| (A) A Medicaid nursing facility operated by the person
or entity who also owns the property will lose the allocation of all
Medicaid beds assigned to the nursing facility property if the nursing
facility's license is denied or revoked.
(B) A Medicaid nursing facility operated by one person
or entity and owned by another person or entity will lose the allocation
of Medicaid beds if two or more of the following actions occur within
a 42-month period:
(i) licensure denial;
(ii) licensure revocation; or
(iii) Medicaid termination.
(C) HHSC may waive this loss of allocation of Medicaid
beds in order to facilitate a change of ownership or other actions
that would protect the health and safety of residents or assure reasonable
access to acceptable nursing facility care.
(3) Voluntary decertification of Medicaid beds.
(A) Facilities may request to voluntarily decertify
Medicaid beds.
(B) The licensee must submit written approval of the
Medicaid bed reduction signed by the property owner and all physical
plant lien holders.
(C) HHSC reduces the number of allocated Medicaid beds
equal to the number of beds voluntarily decertified.
(D) Facilities that voluntarily decertify Medicaid
beds are eligible to receive an increased allocation of Medicaid beds
if the facility qualifies for a bed allocation waiver or exemption.
(4) Nursing facility ceases to operate or participate
in Medicaid.
(A) The property owner of a nursing facility that closes
or ceases to participate in the Medicaid program must inform HHSC
in writing of the intended future use of the Medicaid beds within
90 days after closure or ceasing participation in Medicaid.
(B) Unless the Medicaid beds will be used for a replacement
nursing facility, the allocated beds must be re-certified within 12
months of the date the Medicaid contract was terminated.
(C) Time limits in subparagraphs (A) and (B) of this
paragraph may be extended in accordance with subsection (i)(6) of
this section.
(D) HHSC may de-allocate Medicaid beds for failure
to meet the requirements of this paragraph.
(5) Loss of Medicaid beds based on low occupancy.
(A) HHSC may review Medicaid bed occupancy rates annually
for the purpose of de-allocating and decertifying unused Medicaid
beds. The Medicaid bed occupancy reports for the most recent six-month
period that HHSC has validated are used to determine the bed occupancy
rate of each nursing facility.
(B) HHSC de-allocates and decertifies Medicaid beds
in facilities with an average occupancy rate below 70 percent. The
number of beds decertified is calculated by subtracting the preceding
six-month average occupancy rate of Medicaid-certified beds from 70
percent of the number of allocated certified beds and dividing the
difference by 2, rounding the final figure down if necessary. For
example, for a facility with 100 Medicaid-certified beds and a 50
percent occupancy rate, the difference between 70 percent (70 beds)
and 50 percent (50 beds) is 20 beds, divided by 2, is 10 beds to be
decertified.
(C) Medicaid beds in a nursing facility that has obtained
a replacement nursing facility exemption are not subject to the de-allocation
and decertification process.
(D) Medicaid beds in a new or replacement physical
plant or a newly constructed wing of an existing physical plant are
exempt from this de-allocation and decertification process until the
new physical plant or new wing has been certified for 24 months.
(E) Medicaid beds that have been subject to a change
of ownership within the past 24 months are exempt from the de-allocation
and decertification process.
(F) Medicaid beds in a county or in a precinct in one
of the four most populous counties in the state in which a facility
approved through the waiver process is constructed are exempt from
the de-allocation and decertification process for 24 months after
licensure and certification of the facility.
(G) Medicaid beds allocated to a closed nursing facility
are exempt from this de-allocation and decertification process.
(H) Nursing facilities that lose Medicaid beds through
this process are eligible to receive an additional allocation of Medicaid
beds at a later date if the facility qualifies for a bed allocation
waiver or exemption.
(I) The de-allocation and decertification of unused
beds does not affect the licensed capacity of a nursing facility.
(k) Informal review procedures.
(1) A waiver or exemption applicant, or a Medicaid
nursing facility that has been denied an increase in Medicaid bed
allocation or was subject to decertification or de-allocation of Medicaid
beds, may request an informal review of HHSC actions regarding bed
allocations. The request must be submitted within 30 days after the
date referenced on the notification of the proposed action.
(2) A waiver or exemption applicant or a Medicaid nursing
facility that has been denied an increase in Medicaid bed allocation
or was subject to decertification or de-allocation of Medicaid beds,
must submit a request for an informal review and all documentation
or evidence that forms the basis for the informal review in writing.
(3) The executive commissioner or the executive commissioner's
designee conducts the informal review.
(l) Medicaid occupancy reports.
(1) Medicaid nursing facilities must submit occupancy
reports to HHSC each month.
(A) The occupancy data must be reported on a form prescribed
by HHSC. The form must be completed in accordance with instructions
and the occupancy data must be accurate and verifiable. The completed
report must be received by HHSC no later than the fifth day of the
month following the reporting period.
(B) HHSC determines the Medicaid occupancy rate by
calculating the monthly average of the number of persons who occupy
Medicaid beds.
(C) HHSC includes all persons residing in Medicaid-certified
beds, including Medicaid recipients, Medicare recipients, private-pay
residents, or residents with other sources of payment, in the calculation.
(D) Failure or refusal to submit accurate occupancy
reports in a timely manner may result in the nursing facility's vendor
payment being held in abeyance until the report is submitted.
(2) HHSC determines nursing facility and county occupancy
rates based on the data submitted by the nursing facilities.
(A) HHSC uses the occupancy data to determine eligibility
for or compliance with waiver and exemption requirements. HHSC also
uses the occupancy data to determine if Medicaid beds should be decertified
based on low occupancy.
(B) HHSC makes the occupancy data available to nursing
facilities, licensees, property owners, waiver or exemption applicants,
and others in accordance with public disclosure requirements.
(C) HHSC may disqualify a facility that provides inaccurate
or falsified occupancy data from eligibility for bed allocation exemptions
and waivers. HHSC may refuse to accept corrections to bed occupancy
data submitted more than six months after the due date of the occupancy
report.
(m) School-age residents. Any bed allocation waiver
or exemption applicant that serves or plans to serve school-age residents
must provide written notice to the affected local education agency
(LEA) of its intent to establish or expand a nursing facility within
the LEA's boundary.
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| Source Note: The provisions of this §554.2322 adopted to be effective November 1, 2002, 27 TexReg 9154; amended to be effective October 23, 2013, 38 TexReg 7316; amended to be effective April 1, 2014, 39 TexReg 2313; amended to be effective August 31, 2015, 40 TexReg 5464; amended to be effective February 20, 2018, 43 TexReg 900; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
