Pappas, Rulli, Stanton Introduce Bipartisan Continuous Skilled Nursing Quality Improvement Act

Yesterday Congressman Chris Pappas (NH-01), Congressman Michael Rulli (OH-06), and Congressman Greg Stanton (AZ-04) introduced the Continuous Skilled Nursing Quality Improvement Act of 2025, which would modernize Medicaid’s approach to continuous skilled (private duty) nursing, remove outdated provider red tape, and mandate that the Secretary of Health and Human Services convene a working group to establish national quality standards of care for these services. This would strengthen Medicaid nursing services and expand access to in-home care to ensure that individuals with complex medical needs, many of them children, can access consistent, high-quality care in their homes and communities.

“Granite Staters’ access to the health care they need remains a top priority of mine, and continuous skilled nursing allows for people with disabilities to get the care they need at home. This bipartisan legislation would update Medicaid standards to cut bureaucratic red tape and reflect the unique care these services provide as well as make progress in establishing national quality standards," said Congressman Pappas. “I’ll continue working to strengthen and protect access to health care for all New Hampshire families.”

"Congressman Chris Pappas’s steadfast leadership and dedication to advocating for New Hampshire’s medically complex community make a real difference," said Keliane Totten, CEO of the Home Care, Hospice & Palliative Care Alliance of New Hampshire. "He understands the challenges facing this population, and we deeply appreciate his commitment to ensuring this vulnerable population receives the care and support they need."

“This bill is a game-changer for Medicaid patients who depend on skilled nursing at home,” said Jason Lee, CEO of the Home Care Association of America. “By updating outdated regulations and establishing national quality standards, we can make sure that patients receive the care they need, when and where they need it. Our members are grateful for the bipartisan leadership of Representatives Rulli, Stanton, and Pappas, along with Senators Tillis and Hassan, for championing this important issue.”

"The Alliance is proud to support the Continuous Skilled Nursing Quality Improvement Act and commends Representatives Rulli, Stanton, and Pappas for their leadership," said Dr. Steve Landers, CEO of the Alliance. "Medicaid beneficiaries deserve the highest quality care, and this legislation takes critical steps to ensure they receive it by modernizing the continuous skilled nursing benefit, establishing clear standards for provider participation, and implementing robust quality measures."

The Continuous Skilled Nursing Quality Improvement Act of 2025 directs the Department of Health and Human Services (HHS) to work collaboratively with providers, state Medicaid agencies, and patient advocates to establish national quality standards for continuous skilled nursing services. These updates will improve oversight, ensure consistent quality, and reduce unnecessary administrative barriers. Together, these improvements will strengthen program integrity, expand access to qualified nurses, and deliver greater stability for families who depend on continuous skilled nursing care.

Specifically, the bill includes:

• Terminology Modernization: Updates the definition of private duty nursing to “continuous skilled nursing services” to reflect the needs of patients requiring extended skilled nursing care.
• National Quality Standards: Requires HHS to convene a working group to develop national standards for continuous skilled nursing services.
• Medicaid Coverage Clarity: Ensures Medicaid providers are not subject to Medicare home health agency participation conditions, reducing regulatory burdens and improving access to care.
• Home and Community-Based Services Inclusion: Expands Medicaid’s home and community-based services (HCBS) waiver program to include continuous skilled nursing care.
• Quality Measure Updates: Directs HHS to update and maintain quality measures for Medicaid-covered skilled nursing services.

The Senate companion bill is led by Senator Thom Tillis (NC) and Senator Maggie Hassan (NH).