; and inserting continuous skilled nursing services; . (2) Effective date The amendment made by paragraph (1) takes effect on the date that is 18 months after the date of enactment of this Act. (b) Definition of continuous skilled nursing services Not later than 18 months after the date of enactment of this Act, the Secretary, through notice and comment rulemaking, shall— (1) revise the definition of private duty nursing services in section 440.80 of title 42, Code of Federal Regulations, to be continuous skilled nursing services