Long-Term Care Facilities Council 

Allison Levee
State Agency Responsible for Informal Dispute Resolution Category
Austin

Vacant
For-profit and Non-profit Nursing Facility Provider Category

Corey Kintzer
Survey Enforcement within The State Survey and Certification Agency Category
Austin

Dr. Liam Fry
Physician with Expertise in Infectious Disease or Public Health Category
Austin

Brooke Ellison
Expert in Medicaid Quality-based Payment Systems for Long-term Care Facilities Category
Austin

Dr. Obinna Ogundu
For-profit Nursing Facility Provider Category
Wylie

Patrick Duncan Murray
Non-profit Nursing Facility Provider Category
Manchaca

Dr. Steven Nowonty
Practicing Medical Director of a Long-term Care Facility Category
Corpus Christi

Maria Duncan 
Community-based Provider at an Intermediate Care Facility for Individuals with Intellectual or Developmental Disabilities Licensed under Chapter 252, Health and Safety Code
San Antonio

Recommendations for Legislative Action

A. Medicaid should reimburse the Medicare copayment for residents approved under Long Term Care Medicaid, expanding coverage beyond just the Medicaid QMB program to ensure equitable access to services for dual-eligible residents and reduce financial burdens on long-term care facilities.

B. Nursing facility providers should be fully funded for care provided to Medicaid residents based on median costs. The base Medicaid reimbursement rate in Texas currently ranks second lowest in the country. The expense of a Medicaid nursing home resident is approximately $115.74 per day more than the average reimbursement rate based on the allowable cost in 1 TAC §355.307 Reimbursement Setting Methodology (Source: NF Cost Report data inflated to 2026-2027 biennium).

C. Although the requirement for HHSC to set Medicaid rates under the managed care program was removed from Chapter 533 of the Texas Government Code effective September 1, 2021, HHSC continues to set rates, collect cost reports, and work towards PDPM LTC reimbursement. Statutory regulations should be reinstated to ensure that “the commission is responsible for setting the minimum reimbursement rate paid to nursing facilities under the managed care program.”

D. HHSC has contracted with MPRO to perform IDR reviews for nursing facilities, assisted living facilities, intermediate care facilities, and Home and Community based Service and Texas Home Living waiver providers. According to HHSC data, the majority of the immediate jeopardy citations that were recommended by MPRO to be modified or reversed were not accepted by HHSC, with HHSC relying on authority from interpretation of CMS guidance rather than Texas legislative authorization. Language should be added to §531.058 that provides an IDR decision favorable to a long-term care facility is binding on HHSC.

E. Texas Health & Safety Code §242.070 (the “double-dipping statue”) should be modified to prevent HHSC from imposing an administrative penalty where the CMS has already assessed a fine or required a fine to be levied against a nursing home for the same act or failure to act.

Recommendations to HHSC The following recommendations were agreed upon by the council during deliberations.

F. HHSC should adopt rates for nursing facilities with proportional adjustments to all rate components, including but not limited to direct care, dietary, general & administrative, and fixed capital components of Medicaid reimbursement. These adjustments should occur biennially, utilizing the most recent annual cost report data to maintain fairness and adequacy in funding.

G. In line with the current rule’s intent, HHSC should clarify that a change of ownership between Non-State Government-Owned entities will not automatically result in the exclusion of the facility from the Quality Incentive Payment Program during the current year, provided all other qualifications are met.

H. HHSC should seek a waiver from CMS to allow Qualified Nursing Facilities to make presumptive Medicaid eligibility determinations for elderly and disabled residents while their applications are being processed. This process, already allowed for Qualified Hospitals, would increase access for Texans pending Medicaid approval who are qualifying for nursing home stays, and would require HHSC to establish criteria for nursing facilities to apply for this designation.

I. HHSC should adopt rates for ICF/HCS facilities to recognize the increased cost of staffing in HCS care environments. The increased costs with inflation for items such as groceries and transportation are unsustainable. Current staffing rates as low as $10.60 per hour are unsustainable. This has resulted in high turnover, creating instability in care, straining already limited resources and appears to be the cause for closure of multiple homes throughout the state. HHSC should consider parity with staffing rates provided to State Supported Living Centers.

J. HHSC should adopt rates to recognize the increased costs of care provided to residents in nursing facilities with behavioral support needs related to IDD/Autism. These costs of care are often not appropriately reflected in MDS data. This discrepancy could leave persons with IDD or Autism limited choices in places for care due to the unreimbursed costs of care for providers.

K. HHSC should provide and encourage additional opportunities for training for front line staff for any long-term care providers offering care to persons with IDD. Currently there are limited training opportunities for DSP’s, CNA’s or nurses caring for persons with IDD.

L. HHSC should implement a uniform timeline/time frame for complaint investigations to ensure complaint surveys are completed in a timely manner and the welfare of the residents addressed promptly.

M. HHSC should implement a system where the Informal Dispute Resolution results and data will be published to the providers and the public on at least a quarterly basis, including a link to the data on the HHSC website.

N. Certified Nursing Assistant (CNA) skills tests should be offered in Spanish in addition to English to address workforce shortages, promote equity, and enhance care quality in the long-term care industry. Texas has a significant Spanish-speaking population, and many potential CNAs face unnecessary barriers when tests are only available in English. Expanding access to Spanish speakers allows the state to tap into a larger, diverse talent pool while improving culturally and linguistically appropriate care for Spanish-speaking residents and caregivers.