HR 7106

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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);”. <all>