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 the medical assistance reimbursement for patient care expenses be allocated to direct care costs. 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 for clean claims within ten days and establishes a portal for claim submissions to Medicaid managed care organizations.

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 outlines the process for recouping incentive payments from facilities that fail to meet program requirements and prohibits those facilities from participating in incentive programs for two years following a recoupment. Overall, the legislation seeks to improve the quality of care in nursing facilities while ensuring transparency and accountability in their operations. The act is set to take effect on September 1, 2025.

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