| (E) A facility that has Medicaid beds allocated under
provisions of an Alzheimer's waiver may apply for a waiver in accordance
with other subsections of this section, including subsection (f)(3)
or (4) of this section. HHSC does not count the beds allocated under
an Alzheimer's waiver to determine the allowable bed allocation increase.
For example, a 120-bed nursing facility with 60 Alzheimer waiver beds
would be eligible for 10 percent of the 60 remaining beds or six
additional Medicaid beds.
(6) Teaching nursing facility waiver. A teaching nursing
facility waiver is designed to meet the statewide needs for providing
training and practical experience for health-care professionals. The
applicant must submit documentation that the nursing facility:
(A) is affiliated with a state-supported medical school;
(B) is located on land owned or controlled by the state-supported
medical school; and
(C) serves as a teaching nursing facility for physicians
and related health-care professionals.
(7) Rural county waiver. A rural county waiver is designed
to meet the needs of rural areas of the state that do not have reasonable
access to acceptable nursing facility care. For purposes of this waiver,
a rural county is one that has a population of 100,000 or less according
to the most recent census, and has no more than two Medicaid-certified
nursing facilities. HHSC approves no more than 120 additional Medicaid
beds per county per year and no more than 500 additional Medicaid
beds statewide in a calendar year under this waiver provision. HHSC
considers a waiver application on a first-come, first-served basis.
Requests received in a year in which the 500-bed limit has been met
will be carried over to the next year. The county commissioner's court
must request the waiver.
(A) The commissioner's court must notify HHSC of its
intent to consider a rural county waiver and obtain verification
from HHSC that the county complies with the definition of rural county.
(B) The commissioner's court must publish a notice
in the Texas Register and in a newspaper of general circulation
in the county. The notice must seek:
(i) comments on whether a new Medicaid nursing facility
should be requested; and
(ii) proposals from persons or entities interested
in providing additional Medicaid-certified beds in the county, including
persons or entities currently operating Medicaid-certified facilities
with high occupancy rates. HHSC, in its sole discretion, may eliminate
from participating in the process persons or entities that submit
false or fraudulent information.
(C) The commissioner's court must determine whether
to proceed with the waiver request after considering all comments
and proposals received in response to the notices provided under subparagraph
(B) of this paragraph. In determining whether to proceed with the
waiver request, the commissioner's court must consider:
(i) the demographic and economic needs of the county;
(ii) the quality of existing Medicaid nursing facilities
in the county;
(iii) the quality of the proposals submitted, including
a review of the past history of care provided, if any, by the person
or entity submitting the proposal; and
(iv) the degree of community support for additional
Medicaid nursing facility services.
(D) The commissioner's court must document the comments
received, proposals offered and factors considered in subparagraph
(C) of this paragraph.
(E) If the commissioner's court decides to proceed
with the waiver request, it must submit a recommendation that HHSC
issue a waiver to a person or entity who submitted a proposal for
new or additional Medicaid beds. The recommendation must include:
(i) the name, address, and telephone number of the
person or entity recommended for contracting for the Medicaid beds;
(ii) the location, if the commissioner's court desires
to identify one, of the recommended nursing facility;
(iii) the number of beds recommended; and
(iv) the information listed in subparagraph (D) of
this paragraph used to make the recommendation.
(F) An applicant that is granted a rural county waiver
must provide to HHSC a performance bond, surety bond, or an irrevocable
letter of credit in the amount of $500,000 payable to HHSC to ensure
that the Medicaid beds granted to the applicant under the waiver are
certified within the time periods required by subsection (i)(4)(G)
of this section, including any extensions granted under subsection
(i)(6) of this section. HHSC will revoke a waiver if the performance
bond, surety bond, or irrevocable letter of credit is not provided
within 90 days after HHSC approves the waiver application.
(G) If an applicant chooses to provide a performance
bond or surety bond, instead of an irrevocable letter of credit, the
performance bond or surety bond provided under this subchapter must:
(i) be executed by a corporate entity in accordance
with Texas Insurance Code, Chapter 3503, Subchapter A;
(ii) be in a form approved by HHSC; and
(iii) clearly and prominently display on the face of
the bond:
(I) the name, mailing address, physical address, and
telephone number of the surety company or financial institution to
which any notice of claim should be sent; or
(II) the toll-free telephone number maintained by the
Texas Department of Insurance in accordance with Texas Insurance
Code, Chapter 521, Subchapter B, and a statement that the address
of the surety company to which any notice of claim should be sent
may be obtained from the Texas Department of Insurance by calling
the toll-free telephone number.
(H) If an applicant chooses to provide an irrevocable
letter of credit, the irrevocable letter of credit must be issued
by a banking institution or similar financial/lending institution.
(I) An applicant must notify HHSC at least 60 days
in advance if:
(i) the applicant does not intend to renew its performance
bond, surety bond, or irrevocable letter of credit on the annual renewal
date; or
(ii) the applicant changes the lending institution
or surety bond company administering the performance bond, surety
bond, or irrevocable letter of credit.
(J) An applicant may choose a performance bond, surety
bond, or irrevocable letter of credit, and may substitute one for
the other over the course of development and construction, but regardless
of which option is chosen, the performance bond, surety bond, or irrevocable
letter of credit must continue in effect until the facility if certified
to participate in the Medicaid program; or until paid to HHSC after
notice provided in accordance with subparagraph (K) of this paragraph.
(K) A performance bond, surety bond, or irrevocable
letter of credit is immediately due and must be paid to HHSC upon
receipt of notice from HHSC to the issuer of the performance bond,
surety bond, or irrevocable letter of credit that:
(i) the applicant did not comply with subsection (i)(4)(G)
of this section, which may include an extension granted under subsection
(i)(6) of this section;
(ii) HHSC revokes the applicant's waiver;
(iii) the applicant did not notify HHSC of its intent
not to renew the performance bond, surety bond, or irrevocable letter
of credit at least 60 days before its automatic annual renewal date;
or
(iv) the applicant did not notify HHSC of a change
in the lending institution or surety bond company administering the
performance bond, surety bond, or irrevocable letter of credit.
(8) State veterans homes. State veterans homes, authorized
and built under the auspices of the Texas Veterans Land Board, must
meet all requirements for Medicaid participation.
(9) Small house waiver. A small house waiver is designed
to promote the construction of smaller nursing facility buildings
that provide a homelike environment.
(A) A facility must meet the requirements in §19.345
of this chapter (relating to Small House and Household Facilities)
for HHSC to grant a small house waiver for the facility.
(B) An applicant for a small house waiver must submit
an application to HHSC and a schematic building plan of the proposed
facility with sufficient detail to demonstrate that the proposed
project meets the requirements in §19.345 of this chapter.
(C) An applicant that is granted a small house waiver
must submit final construction documents in accordance with §19.344
of this chapter (relating to Plans, Approvals, and Construction Procedures)
before facility construction begins.
Cont'd... |
