| (7) The executive commissioner, or the executive commissioner's
designee, may make an exception to any of the requirements in this
subsection if the executive commissioner or the executive commissioner's
designee determines the needs of Medicaid recipients in a local community
will be served best by granting a Medicaid bed allocation waiver or
exemption. In determining whether to make an exception to the requirements,
the executive commissioner or the executive commissioner's designee
may consider the following:
(A) the overall compliance record of the waiver or
exemption applicant;
(B) the current availability of Medicaid beds in facilities
that comply with level of acceptable care requirements in the local
community;
(C) the level of support for the waiver or exemption
from the local community;
(D) the way a waiver or exemption will improve the
overall quality of care for nursing facility residents; and
(E) the age and condition of nursing facility physical
plants in the local community.
(f) Exemptions. HHSC may grant an exemption from the
requirements in subsection (d) of this section. All exemption actions
must comply with the requirements in this subsection and with requirements
of the Centers for Medicare & Medicaid Services (CMS) regarding
bed capacity increases and decreases. When a bed allocation exemption
is approved, the licensee must comply with the requirements in §19.201
of this chapter (relating to Criteria for Licensing) at the time of
licensure and Medicaid certification of the new beds or nursing facility.
(1) Replacement Medicaid nursing facilities and beds.
An applicant may request that HHSC approve replacement of allocated
Medicaid beds by the construction of one or more new nursing facilities.
(A) The applicant must own the physical plant where
the beds are allocated or possess a valid assignment of rights to
the Medicaid beds.
(B) The applicant must obtain written approval by all
lien holders of the physical plant where the beds are allocated before
requesting HHSC approval to relocate the Medicaid beds to the replacement
facility if the replacement facility will be constructed at a different
address than the current facility. The applicant must submit the lien
holder approval with the replacement nursing facility request. If
the physical plant where the Medicaid beds are allocated does not
have a lien, the applicant must submit a written attestation of that
fact with the replacement nursing facility request.
(C) Replacement nursing facility applicants, including
those who obtained the rights to the beds through a HHSC assignment
of beds, must comply with the level of acceptable care requirements
in subsection (e) of this section, unless the applicant for a replacement
nursing facility is the current property owner.
(D) HHSC may grant a replacement facility an increase
of up to 25 percent of the currently allocated Medicaid beds, if the
applicant complies with the level of acceptable care requirements
in subsection (e) of this section. HHSC will not transfer or assign
the additional allocation of beds until they are certified at the
replacement facility.
(E) The physical plant of the replacement nursing facility
must be located in the same county in which the Medicaid beds currently
are allocated.
(2) Transfer of Medicaid beds. An applicant may request
HHSC transfer allocated Medicaid beds certified or previously certified
to another physical plant.
(A) The applicant must own the physical plant where
the beds are allocated, or the applicant must present HHSC with:
(i) a valid Medicaid bed transfer agreement that specifies
the number of additional Medicaid beds the applicant is requesting
HHSC allocate to the receiving nursing facility; or
(ii) a valid Medicaid bed assignment that specifies
the number of additional Medicaid beds the applicant is requesting
HHSC allocate to the receiving nursing facility.
(B) If the Medicaid beds are allocated to a specific
physical plant, the applicant must obtain and submit written approval
from the property owner and, if the physical plant has a lien, written
approval from all lien holders to obtain a HHSC transfer of the Medicaid
beds to another facility. If the physical plant where the Medicaid
beds are allocated does not have a lien, the applicant must submit
a written attestation of that fact with the transfer request.
(C) The receiving licensee must comply with level of
acceptable care requirements in subsection (e) of this section.
(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.
Cont'd... |
