> Provide Federal Relief Funding from ARPA (2021) to Support Nursing Homes in Texas during Special Session #3 

The American Rescue Plan was enacted to address the adverse impacts of COVID- 19 across sectors of the economy and state and local governments. The rule narrative includes reference to “support for prevention, mitigation, or other services in congregate living facilities”. It would be prudent to use a portion of these resources to support and improve Texas’ nursing facilities and the residents for whom they provide care. This need was underscored by Gov. Abbott’s Second Special Session call, which included the following:

“Legislation providing appropriations from unappropriated available revenues for COVID-19-related healthcare expenses, such as those listed below, taking into consideration the approximately $10.5 billion in funds received by local governments intended to be used on COVID-19 from the American Rescue Plan Act of 2021 (ARPA), Pub. L. No. 117-2:
• Healthcare staffing needs, including physicians, nurses, and other medical professionals; and
• Supporting the operations of nursing homes, state supported living centers, assisted living facilities, and long-term care facilities”

Texas Health Care Association and LeadingAge Texas has proposed plan that is both short-term and long-term, drawing on one time funding from the American Rescue Plan Act (ARPA) funds allocated to Texas

> Solve the nursing home Medicaid funding shortfall to enhance quality care 

Texas nursing facilities lose an average of $32 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.

Today, almost 70% of all nursing facility patient days are paid for through the Medicaid program. Historically, the Medicaid shortfall grew by 26% in 2015 over 2014 and then again 30% in 2017 over 2016. The median shortfall since 1994 has been 19%.  While rate increases were provided to aid in the shift into Medicaid managed care in 2013, the six percent rate increase was offset by an eight percent rate increase in providers’ costs to process and administer the program across the various MCOs.

Furthermore, the impact of COVID-19 on the financial solvency of the long-term care profession continues to be threatened and further exacerbated by these concerns. Initial financial data suggests that median expenses have increased to over $50,000 per facility per month through August 2020 while additional cost data has indicated these median costs continue to rise as costs for staffing and mandatory testing compliance continue.

> Better prepare for future public health emergencies (PHEs)

The impact of COVID-19 on the long-term care profession has been far reaching and its negative effect on the elderly has placed long-term care at the epicenter of the pandemic. It has placed a spotlight on many issues that exist within the healthcare profession.  When we experience future PHE’s, addressing the following issues can ensure we are in a better position to provide quality care and protect healthcare workers:

  • Caregiver Visitation Standards
  • Licensing and Education waivers and flexibility
  • Physician Service Options
  • Prioritization of Long Term Care for Personal Protective Equipment and Testing supplies to support Infection Control Prevention efforts

> Fix Key Regulatory Issues

The following regulatory changes will better support the long-term care profession and allow it to function more efficiently:

  • Revise the double-dipping statute to prevent the Health and Human Services Commission (HHSC) from imposing an administrative penalty where the Centers for Medicare & Medicaid Services (CMS) has already fined a nursing home for the same violation.
  • Simplify the Change of Ownership (CHOW) process to allow a new owner to accept responsibility more quickly and reduce the delay in Medicaid payments provided for care delivery to the owners.
  • Allow for flexibility in telemedicine and video medicine for physicians and their patients in nursing facilities. This includes allowing physician certifications, orders, assessments, and any other visits that generally require physical presence