By: Brimer S.B. No. 1481

(In the Senate - Filed March 8, 2007; March 20, 2007, read first time and referred to Committee on Health and Human Services; May 4, 2007, reported adversely, with favorable Committee Substitute by the following vote: Yeas 9, Nays 0; May 4, 2007, sent to printer.)

COMMITTEE SUBSTITUTE FOR S.B. No. 1481 By: Deuell

A BILL TO BE ENTITLED

AN ACT

relating to payments to nursing facilities based on TILE classifications assigned to residents of those facilities.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subchapter B, Chapter 531, Government Code, is amended by adding Sections 531.099 and 531.0991 to read as follows:

Sec. 531.099. TILE REIMBURSEMENT PAYMENTS. (a) In this section, "TILE classification" means the classification assigned under the Texas Index for Level of Effort classification system to a nursing facility resident that quantifies the intensity of the care needs of the resident and determines the daily reimbursement rate for that care.

(b) The commission shall ensure that the rules governing reimbursement payments to nursing facilities based on TILE classifications:

(1) do not deny or reduce payments to a nursing facility as a result of a clerical, technical, or nonmedical error made on a commission claims form, including a missing signature, date, or license number, in cases in which medically necessary care was provided by the nursing facility and reimbursement is supported by the facility's level of effort;

(2) provide that a payment may not be recouped or withheld from a nursing facility until the earlier of:

(A) the date all administrative appeals are exhausted or waived;

(B) the date the executive commissioner issues a final order following a proposal for decision from the State Office of Administrative Hearings; or

(C) the first anniversary of the date the nursing facility filed the administrative appeal of the TILE classification determination; and

(3) permit a nursing facility to identify documentation errors related to reimbursement payments based on TILE classifications and provide a process by which the nursing facility may refund any money that was inappropriately paid as a result of an identified documentation error.

Sec. 531.0991. RECONSIDERATION OF TILE CLASSIFICATION. (a) In this section, "TILE classification" has the meaning assigned by Section 531.099.

(b) If a nursing facility or hospice provider disagrees with the commission's TILE classification of a nursing facility resident and submits a reconsideration request for that classification as provided by commission rules, the commission shall review and make a determination on the request not later than the 30th day after the date the commission receives the request.

(c) If the commission does not make a determination on a reconsideration request during the period required by Subsection (b), the TILE classification requested by the nursing facility or hospice provider for the nursing facility resident is considered granted, and that TILE classification and the associated daily reimbursement rate is assigned to the resident retroactively to the effective date of the incorrect TILE classification.

SECTION 2. Section 531.0991, Government Code, as added by this Act, applies to a reimbursement reconsideration request submitted by a nursing facility on or after the effective date of this Act.

SECTION 3. If before implementing any provision of this Act a state agency determines that 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 September 1, 2007.

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