,,ii #aaith ,,congress #ast ,session ,s4 #aibj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #bb1 #bjbe ,mr4 ,tillis 7for himself1 ,ms4 ,hassan1 ,mr4 ,sullivan1 and ,ms4 ,cortez ,masto7 introduced the following bill2 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 ,medicaid1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,continuous ,skilled ,nursing ,quality ,improvement ,act of #bjbe4 #b4 ,definitions ,in this ,act3 7#a7 ,full-benefit dual eligible individual ,the term full-benefit dual eligible individual means an individual who is entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 or enrolled for benefits under part ,b of title ,,xviii of such ,act1 and is eligible for medical assistance under the ,medicaid program for full benefits under section #aijb7;a77#aj77;,a7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 or #aijb7;a77#aj77;,c7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,c771 by reason of section #aijb7;f7 of such ,act 7#db ,u4,s4,c4 #acif;a7f771 or under any other category of eligibility for medical assistance for full benefits1 as determined by the ,secretary4 7#b7 ,medicaid beneficiary ,the term ,medicaid beneficiary means an individual who is eligible for1 and enrolled in1 a ,state ,medicaid program4 7#c7 ,medicaid program ,the term ,medicaid program means1 with respect to a ,state1 the ,state program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 7including any waiver or demonstration under such title or under section #aaae of such ,act 7#db ,u4,s4,c4 #acae7 relating to such title74 7#d7 ,private duty nursing services ,the term private duty nursing services has the meaning given that term for purposes of section #aije7;a77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#h77 7as in effect on the date of enactment of this ,act74 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#f7 ,state ,the term ,state has the meaning given such term in section #aaja7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77 for purposes of title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 #c4 ,redefining private duty nursing services provided through ,medicaid 7a7 ,definition of medical assistance 7#a7 ,in general ,section #aije7;a77#h7 of the ,social ,security ,act 7#db ,u4,s4 #acif;d7a77#h77 is amended by striking private duty nursing services2 and inserting continuous skilled nursing services24 7#b7 ,effective date ,the amendment made by paragraph 7#a7 takes effect on the date that is #ah months after the date of enactment of this ,act4 7b7 ,definition of continuous skilled nursing services ,not later than #ah months after the date of enactment of this ,act1 the ,secretary1 through notice and comment rulemaking1 shall-- 7#a7 revise the definition of private duty nursing services in section #ddj4hj of title #db1 ,code of ,federal ,regulations1 to be continuous skilled nursing services2 and 7#b7 require that such services under the ,medicaid program provided to complex-care patients who require multiple hours of continuous nursing services per day1 as determined by the ,state1 are provided by a licensed nurse1 including a registered nurse or a licensed practical nurse4 #d4 ,development of national quality standards for continuous skilled nursing services provided through ,medicaid 7a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary shall convene a working group that includes representatives of independent and national providers of private duty nursing services under the ,medicaid program1 other private duty nursing agencies1 associations representing providers of continuous skilled nursing services1 full-benefit dual eligible individuals1 ,medicaid beneficiaries1 patient advocacy groups1 officials of ,state ,medicaid programs1 private duty nursing accrediting bodies1 and other relevant stakeholders1 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 program4 7b7 ,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 7#db ,u4,s4,c4 #acie et seq474 7c7 ,publication of national standards ,not later than #a year after the date on which the working group described in subsection 7a7 is first convened1 the ,secretary1 after providing a period of public notice and opportunity for comment1 shall publish the national quality standards developed by the working group for use by ,state ,medicaid programs1 managed care entities that enter into contracts with such programs1 and providers of items and services under such programs4 #e4 ,maintaining up-to-date continuous skilled nursing standards 7a7 ,updating home and community-,based waiver services ,not later than #ah months after the date of enactment of this ,act1 the ,secretary1 through notice and comment rulemaking1 shall revise the list of services that are included as home and community-based waiver services under section #ddj4ahj7;b7 of title #db1 ,code of ,federal ,regulations1 to include continuous skilled nursing care services1 as defined for purposes of section #aije7;a77#h7 of the ,social ,security ,act 7as amended by section #c7;a77 under section #ddj4hj of title #db1 ,code of ,federal ,regulations 7as revised after the application of section #c7;b774 7b7 ,updating the home and community-,based services quality measure set 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall update and publish the ,,hcbs ,quality ,measure ,set1 described in the ,state ,medicaid ,director ,letter #bb-jjc issued on ,july #ba1 #bjbb1 to include core and supplemental quality measures for continuous skilled nursing services for use by ,state ,medicaid programs1 managed care entities that enter into contracts with such programs1 and providers of items and services under such programs4 7#b7 ,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 7#a7 not less frequently than every #h years4 ,any such update shall include a period of public notice and opportunity for comment4