I 

108TH CONGRESS 

2D SESSION H. R. 5322

To amend title IV of the Public Health Service Act to establish a loan 

repayment program for nurse practitioners and physician assistants serving in underserved nursing homes, to establish a mentoring program 

for training nursing home administrators, to encourage high family involvement in nursing homes, and to amend title XIX of the Social 

Security Act to restore payment levels for health care institutions and 

to increase the Federal medical assistance percentage. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 8, 2004

Mr. KENNEDY of Rhode Island (for himself, Ms. ROYBAL-ALLARD, Mr. FARR, 

and Mrs. MCCARTHY of New York) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL

To amend title IV of the Public Health Service Act to 

establish a loan repayment program for nurse practitioners and physician assistants serving in underserved 

nursing homes, to establish a mentoring program for 

training nursing home administrators, to encourage high 

family involvement in nursing homes, and to amend title 

XIX of the Social Security Act to restore payment levels 

for health care institutions and to increase the Federal 

medical assistance percentage.

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

2 This Act may be cited as the ‘‘Managing Our Medi3 care and Medicaid Services and Protecting Our Parents 

4 Act’’ . 

5 SEC. 2. LOAN REPAYMENT PROGRAM FOR NURSE PRACTI6 TIONERS AND PHYSICIANS ASSISTANTS SERV7 ING IN UNDERSERVED NURSING HOMES. 

8 Title IV of the Public Health Service Act (42 U.S.C. 

9 281 et seq.) is amended—

10 (1) by redesignating the second section 487F as 

11 section 487G; and 

12 (2) by inserting after section 487G (as so re13 designated) the following: 

14 ‘‘SEC. 487H. LOAN REPAYMENT PROGRAM FOR NURSE 

15 PRACTITIONERS AND PHYSICIAN ASSISTANTS 

16 SERVING IN UNDERSERVED NURSING 

17 HOMES. 

18 ‘‘(a) ESTABLISHMENT.—To the extent and in the 

19 amounts provided in advance in appropriations Acts, the 

20 Secretary, acting through the Administrator of the Health 

21 Resources and Services Administration, shall establish a 

22 program to enter into contracts with individuals under 

23 which the individual involved agrees to serve for a period 

24 of not less than 3 years as a nurse practitioner or a physi25 cian assistant at an underserved nursing home, in consid26 eration of the Federal Government agreeing to make pay-
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1 ments, for not more than 5 years of such service, on the 

2 principal and interest of the educational loans of the indi3 vidual. 

4 ‘‘(b) AMOUNT OF PAYMENTS.—The amount of a pay5 ment by the Secretary under this section for a year of 

6 service by an individual as a nurse practitioner or physi7 cian assistant at an underserved nursing home shall not 

8 exceed the lesser of the remaining outstanding obligation 

9 on the individual’s educational loans or—

10 ‘‘(1) $2,000 at the completion of the first year 

11 of such service; 

12 ‘‘(2) $2,500 at the completion of the second 

13 year of such service; 

14 ‘‘(3) $3,500 at the completion of the third year 

15 of such service; 

16 ‘‘(4) $4,500 at the completion of the fourth 

17 year of such service; and 

18 ‘‘(5) $5,000 at the completion of the fifth year 

19 of such service. 

20 ‘‘(c) APPLICATION OF PROVISIONS.—Except as in21 consistent with this section, the provisions of sections 

22 338B, 338C, and 338E shall apply to the program estab23 lished under this section to the same extent and in the 

24 same manner as such provisions apply to the National 
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1 Health Service Corps Loan Repayment Program estab2 lished in subpart III of part D of title III. 

3 ‘‘(d) DEFINITIONS.—For purposes of this section: 

4 ‘‘(1) The term ‘medicaid recipient’ means, with 

5 respect to a resident of a nursing home, a resident 

6 of the home who is provided medical assistance 

7 under title XIX of the Social Security Act for nurs8 ing home services. 

9 ‘‘(2) The term ‘medicare recipient’ means, with 

10 respect to a resident of a skilled nursing home, a 

11 resident who is being provided benefits under part A 

12 of title XVIII of the Social Security Act with respect 

13 to extended care services in the home. 

14 ‘‘(3) The term ‘nursing home’ means any insti15 tution or facility defined as such for licensing pur16 poses under State law, or, if State law does not em17 ploy the term nursing home, the equivalent term or 

18 terms as determined by the Secretary, but does not 

19 include a religious nonmedical health care institution 

20 (as defined in section 1861(ss)(1) of the Social Se21 curity Act). 

22 ‘‘(4) The term ‘underserved nursing home’ 

23 means a nursing home in which at least 85 percent 

24 of the number of residents of the home are medicaid 

25 recipients, not more than 8 percent of such residents 
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1 are medicare recipients, and not more than 10 per2 cent of such residents are neither medicaid nor 

3 medicare recipients. 

4 ‘‘(e) FUNDING.—

5 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

6 For the purpose of carrying out this section, there 

7 are authorized to be appropriated such sums as may 

8 be necessary for each fiscal year. 

9 ‘‘(2) AVAILABILITY.—Amounts appropriated for 

10 carrying out this section shall remain available until 

11 the expiration of the second fiscal year beginning 

12 after the fiscal year for which the amounts were 

13 made available.’’. 

14 SEC. 3. TRAINING PROGRAM FOR NURSING HOME ADMINIS15 TRATORS. 

16 (a) IN GENERAL.—The Secretary of Health and 

17 Human Services, acting through the Director of the Cen18 ters for Medicare & Medicaid Services, shall provide grants 

19 to States to implement nursing home administrator men20 tor programs described in subsection (b). 

21 (b) MENTOR PROGRAM DESCRIBED.—A mentor pro22 gram described in this subsection is a program to improve 

23 the training of nursing home administrators and to 

24 strengthen their commitment to serve as leaders in their 

25 States. Such a program shall provide for the following: 
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1 (1) Identification of individuals who are nursing 

2 home administrators and have exceptional potential 

3 to serve as mentors to other nursing home adminis4 trators. 

5 (2) Training of such individuals to serve as 

6 mentors for other nursing home administrators who 

7 are employed in underserved nursing homes (as de8 fined in section 487H(e)(3) of the Public Health 

9 Service Act). 

10 (c) APPLICATIONS.—A State seeking a grant under 

11 this section shall submit an application to the Secretary 

12 at such time, in such manner, and containing such infor13 mation as the Secretary may require. 

14 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated $25,000,000 to carry 

16 out this section. 

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

18 (1) NURSING HOME.—The term ‘‘nursing 

19 home’’ means any institution or facility defined as 

20 such for licensing purposes under State law, or, if 

21 State law does not employ the term nursing home, 

22 the equivalent term or terms as determined by the 

23 Secretary, but does not include a religious nonmed24 ical health care institution (as defined in section 
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1 1861(ss)(1) of the Social Security Act (42 U.S.C. 

2 1395x(ss)(1)). 

3 (2) NURSING HOME ADMINISTRATOR.—The 

4 term ‘‘nursing home administrator’’means any indi5 vidual who is charged with the general administra6 tion of a nursing home whether or not such indi7 vidual has an ownership interest in such home and 

8 whether or not the individual’s functions and duties 

9 are shared with one or more other individuals. 

10 (3) STATE.—The term ‘‘State’’ has the mean11 ing given such term for purposes of title XIX of the 

12 Social Security Act. 

13 SEC. 4. HIGH FAMILY INVOLVEMENT IN NURSING HOMES. 

14 The Director of the Centers for Medicare & Medicaid 

15 Services shall provide, in implementing the Nursing Home 

16 Quality Initiative, the degree of family involvement (as de17 fined by the Director) among the quality indicators for 

18 the evaluation of the quality of nursing homes, . 

19 SEC. 5. REINSTITUTION OF BOREN AMENDMENT MEDICAID 

20 PAYMENT METHODOLOGY. 

21 (a) IN GENERAL.—Section 1902(a)(13) of the Social 

22 Security Act (42 U.S.C. 1396a(a)(13)) is amended to read 

23 as follows: 

24 ‘‘(13) provide for payment of services through 

25 the use of rates determined pursuant to the criteria 
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1 under this paragraph as in effect on August 1, 

2 1997;’’. 

3 (b) ESTABLISHMENT OF SAFE HARBOR RATES.—

4 Section 1902 of such Act (42 U.S.C. 1396a) is amended 

5 by adding at the end the following: ‘‘The Secretary may, 

6 by regulation, promulgate standards or methodologies for 

7 determining rates that comply with paragraph (13), and 

8 a State that pays rates that meet such standards or meth9 odologies is deemed to be in compliance with paragraph 

10 (13).’’. 

11 (c) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply to services furnished on or after 

13 the date that is one year after the date of the enactment 

14 of this Act. 

15 SEC. 6. INCREASE OF MEDICAID FMAP. 

16 Section 1905(b) of the Social Security Act (42 U.S.C. 

17 1396d(b)) is amended by adding at the end the following: 

18 ‘‘Notwithstanding the first sentence of this subsection, 

19 only for purposes of this title (and not with respect to the 

20 determination of the enhanced FMAP) and with respect 

21 to calendar quarters beginning after October 1, 2004, in 

22 the case of a State in which the Federal medical assistance 

23 percentage otherwise determined under the first sentence 

24 is less than 60 percent, such percentage shall be increased 

25 by 2 percentage points, and in the case of a State in which 
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1 such percentage is otherwise so determined to be 60 per2 cent or greater, such percentage shall be increased by 1 

3 percentage point.’’.

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