H.R. 7106

[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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