80R8629 MSE-D

By: Rose 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) a continuing care retirement community.

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 six 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 allowable expenses under the state Medicaid program; or

(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. This Act takes effect September 1, 2007.