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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5457 Introduced in House (IH)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Nursing Home Patient and Medicaid 
Assistance Act of 2010''.

SEC. 2. NURSING FACILITY SUPPLEMENTAL PAYMENT PROGRAM.

    (a) Total Amount Available for Payments.--
            (1) In general.--Out of any funds in the Treasury not 
        otherwise appropriated, there are appropriated to the Secretary 
        of Health and Human Services (in this section referred to as 
        the ``Secretary'') to carry out this section $6,000,000,000, of 
        which the following amounts shall be available for obligation 
        in the following years:
                    (A) $1,500,000,000 shall be available beginning in 
                2011.
                    (B) $1,500,000,000 shall be available beginning in 
                2012.
                    (C) $1,500,000,000 shall be available beginning in 
                2013.
                    (D) $1,500,000,000 shall be available beginning in 
                2014.
            (2) Availability.--Funds appropriated under paragraph (1) 
        shall remain available until all eligible dually-certified 
        facilities (as defined in subsection (b)(3)) have been 
        reimbursed for underpayments under this section during cost 
        reporting periods ending during calendar years 2011 through 
        2014.
            (3) Limitation of authority.--The Secretary may not make 
        payments under this section that exceed the funds appropriated 
        under paragraph (1).
            (4) Disposition of remaining funds into mif.--Any funds 
        appropriated under paragraph (1) which remain available after 
        the application of paragraph (2) shall be deposited into the 
        Medicaid Improvement Fund under section 1941 of the Social 
        Security Act.
    (b) Use of Funds.--
            (1) Authority to make payments.--From the amounts available 
        for obligation in a year under subsection (a), the Secretary, 
        acting through the Administrator of the Centers for Medicare & 
        Medicaid Services, shall pay the amount determined under 
        paragraph (2) directly to an eligible dually-certified facility 
        for the purpose of providing funding to reimburse such facility 
        for furnishing quality care to Medicaid-eligible individuals.
            (2) Determination of payment amounts.--
                    (A) In general.--Subject to subparagraphs (B) and 
                (C), the payment amount determined under this paragraph 
                for a year for an eligible dually-certified facility 
                shall be an amount determined by the Secretary as 
                reported on the facility's latest available Medicare 
                cost report.
                    (B) Limitation on payment amount.--In no case shall 
                the payment amount for an eligible dually-certified 
                facility for a year under subparagraph (A) be more than 
                the payment deficit described in paragraph (3)(D) for 
                such facility as reported on the facility's latest 
                available Medicare cost report.
                    (C) Pro-rata reduction.--If the amount available 
                for obligation under subsection (a) for a year (as 
                reduced by allowable administrative costs under this 
                section) is insufficient to ensure that each eligible 
                dually-certified facility receives the amount of 
                payment calculated under subparagraph (A), the 
                Secretary shall reduce that amount of payment with 
                respect to each such facility in a pro-rata manner to 
                ensure that the entire amount available for such 
                payments for the year be paid.
                    (D) No required match.--The Secretary may not 
                require that a State provide matching funds for any 
                payment made under this subsection.
            (3) Eligible dually-certified facility defined.--For 
        purposes of this section, the term ``eligible dually-certified 
        facility'' means, for a cost reporting period ending during a 
        year (beginning no earlier than 2011) that is covered by the 
        latest available Medicare cost report, a nursing facility that 
        meets all of the following requirements:
                    (A) The facility is participating as a nursing 
                facility under title XIX of the Social Security Act and 
                as a skilled nursing facility under title XVIII of such 
                Act during the entire year.
                    (B) The base Medicaid payment rate (excluding any 
                supplemental payments) to the facility is not less than 
                the base Medicaid payment rate (excluding any 
                supplemental payments) to such facility as of the date 
                of the enactment of this Act.
                    (C) As reported on the facility's latest Medicare 
                cost report--
                            (i) the Medicaid share of patient days for 
                        such facility is not less than 60 percent of 
                        the combined Medicare and Medicaid share of 
                        resident days for such facility; and
                            (ii) the combined Medicare and Medicaid 
                        share of resident days for such facility, as 
                        reported on the facility's latest available 
                        Medicare cost report, is not less than 75 
                        percent of the total resident days for such 
                        facility.
                    (D) The facility has received Medicaid 
                reimbursement (including any supplemental payments) for 
                the provision of covered services to Medicaid eligible 
                individuals, as reported on the facility's latest 
                available Medicare cost report, that is significantly 
                less (as determined by the Secretary) than the 
                allowable costs (as determined by the Secretary) 
                incurred by the facility in providing such services.
                    (E) The facility is not in the highest quartile of 
                costs per day, as determined by the Secretary and as 
                adjusted for case mix, wages, and type of facility.
                    (F) The facility provides quality care, as 
                determined by the Secretary, to--
                            (i) Medicaid eligible individuals; and
                            (ii) individuals who are entitled to items 
                        and services under part A of title XVIII of the 
                        Social Security Act.
                    (G) In the most recent standard survey available, 
                the facility was not cited for any immediate jeopardy 
                deficiencies as defined by the Secretary.
                    (H) In the most recent standard survey available, 
                the facility maintains an appropriate staffing level to 
                attain or maintain the highest practicable well-being 
                of each resident as defined by the Secretary.
                    (I) The facility complies with all the 
                requirements, as determined by the Secretary, contained 
                in sections 6101 through 6106 of the Patient Protection 
                and Affordable Care Act (Public Law 111-148) and the 
                amendments made by such sections.
                    (J) The facility was not listed as a Centers for 
                Medicare & Medicaid Services Special Focus Facility 
                (SFF) nor as a SFF on a State-based list.
            (4) Frequency of payment.--Payment of an amount under this 
        subsection to an eligible dually-certified facility shall be 
        made for a year in a lump sum or in such periodic payments in 
        such frequency as the Secretary determines appropriate.
            (5) Direct payments.--Such payment--
                    (A) shall be made directly by the Secretary to an 
                eligible dually-certified facility or a contractor 
                designated by such facility; and
                    (B) shall not be made through a State.
    (c) Administration.--
            (1) Annual applications; deadlines.--The Secretary shall 
        establish a process, including deadlines, under which 
        facilities may apply on an annual basis to qualify as eligible 
        dually-certified facilities for payment under subsection (b).
            (2) Contracting authority.--The Secretary may enter into 
        one or more contracts with entities for the purpose of 
        implementation of this section.
            (3) Limitation.--The Secretary may not spend more than 0.75 
        percent of the amount made available under subsection (a) in 
        any year on the costs of administering the program of payments 
        under this section for the year.
            (4) Implementation.--Notwithstanding any other provision of 
        law, the Secretary may implement, by program instruction or 
        otherwise, the provisions of this section.
            (5) Limitations on review.--There shall be no 
        administrative or judicial review of--
                    (A) the determination of the eligibility of a 
                facility for payments under subsection (b); or
                    (B) the determination of the amount of any payment 
                made to a facility under such subsection.
    (d) Annual Reports.--The Secretary shall submit an annual report to 
the committees with jurisdiction in the Congress on payments made under 
subsection (b). Each such report shall include information on--
            (1) the facilities receiving such payments;
            (2) the amount of such payments to such facilities; and
            (3) the basis for selecting such facilities and the amount 
        of such payments.
    (e) Definitions.--For purposes of this section:
            (1) Dually-certified facility.--The term ``dually-certified 
        facility'' means a facility that is participating as a nursing 
        facility under title XIX of the Social Security Act and as a 
        skilled nursing facility under title XVIII of such Act.
            (2) Medicaid eligible individual.--The term ``Medicaid 
        eligible individual'' means an individual who is eligible for 
        medical assistance, with respect to nursing facility services 
        (as defined in section 1905(f) of the Social Security Act), 
        under title XIX of the such Act.
            (3) State.--The term ``State'' means the 50 States and the 
        District of Columbia.

SEC. 3. ASSURING ADEQUATE MEDICAID PAYMENT LEVELS FOR SERVICES.

    (a) In General.--Title XIX of the Social Security Act is amended by 
inserting after section 1925 the following new section:

            ``assuring adequate payment levels for services

    ``Sec. 1926.  (a) In General.--A State plan under this title shall 
not be considered to meet the requirement of section 1902(a)(30)(A) for 
a year (beginning with 2011) unless, by not later than April 1 before 
the beginning of such year, the State submits to the Secretary an 
amendment to the plan that specifies the payment rates to be used for 
such services under the plan in such year and includes in such 
submission such additional data as will assist the Secretary in 
evaluating the State's compliance with such requirement, including data 
relating to how rates established for payments to medicaid managed care 
organizations under sections 1903(m) and 1932 take into account such 
payment rates.
    ``(b) Secretarial Review.--The Secretary, by not later than 90 days 
after the date of submission of a plan amendment under subsection (a), 
shall--
            ``(1) review each such amendment for compliance with the 
        requirement of section 1902(a)(30)(A); and
            ``(2) approve or disapprove each such amendment.
If the Secretary disapproves such an amendment, the State shall 
immediately submit a revised amendment that meets such requirement.''.
    (b) Report on Medicaid Payments.--Section 1902 of such Act (42 
U.S.C. 1396), as amended by sections 2001(e) and 2303(a)(2) of the 
Patient Protection and Affordable Care Act (Public Law 111-148) and 
section 1202(a) of the Health Care and Education Reconciliation Act of 
2010 (Public Law 111-152), is amended by adding at the end the 
following new subsection:
    ``(kk) Report on Medicaid Payments.--Each year, on or before a date 
determined by the Secretary, a State participating in the Medicaid 
program under this title shall submit to the Administrator of the 
Centers for Medicare & Medicaid Services--
            ``(1) information on the determination of rates of payment 
        to providers for covered services under the State plan, 
        including--
                    ``(A) the final rates;
                    ``(B) the methodologies used to determine such 
                rates; and
                    ``(C) justifications for the rates; and
            ``(2) an explanation of the process used by the State to 
        allow providers, beneficiaries and their representatives, and 
        other concerned State residents a reasonable opportunity to 
        review and comment on such rates, methodologies, and 
        justifications before the State made such rates final.''.
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