Amend SB 1839 (senate engrossment) as follows:
(1) Strike Article 9 of the bill (page 37, line 5, through
page 42, line 6), and substitute the following:
ARTICLE 9. QUALITY ASSURANCE FEE
SECTION 9.01. Chapter 252, Health and Safety Code, is
amended by adding Subchapter H to read as follows:
SUBCHAPTER H. QUALITY ASSURANCE FEE
Sec. 252.201. DEFINITION. In this subchapter, "gross
receipts" means money paid as compensation for services provided to
residents, including client participation. The term does not
include charitable contributions to a facility.
Sec. 252.202. COMPUTING QUALITY ASSURANCE FEE. (a) A
quality assurance fee is imposed on each facility for which a
license fee must be paid under Section 252.034. The fee:
(1) is an amount established under Subsection (b)
multiplied by the number of patient days as determined in
accordance with Section 252.203;
(2) is payable monthly; and
(3) is in addition to other fees imposed under this
chapter.
(b) The Health and Human Services Commission or the
department at the direction of the commission shall set the quality
assurance fee for each day in the amount necessary to produce
annual revenues equal to an amount that is not more than six
percent of the facility's total annual gross receipts in this
state. The fee is subject to a prospective adjustment as
necessary.
(c) The amount of the quality assurance fee must be
determined using patient days and gross receipts reported to the
department and covering a period of at least six months.
(d) The quality assurance fee is an allowable cost for
reimbursement under the Medicaid program.
Sec. 252.203. PATIENT DAYS. For each calendar day, a
facility shall determine the number of patient days by adding the
following:
(1) the number of patients occupying a facility bed
immediately before midnight of that day;
(2) the number of beds that are on hold on that day
and that have been placed on hold for a period not to exceed three
consecutive calendar days during which a patient is in a hospital;
and
(3) the number of beds that are on hold on that day
and that have been placed on hold for a period not to exceed three
consecutive calendar days during which a patient is on therapeutic
home leave.
Sec. 252.204. REPORTING AND COLLECTION. (a) The Health and
Human Services Commission or the department at the direction of the
commission shall collect the quality assurance fee.
(b) Each facility shall:
(1) not later than the 10th day after the last day of
a month file a report with the Health and Human Services Commission
or the department, as appropriate, stating the total patient days
for the month; and
(2) not later than the 30th day after the last day of
the month pay the quality assurance fee.
Sec. 252.205. RULES; ADMINISTRATIVE PENALTY. (a) The Health
and Human Services Commission shall adopt rules for the
administration of this subchapter, including rules related to the
imposition and collection of the quality assurance fee.
(b) The Health and Human Services Commission may not adopt
rules granting any exceptions from the quality assurance fee.
(c) An administrative penalty assessed under this subchapter
in accordance with Section 252.065 may not exceed one-half of the
amount of the outstanding quality assurance fee or $20,000,
whichever is greater.
Sec. 252.206. QUALITY ASSURANCE FUND. (a) The quality
assurance fund is a fund outside the state treasury held by the
Texas Treasury Safekeeping Trust Company. Notwithstanding any
other law, the comptroller shall deposit fees collected under this
subchapter to the credit of the fund.
(b) The quality assurance fund is composed of:
(1) fees deposited to the credit of the fund under
this subchapter; and
(2) the earnings of the fund.
(c) Money deposited to the quality assurance fund remains
the property of the fund and may be used only for the purposes of
this subchapter.
(d) Subject to legislative appropriation and this
subchapter, quality assurance fees collected under this subchapter,
combined with federal matching funds, will support or maintain an
increase in Medicaid reimbursement for facilities.
Sec. 252.207. REIMBURSEMENT OF FACILITIES. (a) The Health
and Human Services Commission shall use money in the quality
assurance fund, together with any federal money available to match
that money, to:
(1) offset allowable expenses under the Medicaid
program; or
(2) increase reimbursement rates paid under the
Medicaid program to facilities.
(b) The Health and Human Services Commission or the
department at the direction of the commission shall devise the
formula by which amounts received under this section increase the
reimbursement rates paid to facilities under the Medicaid program.
(c) The Health and Human Services Commission shall ensure
that the formula devised under Subsection (b) provides incentives
for facilities to increase direct care staffing and direct care
wages and benefits.
Sec. 252.208. INVALIDITY; FEDERAL FUNDS. If any portion of
this subchapter is held invalid by a final order of a court that is
not subject to appeal, or if the Health and Human Services
Commission determines that the imposition of the fee and the
expenditure as prescribed by this subchapter of amounts collected
will not entitle the state to receive additional federal funds
under the Medicaid program, the commission shall stop collection of
the quality assurance fee and shall return, not later than the 30th
day after the date collection is stopped, any money collected, but
not spent, under this subchapter to the facilities that paid the
fees in proportion to the total amount paid by those facilities.
Sec. 252.209. LEGISLATIVE REVIEW; EXPIRATION. The 79th
Legislature shall review the operation and effectiveness of this
subchapter. Unless continued in effect by the 79th Legislature,
this subchapter expires September 1, 2005.
SECTION 9.02. Notwithstanding Section 252.202, Health and
Safety Code, as added by this article, the quality assurance fee
imposed under Subchapter H, Chapter 252, Health and Safety Code, as
added by this article, that is effective for the first month
following the effective date of this Act is equal to $5.25
multiplied by the number of patient days as determined under that
subchapter. The quality assurance fee established under this
section remains in effect until the Health and Human Services
Commission, or the Texas Department of Human Services at the
direction of the commission, obtains the information necessary to
set the fee under Section 252.202, Health and Safety Code, as added
by this article.
SECTION 9.03. As soon as practicable after the effective date
of this Act, the Health and Human Services Commission shall adopt
rules as necessary to implement Subchapter H, Chapter 252, Health
and Safety Code, as added by this article.
SECTION 9.04. If before implementing any provision of this
article a state agency determines 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.
(2) In SECTION 11.01 of the bill, in Subdivision (10) (page
44, lines 18 and 19), strike "nursing homes, as described by
Subchapter Q, Chapter 242" and substitute "intermediate care
facilities for the mentally retarded, as described by Subchapter H,
Chapter 252".