| (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
(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
(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.
|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