Texas 2025 - 89th Regular

Texas House Bill HB4615 Compare Versions

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

Old	New	Differences
1	1	89R3103 JG-D
2	2	By: Frank H.B. No. 4615
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the regulation of certain nursing facilities, including
10	10	licensing requirements and Medicaid participation requirements.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 540.0752(b), Government Code, as
13	13	effective April 1, 2025, is amended to read as follows:
14	14	(b) Subject to Section 540.0701 and notwithstanding any
15	15	other law, the commission shall provide Medicaid benefits through
16	16	the STAR+PLUS Medicaid managed care program to recipients who
17	17	reside in nursing facilities. In implementing this subsection, the
18	18	commission shall ensure that:
19	19	(1) a nursing facility is paid not later than the 10th
20	20	day after the date the facility submits a clean claim;
21	21	(1-a) a nursing facility complies with the direct care
22	22	expense ratio adopted under Section 32.0286, Human Resources Code;
23	23	(2) services are used appropriately, consistent with
24	24	criteria the commission establishes;
25	25	(3) the incidence of potentially preventable events
26	26	and unnecessary institutionalizations is reduced;
27	27	(4) a Medicaid managed care organization providing
28	28	services under the program:
29	29	(A) provides discharge planning, transitional
30	30	care, and other education programs to physicians and hospitals
31	31	regarding all available long-term care settings;
32	32	(B) assists in collecting applied income from
33	33	recipients; and
34	34	(C) provides payment incentives to nursing
35	35	facility providers that:
36	36	(i) reward reductions in preventable acute
37	37	care costs; and
38	38	(ii) encourage transformative efforts in
39	39	the delivery of nursing facility services, including efforts to
40	40	promote a resident-centered care culture through facility design
41	41	and services provided;
42	42	(5) a portal is established that complies with state
43	43	and federal regulations, including standard coding requirements,
44	44	through which nursing facility providers participating in the
45	45	program may submit claims to any participating Medicaid managed
46	46	care organization;
47	47	(6) rules and procedures relating to certifying and
48	48	decertifying nursing facility beds under Medicaid are not affected;
49	49	(7) a Medicaid managed care organization providing
50	50	services under the program, to the greatest extent possible, offers
51	51	nursing facility providers access to:
52	52	(A) acute care professionals; and
53	53	(B) telemedicine, when feasible and in
54	54	accordance with state law, including rules adopted by the Texas
55	55	Medical Board; and
56	56	(8) the commission approves the staff rate enhancement
57	57	methodology for the staff rate enhancement paid to a nursing
58	58	facility that qualifies for the enhancement under the program.
59	59	SECTION 2. Subchapter F, Chapter 540, Government Code, as
60	60	effective April 1, 2025, is amended by adding Section 540.0283 to
61	61	read as follows:
62	62	Sec. 540.0283. NURSING FACILITY PROVIDER AGREEMENTS:
63	63	COMPLIANCE WITH DIRECT CARE EXPENSE RATIO. (a) A contract to which
64	64	this subchapter applies must require that each provider agreement
65	65	between the contracting Medicaid managed care organization and a
66	66	nursing facility include a requirement that the facility comply
67	67	with the direct care expense ratio adopted under Section 32.0286,
68	68	Human Resources Code.
69	69	(b) This section does not apply to a state-owned facility.
70	70	SECTION 3. Section 242.032, Health and Safety Code, is
71	71	amended by adding Subsection (b-1) to read as follows:
72	72	(b-1) The application must:
73	73	(1) include the name of each person with a direct or
74	74	indirect ownership interest of five percent or more in:
75	75	(A) the nursing facility, including a subsidiary
76	76	or parent company of the facility; and
77	77	(B) the real property on which the nursing
78	78	facility is located, including any owner, common owner, tenant, or
79	79	sublessee; and
80	80	(2) describe the exact ownership interest of each of
81	81	those persons in relation to the facility or property.
82	82	SECTION 4. Subchapter B, Chapter 242, Health and Safety
83	83	Code, is amended by adding Section 242.0333 to read as follows:
84	84	Sec. 242.0333. NOTIFICATION OF CHANGE TO OWNERSHIP INTEREST
85	85	APPLICATION INFORMATION. A license holder shall notify the
86	86	commission, in the form and manner the commission requires, of any
87	87	change to the ownership interest application information provided
88	88	under Section 242.032(b-1).
89	89	SECTION 5. Section 32.028, Human Resources Code, is amended
90	90	by amending Subsection (i) and adding Subsection (i-1) to read as
91	91	follows:
92	92	(i) The executive commissioner shall ensure that rules
93	93	governing the incentives program described by Subsection (g)(1):
94	94	(1) provide that participation in the program by a
95	95	nursing facility is voluntary;
96	96	(2) do not impose on a nursing facility not
97	97	participating in the program a minimum spending requirement for
98	98	direct care staff wages and benefits;
99	99	(3) do not set a base rate for a nursing facility
100	100	participating in the program that is more than the base rate for a
101	101	nursing facility not participating in the program; [and]
102	102	(4) establish a funding process to provide incentives
103	103	for increasing direct care staff and direct care wages and benefits
104	104	in accordance with appropriations provided; and
105	105	(5) to the extent permitted by federal law, require
106	106	the commission to recoup all or part of an incentive payment if the
107	107	nursing facility fails to satisfy a program requirement.
108	108	(i-1) The commission shall prohibit a provider who is the
109	109	subject of the recoupment of an incentive payment under Subsection
110	110	(i)(5) from participating in the incentives program described by
111	111	Subsection (g)(1) for a period of not less than two consecutive
112	112	years following the date on which the recoupment occurs. The
113	113	commission shall publish and maintain on the commission's Internet
114	114	website a list of each provider prohibited from participating in
115	115	the incentives program under this subsection.
116	116	SECTION 6. Subchapter B, Chapter 32, Human Resources Code,
117	117	is amended by adding Section 32.0286 to read as follows:
118	118	Sec. 32.0286. ANNUAL DIRECT CARE EXPENSE RATIO FOR
119	119	REIMBURSEMENT OF CERTAIN NURSING FACILITY PROVIDERS. (a) In this
120	120	section, "direct care expense":
121	121	(1) includes an expense for:
122	122	(A) non-revenue generating support services,
123	123	such as laundry, housekeeping, dietary services, and nursing
124	124	administration;
125	125	(B) ancillary services, such as laboratory tests
126	126	and services, physical therapy services, occupational therapy
127	127	services, speech-language pathology services, or audiological
128	128	services; and
129	129	(C) program services, such as an adult day-care
130	130	program; and
131	131	(2) does not include an expense for:
132	132	(A) administrative costs other than nursing
133	133	administration;
134	134	(B) capital costs;
135	135	(C) debt service;
136	136	(D) taxes, other than sales and payroll taxes;
137	137	(E) capital depreciation;
138	138	(F) rental or lease payments; or
139	139	(G) financial services.
140	140	(b) Notwithstanding any other law, the executive
141	141	commissioner by rule shall establish an annual direct care expense
142	142	ratio, including a process for determining the ratio, applicable to
143	143	the reimbursement of nursing facility providers for providing
144	144	services to recipients under the medical assistance program. In
145	145	establishing the ratio, the executive commissioner shall require
146	146	that at least 80 percent of the portion of the medical assistance
147	147	reimbursement amount paid to a nursing facility that is
148	148	attributable to patient care expenses is spent on reasonable and
149	149	necessary direct care expenses.
150	150	(c) The executive commissioner shall adopt rules necessary
151	151	to ensure each nursing facility provider that participates in the
152	152	medical assistance program complies with the direct care expense
153	153	ratio adopted under this section.
154	154	(d) To the extent permitted by federal law, the commission
155	155	may recoup all or part of the reimbursement amounts paid to a
156	156	nursing facility that are subject to the direct care expense ratio
157	157	under this section if the facility fails to spend the reimbursement
158	158	amounts in accordance with the direct care expense ratio.
159	159	(e) The commission may not require a nursing facility to
160	160	comply with the direct care expense ratio as a condition of
161	161	participation in Medicaid.
162	162	(f) This section does not apply to a state-owned facility.
163	163	SECTION 7. (a) The Health and Human Services Commission
164	164	shall, in a contract between the commission and a managed care
165	165	organization under Chapter 540, Government Code, as effective April
166	166	1, 2025, that is entered into or renewed on or after the effective
167	167	date of this Act, require the managed care organization to comply
168	168	with Section 540.0283, Government Code, as added by this Act.
169	169	(b) The Health and Human Services Commission shall seek to
170	170	amend contracts entered into with managed care organizations under
171	171	Chapter 540, Government Code, as effective April 1, 2025, before
172	172	the effective date of this Act to require those managed care
173	173	organizations to comply with Section 540.0283, Government Code, as
174	174	added by this Act. To the extent of a conflict between that section
175	175	and a provision of a contract with a managed care organization
176	176	entered into before the effective date of this Act, the contract
177	177	provision prevails.
178	178	SECTION 8. If before implementing any provision of this Act
179	179	a state agency determines that a waiver or authorization from a
180	180	federal agency is necessary for implementation of that provision,
181	181	the agency affected by the provision shall request the waiver or
182	182	authorization and may delay implementing that provision until the
183	183	waiver or authorization is granted.
184	184	SECTION 9. This Act takes effect September 1, 2025.