Bill Text: TX SB1629 | 2023-2024 | 88th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to the regulation of certain nursing facilities, including licensing requirements and Medicaid participation requirements.
Spectrum: Partisan Bill (Republican 4-0)
Status: (Engrossed - Dead) 2023-05-23 - Placed on General State Calendar [SB1629 Detail]
Download: Texas-2023-SB1629-Introduced.html
Bill Title: Relating to the regulation of certain nursing facilities, including licensing requirements and Medicaid participation requirements.
Spectrum: Partisan Bill (Republican 4-0)
Status: (Engrossed - Dead) 2023-05-23 - Placed on General State Calendar [SB1629 Detail]
Download: Texas-2023-SB1629-Introduced.html
88R3878 JG-D | ||
By: Kolkhorst | S.B. No. 1629 |
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relating to the regulation of certain nursing facilities and other | ||
long-term care facilities, including licensing requirements and | ||
Medicaid participation requirements. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 533.00251(c), Government Code, as | ||
effective September 1, 2023, is amended to read as follows: | ||
(c) Subject to Section 533.0025 and notwithstanding any | ||
other law, the commission shall provide benefits under Medicaid to | ||
recipients who reside in nursing facilities through the STAR + PLUS | ||
Medicaid managed care program. In implementing this subsection, | ||
the commission shall ensure: | ||
(1) that a nursing facility is paid not later than the | ||
10th day after the date the facility submits a clean claim; | ||
(1-a) that a nursing facility complies with the direct | ||
care expense ratio adopted under Section 32.0286, Human Resources | ||
Code; | ||
(2) the appropriate utilization of services | ||
consistent with criteria established by the commission; | ||
(3) a reduction in the incidence of potentially | ||
preventable events and unnecessary institutionalizations; | ||
(4) that a managed care organization providing | ||
services under the managed care program provides discharge | ||
planning, transitional care, and other education programs to | ||
physicians and hospitals regarding all available long-term care | ||
settings; | ||
(5) that a managed care organization providing | ||
services under the managed care program: | ||
(A) assists in collecting applied income from | ||
recipients; and | ||
(B) provides payment incentives to nursing | ||
facility providers that reward reductions in preventable acute care | ||
costs and encourage transformative efforts in the delivery of | ||
nursing facility services, including efforts to promote a | ||
resident-centered care culture through facility design and | ||
services provided; | ||
(6) the establishment of a portal that is in | ||
compliance with state and federal regulations, including standard | ||
coding requirements, through which nursing facility providers | ||
participating in the STAR + PLUS Medicaid managed care program may | ||
submit claims to any participating managed care organization; | ||
(7) that rules and procedures relating to the | ||
certification and decertification of nursing facility beds under | ||
Medicaid are not affected; | ||
(8) that a managed care organization providing | ||
services under the managed care program, to the greatest extent | ||
possible, offers nursing facility providers access to: | ||
(A) acute care professionals; and | ||
(B) telemedicine, when feasible and in | ||
accordance with state law, including rules adopted by the Texas | ||
Medical Board; and | ||
(9) that the commission approves the staff rate | ||
enhancement methodology for the staff rate enhancement paid to a | ||
nursing facility that qualifies for the enhancement under the | ||
managed care program. | ||
SECTION 2. Subchapter A, Chapter 533, Government Code, is | ||
amended by adding Section 533.00512 to read as follows: | ||
Sec. 533.00512. NURSING AND OTHER LONG-TERM CARE FACILITY | ||
PROVIDER AGREEMENTS: COMPLIANCE WITH DIRECT CARE EXPENSE RATIO. A | ||
contract between a managed care organization and the commission to | ||
provide health care services to recipients must require that each | ||
provider agreement between the organization and a nursing facility | ||
or other long-term care facility include a requirement that the | ||
facility comply with the direct care expense ratio adopted under | ||
Section 32.0286, Human Resources Code. | ||
SECTION 3. Section 242.032, Health and Safety Code, is | ||
amended by adding Subsection (b-1) to read as follows: | ||
(b-1) The application must: | ||
(1) include the name of each person with an ownership | ||
interest in: | ||
(A) the nursing facility, including a subsidiary | ||
or parent company of the facility; and | ||
(B) the real property on which the nursing | ||
facility is located, including any owner, common owner, tenant, or | ||
sublessee; and | ||
(2) describe the exact ownership interest of each of | ||
those persons in relation to the facility or property. | ||
SECTION 4. Subchapter B, Chapter 242, Health and Safety | ||
Code, is amended by adding Section 242.0333 to read as follows: | ||
Sec. 242.0333. NOTIFICATION OF CHANGE TO OWNERSHIP INTEREST | ||
APPLICATION INFORMATION. A license holder shall notify the | ||
commission, in the form and manner the commission requires, of any | ||
change to the ownership interest application information provided | ||
under Section 242.032(b-1). | ||
SECTION 5. Section 32.028, Human Resources Code, is amended | ||
by amending Subsections (g) and (i) and adding Subsection (i-1) to | ||
read as follows: | ||
(g) Subject to Subsection (i), the executive commissioner | ||
shall ensure that the rules governing the determination of rates | ||
paid for nursing facility services improve the quality of care by: | ||
(1) providing a program offering incentives for | ||
increasing direct care staff and direct care wages and benefits[ |
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(2) if appropriated funds are available after money is | ||
allocated for payment of incentive-based rates under Subdivision | ||
(1), providing incentives that incorporate the use of a quality of | ||
care index, a customer satisfaction index, and a resolved | ||
complaints index developed by the commission. | ||
(i) The executive commissioner shall ensure that rules | ||
governing the incentives program described by Subsection (g)(1): | ||
(1) provide that participation in the program by a | ||
nursing facility is voluntary; | ||
(2) do not impose on a nursing facility not | ||
participating in the program a minimum spending requirement for | ||
direct care staff wages and benefits; | ||
(3) do not set a base rate for a nursing facility | ||
participating in the program that is more than the base rate for a | ||
nursing facility not participating in the program; [ |
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(4) establish a funding process to provide incentives | ||
for increasing direct care staff and direct care wages and benefits | ||
in accordance with appropriations provided; and | ||
(5) to the extent permitted by federal law, require | ||
the commission to recoup all or part of an incentive payment if the | ||
nursing facility fails to satisfy a program requirement. | ||
(i-1) The commission shall use money the commission recoups | ||
in accordance with rules adopted under Subsection (i)(5) to | ||
continue funding the incentives program described by Subsection | ||
(g)(1). | ||
SECTION 6. Subchapter B, Chapter 32, Human Resources Code, | ||
is amended by adding Section 32.0286 to read as follows: | ||
Sec. 32.0286. ANNUAL DIRECT CARE EXPENSE RATIO FOR | ||
REIMBURSEMENT OF CERTAIN LONG-TERM CARE FACILITY PROVIDERS. (a) | ||
In this section, "direct care expense": | ||
(1) includes an expense for: | ||
(A) non-revenue generating support services, | ||
such as laundry, housekeeping, dietary services, and nursing | ||
administration; | ||
(B) ancillary services, such as laboratory tests | ||
and services, physical therapy services, occupational therapy | ||
services, speech-language pathology services, or audiological | ||
services; and | ||
(C) program services, such as an adult day-care | ||
program; and | ||
(2) does not include an expense for: | ||
(A) administrative costs other than nursing | ||
administration; | ||
(B) capital costs; | ||
(C) debt service; | ||
(D) taxes, other than sales and payroll taxes; | ||
(E) capital depreciation; | ||
(F) rental or lease payments; or | ||
(G) financial services. | ||
(b) Notwithstanding any other law, the executive | ||
commissioner by rule shall establish an annual direct care expense | ||
ratio, including a process for determining the ratio, applicable to | ||
the reimbursement of nursing facility and other long-term care | ||
facility providers for providing services to recipients under the | ||
medical assistance program. In establishing the ratio, the | ||
executive commissioner shall require that at least 80 percent of | ||
medical assistance reimbursement amounts paid to a nursing facility | ||
or other long-term care facility is spent on direct care expenses. | ||
(c) The executive commissioner shall adopt rules necessary | ||
to ensure each nursing facility provider and other long-term care | ||
facility that participates in the medical assistance program | ||
complies with the direct care expense ratio adopted under this | ||
section. | ||
SECTION 7. (a) The Health and Human Services Commission | ||
shall, in a contract between the commission and a managed care | ||
organization under Chapter 533, Government Code, that is entered | ||
into or renewed on or after the effective date of this Act, require | ||
the managed care organization to comply with Section 533.00512, | ||
Government Code, as added by this Act. | ||
(b) The Health and Human Services Commission shall seek to | ||
amend contracts entered into with managed care organizations under | ||
Chapter 533, Government Code, before the effective date of this Act | ||
to require those managed care organizations to comply with Section | ||
533.00512, Government Code, as added by this Act. To the extent of | ||
a conflict between that section and a provision of a contract with a | ||
managed care organization entered into before the effective date of | ||
this Act, the contract provision prevails. | ||
SECTION 8. If before implementing any provision of this Act | ||
a state agency determines that a waiver or authorization from a | ||
federal agency is necessary for implementation of that provision, | ||
the agency affected by the provision shall request the waiver or | ||
authorization and may delay implementing that provision until the | ||
waiver or authorization is granted. | ||
SECTION 9. This Act takes effect September 1, 2023. |