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A BILL TO BE ENTITLED
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AN ACT
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relating to the creation and administration of a reinvestment |
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allowance for certain long-term care facilities. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 242, Health and Safety Code, is amended |
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by adding Subchapter P to read as follows: |
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SUBCHAPTER P. REINVESTMENT ALLOWANCE |
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Sec. 242.701. DEFINITION. In this subchapter, "gross |
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receipts" means the gross inpatient revenue received by a facility |
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from services provided to facility residents. Gross receipts |
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exclude revenue from nonresident care, including beauty and barber |
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services, vending facilities, interest, charitable contributions, |
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the sale of meals, and outpatient services. |
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Sec. 242.702. REINVESTMENT ALLOWANCE; COMPUTATION. (a) |
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The commission shall impose a reinvestment allowance on each |
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facility licensed under this chapter. The reinvestment allowance |
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is: |
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(1) the product of the amount established under |
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Subsection (b) multiplied by the number of a facility's |
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non-Medicare patient days calculated under Section 242.703; |
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(2) payable monthly; and |
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(3) in addition to other amounts imposed under this |
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chapter. |
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(b) The executive commissioner shall establish for each |
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non-Medicare patient day an amount for use in calculating the |
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reinvestment allowance sufficient to produce annual revenues from |
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all facilities not to exceed the maximum amount that may be assessed |
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within the indirect guarantee threshold provided under 42 C.F.R. |
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Section 433.68(f)(3)(i). |
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(c) The commission shall determine the amount described by |
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Subsection (b) using non-Medicare patient days and gross receipts: |
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(1) reported to the commission; and |
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(2) covering a period of at least six months. |
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(d) A facility may not list the reinvestment allowance as a |
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separate charge on a resident's billing statement or otherwise |
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directly or indirectly attempt to charge the reinvestment allowance |
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to a resident. |
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Sec. 242.703. PATIENT DAYS. For each calendar day, a |
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facility shall determine the number of non-Medicare patient days by |
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adding: |
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(1) the number of non-Medicare residents occupying a |
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bed in the facility immediately before midnight of that day plus the |
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number of residents admitted that day, less the number of residents |
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discharged that day, except a resident is included in the count |
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under this subdivision if: |
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(A) the resident is admitted and discharged on |
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the same day; or |
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(B) the resident is discharged that day because |
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of the resident's death; and |
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(2) the number of beds that are on hold that day and |
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that have been placed on hold for a period not to exceed three |
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consecutive calendar days during which a resident is: |
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(A) in the hospital; or |
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(B) on therapeutic home leave. |
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Sec. 242.704. COLLECTION AND REPORTING. (a) The |
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commission shall collect the reinvestment allowance. |
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(b) Not later than the 25th day after the last day of a |
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month, each facility shall: |
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(1) file with the commission a report stating the |
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total non-Medicare resident days for the month; and |
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(2) pay the reinvestment allowance. |
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Sec. 242.705. RULES; ADMINISTRATIVE PENALTY. (a) The |
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executive commissioner shall adopt rules to administer this |
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subchapter, including rules related to imposing and collecting the |
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reinvestment allowance. |
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(b) Notwithstanding Section 242.066, an administrative |
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penalty assessed under that section for a violation of this |
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subchapter may not exceed the greater of: |
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(1) one-half of the amount of the facility's |
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outstanding reinvestment allowance; or |
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(2) $20,000. |
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Sec. 242.706. NURSING FACILITY REINVESTMENT ALLOWANCE |
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TRUST FUND. (a) The nursing facility reinvestment allowance trust |
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fund is established as a trust fund to be held by the comptroller |
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outside of the state treasury and administered by the commission as |
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trustee. Interest and income from the assets of the trust fund |
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shall be credited to and deposited in the trust fund. The commission |
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may use money in the fund only as provided by Section 242.707. |
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(b) The commission shall remit the reinvestment allowance |
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collected under this subchapter and federal matching funds received |
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by this state to the comptroller for deposit in the trust fund. |
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Sec. 242.707. REIMBURSEMENT OF FACILITIES. (a) The |
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commission may use money in the nursing facility reinvestment |
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allowance trust fund, including any federal matching funds, only |
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for the following purposes: |
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(1) reimbursing the federal share of the reinvestment |
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allowance as a pass-through in the rate; |
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(2) increasing reimbursement rates paid under the |
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state Medicaid program to facilities; and |
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(3) with any money remaining after funding |
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Subdivisions (1) and (2), providing direct care staff programs |
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related to quality incentives and quality metrics. |
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(b) The commission shall devise a formula by which amounts |
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received under this subchapter increase the reimbursement rates |
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paid to facilities under the state Medicaid program. |
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(c) Money in the nursing facility reinvestment allowance |
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trust fund may not be used to expand Medicaid eligibility under the |
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Patient Protection and Affordable Care Act (Pub. L. No. 111-148) as |
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amended by the Health Care and Education Reconciliation Act of 2010 |
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(Pub. L. No. 111-152). |
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Sec. 242.708. INVALIDITY; FEDERAL FUNDS. If any provision |
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of or procedure under this subchapter is held invalid by a final |
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court order that is not subject to appeal, or if the commission |
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determines that the imposition of the reinvestment allowance and |
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the expenditure of amounts collected as prescribed by this |
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subchapter will not entitle the state to receive federal matching |
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funds under the Medicaid program, the commission shall: |
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(1) stop collection of the reinvestment allowance; and |
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(2) not later than the 30th day after the date |
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collection is stopped, return to each facility, in proportion to |
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the total amount paid by the facility, any money deposited to the |
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credit of the nursing facility reinvestment allowance trust fund |
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but not spent. |
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Sec. 242.709. AUTHORITY TO ACCOMPLISH PURPOSES OF |
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SUBCHAPTER. The executive commissioner by rule may adopt a |
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definition, a method of computation, or a rate that differs from |
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those expressly provided by or expressly authorized by this |
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subchapter to the extent the difference is necessary to accomplish |
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the purposes of this subchapter. |
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Sec. 242.710. EXPIRATION. This subchapter expires August |
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31, 2021. |
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SECTION 2. (a) As soon as practicable after the effective |
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date of this Act, the executive commissioner of the Health and Human |
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Services Commission shall: |
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(1) adopt the rules necessary to implement Subchapter |
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P, Chapter 242, Health and Safety Code, as added by this Act; and |
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(2) notwithstanding Section 242.702, Health and |
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Safety Code, as added by this Act, establish the amount of the |
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initial reinvestment allowance imposed under Subchapter P, Chapter |
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242, Health and Safety Code, as added by this Act, based on |
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available revenue and patient day information. |
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(b) The amount of the initial reinvestment allowance |
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established under Subsection (a) of this section remains in effect |
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until the Health and Human Services Commission obtains the |
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information necessary to set the amount of the reinvestment |
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allowance under Section 242.702, Health and Safety Code, as added |
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by 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. Notwithstanding any other law, a reinvestment |
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allowance may not be imposed under Section 242.702, Health and |
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Safety Code, as added by this Act, or collected under Section |
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242.704, Health and Safety Code, as added by this Act, until: |
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(1) an amendment to the state Medicaid plan that |
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increases the rates paid to long-term care facilities licensed |
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under Chapter 242, Health and Safety Code, for providing services |
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under the state Medicaid program is approved by the Centers for |
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Medicare and Medicaid Services or another applicable federal |
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government agency; and |
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(2) long-term care facilities licensed under Chapter |
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242, Health and Safety Code, have been compensated retroactively at |
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the increased rate for services provided under the state Medicaid |
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program for the period beginning with the effective date of this |
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Act. |
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SECTION 5. The Health and Human Services Commission shall |
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discontinue the reinvestment allowance imposed under Subchapter P, |
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Chapter 242, Health and Safety Code, as added by this Act, if the |
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commission reduces Medicaid reimbursement rates, including rates |
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that increased due to funds from the nursing facility reinvestment |
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allowance trust fund or federal matching funds, below the rates in |
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effect on September 1, 2017. |
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SECTION 6. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2017. |