Bill Text: TX HB3342 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to the creation and operation of a health care quality provider participation program; authorizing an administrative penalty.
Spectrum: Moderate Partisan Bill (Republican 9-2)
Status: (Introduced - Dead) 2019-03-18 - Referred to Human Services [HB3342 Detail]
Download: Texas-2019-HB3342-Introduced.html
86R4872 LED-F | ||
By: Sheffield | H.B. No. 3342 |
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relating to the creation and operation of a health care quality | ||
provider participation program; authorizing an administrative | ||
penalty. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 242, Health and Safety Code, is amended | ||
by adding Subchapter P to read as follows: | ||
SUBCHAPTER P. QUALITY PROVIDER PARTICIPATION PROGRAM | ||
Sec. 242.701. PURPOSE. The purpose of this subchapter is to | ||
authorize the commission to administer a long-term care quality | ||
provider participation program that provides additional | ||
compensation to nursing facilities that meet quality requirements | ||
and to increase Medicaid reimbursement rates by collecting payments | ||
from certain nursing facilities. The payments must be used to pay | ||
the nonfederal share of the quality provider participation program | ||
and for other purposes authorized by this subchapter. | ||
Sec. 242.702. DEFINITION. In this subchapter, | ||
"non-Medicare resident day" means a day on which the primary payer | ||
for a nursing facility resident is not Medicare Part A or a Medicare | ||
Advantage or special needs plan. | ||
Sec. 242.703. APPLICABILITY. This subchapter does not | ||
apply to: | ||
(1) a state-owned veterans nursing facility; | ||
(2) a facility that provides on a single campus a | ||
combination of services, which may include independent living | ||
services, licensed assisted living services, or licensed nursing | ||
facility care services, and that either: | ||
(A) holds a certificate of authority to operate a | ||
continuing care retirement community under Chapter 246; or | ||
(B) had during the previous 12 months: | ||
(i) a combined number of non-Medicare | ||
resident days of service provided to independent living and | ||
assisted living residents, excluding services provided to persons | ||
occupying facility beds in a licensed nursing facility, that | ||
exceeded the number of non-Medicare resident days of service | ||
provided to nursing facility residents; and | ||
(ii) on a contiguous campus of a facility, a | ||
minimum ratio of two licensed independent or assisted living beds | ||
for each one nursing facility bed; or | ||
(3) a nonprofit corporation governed by Chapter 22, | ||
Business Organizations Code. | ||
Sec. 242.704. CALCULATION OF PAYMENTS. (a) Each nursing | ||
facility to which this subchapter applies shall pay a quality | ||
provider participation payment. The amount of the payment may not | ||
be uniform to satisfy the redistributive requirements of 42 C.F.R. | ||
Section 433.68(e)(2)(i). | ||
(b) The commission annually shall calculate the quality | ||
provider participation payment. The payment must be set in | ||
accordance with the maximum rate allowed under 42 C.F.R. Section | ||
433.68(f)(3)(i). | ||
(c) If, during the course of the state fiscal year, the | ||
commission determines that the total amount of quality provider | ||
participation payment revenue differs significantly from the | ||
amount previously estimated, the commission may recalculate and | ||
prospectively modify the payment amount to reflect the | ||
recalculation. | ||
(d) A nursing facility may not list the quality provider | ||
participation payment as a separate charge on a resident's billing | ||
statement or otherwise directly or indirectly attempt to charge the | ||
payment to a resident. | ||
Sec. 242.705. RESIDENT DAYS. For each calendar day, a | ||
nursing facility shall determine the number of non-Medicare | ||
resident days by adding the number of non-Medicare residents | ||
occupying a bed in the nursing facility immediately before midnight | ||
of that day plus the number of residents admitted that day, less the | ||
number of residents discharged that day, except a resident is | ||
included in the count under this section if: | ||
(1) the resident is admitted and discharged on the | ||
same day; or | ||
(2) the resident is discharged that day because of the | ||
resident's death. | ||
Sec. 242.706. COLLECTION AND REPORTING. (a) The | ||
commission shall impose and collect the quality provider | ||
participation payment. | ||
(b) Not later than the 25th day after the last day of a | ||
month, each nursing facility shall: | ||
(1) file with the commission a report stating the | ||
total non-Medicare resident days for the month; and | ||
(2) pay the quality provider participation payment. | ||
Sec. 242.707. RULES; ADMINISTRATIVE PENALTY. (a) The | ||
executive commissioner shall adopt rules to administer this | ||
subchapter, including rules related to imposing and collecting the | ||
quality provider participation payment. | ||
(b) Notwithstanding Section 242.066, an administrative | ||
penalty assessed under that section for a violation of this | ||
subchapter may not exceed the greater of: | ||
(1) one-half of the amount of the nursing facility's | ||
outstanding quality provider participation payment; or | ||
(2) $20,000. | ||
(c) An administrative penalty assessed for a violation of | ||
this subchapter is in addition to the nursing facility's | ||
outstanding quality provider participation payment. | ||
(d) A facility described by Section 242.703 is not subject | ||
to an administrative penalty under this subchapter. | ||
Sec. 242.708. QUALITY PROVIDER PARTICIPATION PROGRAM TRUST | ||
FUND. (a) The quality provider participation program trust fund is | ||
established as a trust fund to be held by the comptroller outside of | ||
the state treasury and administered by the commission as trustee. | ||
Interest and income from the assets of the trust fund shall be | ||
credited to and deposited in the trust fund. The commission may use | ||
money in the fund only as provided by Section 242.709. | ||
(b) The commission shall remit the quality provider | ||
participation payment collected under this subchapter to the | ||
comptroller for deposit in the trust fund. | ||
Sec. 242.709. REIMBURSEMENT OF FACILITIES. (a) The | ||
commission shall use money in the quality provider participation | ||
program trust fund, along with any corresponding federal matching | ||
funds, only for the following purposes: | ||
(1) paying any reasonable and necessary commission | ||
cost to develop and administer systems for managing the quality | ||
provider participation payment; | ||
(2) reimbursing the Medicaid share of the payment as | ||
an allowable cost in the Medicaid daily rate; and | ||
(3) allocating the remainder to improve resident care | ||
and quality of life and to be distributed as follows: | ||
(A) 50 percent of the remainder must be | ||
distributed through increased reimbursement rates to nursing | ||
facilities that participate in the state Medicaid program and | ||
demonstrate historical expenditures for capital improvements, | ||
renovations, or other enhancements designed to create a more | ||
home-like environment, wages and benefits, or other direct care | ||
services; and | ||
(B) 50 percent of the remainder must be | ||
distributed to nursing facilities based on the following in order | ||
of importance: | ||
(i) performance under the Centers for | ||
Medicare and Medicaid Services five-star quality rating system; | ||
(ii) increases in direct care staffing and | ||
revenue enhancements program funding for participating facilities | ||
under Sections 32.028(g) and (i), Human Resources Code, to the | ||
maximum level achieved and allowed for those facilities on | ||
September 1, 2019; and | ||
(iii) development and funding of additional | ||
quality payments for unique, long-term care needs that are not | ||
funded separately, including Alzheimer's disease, dementia, | ||
obesity, and other conditions or initiatives identified by the | ||
commission. | ||
(a-1) Notwithstanding Subsection (a)(3), before September | ||
1, 2020, the commission shall allocate 100 percent of the remainder | ||
of the money described by that subsection for distribution to | ||
nursing facilities that participate in the state Medicaid program. | ||
(a-2) The programs described by Subsection (a)(3) may not | ||
begin earlier than September 1, 2020. This subsection and | ||
Subsection (a-1) expire September 1, 2023. | ||
(b) In consultation with the advisory committee established | ||
under Section 242.712, the commission shall devise a formula by | ||
which amounts received under this subchapter increase the | ||
reimbursement rates paid to nursing facilities under the state | ||
Medicaid program consistent with Subsection (a)(3) and with the | ||
goal of improving resident care and quality. The commission, in | ||
consultation with the advisory committee, shall develop a weighted | ||
formula for distributing the money described by Subsection | ||
(a)(3)(B). | ||
(c) The commission shall distribute unearned money for the | ||
programs described by Subsection (a)(3) to all nursing facilities | ||
that qualify for a distribution in proportion to the amount of the | ||
total earned money each qualifying nursing facility receives. | ||
(d) Money in the quality provider participation program | ||
trust fund may not be used to expand Medicaid eligibility under the | ||
Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as | ||
amended by the Health Care and Education Reconciliation Act of 2010 | ||
(Pub. L. No. 111-152). | ||
Sec. 242.710. INVALIDITY; FEDERAL FUNDS. If any provision | ||
of or procedure under this subchapter is held invalid by a final | ||
court order that is not subject to appeal, or if the commission | ||
determines that the imposition of the quality provider | ||
participation payment and the expenditure of amounts collected as | ||
prescribed by this subchapter will not entitle the state to receive | ||
federal matching funds under the Medicaid program or will be | ||
inconsistent with the objectives described by Section | ||
537.002(b)(7), Government Code, the commission shall: | ||
(1) stop collection of the payment; and | ||
(2) not later than the 30th day after the date | ||
collection is stopped, return to each nursing facility, in | ||
proportion to the total amount paid by each facility compared to the | ||
total amount paid by all facilities, any unspent money deposited to | ||
the credit of the quality provider participation program trust | ||
fund. | ||
Sec. 242.711. AUTHORITY TO ACCOMPLISH PURPOSES OF | ||
SUBCHAPTER. (a) Subject to Subsection (b), the executive | ||
commissioner by rule may adopt a definition, a method of | ||
computation, or a rate that differs from those expressly provided | ||
by or expressly authorized by this subchapter to the extent the | ||
difference is necessary to accomplish the purposes of this | ||
subchapter. | ||
(b) The executive commissioner may not modify the | ||
applicability of this subchapter under Section 242.703. | ||
Sec. 242.712. ADVISORY COMMITTEE. (a) The commission | ||
shall establish an advisory committee of interested persons to make | ||
recommendations to the commission before the adoption of a rule, | ||
policy, or procedure affecting persons regulated under this | ||
subchapter. The advisory committee has the purposes, powers, and | ||
duties prescribed by the commission. | ||
(b) Chapter 2110, Government Code, does not apply to the | ||
advisory committee. | ||
(c) The commission shall appoint to the advisory committee | ||
individuals who: | ||
(1) are selected from a list provided by the executive | ||
commissioner; | ||
(2) have knowledge about and interests in the work of | ||
the advisory committee; and | ||
(3) represent a broad range of viewpoints on the work | ||
of the advisory committee. | ||
(d) The advisory committee must include a member of the | ||
public if the commission determines that is appropriate and | ||
beneficial. | ||
(e) A member of the advisory committee may not receive | ||
compensation for serving on the committee and may not be reimbursed | ||
for travel expenses incurred while conducting the business of the | ||
committee. | ||
(f) Meetings of the committee are subject to Chapter 551, | ||
Government Code. | ||
Sec. 242.713. EXPIRATION. This subchapter expires August | ||
31, 2029. | ||
SECTION 2. (a) Not later than January 1, 2020, the | ||
executive commissioner of the Health and Human Services Commission | ||
shall establish the advisory committee as required by Section | ||
242.712, Health and Safety Code, as added by this Act. | ||
(b) As soon as practicable after the effective date of this | ||
Act, the executive commissioner of the Health and Human Services | ||
Commission shall: | ||
(1) in consultation with the advisory committee | ||
established by Section 242.712, Health and Safety Code, as added by | ||
this Act, adopt the rules necessary to implement Subchapter P, | ||
Chapter 242, Health and Safety Code, as added by this Act; and | ||
(2) notwithstanding Section 242.704, Health and | ||
Safety Code, as added by this Act, establish the amount of the | ||
initial payment imposed under Subchapter P, Chapter 242, Health and | ||
Safety Code, as added by this Act, based on available revenue and | ||
resident day information. | ||
(c) The amount of the initial payment established under | ||
Subsection (b) of this section remains in effect until the Health | ||
and Human Services Commission obtains the information necessary to | ||
set the amount of the payment under Section 242.704, Health and | ||
Safety Code, as added by this Act. | ||
SECTION 3. 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 shall delay implementing that provision until the | ||
waiver or authorization is granted. The agency shall begin | ||
implementing the provision on the date the waiver or authorization | ||
is granted. | ||
SECTION 4. Notwithstanding any other law, a payment may not | ||
be imposed under Section 242.704, Health and Safety Code, as added | ||
by this Act, or collected under Section 242.706, Health and Safety | ||
Code, as added by this Act, until an amendment to the state Medicaid | ||
plan that increases the rates paid to long-term care facilities | ||
licensed under Chapter 242, Health and Safety Code, for providing | ||
services under the state Medicaid program is approved by the | ||
Centers for Medicare and Medicaid Services or another applicable | ||
federal government agency. | ||
SECTION 5. The Health and Human Services Commission shall | ||
retroactively compensate long-term care facilities licensed under | ||
Chapter 242, Health and Safety Code, at the increased rate for | ||
services provided under the state Medicaid program: | ||
(1) beginning on the date the state Medicaid plan | ||
amendment is approved by the Centers for Medicare and Medicaid | ||
Services or another applicable federal government agency; and | ||
(2) only for the period for which the payment has been | ||
imposed and collected. | ||
SECTION 6. The Health and Human Services Commission shall | ||
discontinue the payment imposed under Subchapter P, Chapter 242, | ||
Health and Safety Code, as added by this Act, if the commission | ||
reduces Medicaid reimbursement rates below the sum of: | ||
(1) the rates in effect on September 1, 2019; and | ||
(2) the rates that increased due to funds from the | ||
quality provider participation program trust fund and federal | ||
matching funds. | ||
SECTION 7. This Act takes effect immediately if it receives | ||
a vote of two-thirds of all the members elected to each house, as | ||
provided by Section 39, Article III, Texas Constitution. If this | ||
Act does not receive the vote necessary for immediate effect, this | ||
Act takes effect September 1, 2019. |