This bill seeks to enhance the quality of continuous skilled nursing services provided to Medicaid beneficiaries, particularly those with complex care needs. It redefines "private duty nursing services" in the Social Security Act and federal regulations as "continuous skilled nursing services," requiring these services for complex-care patients to be delivered by licensed nurses. A key provision is the establishment of a working group, to be convened within 180 days, comprising diverse stakeholders such as providers, patient advocacy groups, and State Medicaid officials. This group is tasked with developing national quality standards for these services, which the Secretary of Health and Human Services will publish within one year of the group's first meeting, following public notice and comment. The bill also clarifies that these providers are not subject to Medicare home health agency conditions of participation. Furthermore, the legislation mandates updates to federal regulations to include continuous skilled nursing care services within home and community-based waiver services . It also requires the Secretary to update the Home and Community-Based Services (HCBS) Quality Measure Set within one year to incorporate core and supplemental quality measures for continuous skilled nursing services. These measures will undergo regular review and updates at least every eight years to ensure ongoing quality improvement.