The bill, H.B. No. 4615, aims to enhance the regulation of nursing facilities in Texas by establishing new licensing and Medicaid participation requirements. Key provisions include the requirement for nursing facilities to comply with a direct care expense ratio, which mandates that at least 80% of medical assistance reimbursement for patient care expenses be allocated to direct care expenses. Additionally, the bill introduces a new section that requires nursing facility provider agreements to include compliance with this direct care expense ratio. It also mandates that nursing facilities be paid within ten days of submitting a clean claim and establishes a process for recouping incentive payments if facilities fail to meet program requirements.

Further amendments include stricter ownership disclosure requirements for nursing facilities, necessitating the identification of individuals with significant ownership interests and the description of their ownership stakes. The bill also emphasizes the importance of reducing preventable events and unnecessary institutionalizations, while ensuring that managed care organizations provide adequate support and resources to nursing facilities. The provisions of this bill are set to take effect on September 1, 2025, and the Health and Human Services Commission is tasked with ensuring compliance with the new regulations in contracts with managed care organizations.

Statutes affected:
Introduced: Health and Safety Code 242.032, Human Resources Code 32.028 (Health and Safety Code 242, Human Resources Code 32)