| 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
(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.
(J) 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 institution.
(K) 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.
(L) An applicant may choose a performance bond, surety
bond, or irrevocable letter of credit and 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 is certified
to participate in the Medicaid program or until paid to HHSC after
notice provided in accordance with subparagraph (M) of this paragraph.
(M) 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.
(2) Community needs waiver. A community needs waiver
is designed to meet the needs of communities that do not have reasonable
access to acceptable nursing facility care.
(A) The applicant must submit a demographic or health
needs study, prepared by an independent professional experienced at
preparing demographic or health needs studies, that documents:
(i) an immediate need for additional Medicaid beds
in the community; and
(ii) Medicaid residents in the community do not have
reasonable access to acceptable nursing facility care.
(B) The application must include a statement by the
preparer of the study that the preparer has no interest, financial
or otherwise, in the outcome of the waiver application.
(C) The demographic or health needs study must include
at least the following information pertaining to the community's
population:
(i) population growth trends;
(ii) population growth trends specific to the elderly,
including income or financial condition;
(iii) Medicaid bed occupancy data;
(iv) level of acceptable care provided by local nursing
facilities; and
(v) any existing allocated Medicaid beds not currently
certified but that could be used for a new Medicaid nursing facility.
(D) The applicant must submit documentation of substantial
community support for the new nursing facility or beds.
(E) When determining the immediate need for additional
Medicaid beds, and whether residents have reasonable access to acceptable
nursing facility care, HHSC considers:
(i) the number and occupancy rate of certified Medicaid
beds that comply with level of acceptable care requirements; and
(ii) the number of encumbered Medicaid beds that have
been approved by HHSC but are not yet certified.
(F) Replacement beds or waiver beds approved in accordance
with subsection (f)(1) or (h) of this section will not be considered
in the calculation in subparagraph (D) of this paragraph if the owner
of the replacement beds or waiver beds has not purchased land for
a new construction site within 24 months after the date HHSC initially
approves the replacement request or the waiver for the beds.
(G) HHSC considers an application withdrawn if it
is not completed within 90 days after the application is submitted
to HHSC.
Cont'd... |
