| (H) HHSC notifies local nursing facilities when a complete
community needs waiver application is received and affords local nursing
facilities an opportunity to comment on the waiver application. The
notification includes a deadline for submission of comments. HHSC
limits subsequent comments during the review process to facilities
that submit timely comments in response to the notification of a completed
application.
(I) An applicant that is granted a community needs
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.
(J) If an applicant chooses to provide a performance
bond or surety bond, instead of an irrevocable letter of credit, the
performance bond provided under this subparagraph 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.
(K) 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/lending institution.
(L) 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.
(M) An applicant may choose a performance bond, surety
bond, or irrevocable letter of credit, and may 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 (N)
of this paragraph.
(N) 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.
(3) Criminal justice waiver. The criminal justice waiver
is designed to meet the needs of the Texas Department of Criminal
Justice (TDCJ). The applicant must document that:
(A) the waiver is needed to meet the identified and
determined nursing facility needs of TDCJ; and
(B) the new nursing facility is approved by TDCJ to
serve persons under their supervision who have been released on parole,
mandatory supervision, or special needs parole in accordance with
Texas Government Code, Chapter 508, Parole and Mandatory Supervision.
(4) Economically disadvantaged waiver. The economically
disadvantaged waiver is designed to meet the needs of residents of
ZIP codes located in communities where a majority of residents have
an average income below the countywide average income and 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) the ZIP code in which the new nursing facility
will be constructed has a population with an income that is at least
20 percent below the average income of the county according to the
most recent U.S. census or more recent census projection;
(ii) an immediate need for additional Medicaid beds
in the ZIP code in which the new nursing facility will be constructed;
and
(iii) residents in the ZIP code in which the nursing
facility or beds will be located 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 facilities;
and
(v) any existing allocated Medicaid beds not currently
certified but could be used for a new Medicaid nursing facility.
(D) 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.
(E) 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.
(F) HHSC considers an application withdrawn if it
is not completed within 90 days after the application is submitted
to HHSC.
(G) HHSC notifies local nursing facilities when a complete
economically disadvantaged waiver application is received and affords
local nursing facilities an opportunity to comment on the waiver application.
The notification includes a deadline for submission of comments. HHSC
limits subsequent comments during the review process to facilities
that submit timely comments in response to the notification of a completed
application.
(H) An applicant that is granted an economically disadvantaged
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 provided under this subparagraph 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... |
