| (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 of a waiver or exemption in the subject county
or precinct.
(8) HHSC initiates the high occupancy county or precinct
waiver process referenced in subsection (h)(1) of this section if
HHSC determines requirements for the open solicitation process for
a high occupancy county or precinct waiver are met during the temporary
suspension period referenced in paragraph (7) of this subsection.
HHSC does not process any pending waiver applications in the affected
county or precinct until the open solicitation process referenced
in subsection (h)(1) of this section is complete.
(9) HHSC continues to process a suspended waiver application
in the affected county or precinct if HHSC determines requirements
for the open solicitation process of the high occupancy county or
precinct waiver are not met during the suspension period referenced
in paragraph (7) of this subsection.
(h) Specific waiver types. HHSC may grant a waiver
if it determines that Medicaid beds are necessary for the following
circumstances.
(1) High occupancy waiver. A high occupancy waiver
is designed to meet the needs of counties and certain precincts that
have a high county or precinct occupancy rate for multiple months.
(A) HHSC monitors monthly county or precinct occupancy
rates. If HHSC determines that a county or precinct occupancy rate
equals or exceeds 85 percent for at least nine of the previous twelve
months, HHSC may initiate a waiver process by placing a public notice
in the Texas Register and the Electronic State Business Daily
(ESBD) to announce an open solicitation period.
(B) The public notice announces that HHSC may allocate
90 additional Medicaid beds in the county or precinct.
(C) The notice identifies the county or precinct and
the beginning and end dates of the solicitation period. The notice
also includes the HHSC address to which the application for additional
Medicaid beds must be submitted and specifies that the application
must be received by HHSC before the close of business on the end date
of the solicitation period.
(D) An applicant for additional Medicaid beds must
comply with the level of acceptable care requirements in subsection
(e) of this section.
(E) An applicant must submit a complete HHSC waiver
application.
(F) At the end of the solicitation period, HHSC determines
if an applicant is eligible for additional Medicaid beds. If multiple
applicants are eligible, the applicant who will receive the allocation
of beds will be chosen by a lottery selection.
(G) If no application for the waiver process is received
or if no applicant meets the requirements in this section, HHSC conducts
no further solicitation. HHSC closes the process without allocating
Medicaid beds.
(H) An applicant that is granted a high occupancy
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.
(I) 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
Cont'd... |
