Act).
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (6) State.--The term ``State'' has the meaning given such 
        term in section 1101(a) of the Social Security Act (42 U.S.C. 
        1301(a)) for purposes of title XIX of such Act (42 U.S.C. 1396 
        et seq.).

SEC. 3. REDEFINING PRIVATE DUTY NURSING SERVICES PROVIDED THROUGH 
              MEDICAID.

    (a) Definition of Medical Assistance.--
            (1) In general.--Section 1905(a)(8) of the Social Security 
        Act (42 U.S. 1396d(a)(8)) is amended by striking ``private duty 
        nursing services;'' and inserting ``continuous skilled nursing 
        services;''.
            (2) Effective date.--The amendment made by paragraph (1) 
        takes effect on the date that is 18 months after the date of 
        enactment of this Act.
    (b) Definition of Continuous Skilled Nursing Services.--Not later 
than 18 months after the date of enactment of this Act, the Secretary, 
through notice and comment rulemaking, shall--
            (1) revise the definition of ``private duty nursing 
        services'' in section 440.80 of title 42, Code of Federal 
        Regulations, to be ``continuous skilled nursing services''; and
            (2) require that, a condition for Federal financial 
        participation for a State's furnishing medical assistance for 
        such services under the Medicaid program to a complex-care 
        patient who requires more than 2 continuous hours of nursing 
        services per day, is that such services are provided by a 
        licensed nurse (including a registered nurse or a licensed 
        practical nurse).

SEC. 4. DEVELOPMENT OF NATIONAL QUALITY STANDARDS FOR CONTINUOUS 
              SKILLED NURSING SERVICES PROVIDED THROUGH MEDICAID.

    (a) In General.--Not later than 180 days after the date of 
enactment of this Act, the Secretary shall convene a working group that 
includes representatives of independent and national providers of 
private duty nursing services under the Medicaid program, other private 
duty nursing agencies, full-benefit dual eligible individuals, Medicaid 
beneficiaries, patient advocacy groups, officials of State Medicaid 
programs, private duty nursing accrediting bodies, and other relevant 
stakeholders, to develop and establish national quality standards for 
the purposes of improving the standard of care for private duty nursing 
services provided by States under the Medicaid program.
    (b) Ensuring Clinically Appropriate Standards.--The Secretary shall 
issue a letter to State Medicaid Directors stating that providers of 
private duty nursing services under the Medicaid program are not 
required to adhere to conditions of participation for home health 
agencies under title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.).
    (c) Publication of National Standards.--Not later than 1 year after 
the date on which the working group described in subsection (a) is 
first convened, the Secretary shall publish the national quality 
standards developed by the working group for use by State Medicaid 
programs, managed care entities that enter into contracts with such 
programs, and providers of items and services under such programs.

SEC. 5. MAINTAINING UP-TO-DATE CONTINUOUS SKILLED NURSING STANDARDS.

    (a) Updating Home and Community-Based Waiver Services.--Not later 
than 18 months after the date of enactment of this Act, the Secretary, 
through notice and comment rulemaking, shall revise the list of 
services that are included as ``home and community-based waiver 
services'' under section 440.180(b) of title 42, Code of Federal 
Regulations, to include continuous skilled nursing care services, as 
defined for purposes of section 1905(a)(8) of the Social Security Act 
(as amended by section 3(a)) under section 440.80 of title 42, Code of 
Federal Regulations (as revised after the application of section 3(b)).
    (b) Updating the Home and Community-Based Services Quality Measure 
Set.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary shall update and publish 
        the HCBS Quality Measure Set, described in the State Medicaid 
        Director Letter #22-003 issued on July 21, 2022, to include 
        core and supplemental quality measures for continuous skilled 
        nursing services for use by State Medicaid programs, managed 
        care entities that enter into contracts with such programs, and 
        providers of items and services under such programs.
            (2) Regular reviews and updates.--The Secretary shall 
        review and update the core set and supplemental set of 
        continuous skilled nursing services quality measures published 
        under paragraph (1) not less frequently than every 8 years.
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