; and (2) require that, a condition for Federal financial participation for a State's furnishing medical assistance for such services under the Medicaid program to a complex-care patient who requires more than 2 continuous hours of nursing services per day, is that such services are provided by a licensed nurse (including a registered nurse or a licensed practical nurse). 4. Development of national quality standards for continuous skilled nursing services provided through Medicaid (a) In general Not later than 180 days after the date of enactment of this Act, the Secretary shall convene a working group that includes representatives of independent and national providers of private duty nursing services under the Medicaid program, other private duty nursing agencies, full-benefit dual eligible individuals, Medicaid beneficiaries, patient advocacy groups, officials of State Medicaid programs, private duty nursing accrediting bodies, and other relevant stakeholders, to develop and establish national quality standards for the purposes of improving the standard of care for private duty nursing services provided by States under the Medicaid program. (b) Ensuring clinically appropriate standards The Secretary shall issue a letter to State Medicaid Directors stating that providers of private duty nursing services under the Medicaid program are not required to adhere to conditions of participation for home health agencies under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ). (c) Publication of national standards Not later than 1 year after the date on which the working group described in subsection (a) is first convened, the Secretary shall publish the national quality standards developed by the working group for use by State Medicaid programs, managed care entities that enter into contracts with such programs, and providers of items and services under such programs. 5. Maintaining up-to-date continuous skilled nursing standards (a) Updating home and community-Based waiver services Not later than 18