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) intro-
duced 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 serv-
ing Medicare and Medicaid patients and to amend title 
XIX of the Social Security Act to assure adequate Med-
icaid payment levels for services. 
Be it enacted by the Senate and House of Representa-
tives 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’’. 
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SEC. 2. NURSING FACILITY SUPPLEMENTAL PAYMENT PRO-
GRAM. 
(a) TOTAL AMOUNT AVAILABLE FOR PAYMENTS.— 
(1) IN
GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there are ap-
propriated to the Secretary of Health and Human 
Services (in this section referred to as the ‘‘Sec-
retary’’) 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 be-
ginning in 2011. 
(B) $1,500,000,000 shall be available be-
ginning in 2012. 
(C) $1,500,000,000 shall be available be-
ginning in 2013. 
(D) $1,500,000,000 shall be available be-
ginning 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 end-
ing during calendar years 2011 through 2014. 
(3) LIMITATION
OF
AUTHORITY.—The Sec-
retary may not make payments under this section 
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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 para-
graph (2) shall be deposited into the Medicaid Im-
provement 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 Ad-
ministrator 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 reim-
burse such facility for furnishing quality care to 
Medicaid-eligible individuals. 
(2) DETERMINATION OF PAYMENT AMOUNTS.— 
(A) IN
GENERAL.—Subject to subpara-
graphs (B) and (C), the payment amount deter-
mined under this paragraph for a year for an 
eligible dually-certified facility shall be an 
amount determined by the Secretary as re-
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mediate 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 de-
fined by the Secretary. 
(I) The facility complies with all the re-
quirements, 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— 
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(A) shall be made directly by the Secretary 
to an eligible dually-certified facility or a con-
tractor 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 dead-
lines, 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— 
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(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 sub-
section. 
(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 facili-
ties; 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 fa-
cility under title XVIII of such Act. 
(2) MEDICAID
ELIGIBLE
INDIVIDUAL.—The 
term ‘‘Medicaid eligible individual’’ means an indi-
vidual who is eligible for medical assistance, with re-
spect to nursing facility services (as defined in sec-
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tion 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 fol-
lowing 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 begin-
ning 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 compli-
ance 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— 
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‘‘(1) review each such amendment for compli-
ance 
with 
the 
requirement 
of 
section 
1902(a)(30)(A); and 
‘‘(2) approve or disapprove each such amend-
ment. 
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 sec-
tions 2001(e) and 2303(a)(2) of the Patient Protection 
and Affordable Care Act (Public Law 111–148) and sec-
tion 1202(a) of the Health Care and Education Reconcili-
ation 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; 
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