80R17801 MSE-D
 
  By: Rose, Herrero H.B. No. 3778
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the creation and administration of a quality assurance
  fee for nursing facilities; providing an administrative penalty.
         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. 242.701.  DEFINITIONS. In this subchapter:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Department" means the Department of Aging and
  Disability Services.
               (3)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
               (4)  "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. 242.702.  APPLICABILITY.  This subchapter does not
  apply to:
               (1)  a state-owned veterans' nursing facility; or
               (2)  an entity that provides on a single campus a
  combination of services, which may include independent living
  services, licensed assisted living services, or licensed nursing
  facility care services, and:
                     (A)  that operates under a continuing care
  retirement community certificate of authority issued by the Texas
  Department of Insurance; or
                     (B)  in which, during the previous 12 months, the
  combined patient days of service provided to independent living and
  assisted living residents, excluding services provided to persons
  occupying facility beds in a licensed nursing facility, exceeded
  the patient days of service provided to nursing facility residents.
         Sec. 242.703.  COMPUTING QUALITY ASSURANCE FEE. (a)  A
  quality assurance fee is imposed on each institution subject to
  this subchapter 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 242.704;
               (2)  is payable monthly; and
               (3)  is in addition to other fees imposed under this
  chapter.
         (b)  The commission shall establish a quality assurance fee
  for each patient day in an amount that will produce annual revenues
  of not more than 5.5 percent of the institution's total annual gross
  receipts in this state. The fee is subject to adjustment as
  necessary.  The amount of the quality assurance fee may vary
  according to the number of patient days provided by an institution
  as necessary to obtain a waiver under federal regulations at 42
  C.F.R. Section 433.68(e).
         (c)  The amount of the quality assurance fee must be
  determined using patient days and gross receipts:
               (1)  reported to the commission or to the department at
  the direction of the commission; and
               (2)  covering a period of at least six months.
         (d)  The quality assurance fee is an allowable cost for
  reimbursement under the state Medicaid program.
         (e)  A nursing facility may not list the quality assurance
  fee as a separate charge on a patient's or resident's billing
  statement or otherwise directly or indirectly attempt to charge the
  quality assurance fee to a patient or resident.
         Sec. 242.704.  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 plus the number of
  patients admitted that day less the number of patients discharged
  that day, except that a patient is included in the count under this
  subdivision if:
                     (A)  the patient is admitted and discharged on the
  same day; or
                     (B)  the patient is discharged that day because of
  the patient's death; and
               (2)  the number of beds that are on hold that day and
  that have been placed on hold for a period not to exceed three
  consecutive calendar days during which a patient is:
                     (A)  in the hospital; or
                     (B)  on therapeutic home leave.
         Sec. 242.705.  REPORTING AND COLLECTION. (a)  The
  commission or the department as directed by the executive
  commissioner shall collect the quality assurance fee.
         (b)  Each institution shall, not later than the 25th day
  after the last day of a month:
               (1)  file with the commission a report stating the
  total patient days for the month; and
               (2)  pay the quality assurance fee.
         Sec. 242.706.  RULES; ADMINISTRATIVE PENALTY. (a)  The
  executive commissioner shall adopt rules for the administration of
  this subchapter, including rules related to the imposition and
  collection of the quality assurance fee.
         (b)  The executive commissioner may adopt rules granting
  exceptions from the quality assurance fee, including an exception
  for units of service reimbursed through Medicare Part A, if the
  commission obtains all waivers necessary under federal law,
  including 42 C.F.R. Section 433.68(e).
         (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. 242.707.  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 shall be used to support or maintain an increase in Medicaid
  reimbursement for institutions.
         Sec. 242.708.  REIMBURSEMENT OF INSTITUTIONS. (a)  Subject
  to legislative appropriation, the 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 the institution's allowable expenses under
  the state Medicaid program; and
               (2)  increase reimbursement rates paid under the
  Medicaid program to institutions.
         (b)  The commission shall devise the formula by which amounts
  received under this subchapter increase the reimbursement rates
  paid to institutions under the state Medicaid program.
         Sec. 242.709.  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 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,
  not later than the 30th day after the date collection is stopped,
  shall return to the institutions that paid the fees, in proportion
  to the total amount paid by those institutions, any money deposited
  to the credit of the nursing home quality assurance fee account but
  not spent.
         Sec. 242.710.  REVISION IN CASE OF DISAPPROVAL.  If the
  Centers for Medicare and Medicaid Services disapproves the quality
  assurance fee plan established under this subchapter, the
  commission shall revise the associated state plan amendments and
  waiver requests as necessary to comply with federal regulations
  provided by 42 C.F.R. Section 433.68(e).  The revisions must be
  completed as soon as practicable after the date the commission
  receives notice of the disapproval.
         Sec. 242.711.  AUTHORITY TO ACCOMPLISH PURPOSES OF
  SUBCHAPTER.  The executive commissioner by rule may adopt a
  definition, a method of computation, or a rate that differs from
  those expressly provided by or expressly authorized by this
  subchapter to the extent the difference is necessary to accomplish
  the purposes of this subchapter.
         SECTION 2.  (a) Notwithstanding Section 242.703, Health and
  Safety Code, as added by this Act, the executive commissioner of the
  Health and Human Services Commission shall establish the initial
  quality assurance fee imposed under Subchapter P, Chapter 242,
  Health and Safety Code, as added by this Act, based on available
  revenue and patient day information. The initial 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 242.703, Health and Safety
  Code, as added by this Act.
         (b)  As soon as practicable after the effective date of this
  Act, the executive commissioner of 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 3.  Notwithstanding any other provision of law, a
  quality assurance fee may not be imposed under Section 242.703,
  Health and Safety Code, as added by this Act, or collected under
  Section 242.705, Health and Safety Code, as added by this Act,
  until:
               (1)  the amendment to the state plan for Medicaid that
  increases the rates paid to the nursing facilities for providing
  services under the state Medicaid program is approved by the
  Centers for Medicare and Medicaid Services or another applicable
  federal government agency; and
               (2)  nursing facilities have been compensated
  retroactively at the increased rate for services provided under the
  state Medicaid program for the period beginning with the effective
  date of this Act.
         SECTION 4.  This Act takes effect September 1, 2007.