[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7106 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 7106
To amend titles XVIII and XIX of the Social Security Act to streamline
care delivery in skilled nursing facilities and nursing facilities
under the Medicare and Medicaid programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 15, 2026
Mrs. Kiggans of Virginia (for herself and Mrs. Dingell) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to streamline
care delivery in skilled nursing facilities and nursing facilities
under the Medicare and Medicaid programs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Enhancing Skilled Nursing Facilities
Act''.
SEC. 2. STREAMLINING CARE DELIVERY IN SKILLED NURSING FACILITIES AND
NURSING FACILITIES.
(a) Medicare.--
(1) Certification of post-hospital extended care
services.--Section 1814(a)(2) of the Social Security Act (42
U.S.C. 1395f(a)(2)) is amended by striking ``who does not'' and
all that follows through ``physician,,'' and inserting
``working in accordance with State law,''.
(2) Supervision requirement in skilled nursing facility
services.--Section 1819(b)(6)(A) of the Social Security Act (42
U.S.C. 1395i-3(b)(6)(A)) is amended--
(A) in the header, by striking ``Physician
supervision'' and inserting ``Supervision''; and
(B) by inserting ``or a nurse practitioner or
physician assistant, in accordance with State law''
after ``physician''.
(3) Administration of part b.--Section 1842(b)(2)(C) of the
Social Security Act (42 U.S.C. 1395u(b)(2)(C)) is amended--
(A) by inserting ``, a nurse practitioner, or a
physician assistant'' after ``a physician''; and
(B) by striking ``and includes a physician
assistant acting under the supervision of the physician
or a nurse practitioner working in collaboration with
that physician, or both''.
(4) Provision of medical and other health services.--
Section 1861(s)(2)(K)(ii) of the Social Security Act (42 U.S.C.
1395x(s)(2)(K)(ii)) is amended by striking ``or clinical nurse
specialist (as defined in subsection (aa)(5)) working in
collaboration (as defined in subsection (aa)(6)) with a
physician (as defined in subsection (r)(1))'' and inserting
``(as defined in subsection (aa)(5)(A)), or by a clinical nurse
specialist (as defined in subsection (aa)(5)(B)) working in
collaboration with a physician (as defined in subsection
(r)(1)),''.
(5) Scope of services.--Section 1819(b)(2)(B) of the Social
Security Act (42 U.S.C. 1395i-3(b)(2)(B)) is amended by
inserting ``(or a nurse practitioner, physician assistant, or
clinical nurse specialist working in accordance with State
law)'' after ``attending physician''.
(6) Residents' rights.--Section 1819(c) of the Social
Security Act (42 U.S.C. 1395i-3(c)) is amended--
(A) in paragraph (1)(A)(i), by inserting ``nurse
practitioner, physician assistant, or clinical nurse
specialist working in accordance with State law'' after
``attending physician'';
(B) in paragraph (2)(A), in the matter following
clause (vi)--
(i) by inserting ``nurse practitioner,
physician assistant, or clinical nurse
specialist working in accordance with State
law'' after ``resident's physician''; and
(ii) by inserting ``, nurse practitioner,
physician assistant, or clinical nurse
specialist working in accordance with State
law'' after ``a physician''; and
(C) in paragraph (3)(A), by inserting ``, nurse
practitioner, physician assistant, or clinical nurse
specialist working in accordance with State law'' after
``physician''.
(b) Medicaid.--
(1) Certification of skilled nursing facility services and
intermediate care facility services.--Section 1902(a)(44) of
the Social Security Act (42 U.S.C. 1396a(a)(44)) is amended--
(A) in subparagraph (A)--
(i) by striking ``(or, in the case of
skilled nursing facility services or
intermediate care facility services'' and
inserting ``(or, in the case of intermediate
care facility services'';
(ii) by striking ``physician) certifies''
and inserting ``physician, or, in the case of
skilled nursing facility services, a physician,
or a nurse practitioner, a physician assistant,
or a clinical nurse specialist working in
accordance with State law) certifies'';
(iii) by striking ``a physician, or, in the
case of skilled nursing facility services or''
and inserting ``a physician, or, in the case
of''; and
(iv) by inserting ``or, in the case of
skilled nursing facility services, a physician,
or a nurse practitioner, a physician assistant,
or a clinical nurse specialist working in
accordance with State law,'' before
``recertifies''; and
(B) in subparagraph (B)--
(i) by striking ``skilled nursing facility
services or''; and
(ii) by inserting ``, or, in the case of
skilled nursing facility services, a physician,
or a nurse practitioner, a physician assistant,
or a clinical nurse specialist working in
accordance with State law'' before the
semicolon.
(2) Nursing facility services supervision and clinical
records.--Section 1919(b)(6)(A) of the Social Security Act (42
U.S.C. 1396r(b)(6)(A)) is amended to read as follows:
``(A) require that the health care of every
resident be provided under the supervision of a
physician or nurse practitioner or a physician
assistant (or, at the option of a State, under the
supervision of a clinical nurse specialist);''.
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