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A BILL TO BE ENTITLED
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AN ACT
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relating to payments to nursing facilities based on TILE |
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classifications assigned to residents of those facilities. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Sections 531.099 and 531.0991 to read as follows: |
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Sec. 531.099. TILE REIMBURSEMENT PAYMENTS. (a) In this |
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section, "TILE classification" means the classification assigned |
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under the Texas Index for Level of Effort classification system to a |
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nursing facility resident that quantifies the intensity of the care |
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needs of the resident and determines the daily reimbursement rate |
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for that care. |
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(b) The commission shall ensure that the rules governing |
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reimbursement payments to nursing facilities based on TILE |
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classifications: |
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(1) do not deny or reduce payments to a nursing |
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facility as a result of a clerical, technical, or nonmedical error |
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made on a commission claims form, including a missing signature, |
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date, or license number, in cases in which medically necessary care |
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was provided by the nursing facility and reimbursement is supported |
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by the facility's level of effort; |
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(2) provide that a payment may not be recouped or |
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withheld from a nursing facility until the earlier of: |
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(A) the date all administrative appeals are |
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exhausted or waived; |
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(B) the date the executive commissioner issues a |
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final order following a proposal for decision from the State Office |
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of Administrative Hearings; or |
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(C) the first anniversary of the date the nursing |
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facility filed the administrative appeal of the TILE classification |
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determination; and |
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(3) permit a nursing facility to identify |
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documentation errors related to reimbursement payments based on |
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TILE classifications and provide a process by which the nursing |
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facility may refund any money that was inappropriately paid as a |
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result of an identified documentation error. |
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Sec. 531.0991. RECONSIDERATION OF TILE CLASSIFICATION. |
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(a) In this section, "TILE classification" has the meaning |
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assigned by Section 531.099. |
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(b) If a nursing facility or hospice provider disagrees with |
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the commission's TILE classification of a nursing facility resident |
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and submits a reconsideration request for that classification as |
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provided by commission rules, the commission shall review and make |
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a determination on the request not later than the 30th day after the |
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date the commission receives the request. |
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(c) If the commission does not make a determination on a |
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reconsideration request during the period required by Subsection |
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(b), the TILE classification requested by the nursing facility or |
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hospice provider for the nursing facility resident is considered |
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granted, and that TILE classification and the associated daily |
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reimbursement rate is assigned to the resident retroactively to the |
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effective date of the incorrect TILE classification. |
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SECTION 2. Section 531.0991, Government Code, as added by |
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this Act, applies to a reimbursement reconsideration request |
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submitted by a nursing facility on or after the effective date of |
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this Act. |
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SECTION 3. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 4. This Act takes effect September 1, 2007. |
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