PART 1. DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 19. NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER V. ENFORCEMENT
DIVISION 3. REMEDIES IN MEDICAID-CERTIFIED FACILITIES
The Health and Human Services Commission (HHSC), on behalf of the Department of Aging and Disability Services (DADS), adopts an amendment to §19.2146 in Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification, with changes to the proposed text published in the January 23, 2009, issue of the Texas Register (34 TexReg 407).
The amendment is adopted to state the criteria DADS will use to determine whether it may waive termination of a nursing facility provider agreement when a nursing facility has had a Category II or III remedy on it three times in an accountability period of 24 months.
A minor editorial correction was made to §19.2146(e)(3) to improve the accuracy of the section.
DADS received no comments regarding adoption of the amendment.
The amendment is adopted under Texas Government Code, §531.0055, which provides that the HHSC executive commissioner shall adopt rules for the operation and provision of services by the health and human services agencies, including DADS; Texas Human Resources Code, §161.021, which provides that the Aging and Disability Services Council shall study and make recommendations to the HHSC executive commissioner and the DADS commissioner regarding rules governing the delivery of services to persons who are served or regulated by DADS; Texas Government Code, §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; and Texas Human Resources Code, §32.021(m), which requires the adoption of rules establishing criteria under which DADS may waive termination of a provider agreement.
§19.2146.Termination of Provider Agreement on the Basis of the Imposition of Enforcement Actions Three Times Within an Accountability Period.
(a) If DADS determines that DADS or CMS has imposed a required Category II or III remedy (as defined in 42 Code of Federal Regulations (CFR)) on a facility three times within an accountability period, a recommendation is made to terminate the facility's provider agreement, unless DADS waives termination after considering the factors described in subsection (e) of this section.
(b) DADS notifies a facility in writing of its intention to terminate the facility's provider agreement. Notification occurs within:
(1) three calendar days after receipt of the recommendation of remedies for a facility found in immediate jeopardy; or
(2) 15 calendar days after receipt of the recommendation of remedies for a facility not found in immediate jeopardy.
(c) The provider agreement is terminated on the 20th calendar day after the facility receives notice of DADS' decision to terminate the provider agreement.
(d) An appeal for this remedy is the appeal on the issue of noncompliance that led to the imposition of a Category II or III remedy for the third time within the accountability period. The appeal for this remedy follows the federal procedures in 42 CFR Part 498 for a dually-participating facility or in 42 CFR Part 431 for a facility that is Medicaid-certified only.
(e) DADS may waive termination of a facility's provider agreement when a facility has received a Category II or III remedy three times within an accountability period of 24 consecutive months. DADS may consider one or more of the following to waive termination of a facility's provider agreement:
(1) the history of violations committed by the facility resulting in three Category II or III remedies within an accountability period and the resulting enforcement action compared with the history of violations committed by other facilities that received Category II or III remedies three times within an accountability period and the resulting enforcement action;
(2) the history of ownership of the facility when the Category II or III remedies were imposed; or
(3) the efforts the facility has made to correct the violations that resulted in the imposition of the Category II or III remedies.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April 1, 2009.
TRD-200901297
Kenneth L. Owens
General Counsel
Department of Aging and Disability Services
Effective date: April 21, 2009
Proposal publication date: January 23, 2009
For further information, please call: (512) 438-3734
SUBCHAPTER D. BILLINGS AND PAYMENT
The Health and Human Services Commission (HHSC), on behalf of the Department of Aging and Disability Services (DADS), adopts the repeal of §49.43, in Chapter 49, Contracting for Community Care Services, without changes to the proposal as published in the January 23, 2009, issue of the Texas Register (34 TexReg 408).
The repeal is adopted to delete the requirements governing the expedited payments system (EPS), including provider eligibility requirements, participation requirements, and billing options. Since the implementation of the Claims Management System (CMS) in 1999, DADS has made several improvements to claims submittal available to providers. Due to these improvements, providers are able to receive payment more expediently, generally within five to seven days of a claim submittal. In addition, the Texas Medicaid and Healthcare Partnership claims systems currently processes provider claims in a timely fashion, eliminating the need for the EPS.
DADS received no comments regarding adoption of the repeal.
The repeal is adopted under Texas Government Code, §531.0055, which provides that the HHSC executive commissioner shall adopt rules for the operation and provision of services by the health and human services agencies, including DADS; Texas Human Resources Code, §161.021, which provides that the Aging and Disability Services Council shall study and make recommendations to the HHSC executive commissioner and the DADS commissioner regarding rules governing the delivery of services to persons who are served or regulated by DADS; and Texas Government Code, §531.021, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April 1, 2009.
TRD-200901296
Kenneth L. Owens
General Counsel
Department of Aging and Disability Services
Effective date: April 30, 2009
Proposal publication date: January 23, 2009
For further information, please call: (512) 438-3734
CHAPTER 175. GENERAL RULES OF THE VETERANS LAND BOARD
SUBCHAPTER C. PROCEDURES FOR ALTERNATIVE DISPUTE RESOLUTION
The Veterans Land Board (VLB) adopts new §§175.100 - 175.111 in order to provide the availability of Alternative Dispute Resolution procedures for parties of internal and external disputes pending before the VLB. The rules are adopted without changes to the proposed text as published in the February 13, 2009, issue of the Texas Register (34 TexReg 973) and will not be republished.
Chapter 2009 of the Texas Government Code, which was enacted by the 75th Legislature in 1997 and is known as the Governmental Dispute Resolution Act, established the policy of this state that disputes before governmental bodies be resolved as fairly and expeditiously as possible and that each governmental body support this policy by developing and using alternative dispute resolution (ADR) procedures in appropriate aspects of the governmental body's operation and programs. The 80th Legislature in 2007 enacted §161.036 of the Texas Natural Resource Code to further encourage the use of alternative dispute resolution rules to assist in the resolution of internal and external disputes under the Board's jurisdiction, other than disputes governed by §161.311. In order to adhere to and to adopt this legislatively mandated policy, the VLB is adopting a body of new rules that provide ADR procedures as an option for resolving disputes pending before the VLB.
No comments were received on the adoption of this amendment.
Chapter 2009 of the Texas Government Code establishes the policy of this state that disputes before governmental bodies be resolved as fairly and expeditiously as possible and that each governmental body support this policy by developing and using alternative dispute resolution procedures in appropriate aspects of the governmental body's operation and programs. Chapter 2009 provides authority for the VLB to adopt alternative dispute resolution rules necessary to implement this policy.
Section 161.036 of the Texas Natural Resources Code provides further authority for the VLB to adopt alternative dispute resolution rules necessary to implement this policy.
This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 31, 2009.
TRD-200901273
Trace Finley
Deputy Commissioner, Policy and Governmental Affairs, General Land Office
Texas Veterans Land Board
Effective date: April 20, 2009
Proposal publication date: February 13, 2009
For further information, please call: (512) 475-1859