I 

111TH CONGRESS 

2D SESSION H. R. 5457 

To provide supplemental payments to nursing facilities serving Medicare and 

Medicaid patients and to amend title XIX of the Social Security Act 

to assure adequate Medicaid payment levels for services. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 28, 2010 

Ms. CASTOR of Florida (for herself and Mr. MURPHY of Connecticut) 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 provide supplemental payments to nursing facilities serving Medicare and Medicaid patients and to amend title 

XIX of the Social Security Act to assure adequate Medicaid payment levels for services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Nursing Home Patient 

5 and Medicaid Assistance Act of 2010’’. 


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1 SEC. 2. NURSING FACILITY SUPPLEMENTAL PAYMENT PRO2 GRAM. 

3 (a) TOTAL AMOUNT AVAILABLE FOR PAYMENTS.— 

4 (1) IN GENERAL.—Out of any funds in the 

5 Treasury not otherwise appropriated, there are ap6 propriated to the Secretary of Health and Human 

7 Services (in this section referred to as the ‘‘Sec8 retary’’) to carry out this section $6,000,000,000, of 

9 which the following amounts shall be available for 

10 obligation in the following years: 

11 (A) $1,500,000,000 shall be available be12 ginning in 2011. 

13 (B) $1,500,000,000 shall be available be14 ginning in 2012. 

15 (C) $1,500,000,000 shall be available be16 ginning in 2013. 

17 (D) $1,500,000,000 shall be available be18 ginning in 2014. 

19 (2) AVAILABILITY.—Funds appropriated under 

20 paragraph (1) shall remain available until all eligible 

21 dually-certified facilities (as defined in subsection 

22 (b)(3)) have been reimbursed for underpayments 

23 under this section during cost reporting periods end24 ing during calendar years 2011 through 2014. 

25 (3) LIMITATION OF AUTHORITY.—The Sec26 retary may not make payments under this section 


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1 that exceed the funds appropriated under paragraph 

2 (1). 

3 (4) DISPOSITION OF REMAINING FUNDS INTO

4 MIF.—Any funds appropriated under paragraph (1) 

5 which remain available after the application of para6 graph (2) shall be deposited into the Medicaid Im7 provement Fund under section 1941 of the Social 

8 Security Act. 

9 (b) USE OF FUNDS.— 

10 (1) AUTHORITY TO MAKE PAYMENTS.—From 

11 the amounts available for obligation in a year under 

12 subsection (a), the Secretary, acting through the Ad13 ministrator of the Centers for Medicare & Medicaid 

14 Services, shall pay the amount determined under 

15 paragraph (2) directly to an eligible dually-certified 

16 facility for the purpose of providing funding to reim17 burse such facility for furnishing quality care to 

18 Medicaid-eligible individuals. 

19 (2) DETERMINATION OF PAYMENT AMOUNTS.— 

20 (A) IN GENERAL.—Subject to subpara21 graphs (B) and (C), the payment amount deter22 mined under this paragraph for a year for an 

23 eligible dually-certified facility shall be an 

24 amount determined by the Secretary as reVerDate Mar 15 2010 02:50 Jun 02, 2010 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5457.IH H5457

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1 ported on the facility’s latest available Medicare 

2 cost report. 

3 (B) LIMITATION ON PAYMENT AMOUNT.— 

4 In no case shall the payment amount for an eli5 gible dually-certified facility for a year under 

6 subparagraph (A) be more than the payment 

7 deficit described in paragraph (3)(D) for such 

8 facility as reported on the facility’s latest avail9 able Medicare cost report. 

10 (C) PRO-RATA REDUCTION.—If the 

11 amount available for obligation under sub12 section (a) for a year (as reduced by allowable 

13 administrative costs under this section) is insuf14 ficient to ensure that each eligible dually-cer15 tified facility receives the amount of payment 

16 calculated under subparagraph (A), the Sec17 retary shall reduce that amount of payment 

18 with respect to each such facility in a pro-rata 

19 manner to ensure that the entire amount avail20 able for such payments for the year be paid. 

21 (D) NO REQUIRED MATCH.—The Secretary 

22 may not require that a State provide matching 

23 funds for any payment made under this sub24 section. 


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1 (3) ELIGIBLE DUALLY-CERTIFIED FACILITY DE2 FINED.—For purposes of this section, the term ‘‘eli3 gible dually-certified facility’’ means, for a cost re4 porting period ending during a year (beginning no 

5 earlier than 2011) that is covered by the latest avail6 able Medicare cost report, a nursing facility that 

7 meets all of the following requirements: 

8 (A) The facility is participating as a nurs9 ing facility under title XIX of the Social Secu10 rity Act and as a skilled nursing facility under 

11 title XVIII of such Act during the entire year. 

12 (B) The base Medicaid payment rate (ex13 cluding any supplemental payments) to the fa14 cility is not less than the base Medicaid pay15 ment rate (excluding any supplemental pay16 ments) to such facility as of the date of the en17 actment of this Act. 

18 (C) As reported on the facility’s latest 

19 Medicare cost report— 

20 (i) the Medicaid share of patient days 

21 for such facility is not less than 60 percent 

22 of the combined Medicare and Medicaid 

23 share of resident days for such facility; and 

24 (ii) the combined Medicare and Med25 icaid share of resident days for such facilVerDate Mar 15 2010 02:50 Jun 02, 2010 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5457.IH H5457

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1 ity, as reported on the facility’s latest 

2 available Medicare cost report, is not less 

3 than 75 percent of the total resident days 

4 for such facility. 

5 (D) The facility has received Medicaid re6 imbursement (including any supplemental pay7 ments) for the provision of covered services to 

8 Medicaid eligible individuals, as reported on the 

9 facility’s latest available Medicare cost report, 

10 that is significantly less (as determined by the 

11 Secretary) than the allowable costs (as deter12 mined by the Secretary) incurred by the facility 

13 in providing such services. 

14 (E) The facility is not in the highest quar15 tile of costs per day, as determined by the Sec16 retary and as adjusted for case mix, wages, and 

17 type of facility. 

18 (F) The facility provides quality care, as 

19 determined by the Secretary, to— 

20 (i) Medicaid eligible individuals; and 

21 (ii) individuals who are entitled to 

22 items and services under part A of title 

23 XVIII of the Social Security Act. 

24 (G) In the most recent standard survey 

25 available, the facility was not cited for any imVerDate Mar 15 2010 02:50 Jun 02, 2010 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5457.IH H5457

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1 mediate jeopardy deficiencies as defined by the 

2 Secretary. 

3 (H) In the most recent standard survey 

4 available, the facility maintains an appropriate 

5 staffing level to attain or maintain the highest 

6 practicable well-being of each resident as de7 fined by the Secretary. 

8 (I) The facility complies with all the re9 quirements, as determined by the Secretary, 

10 contained in sections 6101 through 6106 of the 

11 Patient Protection and Affordable Care Act 

12 (Public Law 111–148) and the amendments 

13 made by such sections. 

14 (J) The facility was not listed as a Centers 

15 for Medicare & Medicaid Services Special Focus 

16 Facility (SFF) nor as a SFF on a State-based 

17 list. 

18 (4) FREQUENCY OF PAYMENT.—Payment of an 

19 amount under this subsection to an eligible dually20 certified facility shall be made for a year in a lump 

21 sum or in such periodic payments in such frequency 

22 as the Secretary determines appropriate. 

23 (5) DIRECT PAYMENTS.—Such payment— 


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1 (A) shall be made directly by the Secretary 

2 to an eligible dually-certified facility or a con3 tractor designated by such facility; and 

4 (B) shall not be made through a State. 

5 (c) ADMINISTRATION.— 

6 (1) ANNUAL APPLICATIONS; DEADLINES.—The 

7 Secretary shall establish a process, including dead8 lines, under which facilities may apply on an annual 

9 basis to qualify as eligible dually-certified facilities 

10 for payment under subsection (b). 

11 (2) CONTRACTING AUTHORITY.—The Secretary 

12 may enter into one or more contracts with entities 

13 for the purpose of implementation of this section. 

14 (3) LIMITATION.—The Secretary may not 

15 spend more than 0.75 percent of the amount made 

16 available under subsection (a) in any year on the 

17 costs of administering the program of payments 

18 under this section for the year. 

19 (4) IMPLEMENTATION.—Notwithstanding any 

20 other provision of law, the Secretary may implement, 

21 by program instruction or otherwise, the provisions 

22 of this section. 

23 (5) LIMITATIONS ON REVIEW.—There shall be 

24 no administrative or judicial review of— 


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1 (A) the determination of the eligibility of a 

2 facility for payments under subsection (b); or 

3 (B) the determination of the amount of 

4 any payment made to a facility under such sub5 section. 

6 (d) ANNUAL REPORTS.—The Secretary shall submit 

7 an annual report to the committees with jurisdiction in 

8 the Congress on payments made under subsection (b). 

9 Each such report shall include information on— 

10 (1) the facilities receiving such payments; 

11 (2) the amount of such payments to such facili12 ties; and 

13 (3) the basis for selecting such facilities and the 

14 amount of such payments. 

15 (e) DEFINITIONS.—For purposes of this section: 

16 (1) DUALLY-CERTIFIED FACILITY.—The term 

17 ‘‘dually-certified facility’’ means a facility that is 

18 participating as a nursing facility under title XIX of 

19 the Social Security Act and as a skilled nursing fa20 cility under title XVIII of such Act. 

21 (2) MEDICAID ELIGIBLE INDIVIDUAL.—The 

22 term ‘‘Medicaid eligible individual’’ means an indi23 vidual who is eligible for medical assistance, with re24 spect to nursing facility services (as defined in secVerDate Mar 15 2010 02:50 Jun 02, 2010 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5457.IH H5457

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1 tion 1905(f) of the Social Security Act), under title 

2 XIX of the such Act. 

3 (3) STATE.—The term ‘‘State’’ means the 50 

4 States and the District of Columbia. 

5 SEC. 3. ASSURING ADEQUATE MEDICAID PAYMENT LEVELS 

6 FOR SERVICES. 

7 (a) IN GENERAL.—Title XIX of the Social Security 

8 Act is amended by inserting after section 1925 the fol9 lowing new section: 

10 ‘‘ASSURING ADEQUATE PAYMENT LEVELS FOR SERVICES

11 ‘‘SEC. 1926. (a) IN GENERAL.—A State plan under 

12 this title shall not be considered to meet the requirement 

13 of section 1902(a)(30)(A) for a year (beginning with 

14 2011) unless, by not later than April 1 before the begin15 ning of such year, the State submits to the Secretary an 

16 amendment to the plan that specifies the payment rates 

17 to be used for such services under the plan in such year 

18 and includes in such submission such additional data as 

19 will assist the Secretary in evaluating the State’s compli20 ance with such requirement, including data relating to how 

21 rates established for payments to medicaid managed care 

22 organizations under sections 1903(m) and 1932 take into 

23 account such payment rates. 

24 ‘‘(b) SECRETARIAL REVIEW.—The Secretary, by not 

25 later than 90 days after the date of submission of a plan 

26 amendment under subsection (a), shall— 


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1 ‘‘(1) review each such amendment for compli2 ance with the requirement of section 

3 1902(a)(30)(A); and 

4 ‘‘(2) approve or disapprove each such amend5 ment. 

6 If the Secretary disapproves such an amendment, the 

7 State shall immediately submit a revised amendment that 

8 meets such requirement.’’. 

9 (b) REPORT ON MEDICAID PAYMENTS.—Section 

10 1902 of such Act (42 U.S.C. 1396), as amended by sec11 tions 2001(e) and 2303(a)(2) of the Patient Protection 

12 and Affordable Care Act (Public Law 111–148) and sec13 tion 1202(a) of the Health Care and Education Reconcili14 ation Act of 2010 (Public Law 111–152), is amended by 

15 adding at the end the following new subsection: 

16 ‘‘(kk) REPORT ON MEDICAID PAYMENTS.—Each 

17 year, on or before a date determined by the Secretary, a 

18 State participating in the Medicaid program under this 

19 title shall submit to the Administrator of the Centers for 

20 Medicare & Medicaid Services— 

21 ‘‘(1) information on the determination of rates 

22 of payment to providers for covered services under 

23 the State plan, including— 

24 ‘‘(A) the final rates; 


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1 ‘‘(B) the methodologies used to determine 

2 such rates; and 

3 ‘‘(C) justifications for the rates; and 

4 ‘‘(2) an explanation of the process used by the 

5 State to allow providers, beneficiaries and their rep6 resentatives, and other concerned State residents a 

7 reasonable opportunity to review and comment on 

8 such rates, methodologies, and justifications before 

9 the State made such rates final.’’. 

Æ 


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