Medicaid tightens nursing standards, mandates licensed care for complex patients
S. 1920 — Continuous Skilled Nursing Quality Improvement Act of 2025 · Filed by Thom Tillis (R-NC) · 3 cosponsors · Introduced May 22, 2025 · Referred to committee
Your members of Congress
Enter a ZIP to see where your representative and both senators stood on this bill.
Looked up on this device — your ZIP is never stored on our servers.
What it does
This bill redefines how Medicaid pays for private-duty nursing care, requiring it to be called 'continuous skilled nursing services' and mandating that complex-care patients receive care from licensed nurses (RNs or LPNs). It directs the HHS Secretary to develop national quality standards for these services within 18 months, establish a working group of providers and patient advocates to set benchmarks, and update federal regulations to include continuous skilled nursing in home-and-community-based waiver services. The goal is to standardize and improve the quality of nursing care for Medicaid beneficiaries, particularly dual-eligible individuals (those on both Medicare and Medicaid).
Why we flagged it
The bill's core function is regulatory: it redefines a Medicaid service category, mandates licensed-nurse staffing for complex cases, and establishes national quality benchmarks. It is not a funding bill, tax measure, or commemorative act—it is a quality-and-standards-setting intervention in the Medicaid program.
What the text implies
- Redefining 'private duty nursing' as 'continuous skilled nursing' may trigger reclassification of existing service contracts and billing codes, potentially disrupting current provider arrangements and requiring state-level regulatory updates.
- The 18-month timeline for HHS rulemaking and the requirement that complex-care patients receive licensed-nurse care may increase Medicaid costs if states currently rely on lower-cost unlicensed or paraprofessional staff; cost impact is not addressed in the bill.
The full analysis lists 4 implications of this text.
Who stands to gain
licensed nursing providers (RNs, LPNs); private-duty nursing agencies; home-health and skilled-nursing facilities