|(a) Based on Texas Health and Safety Code §533A.062(b-1)
(relating to Plan on Long-Term Care for Persons with an Intellectual
Disability), and as authorized by the Long-Term Care Plan for Individuals
with Intellectual Disabilities and Related Conditions, the Texas Health
and Human Services Commission (HHSC) must:
(1) review the state-wide bed capacity of community
intermediate care facilities for individuals with an intellectual
disability or related conditions (ICF/IID); and
(2) develop a process to reallocate beds held in suspension
(b) As provided in §551.14 of this title (relating
to Increase in Capacity), a facility may not increase its capacity
without approval from HHSC.
(c) For purposes of this section only, "applicant"
means a person who requests reallocated Medicaid beds in accordance
with this section. An applicant may be a person:
(1) who is not a program provider;
(2) who is a program provider operating a licensed
(3) who is a program provider operating a facility
that is exempt from licensure in accordance with Texas Health and
Safety Code §252.003 (relating to Exemptions).
(d) Notwithstanding §261.206 of this chapter (relating
to Application Process), the following provisions establish the process
for HHSC Long-term Care Regulation to reallocate ICF/IID Medicaid
(e) If an applicant wants to request reallocated Medicaid
beds, the applicant:
(1) can request no more than six reallocated beds for
(2) interested in obtaining reallocated beds must:
(A) complete form HHSC 3642, ICF/IID Medicaid Bed Reallocation
(B) email the application and all supporting documentation
(f) For the reallocation, HHSC calculates the number
of available beds based on the numbers of surrendered or expired beds
made available during the relevant state fiscal years.
(g) When HHSC receives a complete application for reallocation,
(1) processes the application in the order received;
(2) reviews the application to determine if the applicant
meets the criteria for reallocation;
(3) determines if ICF/IID beds are available for reallocation;
(4) verifies the applicant is immediately ready to
use the beds;
(5) determines if the applicant demonstrates a need
for the beds as described in subsection (g) of this section; and
(6) if the applicant is a current program provider,
determines whether the applicant has an acceptable regulatory compliance
history with HHSC.
(h) The applicant must provide documentation that demonstrates
the need for the requested reallocated beds by providing:
(1) data demonstrating occupancy rates of 80 percent
or greater for nine of the 12 months preceding the application if
the applicant is a current program provider;
(2) documentation of a wait list, such as letters from
individuals or family members attesting that they want to receive
services from the applicant; or
(3) any other documentation showing a need for a new
(i) HHSC considers the regulatory compliance history
for any facility operated by the applicant. An acceptable regulatory
compliance history means that, in the preceding 24 months, the applicant
and controlling persons have not received any of the following sanctions:
(1) termination of Medicaid or Medicare certification;
(2) termination of Medicaid contract;
(3) denial, suspension or revocation of a provider
(4) cumulative Medicaid or Medicare civil monetary
penalties totaling more than $5,000 in a single facility;
(5) imposition of civil penalties pursuant to Texas
Health and Safety Code §252.064;
(6) denial of payment for new admissions;
(7) a pattern of substantial or repeated licensing
or Medicaid sanctions, including administrative penalties; or
(8) a condition listed in §551.17 of this title
(relating to Criteria for Denying a License or Renewal of a License).
(j) An applicant having no compliance history to consider
must meet all other criteria for reallocation.
(k) If an applicant meets all criteria for reallocation
and ICF/IID beds are available, HHSC approves the application, grants
the number of beds requested, up to a maximum of six beds, and sends
an approval letter to the applicant.
(l) On approval of the reallocation, the applicant
must submit an initial application in the Texas Unified Licensure
Information Portal within 30 days from the date of the approval letter.
The applicant must also complete the provider enrollment and Medicaid
contracting process as referenced in §261.206 of this chapter
and §261.208 of this chapter (relating to Provider Agreement).
(m) If the applicant fails to complete and submit the
initial application, the reallocation application is cancelled, and
HHSC will reallocate the beds to another approved applicant or hold
the beds until another provider is approved.
(n) If HHSC denies the initial application or the applicant
does not complete the provider enrollment or Medicaid contracting
process, HHSC reallocates the beds to another approved applicant or
holds the beds until approval of another applicant.
(o) If HHSC revokes the reallocation of beds, HHSC
notifies the person to whom the beds were allocated. The person may
not appeal the revocation of capacity.
(p) Once HHSC reallocates all available beds, HHSC
will place any approved applicants who did not receive reallocated
beds on a waiting list. As additional beds become available for reallocation,
HHSC will contact approved applicants on the wait list.