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79R2120 JJT-D
By: Isett H.B. No. 2499
A BILL TO BE ENTITLED
AN ACT
relating to the imposition of quality assurance fees for nursing
homes and intermediate care facilities for persons with mental
retardation.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 242, Health and Safety Code, is amended
by adding Subchapter P to read as follows:
SUBCHAPTER P. QUALITY ASSURANCE FEE
Sec. 242.801. 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 an institution.
Sec. 242.802. COMPUTING QUALITY ASSURANCE FEE. (a) A
quality assurance fee is imposed on each institution for which a
license fee must be paid under Section 242.034. The quality
assurance fee:
(1) is an amount established under Subsection (b)
multiplied by the number of patient days as determined in
accordance with Section 242.803;
(2) is payable monthly; and
(3) is in addition to other fees imposed under this
chapter.
(b) The Health and Human Services Commission shall
establish a 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 institution'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 state Medicaid program.
Sec. 242.803. PATIENT DAYS. For each calendar day, an
institution shall determine the number of patient days by adding
the following:
(1) the number of patients occupying an institution
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 the
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. 242.804. REPORTING AND COLLECTION. (a) The Health
and Human Services Commission shall collect the quality assurance
fee.
(b) Each institution shall:
(1) not later than the 10th day after the last day of a
month file with the Health and Human Services Commission a report
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. 242.805. 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 unless
the commission obtains any waiver necessary under federal law,
including 42 C.F.R. Section 433.68(e)(1).
(c) An administrative penalty assessed under this
subchapter in accordance with Section 242.066 may not exceed
one-half of the amount of the outstanding quality assurance fee or
$20,000, whichever is greater.
Sec. 242.806. NURSING HOME QUALITY ASSURANCE FEE ACCOUNT.
(a) The nursing home quality assurance fee account is a dedicated
account in the general revenue fund. Interest earned on money in
the account shall be credited to the account.
(b) The comptroller shall deposit money collected under
this subchapter to the credit of the account.
(c) Subject to legislative appropriation and this
subchapter, money in the account together with federal matching
money may be used to support or maintain an increase in Medicaid
reimbursement for institutions.
Sec. 242.807. REIMBURSEMENT OF INSTITUTIONS. (a) Subject
to legislative appropriation, the Health and Human Services
Commission may use money in the nursing home quality assurance fee
account, together with any federal money available to match that
money, to:
(1) offset allowable expenses under the state Medicaid
program; or
(2) increase reimbursement rates paid under the
Medicaid program to institutions.
(b) The Health and Human Services Commission shall devise
the formula by which amounts received under this section increase
the reimbursement rates paid to institutions under the state
Medicaid program.
(c) The Health and Human Services Commission shall ensure
that the formula devised under Subsection (b) provides incentives
for institutions to increase direct care staffing and direct care
wages and benefits.
Sec. 242.808. 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 institutions that paid the
fees in proportion to the total amount paid by those institutions.
SECTION 2. Section 252.209, Health and Safety Code, is
repealed.
SECTION 3. (a) Notwithstanding Section 242.802, Health and
Safety Code, as added by this Act, the quality assurance fee imposed
under Subchapter P, Chapter 242, Health and Safety Code, as added by
this Act, that is effective for the first month following the
effective date of this Act is equal to $6.15 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 obtains the
information necessary to set the fee under Section 242.802, Health
and Safety Code, as added by this Act.
(b) 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 P, Chapter 242, Health and Safety
Code, as added by this Act.
(c) If before implementing any provision of this Act 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.
SECTION 4. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2005.