HB4615 - Relating to the regulation of certain nursing facilities, including licensing requirements and Medicaid participation requirements.

  89R3103 JG-D     By: Frank H.B. No. 4615       A BILL TO BE ENTITLED   AN ACT   relating to the regulation of certain nursing facilities, including   licensing requirements and Medicaid participation requirements.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 540.0752(b), Government Code, as   effective April 1, 2025, is amended to read as follows:          (b)  Subject to Section 540.0701 and notwithstanding any   other law, the commission shall provide Medicaid benefits through   the STAR+PLUS Medicaid managed care program to recipients who   reside in nursing facilities. In implementing this subsection, the   commission shall ensure that:                (1)  a nursing facility is paid not later than the 10th   day after the date the facility submits a clean claim;                 (1-a) a nursing facility complies with the direct care   expense ratio adopted under Section 32.0286, Human Resources Code;                (2)  services are used appropriately, consistent with   criteria the commission establishes;                (3)  the incidence of potentially preventable events   and unnecessary institutionalizations is reduced;                (4)  a Medicaid managed care organization providing   services under the program:                      (A)  provides discharge planning, transitional   care, and other education programs to physicians and hospitals   regarding all available long-term care settings;                      (B)  assists in collecting applied income from   recipients; and                      (C)  provides payment incentives to nursing   facility providers that:                            (i)  reward reductions in preventable acute   care costs; and                            (ii)  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;                (5)  a portal is established that complies with state   and federal regulations, including standard coding requirements,   through which nursing facility providers participating in the   program may submit claims to any participating Medicaid managed   care organization;                (6)  rules and procedures relating to certifying and   decertifying nursing facility beds under Medicaid are not affected;                (7)  a Medicaid managed care organization providing   services under the 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                (8)  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 program.          SECTION 2.  Subchapter F, Chapter 540, Government Code, as   effective April 1, 2025, is amended by adding Section 540.0283 to   read as follows:           Sec.   540.0283.     NURSING FACILITY PROVIDER AGREEMENTS:   COMPLIANCE WITH DIRECT CARE EXPENSE RATIO. (a) A contract to which   this subchapter applies must require that each provider agreement   between the contracting Medicaid managed care organization and a   nursing facility include a requirement that the facility comply   with the direct care expense ratio adopted under Section 32.0286,   Human Resources Code.           (b)  This section does not apply to a state-owned facility.          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 a direct or   indirect ownership interest of five percent or more 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 Subsection (i) and adding Subsection (i-1) to read as   follows:          (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; [ and ]                (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 prohibit a provider who is the   subject of the recoupment of an incentive payment under Subsection   (i)(5) from participating in the incentives program described by   Subsection (g)(1) for a period of not less than two consecutive   years following the date on which the recoupment occurs. The   commission shall publish and maintain on the commission's Internet   website a list of each provider prohibited from participating in   the incentives program under this subsection.          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 NURSING 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 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 the portion of the medical assistance   reimbursement amount paid to a nursing facility that is   attributable to patient care expenses is spent on reasonable and   necessary direct care expenses.           (c)     The executive commissioner shall adopt rules necessary   to ensure each nursing facility provider that participates in the   medical assistance program complies with the direct care expense   ratio adopted under this section.           (d)     To the extent permitted by federal law, the commission   may recoup all or part of the reimbursement amounts paid to a   nursing facility that are subject to the direct care expense ratio   under this section if the facility fails to spend the reimbursement   amounts in accordance with the direct care expense ratio.           (e)     The commission may not require a nursing facility to   comply with the direct care expense ratio as a condition of   participation in Medicaid.           (f)  This section does not apply to a state-owned facility.          SECTION 7.  (a) The Health and Human Services Commission   shall, in a contract between the commission and a managed care   organization under Chapter 540, Government Code, as effective April   1, 2025, that is entered into or renewed on or after the effective   date of this Act, require the managed care organization to comply   with Section 540.0283, 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 540, Government Code, as effective April 1, 2025, befor [Text truncated for display. 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