Texas 2019 - 86th Regular

Texas House Bill HB3342 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R4872 LED-F
2	2	By: Sheffield H.B. No. 3342
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the creation and operation of a health care quality
8	8	provider participation program; authorizing an administrative
9	9	penalty.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Chapter 242, Health and Safety Code, is amended
12	12	by adding Subchapter P to read as follows:
13	13	SUBCHAPTER P. QUALITY PROVIDER PARTICIPATION PROGRAM
14	14	Sec. 242.701. PURPOSE. The purpose of this subchapter is to
15	15	authorize the commission to administer a long-term care quality
16	16	provider participation program that provides additional
17	17	compensation to nursing facilities that meet quality requirements
18	18	and to increase Medicaid reimbursement rates by collecting payments
19	19	from certain nursing facilities. The payments must be used to pay
20	20	the nonfederal share of the quality provider participation program
21	21	and for other purposes authorized by this subchapter.
22	22	Sec. 242.702. DEFINITION. In this subchapter,
23	23	"non-Medicare resident day" means a day on which the primary payer
24	24	for a nursing facility resident is not Medicare Part A or a Medicare
25	25	Advantage or special needs plan.
26	26	Sec. 242.703. APPLICABILITY. This subchapter does not
27	27	apply to:
28	28	(1) a state-owned veterans nursing facility;
29	29	(2) a facility that provides on a single campus a
30	30	combination of services, which may include independent living
31	31	services, licensed assisted living services, or licensed nursing
32	32	facility care services, and that either:
33	33	(A) holds a certificate of authority to operate a
34	34	continuing care retirement community under Chapter 246; or
35	35	(B) had during the previous 12 months:
36	36	(i) a combined number of non-Medicare
37	37	resident days of service provided to independent living and
38	38	assisted living residents, excluding services provided to persons
39	39	occupying facility beds in a licensed nursing facility, that
40	40	exceeded the number of non-Medicare resident days of service
41	41	provided to nursing facility residents; and
42	42	(ii) on a contiguous campus of a facility, a
43	43	minimum ratio of two licensed independent or assisted living beds
44	44	for each one nursing facility bed; or
45	45	(3) a nonprofit corporation governed by Chapter 22,
46	46	Business Organizations Code.
47	47	Sec. 242.704. CALCULATION OF PAYMENTS. (a) Each nursing
48	48	facility to which this subchapter applies shall pay a quality
49	49	provider participation payment. The amount of the payment may not
50	50	be uniform to satisfy the redistributive requirements of 42 C.F.R.
51	51	Section 433.68(e)(2)(i).
52	52	(b) The commission annually shall calculate the quality
53	53	provider participation payment. The payment must be set in
54	54	accordance with the maximum rate allowed under 42 C.F.R. Section
55	55	433.68(f)(3)(i).
56	56	(c) If, during the course of the state fiscal year, the
57	57	commission determines that the total amount of quality provider
58	58	participation payment revenue differs significantly from the
59	59	amount previously estimated, the commission may recalculate and
60	60	prospectively modify the payment amount to reflect the
61	61	recalculation.
62	62	(d) A nursing facility may not list the quality provider
63	63	participation payment as a separate charge on a resident's billing
64	64	statement or otherwise directly or indirectly attempt to charge the
65	65	payment to a resident.
66	66	Sec. 242.705. RESIDENT DAYS. For each calendar day, a
67	67	nursing facility shall determine the number of non-Medicare
68	68	resident days by adding the number of non-Medicare residents
69	69	occupying a bed in the nursing facility immediately before midnight
70	70	of that day plus the number of residents admitted that day, less the
71	71	number of residents discharged that day, except a resident is
72	72	included in the count under this section if:
73	73	(1) the resident is admitted and discharged on the
74	74	same day; or
75	75	(2) the resident is discharged that day because of the
76	76	resident's death.
77	77	Sec. 242.706. COLLECTION AND REPORTING. (a) The
78	78	commission shall impose and collect the quality provider
79	79	participation payment.
80	80	(b) Not later than the 25th day after the last day of a
81	81	month, each nursing facility shall:
82	82	(1) file with the commission a report stating the
83	83	total non-Medicare resident days for the month; and
84	84	(2) pay the quality provider participation payment.
85	85	Sec. 242.707. RULES; ADMINISTRATIVE PENALTY. (a) The
86	86	executive commissioner shall adopt rules to administer this
87	87	subchapter, including rules related to imposing and collecting the
88	88	quality provider participation payment.
89	89	(b) Notwithstanding Section 242.066, an administrative
90	90	penalty assessed under that section for a violation of this
91	91	subchapter may not exceed the greater of:
92	92	(1) one-half of the amount of the nursing facility's
93	93	outstanding quality provider participation payment; or
94	94	(2) $20,000.
95	95	(c) An administrative penalty assessed for a violation of
96	96	this subchapter is in addition to the nursing facility's
97	97	outstanding quality provider participation payment.
98	98	(d) A facility described by Section 242.703 is not subject
99	99	to an administrative penalty under this subchapter.
100	100	Sec. 242.708. QUALITY PROVIDER PARTICIPATION PROGRAM TRUST
101	101	FUND. (a) The quality provider participation program trust fund is
102	102	established as a trust fund to be held by the comptroller outside of
103	103	the state treasury and administered by the commission as trustee.
104	104	Interest and income from the assets of the trust fund shall be
105	105	credited to and deposited in the trust fund. The commission may use
106	106	money in the fund only as provided by Section 242.709.
107	107	(b) The commission shall remit the quality provider
108	108	participation payment collected under this subchapter to the
109	109	comptroller for deposit in the trust fund.
110	110	Sec. 242.709. REIMBURSEMENT OF FACILITIES. (a) The
111	111	commission shall use money in the quality provider participation
112	112	program trust fund, along with any corresponding federal matching
113	113	funds, only for the following purposes:
114	114	(1) paying any reasonable and necessary commission
115	115	cost to develop and administer systems for managing the quality
116	116	provider participation payment;
117	117	(2) reimbursing the Medicaid share of the payment as
118	118	an allowable cost in the Medicaid daily rate; and
119	119	(3) allocating the remainder to improve resident care
120	120	and quality of life and to be distributed as follows:
121	121	(A) 50 percent of the remainder must be
122	122	distributed through increased reimbursement rates to nursing
123	123	facilities that participate in the state Medicaid program and
124	124	demonstrate historical expenditures for capital improvements,
125	125	renovations, or other enhancements designed to create a more
126	126	home-like environment, wages and benefits, or other direct care
127	127	services; and
128	128	(B) 50 percent of the remainder must be
129	129	distributed to nursing facilities based on the following in order
130	130	of importance:
131	131	(i) performance under the Centers for
132	132	Medicare and Medicaid Services five-star quality rating system;
133	133	(ii) increases in direct care staffing and
134	134	revenue enhancements program funding for participating facilities
135	135	under Sections 32.028(g) and (i), Human Resources Code, to the
136	136	maximum level achieved and allowed for those facilities on
137	137	September 1, 2019; and
138	138	(iii) development and funding of additional
139	139	quality payments for unique, long-term care needs that are not
140	140	funded separately, including Alzheimer's disease, dementia,
141	141	obesity, and other conditions or initiatives identified by the
142	142	commission.
143	143	(a-1) Notwithstanding Subsection (a)(3), before September
144	144	1, 2020, the commission shall allocate 100 percent of the remainder
145	145	of the money described by that subsection for distribution to
146	146	nursing facilities that participate in the state Medicaid program.
147	147	(a-2) The programs described by Subsection (a)(3) may not
148	148	begin earlier than September 1, 2020. This subsection and
149	149	Subsection (a-1) expire September 1, 2023.
150	150	(b) In consultation with the advisory committee established
151	151	under Section 242.712, the commission shall devise a formula by
152	152	which amounts received under this subchapter increase the
153	153	reimbursement rates paid to nursing facilities under the state
154	154	Medicaid program consistent with Subsection (a)(3) and with the
155	155	goal of improving resident care and quality. The commission, in
156	156	consultation with the advisory committee, shall develop a weighted
157	157	formula for distributing the money described by Subsection
158	158	(a)(3)(B).
159	159	(c) The commission shall distribute unearned money for the
160	160	programs described by Subsection (a)(3) to all nursing facilities
161	161	that qualify for a distribution in proportion to the amount of the
162	162	total earned money each qualifying nursing facility receives.
163	163	(d) Money in the quality provider participation program
164	164	trust fund may not be used to expand Medicaid eligibility under the
165	165	Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as
166	166	amended by the Health Care and Education Reconciliation Act of 2010
167	167	(Pub. L. No. 111-152).
168	168	Sec. 242.710. INVALIDITY; FEDERAL FUNDS. If any provision
169	169	of or procedure under this subchapter is held invalid by a final
170	170	court order that is not subject to appeal, or if the commission
171	171	determines that the imposition of the quality provider
172	172	participation payment and the expenditure of amounts collected as
173	173	prescribed by this subchapter will not entitle the state to receive
174	174	federal matching funds under the Medicaid program or will be
175	175	inconsistent with the objectives described by Section
176	176	537.002(b)(7), Government Code, the commission shall:
177	177	(1) stop collection of the payment; and
178	178	(2) not later than the 30th day after the date
179	179	collection is stopped, return to each nursing facility, in
180	180	proportion to the total amount paid by each facility compared to the
181	181	total amount paid by all facilities, any unspent money deposited to
182	182	the credit of the quality provider participation program trust
183	183	fund.
184	184	Sec. 242.711. AUTHORITY TO ACCOMPLISH PURPOSES OF
185	185	SUBCHAPTER. (a) Subject to Subsection (b), the executive
186	186	commissioner by rule may adopt a definition, a method of
187	187	computation, or a rate that differs from those expressly provided
188	188	by or expressly authorized by this subchapter to the extent the
189	189	difference is necessary to accomplish the purposes of this
190	190	subchapter.
191	191	(b) The executive commissioner may not modify the
192	192	applicability of this subchapter under Section 242.703.
193	193	Sec. 242.712. ADVISORY COMMITTEE. (a) The commission
194	194	shall establish an advisory committee of interested persons to make
195	195	recommendations to the commission before the adoption of a rule,
196	196	policy, or procedure affecting persons regulated under this
197	197	subchapter. The advisory committee has the purposes, powers, and
198	198	duties prescribed by the commission.
199	199	(b) Chapter 2110, Government Code, does not apply to the
200	200	advisory committee.
201	201	(c) The commission shall appoint to the advisory committee
202	202	individuals who:
203	203	(1) are selected from a list provided by the executive
204	204	commissioner;
205	205	(2) have knowledge about and interests in the work of
206	206	the advisory committee; and
207	207	(3) represent a broad range of viewpoints on the work
208	208	of the advisory committee.
209	209	(d) The advisory committee must include a member of the
210	210	public if the commission determines that is appropriate and
211	211	beneficial.
212	212	(e) A member of the advisory committee may not receive
213	213	compensation for serving on the committee and may not be reimbursed
214	214	for travel expenses incurred while conducting the business of the
215	215	committee.
216	216	(f) Meetings of the committee are subject to Chapter 551,
217	217	Government Code.
218	218	Sec. 242.713. EXPIRATION. This subchapter expires August
219	219	31, 2029.
220	220	SECTION 2. (a) Not later than January 1, 2020, the
221	221	executive commissioner of the Health and Human Services Commission
222	222	shall establish the advisory committee as required by Section
223	223	242.712, Health and Safety Code, as added by this Act.
224	224	(b) As soon as practicable after the effective date of this
225	225	Act, the executive commissioner of the Health and Human Services
226	226	Commission shall:
227	227	(1) in consultation with the advisory committee
228	228	established by Section 242.712, Health and Safety Code, as added by
229	229	this Act, adopt the rules necessary to implement Subchapter P,
230	230	Chapter 242, Health and Safety Code, as added by this Act; and
231	231	(2) notwithstanding Section 242.704, Health and
232	232	Safety Code, as added by this Act, establish the amount of the
233	233	initial payment imposed under Subchapter P, Chapter 242, Health and
234	234	Safety Code, as added by this Act, based on available revenue and
235	235	resident day information.
236	236	(c) The amount of the initial payment established under
237	237	Subsection (b) of this section remains in effect until the Health
238	238	and Human Services Commission obtains the information necessary to
239	239	set the amount of the payment under Section 242.704, Health and
240	240	Safety Code, as added by this Act.
241	241	SECTION 3. If before implementing any provision of this Act
242	242	a state agency determines that a waiver or authorization from a
243	243	federal agency is necessary for implementation of that provision,
244	244	the agency affected by the provision shall request the waiver or
245	245	authorization and shall delay implementing that provision until the
246	246	waiver or authorization is granted. The agency shall begin
247	247	implementing the provision on the date the waiver or authorization
248	248	is granted.
249	249	SECTION 4. Notwithstanding any other law, a payment may not
250	250	be imposed under Section 242.704, Health and Safety Code, as added
251	251	by this Act, or collected under Section 242.706, Health and Safety
252	252	Code, as added by this Act, until an amendment to the state Medicaid
253	253	plan that increases the rates paid to long-term care facilities
254	254	licensed under Chapter 242, Health and Safety Code, for providing
255	255	services under the state Medicaid program is approved by the
256	256	Centers for Medicare and Medicaid Services or another applicable
257	257	federal government agency.
258	258	SECTION 5. The Health and Human Services Commission shall
259	259	retroactively compensate long-term care facilities licensed under
260	260	Chapter 242, Health and Safety Code, at the increased rate for
261	261	services provided under the state Medicaid program:
262	262	(1) beginning on the date the state Medicaid plan
263	263	amendment is approved by the Centers for Medicare and Medicaid
264	264	Services or another applicable federal government agency; and
265	265	(2) only for the period for which the payment has been
266	266	imposed and collected.
267	267	SECTION 6. The Health and Human Services Commission shall
268	268	discontinue the payment imposed under Subchapter P, Chapter 242,
269	269	Health and Safety Code, as added by this Act, if the commission
270	270	reduces Medicaid reimbursement rates below the sum of:
271	271	(1) the rates in effect on September 1, 2019; and
272	272	(2) the rates that increased due to funds from the
273	273	quality provider participation program trust fund and federal
274	274	matching funds.
275	275	SECTION 7. This Act takes effect immediately if it receives
276	276	a vote of two-thirds of all the members elected to each house, as
277	277	provided by Section 39, Article III, Texas Constitution. If this
278	278	Act does not receive the vote necessary for immediate effect, this
279	279	Act takes effect September 1, 2019.