A nursing facility may voluntarily terminate or be involuntarily
terminated from Medicaid participation. A facility must have policies
and procedures in place to ensure that the administrator's duties
and responsibilities include providing the appropriate notices in
the event of a Medicaid termination.
(1) If a facility voluntarily closes and ceases providing
nursing facility services, the facility must comply with this paragraph.
(A) The facility must close on the first day of a month.
(B) At least 75 days before closure, the administrator
must submit to the HHSC regional director a plan for relocation of
all residents. The plan must:
(i) provide for the transfer and adequate relocation
of the residents;
(ii) include assurances that residents are transferred
to the most appropriate facility or other setting in terms of quality,
services, and location, taking into consideration the needs, choice,
and best interests of each resident; and
(iii) be revised as necessary to obtain HHSC approval.
(C) At least 60 days before closure, the administrator
must submit written notice of the closure that includes the approved
closure plan and the closure date to:
(i) the secretary or the secretary's designee;
(ii) HHSC Regulatory Services;
(iii) the State Ombudsman;
(iv) each resident; and
(v) each resident's legal representative or responsible
party.
(D) The notice to each resident and the resident's
legal representative or responsible party must include the information
required by §19.502(f) of this chapter (relating to Transfer
and Discharge in Medicaid-certified Facilities).
(E) The facility must not admit any new residents on
or after the date the written notice is submitted.
(F) The facility must have the resources to operate
through the closure date.
(2) If HHSC or CMS terminates a facility's Medicaid
provider agreement, the facility must comply with this paragraph.
(A) At least 15 days before the notice date set by
HHSC or CMS, the administrator must submit to the HHSC regional director
a plan for relocation of all residents. The plan must:
(i) provide for the transfer and adequate relocation
of the residents;
(ii) include assurances that residents are transferred
to the most appropriate facility or other setting in terms of quality,
services, and location, taking into consideration the needs, choice,
and best interests of each resident; and
(iii) be revised as necessary to obtain HHSC approval.
(B) By the date set by HHSC or CMS, the administrator
must submit written notice of the closure that includes the approved
plan and the closure date to:
(i) the secretary or secretary's designee;
(ii) HHSC Regulatory Services;
(iii) the State Ombudsman;
(iv) each resident; and
(v) each resident's legal representative or responsible
party.
(C) The notice to each resident and the resident's
legal representative or responsible party must include the information
required by §19.502(f) of this chapter.
(D) The facility must not admit any new residents on
or after the date the notice is submitted.
(3) If a facility voluntarily withdraws from Medicaid
but continues to provide nursing facility services, the facility must
comply with this paragraph.
(A) The facility may not use the withdrawal as a reason
to transfer or discharge a resident who was residing in the facility
on the day before the effective withdrawal date.
(B) The facility is deemed to have a provider agreement
with regard to any resident who was residing in the facility on the
day before the effective withdrawal date and who is eligible for Medicaid
or who later becomes eligible for Medicaid.
(C) The facility must:
(i) provide oral and written notice to an individual
who is admitted after withdrawal from Medicaid that:
(I) the facility is not participating in the Medicaid
program with respect to new residents; and
(II) the facility may transfer or discharge a resident
if the resident does not pay the facility charges even though the
resident may have become eligible for Medicaid nursing facility services;
(ii) provide the written notice in a prominent manner
on a separate page of the admission agreement when the resident is
admitted; and
(iii) have the resident sign a written receipt, separate
from other signed documents, that the resident received the information
in the written notice.
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| Source Note: The provisions of this §554.2310 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective August 1, 2000, 25 TexReg 6779; amended to be effective October 31, 2013, 38 TexReg 7465; amended to be effective April 5, 2018, 43 TexReg 2017; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
