CLC C.S.H.B. 606 75(R)BILL ANALYSIS HUMAN SERVICES C.S.H.B. 606 By: Zbranek 3-17-97 Committee Report (Substituted) BACKGROUND This bill would allow the Department of Human Services (D.H.S.) to consider the construction of an additional nursing facility in rural counties with not more than two licensed Medicaid-bed facilities, regardless of the status of the current occupancy rate. Rural counties with only one nursing facility may have certain factors that need to be considered. These criteria can be best determined at the local level. The moratorium which addresses occupancy rates is very restrictive and overlooks local factors that should be considered when the need for additional facilities arises. In order to balance the local interests with the business and commerce goals of all concerned, this bill directs D.H.S. to consider contracting for nursing home beds under the State's Medicaid program with an additional nursing facility at the request of the county commissioners court. A rider in the Appropriations Act provides that if the occupancy rate for all of the nursing homes in a county for each of the previous six months is 85% or more, only then can D.H.S. contract for additional Medicaid beds in that county. Some rural counties have only one or two nursing facilities which hold the license for all the Medicaid beds in that county because the moratorium prohibits the construction of new licensed Medicaid-bed nursing facilities. In rural counties, this scenario severely limits competition. Factors may exist in the currently licensed facilities which artificially hold the occupancy rate under the 85% threshold; therefore, an additional facility may not be requested under current law. The quality of care, the physical condition of the current nursing facility, and the lack of credible space in the current nursing facility to actually accommodate all of the beds for which it is licensed are just some of the intrinsic problems. In summary, there is a need for rural counties with two or less licensed Medicaid-bed facilities to request that D.H.S. contract for additional nursing home beds under the State's Medicaid Program with an additional nursing facility. Due to time constraints, financial obligations, children's issues, employment responsibilities, and other demands placed upon families, nursing home facilities need to be located in closer proximity to families. The average nursing home resident is a widow over 80, and the average age of a nursing home resident is about 80 years of age. About 50% of nursing home residents have no close relatives, and approximately 60% of nursing home residents never have visitors. In addition, if living, the spouse of a resident may be in poor health, quite elderly, and may have only limited resources. Therefore, a nursing facility 30-50 miles away not only puts a financial and physical strain upon family members, but it is also not conducive to daily visits to the nursing home resident. If more families were able to visit and to monitor nursing home residents, the quality of care would improve. PURPOSE This bill proposes to allow a commissioners court of a rural county with two or fewer licensed Medicaid-bed nursing facilities to request the Department of Human Services to grant a waiver to allow another licensed Medicaid nursing facility in that county regardless of the occupancy rate. RULE MAKING AUTHORITY It is the committee's opinion that this bill does not expressly grant any additional RULE MAKING authority to a state officer, department, agency or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter B, Chapter 32 of the Human Resources Code by adding a new section, 32.0246. (a) This section would allow counties with not more than two nursing home facilities certified to participate in the state Medicaid program to request that the Department of Human Services grant a waiver for the department to contract with additional nursing home beds under Medicaid in that county, regardless of the occupancy rate of the Medicaid beds in that county and with in the limits set up in Section 1(d). (b) A notice of intent requesting comments and proposals from interested persons shall be published by the commissioners court that intends to make a request under subsection (a). The notice shall be published in the Texas Register and in a newspaper of general circulation in the county. (c) A commissioners court shall determine whether to proceed with a request based on the following considerations: (1) the demographic and economic needs of a county; (2) the quality of existing nursing facility services under the state Medicaid program in the county; (3) the quality of the proposals submitted; and (4) the degree on community support. (d) The department may not contract for more than 500 additional nursing home beds per calendar year under this section. SECTION 2. Allows the Department of Human Services to delay implementation of this act if it is necessary to receive authorization from a federal agency. SECTION 3. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE 1)SECTION 1. Sec. 32.0246. (a) Language was modified to include, in this provision, counties with no more than two (rather than one) nursing facilities certified to participate in the state Medicaid program. 2)SECTION 1. Sec. 32.0246. (a) Language was also modified to indicate that the department "may contract" (rather than "shall contract") for additional nursing home beds without regard to occupancy rate. 3)SECTION 1. Sec. 32.0246. (b) In the Committee Substitute, the department is no longer required to contract with entities that do not meet certification requirements; therefore, the language in HB 606 was unnecessary. 4)SECTION 1. Sec. 32.0246. (b) Language was added to require the county commissioners court to publish notice of its intent to make a request in the Texas Register and a local newspaper in the county. CSHB 606 also now requires the above notice to include a request for comments. 5) SECTION 1.Sec. 32.0246. (c) Language was added to require the commissioners court to determine, following the consideration of the comments requested in item 4) above, whether or not to proceed with the request. If it proceeds, the court may recommend contracting with a particular nursing facility. Further, language is added that outlines four considerations that must be made by the court. 6)SECTION 1.Sec. 32.0246. (d) The section was added to prohibit the department from contracting for more than 500 additional beds per year.