Real bill currently in Congress c/o S/119/4467

A bill to amend titles XVIII and XIX of the Social Security Act with respect to nursing facility requirements, and for other purposes.

▲ 35 days since action Sponsor: Mark R. Warner, VA-Senate, D → Congress.gov

Latest action (2026-04-30): Read twice and referred to the Committee on Finance.

What should pass

“AI Consensus Solution”

Nursing Facility Quality Incentives and Accountability Act

To strengthen nursing facility standards under Medicare (Title XVIII) and Medicaid (Title XIX) of the Social Security Act to improve resident care quality, safety, and staffing.

Bipartisan rationale: Honors Democratic priorities of enhancing senior care quality and staffing through targeted investments; honors Republican priorities of fiscal restraint via capped spending/offsets, performance incentives over mandates, state grant flexibility, and strong oversight/sunsets.

Funding: Offsets from Medicare and Medicaid imprope $1.8 billion cap over 5 years Sunset 5y Oversight: HHS Office of Inspector Genera Enforcement: CMS payment bonuses/withholds tied t

Vote-count path: ~240 House votes: 210 D moderates + 30 R health reformers; ~68 Senate votes: 50 D + 18 R from oversight and rural caucuses.

→ Article I, Section 8, Clause 1 (Spending Clause for conditional federal grants) → Article I, Section 8, Clause 18 (Necessary and Proper Clause for program administration) → Tenth Amendment (respects state sovereignty via voluntary incentives, no direct commands)

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