; (B) by striking the period at the end of paragraph (83) and inserting ; and ; and (C) by inserting after paragraph (83) the following new paragraph: (84) provide that any hospital that receives a payment under such plan comply with the provisions of title XXXIV of the Public Health Service Act (relating to minimum direct care registered nurse staffing requirements). . (e) Nursing homes No later than one year after enactment of this Act, the Secretary of Health and Human Services shall promulgate a rule for minimum staffing standards for skilled nursing facilities under the Medicare program and for nursing facilities under the Medicaid program that align with the standards set in this section. 134. Enhancements for reduced cost-sharing (a) In general Section 1402 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18071 ) is amended— (1) in subsection (b)(1), by striking silver and inserting gold ; (2) by amending subsection (c)(1)(B) to read as follows: (B) Coordination with actuarial limits The Secretary shall ensure the reduction under this paragraph shall not result in the plan’s share of the total allowed costs of benefits provided under the plan becoming less than— (i) 95 percent in the case of an eligible insured described in paragraph (2)(A); (ii) 90 percent in the case of an eligible insured described in paragraph (2)(B); and (iii) 85 percent in the case of an eligible insured described in paragraph (2)(C). ; and (3) by amending subsection (c)(2) to read as follows: (2) Additional reduction The Secretary shall establish procedures under which the issuer of a qualified health plan to which this section applies shall further reduce cost-sharing under the plan in a manner sufficient to— (A) in the case of an eligible insured whose household income is not less than 100 percent but not more than 200 percent of the poverty line for a family of the size involved, increase the plan’s share of the total allowed costs of benefits provided under the plan to 95 percent of such costs