In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.

Input: Consider Input: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Water Advanced Technologies for 
Efficient Resource Use Act of 2009''.

SEC. 2. WATERSENSE.

    (a) In General.--There is established within the Environmental 
Protection Agency a WaterSense program to identify and promote water 
efficient products, buildings and landscapes, and services in order--
            (1) to reduce water use;
            (2) to reduce the strain on water, wastewater, and 
        stormwater infrastructure;
            (3) to conserve energy used to pump, heat, transport, and 
        treat water; and
            (4) to preserve water resources for future generations,
through voluntary labeling of, or other forms of communications about, 
products, buildings and landscapes, and services that meet the highest 
water efficiency and performance standards.
    (b) Duties.--The Administrator of the Environmental Protection 
Agency shall--
            (1) promote WaterSense labeled products, buildings and 
        landscapes, and services in the market place as the preferred 
        technologies and services for--
                    (A) reducing water use; and
                    (B) ensuring product and service performance;
            (2) work to enhance public awareness of the WaterSense 
        label through public outreach, education, and other means;
            (3) establish and maintain performance standards so that 
        products, buildings and landscapes, and services labeled with 
        the WaterSense label perform as well or better than their less 
        efficient counterparts;
            (4) publicize the importance of proper installation of 
        WaterSense plumbing products by a WaterSense-certified or, if 
        WaterSense certification guidelines do not exist, licensed 
        plumber or mechanical contractor, and the installation, 
        maintenance, and audit of WaterSense irrigation systems by a 
        WaterSense-certified irrigation professional to ensure optimal 
        performance;
            (5) preserve the integrity of the WaterSense label;
            (6) regularly review and, when appropriate, update 
        WaterSense criteria for categories of products, buildings and 
        landscapes, and services, at least once every four years;
            (7) regularly collect and make available to the public 
        summary data on the production and relative market shares of 
        WaterSense labeled products, buildings and landscapes, and 
        services, at least annually;
            (8) regularly estimate and make available to the public the 
        water and energy savings attributable to the use of WaterSense 
        labeled products, buildings and landscapes, and services, at 
        least annually;
            (9) solicit comments from interested parties and the public 
        prior to establishing or revising a WaterSense category, 
        specification, installation criterion, or other criterion (or 
        prior to effective dates for any such category, specification, 
        installation criterion, or other criterion);
            (10) provide reasonable notice to interested parties and 
        the public of any changes (including effective dates), on the 
        adoption of a new or revised category, specification, 
        installation criterion, or other criterion, along with--
                    (A) an explanation of changes; and
                    (B) as appropriate, responses to comments submitted 
                by interested parties;
            (11) provide appropriate lead time (as determined by the 
        Administrator) prior to the applicable effective date for a new 
        or significant revision to a category, specification, 
        installation criterion, or other criterion, taking into account 
        the timing requirements of the manufacturing, marketing, 
        training, and distribution process for the specific product, 
        building and landscape, or service category addressed; and
            (12) identify and, where appropriate, implement other 
        voluntary approaches, such as labeling waterless devices that 
        perform the same function as a water consuming product or 
        encouraging reuse, reclamation, and recycling technologies, in 
        commercial, institutional, residential, municipal, and 
        industrial sectors to improve water efficiency or lower water 
        use while meeting the performance standards established under 
        paragraph (3).
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated $7,500,000 for fiscal year 2010, $10,000,000 for fiscal 
year 2011, $20,000,000 for fiscal year 2012, and $50,000,000 for fiscal 
year 2013 and each year thereafter, adjusted for inflation, to carry 
out this section.

SEC. 3. FEDERAL PROCUREMENT OF WATER EFFICIENT PRODUCTS.

    (a) Definitions.--In this section:
            (1) Agency.--The term ``agency'' has the meaning given that 
        term in section 7902(a) of title 5, United States Code.
            (2) Watersense product or service.--The term ``WaterSense 
        product or service'' means a product or service that is rated 
        for water efficiency under the WaterSense program.
            (3) Watersense program.--The term ``WaterSense program'' 
        means the program established by section 2 of this Act.
            (4) FEMP designated product.--The term ``FEMP designated 
        product'' means a product that is designated under the Federal 
        Energy Management Program of the Department of Energy as being 
        among the highest 25 percent of equivalent products for 
        efficiency.
            (5) Product and service.--The terms ``product'' and 
        ``service'' do not include any water consuming product or 
        service designed or procured for combat or combat-related 
        missions. The terms also exclude products or services already 
        covered by the Federal procurement regulations established 
        under section 553 of the National Energy Conservation Policy 
        Act (42 U.S.C. 8259b).
    (b) Procurement of Water Efficient Products.--
            (1) Requirement.--To meet the requirements of an agency for 
        a water consuming product or service, the head of the agency 
        shall, except as provided in paragraph (2), procure--
                    (A) a WaterSense product or service; or
                    (B) a FEMP designated product.
        A WaterSense plumbing product should preferably, when possible, 
        be installed by a WaterSense-certified or, if WaterSense 
        certification guidelines do not exist, licensed plumber or 
        mechanical contractor, and a WaterSense irrigation system 
        should preferably, when possible, be installed, maintained, and 
        audited by a WaterSense-certified irrigation professional to 
        ensure optimal performance.
            (2) Exceptions.--The head of an agency is not required to 
        procure a WaterSense product or service or FEMP designated 
        product under paragraph (1) if the head of the agency finds in 
        writing that--
                    (A) a WaterSense product or service or FEMP 
                designated product is not cost-effective over the life 
                of the product, taking current and future energy, 
                water, and wastewater cost savings into account; or
                    (B) no WaterSense product or service or FEMP 
                designated product is reasonably available that meets 
                the functional requirements of the agency.
            (3) Procurement planning.--The head of an agency shall 
        incorporate into the specifications for all procurements 
        involving water consuming products and systems, including guide 
        specifications, project specifications, and construction, 
        renovation, and services contracts that include provision of 
        water consuming products and systems, and into the factors for 
        the evaluation of offers received for the procurement, criteria 
        used for rating WaterSense products and services and FEMP 
        designated products. The head of an agency shall consider, to 
        the maximum extent practicable, additional measures for 
        reducing agency water consumption, including water reuse, 
        reclamation, and recycling technologies, leak detection and 
        repair, and use of waterless products that perform similar 
        functions to existing water-consuming products.
    (c) Listing of Water Efficient Products in Federal Catalogs.--
WaterSense products and services and FEMP designated products shall be 
clearly identified and prominently displayed in any inventory or 
listing of products by the General Services Administration or the 
Defense Logistics Agency. The General Services Administration and the 
Defense Logistics Agency shall supply only WaterSense products or FEMP 
designated products for all product categories covered by the 
WaterSense program or the Federal Energy Management Program, except in 
cases where the agency ordering a product specifies in writing that no 
WaterSense product or FEMP designated product is available to meet the 
buyer's functional requirements, or that no WaterSense product or FEMP 
designated product is cost-effective for the intended application over 
the life of the product, taking energy, water, and wastewater cost 
savings into account.
    (d) Regulations.--Not later than 180 days after the date of 
enactment of this Act, the Administrator of the Environmental 
Protection Agency shall issue regulations to carry out this section.

SEC. 4. EARLY ADOPTER WATER EFFICIENT PRODUCTS INCENTIVE PROGRAMS.

    (a) Definitions.--In this section:
            (1) Administrator.--The term ``Administrator'' means the 
        Administrator of the Environmental Protection Agency.
            (2) Eligible entity.--The term ``eligible entity'' means a 
        State government, local or county government, tribal 
        government, wastewater or sewage utility, municipal water 
        authority, energy utility, water utility, or nonprofit 
        organization that meets the requirements of subsection (b).
            (3) Incentive program.--The term ``incentive program'' 
        means a program for administering financial incentives for 
        consumer purchase and installation of residential water 
        efficient products and services as described in subsection 
        (b)(1).
            (4) Residential water efficient product or service.--The 
        term ``residential water efficient product or service'' means a 
        product or service for a single-family or multifamily residence 
        or its landscape that is rated for water efficiency and 
        performance--
                    (A) by the WaterSense program; or
                    (B) by an incentive program and approved by the 
                Administrator.
        Categories of water efficient products and services may include 
        faucets, irrigation technologies and services, point-of-use 
        water treatment devices, reuse, reclamation, and recycling 
        technologies, toilets, and showerheads.
            (5) Watersense program.--The term ``WaterSense program'' 
        means the program established by section 2 of this Act.
    (b) Eligible Entities.--An entity shall be eligible to receive an 
allocation under subsection (c) if the entity--
            (1) establishes (or has established) an incentive program 
        to provide rebates, vouchers, other financial incentives, or 
        direct installs to consumers for the purchase and installation 
        of residential water efficient products or services;
            (2) submits an application for the allocation at such time, 
        in such form, and containing such information as the 
        Administrator may require; and
            (3) provides assurances satisfactory to the Administrator 
        that the entity will use the allocation to supplement, but not 
        supplant, funds made available to carry out the incentive 
        program.
    (c) Amount of Allocations.--
            (1) In general.--Subject to paragraph (2), for each fiscal 
        year, the Administrator shall determine the amount to allocate 
        to each eligible entity to carry out subsection (d) taking into 
        consideration--
                    (A) the population served by the eligible entity in 
                the most recent calendar year for which data are 
                available;
                    (B) the targeted population of the eligible 
                entity's incentive program, such as general households, 
                low-income households, or first-time homeowners, and 
                the probable effectiveness of the incentive program for 
                that population;
                    (C) for existing programs, the effectiveness of the 
                incentive program in encouraging the adoption of water 
                efficient products and services; and
                    (D) any prior year's allocation to the eligible 
                entity that remains unused.
    (d) Use of Allocated Funds.--Funds allocated to an entity under 
subsection (c) may be used to pay up to 50 percent of the cost of 
establishing and carrying out an incentive program.
    (e) Fixture Recycling.--Entities are encouraged to promote or 
implement fixture recycling programs to manage the disposal of older 
fixtures replaced due to the incentive program under this section.
    (f) Issuance of Rebates.--Financial incentives may be provided to 
consumers that meet the requirements of the incentive program. The 
entity may issue all financial incentives directly to consumers or, 
with approval of the Administrator, delegate some or all financial 
incentive administration to other organizations including, but not 
limited to, local governments, municipal water authorities, and water 
utilities. The amount of a financial incentive shall be determined by 
the entity, taking into consideration--
            (1) the amount of the allocation to the entity under 
        subsection (c);
            (2) the amount of any Federal, State, or other 
        organization's tax or financial incentive available for the 
        purchase of the residential water efficient product or service;
            (3) the amount necessary to change consumer behavior to 
        purchase water efficient products and services; and
            (4) the consumer expenditures for onsite preparation, 
        assembly, and original installation of the product.
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated to the Administrator to carry out this section $50,000,000 
for fiscal year 2010, $100,000,000 for fiscal year 2011, $150,000,000 
for fiscal year 2012, $100,000,000 for fiscal year 2013, and 
$50,000,000 for fiscal year 2014.

Output: Water Advanced Technologies for Efficient Resource Use Act of 2009 - Establishes within the Environmental Protection Agency (EPA) a WaterSense program to identify and promote water efficient products, buildings and landscapes, and services to reduce water use, conserve energy, and preserve water resources. Sets forth the duties of the EPA Administrator for promoting, publicizing, and administering the WaterSense program.

Requires federal agencies to purchase WaterSense products or services or a Federal Energy Management Program designated product through their procurement process.

Establishes a program to provide financial incentives for consumer purchase and installation of residential water efficient products and services.


Input: Consider Input: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Congressional Pay for Performance 
Act''.

SEC. 2. DEFINITIONS.

    For the purpose of this Act--
            (1) the term ``Federal deficit'' or ``deficit'' means, with 
        respect to any fiscal year, the amount by which total budget 
        outlays of the Government for such fiscal year exceed total 
        revenues of the Government for such fiscal year;
            (2) the term ``Member of Congress'' means an individual 
        serving in a position referred to in section 601(a)(1) of the 
        Legislative Reorganization Act of 1946 (2 U.S.C. 31(1)); and
            (3) the term ``year'' means a calendar year.

SEC. 3. TEMPORARY SUSPENSION OF USUAL PAY ADJUSTMENT PROCEDURES.

    Subject to section 5, rates of basic pay for Members of Congress 
shall not be adjusted except in accordance with section 4.

SEC. 4. TEMPORARY ALTERNATIVE PROCEDURES.

    (a) In General.--Effective as of the first day of the first 
applicable pay period beginning on or after January 1st of each year, 
the rate of basic pay for each Member of Congress shall be reduced by 
the percentage derived by multiplying the applicable factor under 
subsection (b) for such year by the applicable factor under subsection 
(c) for such year.
    (b) Factor Reflecting Magnitude of the Deficit.--The applicable 
factor under this subsection for any year is the number of hundreds of 
billions of dollars to which the Federal deficit is equal, as 
determined under subsection (d) with respect to such year.
    (c) Factor Reflecting Degree of Success in Reducing or Eliminating 
the Deficit.--The applicable factor under this subsection for any year 
shall be determined in accordance with the following:
            (1) For the first year beginning on or after the effective 
        date of this Act, the applicable factor under this subsection 
        is 2 percent.
            (2) For each year thereafter, the applicable factor under 
        this subsection is--
                    (A) the same percentage as was applicable under 
                this subsection in the previous year, if the deficit 
                for the year in question is at least $100,000,000,000 
                less than--
                            (i) the size of the deficit for the year 
                        referred to in paragraph (1), or
                            (ii) the lowest level attained in the 
                        deficit for any year after the year referred to 
                        in paragraph (1),
                whichever is less; or
                    (B) 2 times the percentage which was applicable 
                under this subsection in the previous year, if 
                subparagraph (A) does not apply.
    (d) Determining the Size of the Deficit.--For the purpose of any 
determination under this Act, the size or level of the Federal deficit 
for any year--
            (1) shall be equal to the size or level of the deficit for 
        the fiscal year ending on the September 30th immediately 
        preceding the start of such year; and
            (2) shall be rounded to the nearest multiple of 
        $100,000,000,000 (or, if midway between multiples of 
        $100,000,000,000, to the next higher multiple of 
        $100,000,000,000).
    (e) Limitation.--Nothing in this Act shall have the effect of 
reducing any rate of basic pay below $1.
    (f) Suspension in Time of War.--
            (1) In general.--Subject to paragraph (2), upon the 
        enactment of a declaration of war--
                    (A) subsections (a) through (d) shall be suspended; 
                and
                    (B) any subsequent reduction in rates of basic pay 
                for Members of Congress under such subsections shall be 
                precluded.
            (2) Restoration.--In the event of a suspension of 
        subsections (a) through (d) due to a declaration of war, then, 
        effective with the first year that begins in the session after 
        the state of war is concluded by Senate ratification of the 
        necessary treaties--
                    (A) the provisions of subsections (a) through (d) 
                shall be restored to full force and effect, and any 
                adjustment scheduled to take effect on or after the 
                first day of such year shall be implemented in 
                accordance with such provisions; and
                    (B) the initial rate of basic pay for a Member of 
                Congress (before the implementation of any adjustment 
                referred to in subparagraph (A)) shall be equal to the 
                rate of basic pay in effect for such a Member as of the 
                day before the effective date of this Act.

SEC. 5. EFFECT OF ELIMINATING THE DEFICIT.

    (a) In General.--Effective as of the first day of the first 
applicable pay period beginning on or after January 1st of the first 
year with respect to which the deficit is determined to have been 
eliminated--
            (1) the provisions of law suspended by section 2 
        (disregarding subsection (f) thereof) shall be restored to full 
        force and effect, and any adjustment scheduled to take effect 
        on or after such first day under such provisions shall be 
        implemented in accordance with such provisions;
            (2) the initial rate of basic pay for a Member of Congress 
        (before the implementation of any adjustment referred to in 
        paragraph (1)) shall be equal to 2 times the rate of basic pay 
        in effect for such a Member as of the effective date of this 
        Act.
            (3) the provisions of section 4 shall cease to be 
        effective.
    (b) Rule Relating to Determining When the Deficit Has Been 
Eliminated.--
            (1) In general.--For the purpose of this Act, the deficit 
        shall be considered to have been eliminated as of the start of 
        the first year for which the applicable factor under section 
        4(b) would be less than 1.
            (2) No tax increase.--The condition under paragraph (1) 
        shall be considered unmet if there is enacted, after the 
        effective date of this Act, any legislation that reduces the 
        Federal deficit by changing the Internal Revenue Code of 1986.

SEC. 6. EFFECTIVE DATE.

    (a) In General.--This Act shall take effect on January 1st of the 
first year beginning after the first election of Representatives 
following the date of the enactment of this Act.
    (b) Definition.--For the purpose of subsection (a), the term 
``election of Representatives'' has the meaning given such term by 
225(i)(4)(B) of the Federal Salary Act of 1967 (2 U.S.C. 359(4)(B)).

Output: Congressional Pay for Performance Act - Suspends basic pay adjustments for Members of Congress, and requires pay reductions, until the deficit is reduced to below $50,000,000,000 without the enactment of any change in the Internal Revenue Code. 
Requires an annual reduction in pay by a percentage equal to:  (1) two percent times the number of hundreds of billions of dollars of the deficit in the first year after enactment; or (2) twice that percentage for any year following a year for which the deficit is not at least $100,000,000,000 less than the lowest level attained after enactment of this Act. 
Suspends pay reductions upon enactment of a declaration of war and reinstates them when the state of war is concluded. 
Restores pay adjustment procedures suspended by this Act, and provides for a rate of basic pay of twice the rate in effect as of the effective date of this Act, for the first year with respect to which the deficit is less than $50,000,000,000.


Input: Consider Input: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Nursing Facility Pay-for-
Performance Act of 2004''.

SEC. 2. ADDITIONAL MEDICARE PAYMENT FOR FACILITIES THAT REPORT 
              ADDITIONAL QUALITY DATA.

    (a) Voluntary Reporting of Quality Measures and Adjustment in 
Payment.--
            (1) In general.--Section 1888 of the Social Security Act 
        (42 U.S.C. 1395yy) is amended by adding at the end the 
        following new subsection:
    ``(f) Voluntary Reporting of Quality Measures; Change in Payment 
Based on Reported Quality Measures.--
            ``(1) Establishment of additional quality measures.--
                    ``(A) In general.--Not later than 6 months after 
                the date of the enactment of this subsection, the 
                Secretary, through a contract with a qualified 
                independent party (such as the National Quality Forum) 
                identified by the Secretary, shall provide for the 
                identification of--
                            ``(i) at least 10, and not more than 15, 
                        quality measures for the performance of skilled 
                        nursing facilities under this title; and
                            ``(ii) the data to be reported, including 
                        their collection and formatting, on a calendar 
                        quarter basis for each such quality measure to 
                        measure the performance of a skilled nursing 
                        facility.
                Such measures may be outcome or process measures. Such 
                measures shall be in addition to the 14 enhanced 
                measures published by the Secretary for such facilities 
                for use as of September 1, 2004.
                    ``(B) Measure of staffing level.--The quality 
                measures identified under subparagraph (A) shall 
                include a measure of the level of facility staffing and 
                the mix of licensed staff at a facility.
                    ``(C) Risk adjustment.--The values obtained for 
                quality measures identified under subparagraph (A), 
                including the existing 14 enhanced measures, shall be 
                appropriately risk adjusted as applied to individual 
                skilled nursing facilities in order to increase the 
                likelihood that any differences in such values reflect 
                differences in the care provided by the skilled nursing 
                facilities and not differences in the characteristics 
                of the residents in such facilities. Such risk 
                adjustment shall take into account resident 
                characteristics that are related to triggering a value 
                for a quality measure but are not reflective of 
                facility care processes. Risk adjustment approaches may 
                include, as appropriate--
                            ``(i) excluding certain types of residents;
                            ``(ii) stratifying residents into high-risk 
                        and low-risk groups; or
                            ``(iii) statistical adjustment (such as 
                        regression analysis) that takes into 
                        consideration multiple characteristics 
                        (covariates) for each resident simultaneously 
                        and adjusts the nursing facilities' quality 
                        measure values for different resident 
                        characteristics.
                    ``(D) Small facilities.--
                            ``(i) In general.--In selecting and 
                        applying quality measures, there shall be taken 
                        into account the circumstances of small skilled 
                        nursing facilities.
                            ``(ii) Definition.--For purposes of clause 
                        (i), the term `small skilled nursing facility' 
                        means a skilled nursing facility which had, in 
                        most recent preceding cost reporting period, 
                        fewer than 1,500 patient days with respect to 
                        which payments were made under this title.
                    ``(E) Annual evaluation.--The Secretary shall 
                provide for an annual process whereby the use of 
                particular quality measures are evaluated and, as 
                appropriate, adjusted in consultation with the National 
                Quality Forum.
                    ``(F) Posting on website.--The Secretary shall 
                provide for the posting on its website, and the 
                publication at least annually, of the quality 
                performance of skilled nursing facilities as measured 
                through values reported under this subsection by such 
                facilities.
            ``(2) Adjustment in payment based on quality performance.--
                    ``(A) In general.--For each fiscal year beginning 
                with fiscal year 2006, in the case of a skilled nursing 
                facility that reports data under paragraph (1) for the 
                data reporting period with respect to that fiscal year 
                (as defined in subparagraph (C)), the aggregate amount 
                of payment under this subsection shall be adjusted as 
                follows:
                            ``(i) Increase of 2 percent for facilities 
                        in top 10 percent in quality.--In the case of a 
                        facility that, based on such data, has a 
                        composite score for quality that is equal to or 
                        exceeds such score for the baseline period (as 
                        defined in subparagraph (D)) for the top 10 
                        percent of skilled nursing facilities that have 
                        reported such data for such baseline period, 
                        such aggregate payment shall be increased by 
                        such amount as reflects an increase in the 
                        market basket percentage increase applied for 
                        the fiscal year involved under subsection 
                        (e)(4)(E)(ii)(V) by 2 percentage points.
                            ``(ii) Increase of 1 percent for facilities 
                        in next 10 percent in quality.--In the case of 
                        a facility that, based on such data, has a 
                        composite score for quality that exceeds such 
                        score for the baseline period for the top 10 
                        percent of skilled nursing facilities that have 
                        reported such data for such baseline period, 
                        but is equal to or exceeds such score for the 
                        baseline period for the top 20 percent of such 
                        skilled nursing facilities, such aggregate 
                        payment shall be increased by such amount as 
                        reflects an increase in the market basket 
                        percentage increase applied for the fiscal year 
                        involved under subsection (e)(4)(E)(ii)(V) by 1 
                        percentage point.
                            ``(iii) Quality threshold covering 80 
                        percent of facilities.--For a baseline period, 
                        the Secretary shall establish a quality 
                        threshold score that covers 80 percent of the 
                        skilled nursing facilities that have reported 
                        such data for such baseline period.
                            ``(iv) Decrease of 1 percent for facilities 
                        below quality threshold.--In the case of a 
                        fiscal year beginning with fiscal year 2007, in 
                        the case of a facility that, based on such 
                        data, has a composite score on quality measures 
                        that is below the quality threshold score 
                        established under clause (iii) for the baseline 
                        period, the aggregate payment for the fiscal 
                        year involved shall be decreased by such amount 
                        as reflects a decrease in the market basket 
                        percentage increase applied under subsection 
                        (e)(4)(E)(ii)(V) by 1 percentage point.
                            ``(v) Year by year determination.--Any 
                        increase or decrease in payments to a skilled 
                        nursing facility under the preceding provisions 
                        of this subparagraph for a fiscal year shall 
                        not affect or apply to payments to such 
                        facility in any subsequent fiscal year.
                    ``(B) Treatment of small facilities.--In the case 
                of a skilled nursing facility which because of its 
                small size is unable to submit data on one or more 
                quality measures--
                            ``(i) the facility shall not be penalized 
                        under this paragraph due to its non-reporting 
                        of such data; and
                            ``(ii) the composite rank or score shall be 
                        based on the data so reported, with appropriate 
                        adjustments so as to be comparable to other 
                        facilities.
                    ``(C) Data reporting period.--For purposes of 
                subparagraph (A), the term `data reporting period' 
                means, with respect to--
                            ``(i) fiscal year 2006, such period of 
                        calendar quarters in fiscal year 2005 as the 
                        Secretary shall specify, which, to the extent 
                        feasible, shall be a period of at least 2 
                        calendar quarters; or
                            ``(ii) a subsequent fiscal year, the period 
                        of 4 consecutive calendar quarters ending on 
                        the June 30 preceding the fiscal year.
                    ``(D) Baseline period.--For purposes of 
                subparagraph (A), the term `baseline period' means, 
                with respect to--
                            ``(i) fiscal year 2006, the period of 
                        calendar quarters specified under subparagraph 
                        (C)(i); or
                            ``(ii) a subsequent fiscal year, the period 
                        of 4-calendar-quarters ending on June 30, 
                        2006.''.
            (2) Limiting market basket increases to facilities that 
        voluntarily report information.--Subsection (e)(4)(E)(ii) of 
        such section is amended--
                    (A) in subclause (III), by striking ``and'' at the 
                end;
                    (B) in subclause (IV), by inserting ``before the 
                first fiscal year in which the reporting of quality 
                measures is in effect under subsection (f)(1)'' after 
                ``each subsequent fiscal year'' and by striking the 
                period at the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subclause:by inserting before the period at the end the 
                following:
                                    ``(V) for each subsequent year, the 
                                rate computed for the previous fiscal 
                                year increased, in the case of a 
                                skilled nursing facility that reports 
                                data under subsection (f)(1) for the 
                                fiscal year, by the skilled nursing 
                                facility market basket percentage for 
                                the fiscal year involved.''.
    (b) Using Fiscal Year 2005 Payment Rates as a Floor for Subsequent 
Updates.--
            (1) In general.--Subsection (e)(4)(E)(ii)(IV) and 
        subsection (e)(4)(E)(ii)(V), as added by subsection (a)(2), of 
        such section is amended by inserting ``(taking into account, 
        with respect to a previous fiscal year that was fiscal year 
        2005, all add-ons to such rate that were applicable in such 
        fiscal year as well as market basket adjustments made in 
        subsequent fiscal years)'' after ``the rate computed for the 
        previous fiscal year''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to the computation of rates for fiscal years 
        beginning with fiscal year 2006.

SEC. 3. LONG-TERM CARE FINANCING COMMISSION.

    (a) Establishment.--There is hereby established a commission to be 
known as the ``Long-Term Care Financing Commission'' (in this section 
referred to as the ``Commission'').
    (b) Composition.--The Commission shall be composed of 10 members 
appointed by the Secretary of Health and Human Services.
    (c) Duties.--
            (1) Analyses.--The Commission shall conduct analyses of the 
        financing of long-term care, including the financing of nursing 
        facilities. Such analyses shall include an analysis of each of 
        the following:
                    (A) The adequacy of Medicaid program financing of 
                the long term care system.
                    (B) Medicare's cross-subsidization of long-term 
                care for Medicaid patients.
                    (C) Total industry margins in long-term care.
                    (D) Long-term demographic challenges.
                    (E) The impact of current trends, including 
                staffing shortages and litigation costs, on long-term 
                care spending.
                    (F) Different approaches to refinements in the per 
                diem RUG payment amounts and related payment 
                methodologies under section 1888(e) of the Social 
                Security Act (42 U.S.C. 1395yy(e)) .
            (2) Report.--The Commission shall submit to Congress an 
        annual report on its analyses. Each such report shall include 
        recommendations for such changes in financing of long-term care 
        as the Commission deems appropriate.
    (d) Terms, Compensation, Chairman, Meetings, Staff, and Powers.--
The provisions of subsections (c)(3), (c)(4), (c)(5), (c)(6), (d), and 
(e) of section 1805 of the Social Security Act (42 U.S.C. 1395b-6) 
(relating to provisions for the Medicare Payment Advisory Commission) 
shall apply to the Commission in the same manner as they apply to the 
Medicare Payment Advisory Commission.


Output: Medicare Nursing Facility Pay-for-Performance Act of 2004 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to direct the Secretary of Health and Human Services, through a contract with a qualified independent party (such as the National Quality Forum), to provide for identification of: (1) between ten and 15 quality measures for the performance of skilled nursing facilities under Medicare; and (2) the data to be reported, including their collection and formatting, on a calendar quarter basis for each such quality measure.

Requires the values obtained for quality measures to be appropriately risk-adjusted as applied to individual skilled nursing facilities in order to increase the likelihood that any differences in such values reflect differences in the care provided by the facilities and not differences in the characteristics of their residents.

Provides for: (1) adjusting payments for skilled nursing facilities based on quality performance, including an increase of two percent for facilities in the top ten percent in quality as well as a decrease of one percent for facilities below the quality threshold; (2) limiting market basket increases to facilities that voluntarily report information; and (3) using FY 2005 payment rates as a floor for subsequent updates.

Establishes the Long-Term Care Financing Commission to analyse and report to Congress on the financing of long-term care.