New Bill Looks to Improve Skilled Nursing Care Quality

WASHINGTON—A newly introduced bill seeks to modernize Medicaid’s approach to private duty nursing in order to improve the quality and accessibility of skilled nursing care. The Continuous Skilled Nursing Quality Improvement Act of 2025 (S 1920) was introduced by Senator Thom Tillis (R-NC) and Senator Maggie Hassan (D-NH). 

“Patients and families who rely on in-home skilled nursing are being left behind due to outdated regulations and inconsistent standards,” said Tillis. “I’m proud to introduce this bipartisan legislation to modernize support for those with serious medical needs by removing red tape and creating consistent guidelines that will improve quality of care.” 

The bill directs the Department of Health and Human Services (HHS) to work with stakeholders, including providers, patient advocacy groups and state Medicaid agencies, to develop national quality standards. These standards will aim to improve oversight and ensure that Medicaid patients receive high-quality care from licensed nurses. 

The National Alliance for Care at Home (the Alliance) voiced its support for the bill. 

“This legislation addresses critical gaps in care that leave thousands of medically complex patients and their families struggling to access consistent, quality skilled nursing services in their homes—a situation that has reached crisis levels in many communities across the nation,” the Alliance said in a statement. 

Additional key provisions of the bill include: 

• Ensuring Medicaid providers are not subject to Medicare home health agency conditions of participation
• Expanding Medicaid’s home and community-based services (HCBS) waiver program to include continuous skilled nursing care

“We are proud to champion the Continuous Skilled Nursing Quality Improvement Act and want to thank Senators Tillis, Sullivan, Hassan and Cortez Masto for their leadership on this legislation,” said Steve Landers, CEO of the Alliance. “This bill will make important updates to the continuous skilled nursing services program, including improving quality measurement, clarifying provider participation requirements, and updating the benefit to reflect modern service delivery. These improvements will increase access to services and improve the quality of care provided to individuals in Medicaid.”

On June 24, Landers released a statement in response to HHS Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz’s announcement regarding commitments from major health insurers to reform prior authorization practices.  

“The Alliance welcomes today’s announcement made by Secretary Kennedy and CMS Administrator Dr. Oz regarding commitments from major health insurers to streamline prior authorization practices, including implementing enhanced digital interoperability standards and reducing administrative barriers,” said Landers. “If these promises are fully kept, this could be a meaningful step toward addressing longstanding barriers that have delayed access to critical care at home for patients who need it.” 

“Our members who provide essential care welcome initiatives that potentially reduce administrative burden and improve communication with insurers, freeing up scarce clinical capacity and resources for direct patient care rather than navigating red tape,” Landers continued. 

The Alliance said it will continue to work closely with Congress, HHS and state Medicaid agencies to advocate for the passage and implementation of this legislation.