(G) Subject to subparagraph (E) of this paragraph,
HHSC approves the replacement or transfer of beds certified at a small
house nursing facility in accordance with subsection (f)(1) or (2)
of this section only to another small house or household facility.
(H) A facility that has Medicaid beds allocated under
provisions of a small house waiver may apply for general Medicaid
beds in accordance with other subsections of this section, including
subsection (f)(3) or (4) of this section. HHSC does not count the
beds allocated under a small house waiver provision in determining
the allowable bed allocation increase. For example, a 120-bed nursing
facility with 60 Small House waiver beds would be eligible for 10
percent of the 60 remaining beds or six additional Medicaid beds.
(I) An applicant that is granted a small house 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 or surety 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 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.
(i) Time Limits and Extensions.
(1) Medicaid beds transferred in accordance with subsection
(f)(2) of this section must be certified within six months after HHSC
grants the exemption.
(2) Time limits applicable to temporary Medicaid beds
are specified in subsection (f)(6) of this section.
(3) All facilities and beds approved in accordance
with waiver provisions of subsection (h) of this section and replacement
nursing facilities approved in accordance with subsection (f)(1)
of this section, must be constructed, licensed, and Medicaid-certified
within 42 months after the waiver or replacement exemption is granted.
(4) A recipient of a waiver must provide HHSC with
evidence of compliance with subparagraphs (A) - (G) of this paragraph.
The recipient must submit evidence of compliance on or before the
date stated in the subparagraph, including any extensions granted
under paragraph (6) of this subsection.
(A) The land must be under contract within 12 months
after HHSC approval of the waiver or replacement.
(B) An architect or engineer must be under contract
to prepare final construction documents within 15 months after HHSC
approval of the waiver or replacement.
(C) The facility's preliminary plans must be completed
within 18 months after HHSC approval of the waiver or replacement.
(D) The land must be purchased and a progress report
submitted to HHSC within 24 months after HHSC approval of the waiver
or replacement.
(E) Entitlements (including municipality, planning
and zoning, building permit) and the facility's foundation must be
completed within six months after land purchase or 30 months after
HHSC approval of the waiver or replacement, whichever is later.
(F) Facility construction must be active and ongoing,
as evidenced by a construction progress report submitted to HHSC within
12 months after land purchase or 36 months after HHSC approval of
the waiver or replacement, whichever is later.
(G) The facility must be constructed, licensed, and
certified within 18 months after land purchase or 42 months after
HHSC approval of the waiver or replacement, whichever is later.
(5) HHSC, in its sole discretion, may declare the exemption
or the waiver void if the applicant fails or refuses to provide evidence
of compliance with each benchmark or deadline, or the evidence of
compliance submitted to HHSC in accordance with paragraph (4) of this
subsection contains false or fraudulent information.
(6) Waiver or exemption recipients may request an extension
of the deadlines in this section. At the discretion of the executive
commissioner or the executive commissioner's designee, deadlines
specified in this section may be extended. The applicant must substantiate
every element of its extension request with evidence of good-faith
efforts to meet the benchmarks and construction deadlines or evidence
confirming that delays were beyond the applicant's control.
(7) Waiver or exemption recipients who receive an extension
of their waiver or exemption must submit a progress report every six
months after approval of the extension until the nursing facility
beds are certified. HHSC may declare the waiver or exemption void
if the applicant fails or refuses to provide the progress report as
required or if the progress report contains false or fraudulent information.
(8) HHSC may revoke a bed allocation for failure to
meet the requirements of this section.
(j) Loss of Medicaid Beds.
(1) Loss of Medicaid beds that are not available to
be occupied.
(A) Medicaid nursing facilities must report certified
Medicaid beds that do not comply with requirements of §19.1701
of this chapter (relating to Physical Environment) and are not available
for occupancy on monthly Medicaid occupancy reports.
(B) HHSC decertifies and de-allocates Medicaid beds
that are intended for use in bedrooms that have been converted to
other uses if the rooms are not being used for bedroom occupancy use
on two consecutive standard surveys.
(C) HHSC does not decertify and de-allocate Medicaid
beds that are intended for use in rooms that are licensed and certified
for multi-occupancy use but are being used for single occupancy only.
(D) HHSC decertifies and de-allocates Medicaid beds
granted through a criminal justice waiver, Alzheimer's waiver, a teaching
nursing facility waiver, state veterans home waiver, or a small house
waiver that are no longer being used for the intended purpose for
which the waiver was granted.
(2) Loss of Medicaid beds based on sanctions.
Cont'd... |