SB457 - Relating to the regulation of certain nursing facilities, including licensing requirements and Medicaid participation and reimbursement requirements.

      S.B. No. 457         AN ACT   relating to the regulation of certain nursing facilities, including   licensing requirements and Medicaid participation and   reimbursement requirements.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter D, Chapter 532, Government Code, is   amended by adding Section 532.0159 to read as follows:           Sec.   532.0159.     CONTINUED REIMBURSEMENT OF NURSING   FACILITIES WHILE CHANGE IN OWNERSHIP APPLICATION PENDING. (a)   Notwithstanding any other law, the commission shall ensure that a   nursing facility providing Medicaid services to recipients   continues to receive Medicaid reimbursement uninterrupted while a   change in ownership application for the facility is pending with   the commission, provided the facility under the new ownership:                 (1)     accepts assignment of the previous owner's   Medicaid provider agreement subject to applicable federal and state   law, including applicable federal and state regulations;                 (2)     satisfies applicable requirements under federal   and state law, including the licensing requirement under Chapter   242, Health and Safety Code;                 (3)     if required by the terms of and agreed to by the   parties to the contract, assumes the contract to deliver Medicaid   nursing facility services in effect before the change in ownership;                 (4)     subject to Subsection (b), enters into a successor   liability agreement, approved by the commission; and                 (5)     meets any additional requirements prescribed by   the commission.           (b)     A successor liability agreement under Subsection (a)(4)   must require that the facility under the new ownership:                 (1)     pay the commission for any outstanding liabilities   under the contract in effect before the change in ownership that are   identified by the commission; and                 (2)     agree that an outstanding liability identified by   the commission may include a liability incurred by the previous   owner without regard to:                       (A)     when a service was provided or a claim was   filed; or                       (B)     whether the liability is identified by the   commission or another authorized entity, including a Medicaid   managed care organization.           (c)     This section does not apply to a supplemental payment   program or a directed payment program, as defined by Section   532.0102, operated or administered by the commission.           (d)     The executive commissioner shall adopt rules necessary   to implement this section.          SECTION 2.  Section 540.0752(b), Government Code, 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 patient 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;   and                (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 3.  Subchapter F, Chapter 540, Government Code, is   amended by adding Section 540.0283 to read as follows:           Sec.   540.0283.     NURSING FACILITY PROVIDER AGREEMENTS:   COMPLIANCE WITH PATIENT 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 patient care expense ratio adopted under   Section 32.0286, Human Resources Code.           (b)  This section does not apply to a state-owned facility.          SECTION 4.  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 5.  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 6.  Subchapter B, Chapter 32, Human Resources Code,   is amended by adding Section 32.0286 to read as follows:           Sec.   32.0286.     ANNUAL PATIENT CARE EXPENSE RATIO FOR   REIMBURSEMENT OF CERTAIN NURSING FACILITY PROVIDERS. (a) In this   section, "patient care expense":                 (1)     includes an expense incurred by a nursing facility   for:                       (A)  providing compensation and benefits to:                             (i)     direct care staff of a facility,   whether the staff are employees of or contract labor for the   facility, including:                                   (a)     licensed registered nurses and   licensed vocational nurses, including directors of nursing and   assistant directors of nursing;                                   (b)  medication aides;                                   (c)  restorative aides;                                   (d)     nurse aides who provide   nursing-related care to residents occupying medical assistance   beds;                                   (e)  licensed social workers; and                                   (f)  social services assistants;                             (ii)     additional staff associated with   providing care to facility residents with a severe cognitive   impairment;                             (iii)     nonprofessional administrative   staff, including medical records staff and accounting or   bookkeeping staff;                             (iv)     central supply staff and ancillary   facility staff;                             (v)     housekeeping staff and laundry staff;   and                             (vi)  food service staff;           &#xA [Text truncated for display. 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