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78R3360 KLA-D
By: Janek S.B. No. 1672
A BILL TO BE ENTITLED
AN ACT
relating to reimbursements for and quality of care in nursing
facilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 32.021, Human Resources Code, is amended
by adding Subsections (q), (r), and (s) to read as follows:
(q) The department shall include in its contracts for the
delivery of medical assistance by nursing facilities clearly
defined minimum standards that relate directly to the quality of
care for residents of those facilities. The department shall
implement the recommendations made by the nursing facility quality
assurance team under Section 32.060 in establishing the standards.
The department shall include in each contract:
(1) specific performance measures by which the
department may evaluate the extent to which the nursing facility is
meeting the standards; and
(2) provisions that allow the department to terminate
the contract if the nursing facility is not meeting the standards.
(r) The department may not award a contract for the delivery
of medical assistance to a nursing facility that does not meet the
minimum standards that would be included in the contract as
required by Subsection (q). The department shall terminate a
contract for the delivery of medical assistance by a nursing
facility that does not meet or maintain the minimum standards
included in the contract in a manner consistent with the terms of
the contract.
(s) Not later than November 15 of each even-numbered year,
the department shall submit a report to the legislature regarding
nursing facilities that contract with the department to provide
medical assistance under this chapter and other facilities with
which the department was prohibited to contract as provided by
Subsection (r). The department may include the report required
under this section with the report made by the long-term care
legislative oversight committee as required by Section 242.654,
Health and Safety Code. The report must include:
(1) recommendations for improving the quality of
information provided to consumers about the facilities;
(2) the minimum standards and performance measures
included in the department's contracts with those facilities;
(3) the performance of the facilities with regard to
the minimum standards;
(4) the number of facilities with which the department
has terminated a contract or to which the department will not award
a contract because the facilities do not meet the minimum
standards; and
(5) the overall impact of the minimum standards on the
quality of care provided by the facilities, consumers' access to
facilities, and cost of care.
SECTION 2. Section 32.050, Human Resources Code, is
amended by adding Subsection (d) to read as follows:
(d) For a nursing facility service provided to an individual
who is eligible under the medical assistance program and Medicare,
the medical assistance program may not pay any portion of the
Medicare deductibles or coinsurance, and the nursing facility that
provided the service shall consider the amount paid by Medicare as
payment in full if the amount paid by Medicare is equal to or
exceeds the Medicaid reimbursement rate for a service.
SECTION 3. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.060 to read as follows:
Sec. 32.060. NURSING FACILITY QUALITY ASSURANCE TEAM. (a)
The nursing facility quality assurance team is established to make
recommendations to the department designed to promote high-quality
care for residents of nursing facilities.
(b) The team is composed of nine members appointed as
follows:
(1) two physicians with expertise in providing
long-term care, one to be appointed by the governor and one by the
lieutenant governor;
(2) one registered nurse with expertise in providing
long-term care, to be appointed by the speaker of the house of
representatives;
(3) three nursing facility advocates not affiliated
with the nursing facility industry, one to be appointed by the
governor, one by the lieutenant governor, and one by the speaker of
the house of representatives; and
(4) three representatives of the nursing facility
industry, one to be appointed by the governor, one by the lieutenant
governor, and one by the speaker of the house of representatives.
(c) The governor shall designate a member of the team to
serve as presiding officer. The members of the team shall elect any
other necessary officers.
(d) The team shall meet at the call of the presiding
officer.
(e) A member of the team serves at the will of the appointing
official.
(f) A member of the team may not receive compensation for
serving on the team but is entitled to reimbursement for travel
expenses incurred by the member while conducting the business of
the team as provided by the General Appropriations Act.
(g) The team shall:
(1) develop and recommend clearly defined minimum
standards to be included in contracts between the department and
nursing facilities for the delivery of medical assistance under
this chapter that are designed to:
(A) ensure that the care provided by nursing
facilities to residents who are recipients of medical assistance
meets or exceeds the minimum acceptable standard of care; and
(B) encourage nursing facilities to provide the
highest quality of care to those residents; and
(2) develop and recommend improvements to consumers'
access to information regarding the quality of care provided by
nursing facilities that contract with the department to provide
medical assistance, including improvements in:
(A) the types and amounts of information to which
consumers have access, such as expanding the types and amounts of
information available through the department's Internet website;
and
(B) the department's data systems that compile
nursing facilities' inspection or survey data and other data
relating to quality of care in nursing facilities.
(h) In developing minimum standards for contracts as
required by Subsection (g)(1), the team shall:
(1) study the risk factors identified by the Texas
Department of Insurance as contributing to lawsuits against
nursing facilities;
(2) consider for inclusion in the minimum standards:
(A) the practices the Texas Department of
Insurance recommends nursing facilities adopt to reduce the
likelihood of those lawsuits; and
(B) other standards designed to improve the
quality of care; and
(3) focus on a minimum number of critical standards
necessary to identify nursing facilities with poor quality services
that should not be awarded contracts for the delivery of medical
assistance.
(i) The department shall ensure the accuracy of information
provided to the team for use by the team in performing the team's
duties under this section. The Health and Human Services
Commission shall provide administrative support and resources to
the team and request additional administrative support and
resources from health and human services agencies as necessary.
SECTION 4. Subchapter K, Chapter 242, Health and Safety
Code, is amended by adding Section 242.406 to read as follows:
Sec. 242.406. GRANT PROGRAM FOR NURSING FACILITIES
PROVIDING QUALITY ENVIRONMENTS. (a) The department shall
establish a competitive grant program to pay part of the costs of a
project proposed by a nursing facility that is designed to improve
the quality of life for residents of the facility by providing:
(1) homelike environments for residents, including
providing opportunities for residents to engage in meaningful
activities such as gardening or other outdoor activities;
(2) direct care staff members who tailor care to the
individual needs of a resident and allow the resident and the
resident's family members to participate in the decision-making
process regarding that care;
(3) opportunities for residents to interact with
companion animals, children, family members, and other visitors
from the community; or
(4) other innovative programs designed to improve the
quality of residents' care.
(b) A project proposed by a nursing facility under
Subsection (a) must be designed to serve as a model of best
practices for the nursing facility industry.
(c) The department shall monitor the expenditure of grant
money to ensure that the money is being used for the intended
purpose.
(d) The department by rule shall establish guidelines for
the grant program, including guidelines that specify:
(1) the procedures for submitting a grant proposal;
(2) the criteria the department will follow in
evaluating the proposals; and
(3) the reports that a grant recipient must file to
allow the department and the industry to evaluate the feasibility
and success of the project.
(e) The department shall fund the grant program using
available resources attributable to the savings realized from
implementing Section 32.050(d), Human Resources Code.
(f) The department shall award each grant under a contract.
A contract may further detail:
(1) reports that the grant recipient must file; and
(2) monitoring of the project that the grant recipient
must allow.
(g) The department shall post a summary of best practices
under the grant program on its Internet site to serve as a model of
best practices for the industry. The department shall report to the
legislature regarding those best practices.
SECTION 5. (a) The Texas Department of Human Services
shall implement the recommendations for improving the quality of
nursing facility information provided to consumers that are made by
the nursing facility quality assurance team as required by Section
32.021, Human Resources Code, as added by this Act, not later than
September 1, 2004.
(b) Section 32.021(q), Human Resources Code, as added by
this Act, applies only to a contract for the delivery of medical
assistance by a nursing facility that is entered into or renewed on
or after May 1, 2004. A contract for the delivery of medical
assistance by a nursing facility entered into before that date is
governed by the law in effect on the date the contract was entered
into, and the former law is continued in effect for that purpose.
SECTION 6. (a) The governor, the lieutenant governor, and
the speaker of the house of representatives shall appoint the
members of the nursing facility quality assurance team established
under Section 32.060, Human Resources Code, as added by this Act,
not later than October 1, 2003.
(b) The nursing facility quality assurance team shall
develop and make the recommendations required by Section 32.060,
Human Resources Code, as added by this Act, not later than March 1,
2004.
SECTION 7. This Act takes effect September 1, 2003.