Medicaid Overhauls At-Home Nursing Care: New National Quality Standards Mandated for Complex Patients

If you or someone you know relies on Medicaid for high-level, continuous nursing care at home, this bill is a big deal. The Continuous Skilled Nursing Quality Improvement Act of 2025 is designed to raise the bar on quality for some of the most vulnerable patients by establishing national standards for in-home care. It starts by swapping out the old term “private duty nursing services” for the more descriptive “continuous skilled nursing services” within Medicaid, specifically targeting “complex-care patients” who need constant daily nursing. This name change takes effect 18 months after the bill becomes law (SEC. 3).

The Quality Control Kick-Off

This isn't just a name change; it’s a commitment to quality control. Within 180 days, the Secretary of Health and Human Services has to assemble a working group composed of providers, patient advocates, state officials, and, crucially, the people who actually use these services—Medicaid recipients and dual eligibles. Their mission? To develop national quality standards to “seriously boost the level of care” (SEC. 4). This means that for the first time, the intensive, high-hour nursing care that keeps complex patients out of institutions will be held to a consistent, national benchmark, which should be a win for patient safety and consistency.

Cutting the Red Tape for Home Care

One major clarification in the bill addresses a common bureaucratic headache. The Secretary must immediately notify State Medicaid Directors that providers offering this continuous skilled nursing care do not have to follow the same participation rules that Medicare home health agencies do (SEC. 4). This is important because the rules for short-term, acute Medicare home health are often a poor fit for the ongoing, complex needs of long-term Medicaid patients. By clarifying the separation, the bill aims to reduce administrative confusion and potentially make it easier for specialized providers to offer this critical care.

The Real-World Impact and the Fine Print

For families relying on this service, the biggest immediate benefit will be the creation of clear, measurable standards. If you’re a parent coordinating care for a child with complex medical needs, these new quality measures—which must be developed and finalized within one year—will give you clear benchmarks to hold your providers and state agencies accountable (SEC. 5). The bill also requires these standards to be reviewed and updated at least every eight years, ensuring they don't become outdated.

However, there is a catch: the bill leaves the definition of a “complex-care patient” up to the individual state (SEC. 3). This means that while the quality standards themselves will be national, who actually qualifies for these intensive services could still vary across state lines. If you live near a state border, the level of care you can access for the same condition might be different, depending on how your state decides to define that term. State Medicaid programs and managed care organizations will also face a short-term administrative lift as they implement the new definitions and integrate the required quality measures into their systems (SEC. 5).