26 Tex. Admin. Code § 554.2302 - Requirements for a Contracted Medicaid Facility
(a) This section applies to nursing
facilities (NFs) that have been licensed and certified as eligible for
participation under Title XIX.
(b)
Each nursing facility (NF) must comply with the state requirements for
participation and the facility's contract on a continuing basis.
(c) Each NF must comply with the Texas Health
and Human Services Commission's (HHSC's) utilization review requirements as
provided in 1 TAC §
371.212 (relating to Minimum Data
Set Assessments) and §371.214 (relating to Resource Utilization Group
Classification System).
(d) A
facility may not participate in the Texas Medical Assistance Program if it has
restrictive policies or practices, including:
(1) requiring the resident to make a will,
with the facility named as legatee or devisee;
(2) requiring the resident to assign his life
insurance to the facility;
(3)
requiring the resident to transfer property to the facility;
(4) requiring the resident to pay a lump sum
entrance fee or make any other payment or concession to the facility beyond the
recognized rate for board, room, and care as a condition for entry, departure,
or continued stay;
(5) controlling
or restricting the resident, the resident's guardian, or responsible party in
the use of the resident's personal needs allowance;
(6) restricting the resident from leaving the
facility at will except as provided by state law;
(7) restricting the resident from applying
for Medicaid for a specified period of time;
(8) denying appropriate care to an individual
on the basis of his race, religion, color, national origin, sex, age,
disability, marital status, or source of payment; and
(9) preventing terminally ill adult residents
from exercising their will in making written or unwritten directives to reject
life-sustaining procedures.
(e) If DADS has documentation showing good
cause, it reserves the right to reject the facility's participation or to
cancel an existing contract if the facility charges the Title XIX resident, any
member of his family, or any other source for supplementation or for any item
except as allowed within DADS policies and regulations.
(f) If DADS suspends a facility's vendor
payments or proposes to terminate a facility's contract, the facility may
request an administrative hearing to challenge the action. If a facility
requests a hearing, the facility must make the request in accordance with HHSC
rules at 1 TAC Chapter 357, Subchapter I.
(g) DADS' interpretations of the requirements
for participation or the contract may not be appealed to HHSC's hearings
department unless the interpretation has caused an adverse action for the
facility.
(h) Facilities must allow
representatives of DADS, the Medicaid Fraud Control Unit, and the Department of
Health and Human Services to enter the premises at any time to make inspections
or to privately interview the residents receiving assistance from
DADS.
(i) Facilities must supply
DADS complete information according to federal and state requirements about the
identity of:
(1) each person who directly or
indirectly owns interest of 5% or more in the facility;
(2) each owner (in whole or in part) of any
property, assets, mortgage, deed of trust, note, or other obligation secured by
the facility;
(3) each officer and
director, if the facility is organized as a corporation;
(4) each partner, if the facility is
organized as a partnership (A copy of the partnership agreement is required,
but the dollar amount of capital contributions of the partners may be omitted);
and
(5) any director, officer,
agency, or managing employee of the institution, agency, or organization, who
has ever been convicted of a criminal offense related to the person's
involvement in programs established by Title XVIII, XIX, and XX (Effective
dates for disclosure of any convictions are July 1, 1966, for Medicare, and
January 1, 1969, for Medicaid.)
(j) If a profit-making corporation operates
the facility, a copy of the following material is required:
(1) certificate of incorporation (for Texas
corporations only);
(2) certificate
of authority to do business in Texas (for out-of-state corporations
only);
(3) a resolution from the
board of directors authorizing a specific person or officer to sign contracts
between DADS and the corporation; and
(4) any management contract for the facility.
If no stockholder owns, directly or beneficially, 5.0% or more of the corporate
stock, the president and secretary of the corporation should state this on the
department form.
(k) If
a nonprofit corporation operates the facility, a copy of the following material
is required:
(1) certificate of incorporation
(for Texas corporations only);
(2)
certificate of authority to do business in Texas (for out-of-state corporations
only);
(3) a resolution from the
board of directors authorizing a specific person or officer to sign contracts
with DADS; and
(4) a copy of any
management contract for the facility.
(l) Facilities other than those described in
subsections (j) and (k) of this section must furnish a copy of:
(1) charter or other legal basis for the
organization which owns the facility;
(2) any management contract or agreement for
the facility;
(3) by-laws of the
organization (if applicable); and
(4) other information required by DADS to
determine the status of the legal entity that owns the facility.
(m) Facilities must disclose
business transaction information. A facility must send to DADS, within 35 days
after the date of a written request, complete information on:
(1) the ownership of a subcontractor with
whom the facility has had, during the previous 12 months, business transactions
totaling more than $25,000; and
(2)
any business transactions between the facility and any wholly owned supplier,
or between the facility and any subcontractor during the five-year period
ending on the date of the request.
(n) The facility must report changes in the
required information promptly to DADS.
(o) Failure to provide this information may
result in suspension, termination, or other contract action, including holding
vendor funds. Payment to the facility is denied beginning on the day after the
date information was due, and ending on the day before the date the information
is received by DADS.
(p) Each
facility must comply with Texas Government Code §
545.0201. A facility
that furnishes services under the Medicaid program is subject to Occupations
Code, Chapter 102. The facility's compliance with that chapter is a condition
of the facility's eligibility to participate as a facility under those
programs.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.