TITLE: Relating to the creation and administration of a reinvestment allowance for certain long-term care facilities.

SUMMARY: Relating to the creation and administration of a reinvestment allowance for certain long-term care facilities.

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