[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5322 Introduced in House (IH)]






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.

    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 ``Managing Our Medicare and Medicaid 
Services and Protecting Our Parents Act'' .

SEC. 2. LOAN REPAYMENT PROGRAM FOR NURSE PRACTITIONERS AND PHYSICIANS 
              ASSISTANTS SERVING IN UNDERSERVED NURSING HOMES.

    Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) 
is amended--
            (1) by redesignating the second section 487F as section 
        487G; and
            (2) by inserting after section 487G (as so redesignated) 
        the following:

``SEC. 487H. LOAN REPAYMENT PROGRAM FOR NURSE PRACTITIONERS AND 
              PHYSICIAN ASSISTANTS SERVING IN UNDERSERVED NURSING 
              HOMES.

    ``(a) Establishment.--To the extent and in the amounts provided in 
advance in appropriations Acts, the Secretary, acting through the 
Administrator of the Health Resources and Services Administration, 
shall establish a program to enter into contracts with individuals 
under which the individual involved agrees to serve for a period of not 
less than 3 years as a nurse practitioner or a physician assistant at 
an underserved nursing home, in consideration of the Federal Government 
agreeing to make payments, for not more than 5 years of such service, 
on the principal and interest of the educational loans of the 
individual.
    ``(b) Amount of Payments.--The amount of a payment by the Secretary 
under this section for a year of service by an individual as a nurse 
practitioner or physician assistant at an underserved nursing home 
shall not exceed the lesser of the remaining outstanding obligation on 
the individual's educational loans or--
            ``(1) $2,000 at the completion of the first year of such 
        service;
            ``(2) $2,500 at the completion of the second year of such 
        service;
            ``(3) $3,500 at the completion of the third year of such 
        service;
            ``(4) $4,500 at the completion of the fourth year of such 
        service; and
            ``(5) $5,000 at the completion of the fifth year of such 
        service.
    ``(c) Application of Provisions.--Except as inconsistent with this 
section, the provisions of sections 338B, 338C, and 338E shall apply to 
the program established under this section to the same extent and in 
the same manner as such provisions apply to the National Health Service 
Corps Loan Repayment Program established in subpart III of part D of 
title III.
    ``(d) Definitions.--For purposes of this section:
            ``(1) The term `medicaid recipient' means, with respect to 
        a resident of a nursing home, a resident of the home who is 
        provided medical assistance under title XIX of the Social 
        Security Act for nursing home services.
            ``(2) The term `medicare recipient' means, with respect to 
        a resident of a skilled nursing home, a resident who is being 
        provided benefits under part A of title XVIII of the Social 
        Security Act with respect to extended care services in the 
        home.
            ``(3) The term `nursing home' means any institution or 
        facility defined as such for licensing purposes under State 
        law, or, if State law does not employ the term nursing home, 
        the equivalent term or terms as determined by the Secretary, 
        but does not include a religious nonmedical health care 
        institution (as defined in section 1861(ss)(1) of the Social 
        Security Act).
            ``(4) The term `underserved nursing home' means a nursing 
        home in which at least 85 percent of the number of residents of 
        the home are medicaid recipients, not more than 8 percent of 
        such residents are medicare recipients, and not more than 10 
        percent of such residents are neither medicaid nor medicare 
        recipients.
    ``(e) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there are authorized to be 
        appropriated such sums as may be necessary for each fiscal 
        year.
            ``(2) Availability.--Amounts appropriated for carrying out 
        this section shall remain available until the expiration of the 
        second fiscal year beginning after the fiscal year for which 
        the amounts were made available.''.

SEC. 3. TRAINING PROGRAM FOR NURSING HOME ADMINISTRATORS.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Medicare & Medicaid Services, 
shall provide grants to States to implement nursing home administrator 
mentor programs described in subsection (b).
    (b) Mentor Program Described.--A mentor program described in this 
subsection is a program to improve the training of nursing home 
administrators and to strengthen their commitment to serve as leaders 
in their States. Such a program shall provide for the following:
            (1) Identification of individuals who are nursing home 
        administrators and have exceptional potential to serve as 
        mentors to other nursing home administrators.
            (2) Training of such individuals to serve as mentors for 
        other nursing home administrators who are employed in 
        underserved nursing homes (as defined in section 487H(e)(3) of 
        the Public Health Service Act).
    (c) Applications.--A State seeking a grant under this section shall 
submit an application to the Secretary at such time, in such manner, 
and containing such information as the Secretary may require.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated $25,000,000 to carry out this section.
    (e) Definitions.--For purposes of this section:
            (1) Nursing home.--The term ``nursing home'' means any 
        institution or facility defined as such for licensing purposes 
        under State law, or, if State law does not employ the term 
        nursing home, the equivalent term or terms as determined by the 
        Secretary, but does not include a religious nonmedical health 
        care institution (as defined in section 1861(ss)(1) of the 
        Social Security Act (42 U.S.C. 1395x(ss)(1)).
            (2) Nursing home administrator.--The term ``nursing home 
        administrator''means any individual who is charged with the 
        general administration of a nursing home whether or not such 
        individual has an ownership interest in such home and whether 
        or not the individual's functions and duties are shared with 
        one or more other individuals.
            (3) State.--The term ``State'' has the meaning given such 
        term for purposes of title XIX of the Social Security Act.

SEC. 4. HIGH FAMILY INVOLVEMENT IN NURSING HOMES.

    The Director of the Centers for Medicare & Medicaid Services shall 
provide, in implementing the Nursing Home Quality Initiative, the 
degree of family involvement (as defined by the Director) among the 
quality indicators for the evaluation of the quality of nursing homes, 

SEC. 5. REINSTITUTION OF BOREN AMENDMENT MEDICAID PAYMENT METHODOLOGY.

    (a) In General.--Section 1902(a)(13) of the Social Security Act (42 
U.S.C. 1396a(a)(13)) is amended to read as follows:
            ``(13) provide for payment of services through the use of 
        rates determined pursuant to the criteria under this paragraph 
        as in effect on August 1, 1997;''.
    (b) Establishment of Safe Harbor Rates.--Section 1902 of such Act 
(42 U.S.C. 1396a) is amended by adding at the end the following: ``The 
Secretary may, by regulation, promulgate standards or methodologies for 
determining rates that comply with paragraph (13), and a State that 
pays rates that meet such standards or methodologies is deemed to be in 
compliance with paragraph (13).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the date that is one year after 
the date of the enactment of this Act.

SEC. 6. INCREASE OF MEDICAID FMAP.

    Section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is 
amended by adding at the end the following: ``Notwithstanding the first 
sentence of this subsection, only for purposes of this title (and not 
with respect to the determination of the enhanced FMAP) and with 
respect to calendar quarters beginning after October 1, 2004, in the 
case of a State in which the Federal medical assistance percentage 
otherwise determined under the first sentence is less than 60 percent, 
such percentage shall be increased by 2 percentage points, and in the 
case of a State in which such percentage is otherwise so determined to 
be 60 percent or greater, such percentage shall be increased by 1 
percentage point.''.
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