Texas 2025 - 89th Regular

Texas Senate Bill SB457 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	By: Kolkhorst, et al. S.B. No. 457
	1	+	By: Kolkhorst S.B. No. 457
	2	+	(In the Senate - Filed November 21, 2024; February 3, 2025,
	3	+	read first time and referred to Committee on Health & Human
	4	+	Services; April 28, 2025, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 9, Nays 0;
	6	+	April 28, 2025, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 457 By: Hancock
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6	13		A BILL TO BE ENTITLED
7	14		AN ACT
8	15		relating to the regulation of certain nursing facilities, including
9	16		licensing requirements and Medicaid participation and
10	17		reimbursement requirements.
11	18		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	19		SECTION 1. Section 540.0752(b), Government Code, is amended
13	20		to read as follows:
14	21		(b) Subject to Section 540.0701 and notwithstanding any
15	22		other law, the commission shall provide Medicaid benefits through
16	23		the STAR+PLUS Medicaid managed care program to recipients who
17	24		reside in nursing facilities. In implementing this subsection, the
18	25		commission shall ensure that:
19	26		(1) a nursing facility is paid not later than the 10th
20	27		day after the date the facility submits a clean claim;
21	28		(1-a) a nursing facility complies with the patient care
22	29		expense ratio adopted under Section 32.0286, Human Resources Code;
23	30		(2) services are used appropriately, consistent with
24	31		criteria the commission establishes;
25	32		(3) the incidence of potentially preventable events
26	33		and unnecessary institutionalizations is reduced;
27	34		(4) a Medicaid managed care organization providing
28	35		services under the program:
29	36		(A) provides discharge planning, transitional
30	37		care, and other education programs to physicians and hospitals
31	38		regarding all available long-term care settings;
32	39		(B) assists in collecting applied income from
33	40		recipients; and
34	41		(C) provides payment incentives to nursing
35	42		facility providers that:
36	43		(i) reward reductions in preventable acute
37	44		care costs; and
38	45		(ii) encourage transformative efforts in
39	46		the delivery of nursing facility services, including efforts to
40	47		promote a resident-centered care culture through facility design
41	48		and services provided;
42	49		(5) a portal is established that complies with state
43	50		and federal regulations, including standard coding requirements,
44	51		through which nursing facility providers participating in the
45	52		program may submit claims to any participating Medicaid managed
46	53		care organization;
47	54		(6) rules and procedures relating to certifying and
48	55		decertifying nursing facility beds under Medicaid are not affected;
49	56		and
50	57		(7) a Medicaid managed care organization providing
51	58		services under the program, to the greatest extent possible, offers
52	59		nursing facility providers access to:
53	60		(A) acute care professionals; and
54	61		(B) telemedicine, when feasible and in
55	62		accordance with state law, including rules adopted by the Texas
56	63		Medical Board[; and
57	64		[(8) the commission approves the staff rate
58	65		enhancement methodology for the staff rate enhancement paid to a
59	66		nursing facility that qualifies for the enhancement under the
60	67		program].
61	68		SECTION 2. Subchapter F, Chapter 540, Government Code, is
62	69		amended by adding Section 540.0283 to read as follows:
63	70		Sec. 540.0283. NURSING FACILITY PROVIDER AGREEMENTS:
64	71		COMPLIANCE WITH PATIENT CARE EXPENSE RATIO. (a) A contract to
65	72		which this subchapter applies must require that each provider
66	73		agreement between the contracting Medicaid managed care
67	74		organization and a nursing facility include a requirement that the
68	75		facility comply with the patient care expense ratio adopted under
69	76		Section 32.0286, Human Resources Code.
70	77		(b) This section does not apply to a state-owned facility.
71	78		SECTION 3. Section 242.032, Health and Safety Code, is
72	79		amended by adding Subsection (b-1) to read as follows:
73	80		(b-1) The application must:
74	81		(1) include the name of each person with a direct or
75	82		indirect ownership interest of five percent or more in:
76	83		(A) the nursing facility, including a subsidiary
77	84		or parent company of the facility; and
78	85		(B) the real property on which the nursing
79	86		facility is located, including any owner, common owner, tenant, or
80	87		sublessee; and
81	88		(2) describe the exact ownership interest of each of
82	89		those persons in relation to the facility or property.
83	90		SECTION 4. Subchapter B, Chapter 242, Health and Safety
84	91		Code, is amended by adding Section 242.0333 to read as follows:
85	92		Sec. 242.0333. NOTIFICATION OF CHANGE TO OWNERSHIP INTEREST
86	93		APPLICATION INFORMATION. A license holder shall notify the
87	94		commission, in the form and manner the commission requires, of any
88	95		change to the ownership interest application information provided
89	96		under Section 242.032(b-1).
90	97		SECTION 5. Subchapter B, Chapter 32, Human Resources Code,
91	98		is amended by adding Section 32.0286 to read as follows:
92	99		Sec. 32.0286. ANNUAL PATIENT CARE EXPENSE RATIO FOR
93	100		REIMBURSEMENT OF CERTAIN NURSING FACILITY PROVIDERS. (a) In this
94	101		section, "patient care expense":
95	102		(1) includes an expense incurred by a nursing facility
96	103		for:
97	104		(A) providing compensation and benefits to:
98	105		(i) direct care staff of a facility,
99	106		whether the staff are employees of or contract labor for the
100	107		facility, including:
101	108		(a) licensed registered nurses and
102	109		licensed vocational nurses, including directors of nursing and
103	110		assistant directors of nursing;
104	111		(b) medication aides;
105	112		(c) restorative aides;
106	113		(d) nurse aides who provide
107	114		nursing-related care to residents occupying medical assistance
108	115		beds;
109	116		(e) licensed social workers; and
110	117		(f) social services assistants;
111	118		(ii) additional staff associated with
112	119		providing care to facility residents with a severe cognitive
113	120		impairment;
114	121		(iii) nonprofessional administrative
115	122		staff, including medical records staff and accounting or
116	123		bookkeeping staff;
117	124		(iv) central supply staff and ancillary
118	125		facility staff;
119	126		(v) laundry staff; and
120	127		(vi) food service staff;
121	128		(B) central supply costs and ancillary costs for
122	129		facility services and supplies, including:
123	130		(i) diagnostic laboratory and radiology
124	131		costs;
125	132		(ii) durable medical equipment costs,
126	133		including costs to purchase, rent, or lease the equipment;
127	134		(iii) costs for oxygen used to provide
128	135		oxygen treatment;
129	136		(iv) prescription and nonprescription drug
130	137		costs; and
131	138		(v) therapy consultant costs; and
132	139		(C) costs for dietary and nutrition services,
133	140		including costs for:
134	141		(i) food service and related supplies; and
135	142		(ii) nutritionist services; and
136	143		(2) does not include an expense for:
137	144		(A) administrative or operational costs, other
138	145		than administrative or operational costs described by Subdivision
139	146		(1); or
140	147		(B) fixed capital asset costs.
141	148		(b) The executive commissioner by rule shall establish an
142	149		annual patient care expense ratio, including a process for
143	150		determining the ratio, applicable to the reimbursement of nursing
144	151		facility providers for providing services to recipients under the
145	152		medical assistance program. In establishing the ratio, the
146	153		executive commissioner shall require that at least 85 percent of
147	154		the portion of the medical assistance reimbursement amount paid to
148	155		a nursing facility that is attributable to patient care expenses is
149	156		spent on reasonable and necessary patient care expenses.
150	157		(c) The executive commissioner shall adopt rules necessary
151	158		to ensure each nursing facility provider that participates in the
152	159		medical assistance program complies with the patient care expense
153	160		ratio adopted under this section.
154	161		(d) Except as provided by Subsection (e) and to the extent
155	162		permitted by federal law, the commission may recoup all or part of
156	163		the medical assistance reimbursement amount paid to a nursing
157	164		facility that is subject to the patient care expense ratio under
158	165		this section if the facility fails to spend the reimbursement
159	166		amount in accordance with the patient care expense ratio.
160	167		(e) The commission may not recoup a medical assistance
161	168		reimbursement amount under Subsection (d) if, during the period
162	169		patient care expenses attributable to the reimbursement amount are
163	170		calculated, the facility:
164	171		(1) held at least a four-star rating under the Centers
165	172		for Medicare and Medicaid Services five-star quality rating system
166	173		for nursing facilities in two or more of the following categories:
167	174		(A) overall;
168	175		(B) health inspections;
169	176		(C) staffing; and
170	177		(D) long-stay quality measures;
171	178		(2) both:
172	179		(A) maintained an average daily occupancy rate of
173	180		75 percent or less; and
174	181		(B) spent at least 70 percent of the portion of
175	182		the reimbursement amount paid to the facility that was attributable
176	183		to patient care expenses on reasonable and necessary patient care
177	184		expenses; or
178	185		(3) incurred expenses related to a disaster for which
179	186		the governor issued a disaster declaration under Chapter 418,
180	187		Government Code.
181	188		(f) The commission shall publish and maintain on the
182	189		commission's Internet website a list of all nursing facilities from
183	190		which the commission recouped medical assistance reimbursement
184	191		amounts under Subsection (d).
185	192		(g) The commission may not require a nursing facility to
186	193		comply with the patient care expense ratio as a condition of
187	194		participation in the medical assistance program.
188	195		(h) This section does not apply to a state-owned facility.
189	196		SECTION 6. Sections 32.028(g), (i), and (m), Human
190	197		Resources Code, are repealed.
191	198		SECTION 7. (a) The Health and Human Services Commission
192	199		shall, subject to this section, require compliance with the initial
193	200		annual patient care expense ratio adopted under Section 32.0286,
194	201		Human Resources Code, as added by this Act, beginning on September
195	202		1, 2025.
196	203		(b) The Health and Human Services Commission shall, in a
197	204		contract between the commission and a managed care organization
198	205		under Chapter 540, Government Code, that is entered into or renewed
199	206		on or after the effective date of this Act, require the managed care
200	207		organization to comply with Section 540.0283, Government Code, as
201	208		added by this Act.
202	209		(c) The Health and Human Services Commission shall seek to
203	210		amend contracts entered into with managed care organizations under
204	211		Chapter 533 or 540, Government Code, before the effective date of
205	212		this Act to require those managed care organizations to comply with
206	213		Section 540.0283, Government Code, as added by this Act. To the
207	214		extent of a conflict between that section and a provision of a
208	215		contract with a managed care organization entered into before the
209	216		effective date of this Act, the contract provision prevails.
210	217		SECTION 8. Not later than November 1, 2027, the Health and
211	218		Human Services Commission shall prepare and submit to the
212	219		legislature a written report that includes an assessment of the
213	220		impact of the patient care expense ratio established under Section
214	221		32.0286, Human Resources Code, as added by this Act, on nursing
215	222		facility care provided to Medicaid recipients during the preceding
216	223		state fiscal biennium, including the impact on the cost and quality
217	224		of care and any other information the commission determines
218	225		appropriate.
219	226		SECTION 9. If before implementing any provision of this Act
220	227		a state agency determines that a waiver or authorization from a
221	228		federal agency is necessary for implementation of that provision,
222	229		the agency affected by the provision shall request the waiver or
223	230		authorization and may delay implementing that provision until the
224	231		waiver or authorization is granted.
225	232		SECTION 10. This Act takes effect September 1, 2025.
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