BILL ANALYSIS |
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C.S.H.B. 2766 |
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By: Sheffield |
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Human Services |
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Committee Report (Substituted) |
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BACKGROUND AND PURPOSE
Interested parties have expressed a need to further improve the quality of care for long-term care facility residents and to provide funding to address a significant Medicaid reimbursement shortfall. C.S.H.B. 2766 seeks to create a reinvestment allowance for certain long-term care facilities.
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CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
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RULEMAKING AUTHORITY
It is the committee's opinion that rulemaking authority is expressly granted to the executive commissioner of the Health and Human Services Commission in SECTION 1 of this bill.
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ANALYSIS
C.S.H.B. 2766 amends the Health and Safety Code to require the Health and Human Services Commission (HHSC) to impose a reinvestment allowance on licensed convalescent and nursing facilities and related institutions, except for a state-owned veterans nursing facility. The bill requires the executive commissioner of HHSC to establish for each non-Medicare patient day, defined by the bill as a day on which the primary payer for a facility resident is not Medicare Part A or a Medicare Advantage or special needs plan, an amount for use in calculating the reinvestment allowance sufficient to produce annual revenues from all facilities not to exceed the maximum amount that may be assessed within the indirect guarantee threshold provided under federal regulations and requires HHSC to determine the amount using non-Medicare patient days and gross receipts, excluding specified revenue from nonresident care, reported to HHSC and covering a period of at least six months. The reinvestment allowance is the product of that amount multiplied by the number of a facility's non-Medicare patient days calculated by the facility under the bill's provisions, is payable monthly, and is in addition to other amounts imposed under applicable state law regarding convalescent and nursing facilities and related institutions.
C.S.H.B. 2766 prohibits a facility from listing the reinvestment allowance as a separate charge on a resident's billing statement or otherwise directly or indirectly attempting to charge the reinvestment allowance to a resident. The bill requires a facility to determine the number of non‑Medicare patient days for each calendar day and sets out the formula for making that determination. The bill requires HHSC to collect the reinvestment allowance and requires each facility, not later than the 25th day after the last day of a month, to file with HHSC a report stating the total non-Medicare patient days for the month and pay the reinvestment allowance.
C.S.H.B. 2766 establishes the nursing facility reinvestment allowance trust fund as a trust fund to be held by the comptroller of public accounts outside the state treasury and administered by HHSC as trustee. The bill requires interest and income from the trust fund's assets to be credited to and deposited into the fund and requires HHSC to remit the reinvestment allowance and federal matching dollars received by the state to the comptroller for deposit in the fund. The bill restricts HHSC use of money in the trust fund, including any federal matching funds, to paying any HHSC cost to develop and administer systems for managing the reinvestment allowance, reimbursing the Medicaid share of the reinvestment allowance as an allowable cost in the Medicaid daily rate, and increasing reimbursement rates paid under the state Medicaid program to facilities. The bill requires HHSC to allocate 50 percent of the money used to increase those reimbursement rates for increased reimbursement rate payments based on the total rating of the Centers for Medicare and Medicaid Services five-star quality rating system. The bill requires HHSC to devise a formula by which amounts received under the bill's provisions increase those reimbursement rates and sets out related provisions. The bill prohibits money in the trust fund from being used to expand Medicaid eligibility under the federal Patient Protection and Affordable Care Act. The bill requires HHSC, not later than January 1 of each year, to prepare and deliver to the governor, the lieutenant governor, and the speaker of the house of representatives a report relating to the status of the nursing facility reinvestment allowance program, sets out provisions relating to the contents of such a report, and requires the report to be posted on the HHSC website.
C.S.H.B. 2766 requires HHSC to stop collection of the reinvestment allowance if any of the bill's provisions or any procedures under those provisions are held invalid by a final court order that is not subject to appeal or if HHSC determines that the imposition of the reinvestment allowance and the expenditure of amounts collected will not entitle the state to receive federal matching funds under the Medicaid program. The bill requires HHSC to proportionally return to each facility any unspent money deposited to the credit of the trust fund not later than the 30th day after the date collection of the reinvestment allowance is stopped.
C.S.H.B. 2766 requires the executive commissioner to adopt rules to administer the bill's provisions, including rules related to imposing and collecting the reinvestment allowance. The bill caps an administrative penalty assessed for a violation of the bill's provisions at the greater of one-half of the amount of the facility's outstanding reinvestment allowance or $20,000 and establishes that such a penalty is in addition to the facility's outstanding reinvestment allowance. The bill authorizes the executive commissioner by rule to adopt a definition, a method of computation, or a rate that differs from those expressly provided by or expressly authorized by the bill to the extent the difference is necessary to accomplish the bill's purposes.
C.S.H.B. 2766 requires HHSC, not later than November 1, 2020, to prepare and deliver to the governor, the lieutenant governor, and the speaker of the house of representatives a report that assesses whether and to what degree payments associated with quality-based care are resulting in improvements to overall nursing home quality. The bill's provisions regarding the creation and administration of a reinvestment allowance expire August 31, 2021.
C.S.H.B. 2766 requires the executive commissioner to establish the amount of the initial reinvestment allowance as soon as practicable after the bill's effective date based on available revenue and patient day information. The amount of the initial reinvestment allowance remains in effect until HHSC obtains the information necessary to set the amount of the reinvestment allowance under the bill's provisions.
C.S.H.B. 2766 prohibits a reinvestment allowance from being imposed or collected until an amendment to the state Medicaid plan that increases the rates paid to licensed long-term care 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 those facilities have been compensated retroactively at the increased rate for services provided under the state Medicaid program for the period beginning with the bill's effective date. The bill requires HHSC to discontinue the reinvestment allowance if HHSC reduces Medicaid reimbursement rates below the rates in effect on September 1, 2017.
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EFFECTIVE DATE
On passage, or, if the bill does not receive the necessary vote, September 1, 2017.
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COMPARISON OF ORIGINAL AND SUBSTITUTE
While C.S.H.B. 2766 may differ from the original in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the introduced and committee substitute versions of the bill.
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