HB 4615 — Relating to the regulation of certain nursing facilities, including licensing requirements and Medicaid participation requirements.

Summary

Relating to the regulation of certain nursing facilities, including licensing requirements and Medicaid participation requirements.

Bill Text

Compared against the Texas statutes as published AI-generated reading aid — verify against the official bill.

This bill amends 6 section(s) of the Texas statutes: Section 540.0752(b), Government Code, Section 540.0283, Government Code, Section 242.032, Health and Safety Code, Section 242.0333, Section 32.028, Human Resources Code, Section 32.0286, Human Resources Code.

• Section 540.0752(b), Government Code

  (1-a) a nursing facility complies with the direct care expense ratio adopted under Section 32.0286, Human Resources Code;

  amended

• Section 540.0283, Government Code

  Sec. 540.0283. NURSING FACILITY PROVIDER AGREEMENTS: COMPLIANCE WITH DIRECT CARE EXPENSE RATIO. (a) A contract to which this subchapter applies must require that each provider agreement between the contracting Medicaid managed care organization and a nursing facility include a requirement that the facility comply with the direct care expense ratio adopted under Section 32.0286, Human Resources Code. (b) This section does not apply to a state-owned facility.

  added

• Section 242.032, Health and Safety Code

  (b-1) The application must: (1) include the name of each person with a direct or indirect ownership interest of five percent or more in: (A) the nursing facility, including a subsidiary or parent company of the facility; and (B) the real property on which the nursing facility is located, including any owner, common owner, tenant, or sublessee; and (2) describe the exact ownership interest of each of those persons in relation to the facility or property.

  amended

• Section 242.0333

  Sec. 242.0333. NOTIFICATION OF CHANGE TO OWNERSHIP INTEREST APPLICATION INFORMATION. A license holder shall notify the commission, in the form and manner the commission requires, of any change to the ownership interest application information provided under Section 242.032(b-1).

  added

• Section 32.028, Human Resources Code

  and → ; and (5) to the extent permitted by federal law, require the commission to recoup all or part of an incentive payment if the nursing facility fails to satisfy a program requirement (i-1) The commission shall prohibit a provider who is the subject of the recoupment of an incentive payment under Subsection (i)(5) from participating in the incentives program described by Subsection (g)(1) for a period of not less than two consecutive years following the date on which the recoupment occurs. The commission shall publish and maintain on the commission's Internet website a list of each provider prohibited from participating in the incentives program under this subsection.

  amended

• Section 32.0286, Human Resources Code

  Sec. 32.0286. ANNUAL DIRECT CARE EXPENSE RATIO FOR REIMBURSEMENT OF CERTAIN NURSING FACILITY PROVIDERS. (a) In this section, "direct care expense": (1) includes an expense for: (A) non-revenue generating support services, such as laundry, housekeeping, dietary services, and nursing administration; (B) ancillary services, such as laboratory tests and services, physical therapy services, occupational therapy services, speech-language pathology services, or audiological services; and (C) program services, such as an adult day-care program; and (2) does not include an expense for: (A) administrative costs other than nursing administration; (B) capital costs; (C) debt service; (D) taxes, other than sales and payroll taxes; (E) capital depreciation; (F) rental or lease payments; or (G) financial services. (b) Notwithstanding any other law, the executive commissioner by rule shall establish an annual direct care expense ratio, including a process for determining the ratio, applicable to the reimbursement of nursing facility providers for providing services to recipients under the medical assistance program. In establishing the ratio, the executive commissioner shall require that at least 80 percent of the portion of the medical assistance reimbursement amount paid to a nursing facility that is attributable to patient care expenses is spent on reasonable and necessary direct care expenses. (c) The executive commissioner shall adopt rules necessary to ensure each nursing facility provider that participates in the medical assistance program complies with the direct care expense ratio adopted under this section. (d) To the extent permitted by federal law, the commission may recoup all or part of the reimbursement amounts paid to a nursing facility that are subject to the direct care expense ratio under this section if the facility fails to spend the reimbursement amounts in accordance with the direct care expense ratio. (e) The commission may not require a nursing facility to comply with the direct care expense ratio as a condition of participation in Medicaid. (f) This section does not apply to a state-owned facility.

  added

Action History

1. April 29, 2025

   Left pending in committee

2. April 29, 2025

   Testimony taken/registration(s) recorded in committee

3. April 29, 2025

   Committee substitute considered in committee

4. April 29, 2025

   Considered in public hearing

5. April 29, 2025

   Scheduled for public hearing on . . .

6. April 03, 2025

   Referred to Human Services

7. April 03, 2025

   Read first time

8. March 12, 2025

   Filed

Sponsors

• James B. Frank · Primary

Subjects