| (a) Basis. The Texas Department of Human Services,
hereinafter referred to as TDHS, the Texas Department of Health, hereinafter
referred to as TDH, and the Texas Department of Mental Health and
Mental Retardation, hereinafter referred to as TDMHMR, are required
under the provisions of Human Resources Code, § 22.014, to enter
into a memorandum of understanding regarding responsibilities, procedures,
and standards involved in the provision, regulation, and/or funding
of services in hospitals or long term care institutions. However,
this agreement does not apply to state hospitals or to any TDMHMR
service not funded under Title XIX of the Social Security Act.
(b) Provision of services.
(1) Hospital and long term care services are provided
by facilities under contract to TDHS as the Title XIX designated single
state agency. TDHS contracts for intermediate care provided by facilities
for the mentally retarded (ICF-MR) in community-based settings and
in state schools and state centers, and for intermediate care (ICF)
and skilled nursing facility (SNF) care in nursing homes.
(2) TDHS is also responsible for reimbursing Title
XIX participating hospitals and long term care facilities for covered
Title XIX services provided to Title XIX eligible individuals. Reimbursement
is subject to the specifications, conditions, limitations, and requirements
established by the department or its designee.
(c) Regulation of service/standards and procedures
of operations.
(1) TDHS promulgates standards and policies, appropriate
to complement and support federal regulations, to govern the participation
of acute care hospitals and the operation of intermediate care and
skilled nursing facility care in nursing homes. TDMHMR develops, with
the approval of TDHS, standards and policies, appropriate to complement
and support federal regulations, to govern the operation of community-based
IFC-MR facilities and state schools for the mentally retarded.
(2) TDH, under contract to TDHS, surveys, certifies,
and monitors facilities providing services to ICF-MR clients and to
ICF-SNF clients. TDH develops and publishes licensure requirements
for all facilities providing health care. Consonant with federal regulations,
TDH develops and publishes the certification procedures which govern
the certification of facilities desiring to enter into contracts with
TDHS as providers of ICF/SNF service. TDH has administrative penalties
which provide sanctions for nursing home facilities who fail to provide
acceptable care and to maintain compliance with state licensure requirements.
TDHS' standards for participation contain sanctions requirements for
facilities who fail to carry out their contractual responsibilities.
(3) TDHS and TDH entered into contracts in 1972, whereby
TDH agreed to survey and certify as meeting state and federal standards,
all nursing facilities wishing to contract or continue to contract
with TDHS as ICFs and SNFs under Title XIX. These contracts have been
in force continuously since 1972. In 1977, pursuant to State Bill
9, 65th Legislature, 1st Called Session 1977, TDHS and TDH entered
into a contract whereby TDH agreed to be responsible for monitoring
and evaluating the quality of care provided by ICF, SNF, and ICF-MR
facilities.
(4) TDHS and TDMHMR, pursuant to House Bill 656, 67th
Legislature, 1981, agreed that TDMHMR would develop and recommend
policy and standards, and that TDMHMR would assume the responsibility
for monitoring TDH's activities regarding quality of care review in
community-based ICF-MR facilities and state schools.
(d) Funding of services.
(1) TDHS requests state funds and matching federal
funds in support of the Medicaid program in Title XIX participating
hospitals and long term care facilities. TDHS also requests federal
matching funds for expenditures made by TDH and TDMHMR on behalf
of Medicaid.
(2) TDMHMR requests state funds for its activities
and certifies expenditures to TDHS for the purpose of drawing down
federal matching funds under Title XIX. TDH requests state funds for
its activities and certifies expenditures to TDHS for the purpose
of drawing down federal matching funds as they relate to survey and
certification of nursing facilities for Title XIX participation and
quality of care in such facilities.
(e) Promulgation of rules.
(1) TDHS, TDH, and TDMHMR agree that no new rules or
regulations that would increase the cost of providing the required
services or increase the number of personnel in hospitals or long
term care facilities will be promulgated by the agencies unless:
(A) the commissioner of health certifies that the new
rules or regulations are urgent and necessary to protect the health
or safety of recipients of hospital or long term care services; or
(B) TDHS provides written verification that funds are
available to adequately reimburse hospital or long term care service
providers for any increased costs resulting from the rule or regulation
and establishes reimbursement rates that are sufficient to cover the
increased costs; or
(C) the rules are required by state or federal law
or federal regulations.
(2) TDHS, TDH, and TDMHMR agree that any rules or regulations
proposed by the agencies which would increase the costs of providing
the required services or increase the number of personnel in hospital
or long term care facilities will be accompanied by a preliminary
fiscal note prepared for the agency promulgating the rules. The fiscal
note will be submitted to TDHS and will state the expected impact
on the cost of providing the required service and the anticipated
impact on the number of personnel in hospital or long term care facilities.
For a rule to be finally adopted, TDHS must provide written verification
that funds are available to adequately reimburse hospital or long
term care service providers for any increased costs resulting from
the rule or regulation. Written verification is not required if the
commissioner of health certifies that the new rule or regulation is
urgent and necessary to protect the health or safety of recipients
of hospital or long term care services. The provisions of this paragraph
do not apply if the rules are required by state or federal law or
federal regulations.
(f) Termination. In the event that federal and/or state
laws or other requirements should be amended or judicially interpreted
so as to render continued fulfillment of this agreement substantially
unreasonable or impossible, or if the parties should be unable to
agree upon any amendment which would therefore be needed to enable
the substantial continuation of services contemplated herein, then,
and in that event, the parties shall be discharged from any further
obligation created under the terms of this agreement, except for the
equitable settlement of the respective accrued interests or obligations
incurred up to the date of termination.
(g) Annual review. TDHS, TDH, and TDMHMR shall review
and, if necessary, update this memorandum of understanding prior to
the close of each fiscal year.
(h) Effective date. For the faithful performance of
this agreement, this agreement is executed by the commissioners of
TDHS, TDMHMR, and TDH, to be effective January 1, 1988.
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