Bill Text: TX SB1050 | 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: Slight Partisan Bill (Democrat 2-1)

Status: (Introduced) 2019-04-24 - Left pending in committee [SB1050 Detail]

Download: Texas-2019-SB1050-Introduced.html
  86R4872 LED-F
 
  By: Hughes S.B. No. 1050
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  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.
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