87R4729 BDP-D
By: Guillen H.B. No. 1816
A BILL TO BE ENTITLED
AN ACT
relating to the reimbursement of nursing facilities under Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 32.028(g), (i), and (m), Human
Resources Code, are amended to read as follows:
(g) Subject to Subsection (i), the executive commissioner
shall:
(1) set the base rate reimbursement for each nursing
facility at an amount that is at least equal to the rate in effect on
April 1, 2020, including any emergency temporary rate increase
authorized under 1 T.A.C. Section 355.205; and
(2) ensure that the rules governing the determination
of rates paid for nursing facility services improve the quality of
care by:
(A) [(1)] providing a program offering
incentives for increasing direct care staff and direct care wages
and benefits, but only to the extent that appropriated funds are
available after money is allocated to base rate reimbursements as
determined by the commission's nursing facility rate setting
methodologies; and
(B) [(2)] if appropriated funds are available
after money is allocated for payment of incentive-based rates under
Paragraph (A) [Subdivision (1)], providing incentives that
incorporate the use of a quality of care index, a customer
satisfaction index, and a resolved complaints index developed by
the commission.
(i) The executive commissioner shall ensure that rules
governing the incentives program described by Subsection (g)(2)(A)
[(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.
(m) The commission may not fund an incentive program under
Subsection (g)(2)(A) [(g)(1)] using money appropriated for base
rate reimbursements for nursing facilities.
SECTION 2. Section 533.00251(c), Government Code, as
effective September 1, 2021, is amended to read as follows:
(c) Subject to Section 533.0025 and notwithstanding any
other law, the commission shall provide benefits under Medicaid to
recipients who reside in nursing facilities through the STAR + PLUS
Medicaid managed care program. In implementing this subsection,
the commission shall ensure:
(1) that a managed care organization providing
services under the managed care program sets the base rate
reimbursement paid to a nursing facility at an amount that is at
least equal to the minimum amount required by Section 32.028(g),
Human Resources Code;
(1-a) a nursing facility is paid not later than the
10th day after the date the facility submits a clean claim;
(2) the appropriate utilization of services
consistent with criteria established by the commission;
(3) a reduction in the incidence of potentially
preventable events and unnecessary institutionalizations;
(4) that a managed care organization providing
services under the managed care program provides discharge
planning, transitional care, and other education programs to
physicians and hospitals regarding all available long-term care
settings;
(5) that a managed care organization providing
services under the managed care program:
(A) assists in collecting applied income from
recipients; and
(B) provides payment incentives to nursing
facility providers that reward reductions in preventable acute care
costs and 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;
(6) the establishment of a portal that is in
compliance with state and federal regulations, including standard
coding requirements, through which nursing facility providers
participating in the STAR + PLUS Medicaid managed care program may
submit claims to any participating managed care organization;
(7) that rules and procedures relating to the
certification and decertification of nursing facility beds under
Medicaid are not affected;
(8) that a managed care organization providing
services under the managed care 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
(9) that 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
managed care program.
SECTION 3. (a) The Health and Human Services Commission
shall, in a contract between the commission and a managed care
organization under Chapter 533, Government Code, that is entered
into or renewed on or after the effective date of this Act, require
that the managed care organization comply with Section
533.00251(c), Government Code, as amended by this Act.
(b) The Health and Human Services Commission shall seek to
amend contracts entered into with managed care organizations under
Chapter 533, Government Code, before the effective date of this Act
to require those managed care organizations to comply with Section
533.00251(c), Government Code, as amended by this Act. To the
extent of a conflict between that section and a provision of a
contract with a managed care organization entered into before the
effective date of this Act, the contract provision prevails.
SECTION 4. 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 may delay implementing that provision until the
waiver or authorization is granted.
SECTION 5. This Act takes effect September 1, 2021.