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Q: 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.''.
A:
Nursing Home Patient and Medicaid Assistance Act of 2010 - Makes appropriations to the Secretary of Health and Human Services (HHS), who, acting through the Administrator of the Centers for Medicare & Medicare Services, shall pay an amount directly to an eligible dually-certified facility to reimburse it for furnishing quality care to Medicaid-eligible individuals.

Defines "dually-certified facility" as one meeting several requirements, including participation as a nursing facility under title XIX (Medicaid) of the Social Security Act (SSA) and as a skilled nursing facility under SSA title XVIII (Medicare) during the entire year.

Amends title XIX (Medicaid) of the Social Security Act to prohibit a state Medicaid plan from being considered to meet the requirement for methods and procedures relating to the utilization of care and services unless, by April 1 before the beginning of any plan year (beginning with 2011), the state submits to the Secretary a plan amendment specifying the payment rates for such services, including data on how rates for payments to Medicaid managed care organizations take such payment rates into account.

Requires the Secretary to review each such plan amendment and approve or disapprove it.

Requires a state participating in the Medicaid program to submit to the Administrator of the Centers for Medicare and Medicaid Services: (1) information on the determination of payment rates for service providers; and (2) an explanation of the process used 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.