86th LEGISLATIVE AGENDA
> Solve the nursing home Medicaid funding shortfall to enhance quality care
Texas nursing facilities lose an average of $27 per patient per day on Medicaid residents. This gap impacts quality care because it contributes to staffing issues and an inability to maintain modern facilities. In fact, the largest provider of long term care in the state recently declared bankruptcy.
THCA supports legislation that will close the gap using federal dollars through a program currently used in 43 states and the District of Columbia. No additional state budget funds will be required nor will Medicaid eligibility be expanded.
We support a solution built on personal responsibility that directs funding towards infrastructure and process improvements. Programs to improve care delivery and reward providers who demonstrate improved outcomes will be established. This will create the largest nursing home pay-for-performance health care program in the U.S.
> Improve the Medicaid Star+Plus Program for nursing home providers and residents
Since starting in 2015, Medicaid Managed Care has been a significant challenge, both administratively and financially for providers. Medicaid Managed Care has raised costs for providers because of delayed payments, additional billing/administrative costs, lack of standardization and other expenses. Continuous efforts by THCA and other providers to improve MCO services have led to some improvements—but too many issues persist.
The Legislature must ensure that Medicaid rates are set by the Health and Human Services Commission and should compel the managed care organizations to streamline their processes, pay bills on time, and help improve quality for long term care facility residents.
> Make the survey process in nursing homes fairer and more efficient
A lack of compliance with the survey process for nursing homes can result in heavy fines, a damaged reputation for the facility, and even closure. Although necessary, the survey process should be fair and consistent.
When allegations of violations are made against a facility, surveyors responsible for alleged finding should be available to answer questions as part of the informal dispute resolution (IDR) process. Review of citations for clinical violations through IDR should only be conducted by a registered nurse with long term care experience. When a violation of Immediate Jeopardy (i.e. non-compliance has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident, a surveyor should remain in the building until the plan of correction has been accepted.
> Stop unnecessary regulations that make providing quality care more difficult
Long term care is among the most heavily regulated industries in the nation. The Legislature has added penalties and regulation in the last two sessions, even while federal regulation has increased. Funding to comply with new rules and requirements has not kept up. The Legislature should not adopt any new regulations that add burdens for already over-regulated providers.
> Preserve Tort Reform Protection
Patients and providers have benefited from reforms in Texas tort laws that were approved by voters in 2003. These reforms should remain in place.