89th LEGISLATIVE PRIORITIES

Texas nursing facilities do not have the privilege of shutting down, even on holidays. Our professionals care for the most frail and elderly Texans 24 hours a day, 7 days a week.

The regulatory environment in which Texas long-term care professionals operate can pose very serious obstacles for our workforce and the vulnerable residents that the employees serve.

The following are the THCA Legislative Priorities for the 2025 Session.

CONFIRMING MEDICAID PRESUMPTIVE ELIGIBILITY

Potential Medicaid beneficiaries should be presumed to be eligible, so long as a nursing facility agrees to reimburseHHSC in the event that an applicant is ultimately found to be ineligible. This is a recommendation from HHSC’s Long-Term Care Facilities Council (LTCFC).

THCA supports increasing Medicaid eligibility case workers, also as requested by HHSC, and streamlining the enrollment process so that it is less cumbersome for beneficiaries over 65 years of age.

ESTABLISHING BEHAVIORAL HEALTH ADD-ON

THCA supports funding to address behavioral needs in nursing facilities and is developing legislation to establish abehavioral health add-on for Texas Medicaid. The American Health Care Association (AHCA) has committed to fullysupport our efforts to develop this program. AHCA and THCA are partnering with Behavioral Health Solution (BHS) toprovide guidance on what has been successful in other states.

REFORMING IDR & ENDING DUPLICATIVE PENALTIES

Currently, the Health & Human Services Commission (HHSC) can impose administrative penalties at the same time as the Centers for Medicare & Medicaid Services (CMS) are imposing civil monetary penalties. These provisions should be revised to prevent this kind of “double dipping.”

THCA also seeks to incorporate “double dipping” into the request for clarification of the informal dispute resolution(IDR) process to ensure the Michigan Peer Review Organization (MPRO) decisions would be binding on HHSC.

Both of these items are also recommendations from HHSC’s LTCFC.

STREAMLINING CHANGE OF OWNERSHIP

The change of ownership (CHOW) process for nursing facilities used to take approximately 90 days, and now it takesalmost 9 months. THCA is pushing for adjustments to streamline this process. Significant delays cause serious Medicaid cashflow problems.

IMPLEMENTING PATIENT DRIVEN PAYMENT MODEL RIDER

Rider 25 of the Texas state budget, passed in the 88th Legislative Session, provided $100 million in “hold harmless” funding for the patient driven payment model (PDPM) in Medicaid nursing facility services. HHSC has advised that Rider 25 will be part of the filed versions of the 89th Legislature’s state budget, and THCA seeks to ensure it is fully funded and implemented.