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 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 submit ownership interest information as part of their application process and notify the commission of any changes to ownership interests.

Furthermore, the bill outlines specific requirements for Medicaid managed care organizations, including timely payment to nursing facilities for clean claims and the establishment of a portal for claim submissions. It also emphasizes the importance of reducing preventable events and unnecessary institutionalizations while promoting a resident-centered care culture. The bill includes provisions for recouping incentive payments from nursing facilities that fail to meet program requirements and prohibits those facilities from participating in the incentives program for two years following such recoupment. 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 (Health and Safety Code 242, Human Resources Code 32)