Texas 2021 - 87th Regular

Texas House Bill HB1816 Compare Versions

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

Old	New	Differences
1	1	87R4729 BDP-D
2	2	By: Guillen H.B. No. 1816
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the reimbursement of nursing facilities under Medicaid.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Sections 32.028(g), (i), and (m), Human
10	10	Resources Code, are amended to read as follows:
11	11	(g) Subject to Subsection (i), the executive commissioner
12	12	shall:
13	13	(1) set the base rate reimbursement for each nursing
14	14	facility at an amount that is at least equal to the rate in effect on
15	15	April 1, 2020, including any emergency temporary rate increase
16	16	authorized under 1 T.A.C. Section 355.205; and
17	17	(2) ensure that the rules governing the determination
18	18	of rates paid for nursing facility services improve the quality of
19	19	care by:
20	20	(A) [(1)] providing a program offering
21	21	incentives for increasing direct care staff and direct care wages
22	22	and benefits, but only to the extent that appropriated funds are
23	23	available after money is allocated to base rate reimbursements as
24	24	determined by the commission's nursing facility rate setting
25	25	methodologies; and
26	26	(B) [(2)] if appropriated funds are available
27	27	after money is allocated for payment of incentive-based rates under
28	28	Paragraph (A) [Subdivision (1)], providing incentives that
29	29	incorporate the use of a quality of care index, a customer
30	30	satisfaction index, and a resolved complaints index developed by
31	31	the commission.
32	32	(i) The executive commissioner shall ensure that rules
33	33	governing the incentives program described by Subsection (g)(2)(A)
34	34	[(g)(1)]:
35	35	(1) provide that participation in the program by a
36	36	nursing facility is voluntary;
37	37	(2) do not impose on a nursing facility not
38	38	participating in the program a minimum spending requirement for
39	39	direct care staff wages and benefits;
40	40	(3) do not set a base rate for a nursing facility
41	41	participating in the program that is more than the base rate for a
42	42	nursing facility not participating in the program; and
43	43	(4) establish a funding process to provide incentives
44	44	for increasing direct care staff and direct care wages and benefits
45	45	in accordance with appropriations provided.
46	46	(m) The commission may not fund an incentive program under
47	47	Subsection (g)(2)(A) [(g)(1)] using money appropriated for base
48	48	rate reimbursements for nursing facilities.
49	49	SECTION 2. Section 533.00251(c), Government Code, as
50	50	effective September 1, 2021, is amended to read as follows:
51	51	(c) Subject to Section 533.0025 and notwithstanding any
52	52	other law, the commission shall provide benefits under Medicaid to
53	53	recipients who reside in nursing facilities through the STAR + PLUS
54	54	Medicaid managed care program. In implementing this subsection,
55	55	the commission shall ensure:
56	56	(1) that a managed care organization providing
57	57	services under the managed care program sets the base rate
58	58	reimbursement paid to a nursing facility at an amount that is at
59	59	least equal to the minimum amount required by Section 32.028(g),
60	60	Human Resources Code;
61	61	(1-a) a nursing facility is paid not later than the
62	62	10th day after the date the facility submits a clean claim;
63	63	(2) the appropriate utilization of services
64	64	consistent with criteria established by the commission;
65	65	(3) a reduction in the incidence of potentially
66	66	preventable events and unnecessary institutionalizations;
67	67	(4) that a managed care organization providing
68	68	services under the managed care program provides discharge
69	69	planning, transitional care, and other education programs to
70	70	physicians and hospitals regarding all available long-term care
71	71	settings;
72	72	(5) that a managed care organization providing
73	73	services under the managed care program:
74	74	(A) assists in collecting applied income from
75	75	recipients; and
76	76	(B) provides payment incentives to nursing
77	77	facility providers that reward reductions in preventable acute care
78	78	costs and encourage transformative efforts in the delivery of
79	79	nursing facility services, including efforts to promote a
80	80	resident-centered care culture through facility design and
81	81	services provided;
82	82	(6) the establishment of a portal that is in
83	83	compliance with state and federal regulations, including standard
84	84	coding requirements, through which nursing facility providers
85	85	participating in the STAR + PLUS Medicaid managed care program may
86	86	submit claims to any participating managed care organization;
87	87	(7) that rules and procedures relating to the
88	88	certification and decertification of nursing facility beds under
89	89	Medicaid are not affected;
90	90	(8) that a managed care organization providing
91	91	services under the managed care program, to the greatest extent
92	92	possible, offers nursing facility providers access to:
93	93	(A) acute care professionals; and
94	94	(B) telemedicine, when feasible and in
95	95	accordance with state law, including rules adopted by the Texas
96	96	Medical Board; and
97	97	(9) that the commission approves the staff rate
98	98	enhancement methodology for the staff rate enhancement paid to a
99	99	nursing facility that qualifies for the enhancement under the
100	100	managed care program.
101	101	SECTION 3. (a) The Health and Human Services Commission
102	102	shall, in a contract between the commission and a managed care
103	103	organization under Chapter 533, Government Code, that is entered
104	104	into or renewed on or after the effective date of this Act, require
105	105	that the managed care organization comply with Section
106	106	533.00251(c), Government Code, as amended by this Act.
107	107	(b) The Health and Human Services Commission shall seek to
108	108	amend contracts entered into with managed care organizations under
109	109	Chapter 533, Government Code, before the effective date of this Act
110	110	to require those managed care organizations to comply with Section
111	111	533.00251(c), Government Code, as amended by this Act. To the
112	112	extent of a conflict between that section and a provision of a
113	113	contract with a managed care organization entered into before the
114	114	effective date of this Act, the contract provision prevails.
115	115	SECTION 4. If before implementing any provision of this Act
116	116	a state agency determines that a waiver or authorization from a
117	117	federal agency is necessary for implementation of that provision,
118	118	the agency affected by the provision shall request the waiver or
119	119	authorization and may delay implementing that provision until the
120	120	waiver or authorization is granted.
121	121	SECTION 5. This Act takes effect September 1, 2021.