| (D) Both facilities must be located in the same county.
(3) High-occupancy facilities. Medicaid-certified nursing
facilities with high occupancy rates may periodically apply to HHSC
to receive bed allocation increases.
(A) The occupancy rate of the Medicaid beds of the
applicant nursing facility must be at least 90.0 percent for nine
of the previous 12 months prior to the application.
(B) The application for additional Medicaid beds may
be for no more than 10 percent (rounded to the nearest whole number)
of the facility's Medicaid-certified nursing facility beds.
(C) The applicant nursing facility must comply with
level of acceptable care requirements in subsection (e) of this section.
(D) The applicant nursing facility may reapply for
additional Medicaid beds no sooner than nine months from the date
of the previous allocation increase.
(E) Medicaid beds allocated to a nursing facility
under this requirement may only be certified at the applicant nursing
facility. HHSC does not transfer or assign the additional allocation
of beds until they are certified at the applicant nursing facility.
(4) Non-certified nursing facilities. Licensed nursing
facilities that do not have Medicaid-certified beds may apply to HHSC
for an initial allocation of Medicaid beds.
(A) The application for Medicaid beds may be for no
more than 10 percent (rounded to the nearest whole number) of the
facility's licensed nursing facility beds.
(B) The applicant nursing facility must comply with
level of acceptable care requirements in subsection (e) of this section.
(C) After the applicant nursing facility receives an
allocation of Medicaid beds, the facility may apply for additional
Medicaid beds in accordance with paragraph (3) of this subsection.
(5) Low-capacity facilities. For purposes of efficiency,
nursing facilities with a Medicaid bed capacity of less than 60 may
receive additional Medicaid beds to increase their capacity up to
a total of 60 Medicaid beds.
(A) The nursing facility must be licensed for less
than 60 beds and have a current certification of less than 60 Medicaid
beds.
(B) The nursing facility must have been Medicaid-certified
before June 1, 1998.
(C) The applicant licensee must comply with level of
acceptable care requirements in subsection (e) of this section.
(D) Facilities that have a Medicaid capacity of less
than 60 beds due to the loss of Medicaid beds under provisions in
subsection (j) of this section are not eligible for this exemption.
(6) Spend-down Medicaid beds. Licensed nursing facilities
may apply to HHSC for temporary spend-down Medicaid beds for residents
who have "spent down" their resources to become eligible for Medicaid,
but for whom no Medicaid bed is available. A HHSC approval of spend-down
Medicaid beds allows a nursing facility to exceed temporarily its
allocated Medicaid bed capacity.
(A) The applicant nursing facility must have a Medicaid
contract with a Medicaid bed capacity of at least 10 percent of licensed
capacity authorized in paragraph (4) of this subsection. If the nursing
facility is not currently Medicaid-certified, the licensee must be
approved for Medicaid certification and obtain a Medicaid contract
with a Medicaid bed capacity at least as large as that authorized
in paragraph (4) of this subsection.
(B) All Medicaid or dually certified beds must be occupied
by Medicaid or Medicare recipients at the time of application.
(C) The application for a spend-down Medicaid bed must
include documentation that the person for whom the spend-down bed
is requested:
(i) was not eligible for Medicaid at the time of the
resident's most recent admission to the nursing facility; and
(ii) was a resident of the nursing facility for at
least the immediate three months before becoming eligible for Medicaid,
excluding hospitalizations.
(D) The nursing facility is eligible to receive Medicaid
benefits effective the date the resident meets Medicaid eligibility
requirements.
(E) The nursing facility must assign a permanent Medicaid
bed to the resident as soon as one becomes available.
(F) Facilities with multiple residents in spend-down
beds must assign permanent Medicaid beds to those residents in the
same order the residents were admitted to spend-down beds.
(G) The assignment of residents in spend-down beds
to permanent Medicaid beds must precede the admission of new residents
to permanent beds.
(H) The nursing facility must notify HHSC immediately
upon the death or permanent discharge of the resident or transfer
of the resident to a permanent Medicaid bed. Failure of the nursing
facility to notify HHSC of these occurrences in a timely manner is
basis for denying applications for spend-down Medicaid beds.
(I) The nursing facility is not required to comply
with level of acceptable care requirements in subsection (e) of this
section.
(g) Waivers. The executive commissioner or the executive
commissioner's designee may grant a waiver of the requirements stated
in subsection (d) of this section under certain conditions.
(1) Applicants must meet the following conditions to
be eligible for the specific waivers in subsection (h) of this section.
(A) The applicant must meet the level of acceptable
care requirement in subsection (e) of this section.
(B) The applicant must submit a complete HHSC waiver
application.
(C) At the time of licensure and Medicaid certification
of the allocated beds, the licensee must comply with the requirements
in §19.201 of this chapter.
(D) A waiver recipient or a subsequent waiver assignee
must, at the time of licensure and Medicaid certification, be the
property owner or the licensee of the facility where Medicaid beds
allocated through the waiver process are certified.
(2) A waiver recipient may request that HHSC approve
the assignment of an approved waiver to another entity in accordance
with this paragraph. A waiver recipient may request HHSC approval
of only one assignment. A waiver assignment is not valid unless and
until it is approved by HHSC.
(A) The waiver recipient or the owner of the waiver
recipient must maintain majority ownership and management control
of the assignee.
(B) The assignee must not have an owner or controlling
person who was not an owner or controlling person of the waiver recipient.
(C) The assignee must own the physical plant of the
waiver facility at the time of licensure and certification (as landlord)
or be the licensee at the time of licensure and certification (as
the licensed operator). Under either circumstance, the allocated beds
are subject to subsection (c) of this section.
(D) The assignee must meet the requirements in subsection
(e) of this section regarding level of acceptable care.
(3) A waiver recipient entity may remove a controlling
person from ownership of the entity, but the waiver recipient entity
must not add an owner after the waiver is approved by HHSC. A change
to the ownership of the waiver recipient entity or the waiver assignment
entity must be reported to HHSC.
(4) HHSC may in its sole discretion determine that
a waiver applicant that submits false or fraudulent information is
not eligible for a waiver. HHSC may, in its sole discretion, revoke
a waiver issued and decertify Medicaid beds issued based on false
or fraudulent information provided by the applicant.
(5) Except as provided in paragraphs (6) - (9) of this
subsection, HHSC considers waiver applications in the order in which
they are received. A waiver applicant may request that review of its
application be deferred until one or more applications submitted after
its application has been reviewed. This request must be in writing.
(6) HHSC gives priority to a small house waiver application
submitted in accordance with subsection (h)(9) of this section over
a pending community needs waiver application submitted in accordance
with subsection (h)(2) of this section for the same county. If approved,
HHSC includes the small house facility beds when determining the need
for a community needs waiver.
(7) During any period in which HHSC is processing a
waiver application in accordance with subsection (h)(2), (4), (5),
or (9) of this section, HHSC may suspend processing the waiver application
for up to six months if HHSC determines the county or precinct occupancy
rate of the county or precinct in which the site of the proposed waiver
is located is at least 85 percent during at least six of the previous
nine months. HHSC calculates the occupancy rate based on the monthly
Medicaid occupancy reports submitted to HHSC by Medicaid-certified
nursing facilities and includes the occupancy rate of certified Medicaid
beds and allocated Medicaid beds that are encumbered for future certification
as a result of approval Cont'd... |
