Section 554.2310 - Nursing Facility Ceases to ParticipateA nursing facility may voluntarily terminate or be involuntarily terminated from Medicaid participation. A facility must have policies and procedures in place to ensure that the administrator's duties and responsibilities include providing the appropriate notices in the event of a Medicaid termination.
(1) If a facility voluntarily closes and ceases providing nursing facility services, the facility must comply with this paragraph.(A) The facility must close on the first day of a month.(B) At least 75 days before closure, the administrator must submit to the HHSC regional director a plan for relocation of all residents. The plan must: (i) provide for the transfer and adequate relocation of the residents;(ii) include assurances that residents are Transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident; and(iii) be revised as necessary to obtain HHSC approval.(C) At least 60 days before closure, the administrator must submit written notice of the closure that includes the approved closure plan and the closure date to: (i) the secretary or the secretary's designee;(ii) HHSC Regulatory Services;(iii) the State Ombudsman;(v) each resident's legal representative or responsible party.(D) The notice to each resident and the resident's legal representative or responsible party must include the information required by § 554.502(f) of this chapter (relating to Transfer and Discharge in Medicaid-certified Facilities).(E) The facility must not admit any new residents on or after the date the written notice is submitted.(F) The facility must have the resources to operate through the closure date.(2) If HHSC or CMS terminates a facility's Medicaid provider agreement, the facility must comply with this paragraph. (A) At least 15 days before the notice date set by HHSC or CMS, the administrator must submit to the HHSC regional director a plan for relocation of all residents. The plan must: (i) provide for the transfer and adequate relocation of the residents;(ii) include assurances that residents are Transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident; and(iii) be revised as necessary to obtain HHSC approval.(B) By the date set by HHSC or CMS, the administrator must submit written notice of the closure that includes the approved plan and the closure date to: (i) the secretary or secretary's designee;(ii) HHSC Regulatory Services;(iii) the State Ombudsman;(v) each resident's legal representative or responsible party.(C) The notice to each resident and the resident's legal representative or responsible party must include the information required by § 554.502(f) of this chapter.(D) The facility must not admit any new residents on or after the date the notice is submitted.(3) If a facility voluntarily withdraws from Medicaid but continues to provide nursing facility services, the facility must comply with this paragraph. (A) The facility may not use the withdrawal as a reason to transfer or discharge a resident who was residing in the facility on the day before the effective withdrawal date.(B) The facility is deemed to have a provider agreement with regard to any resident who was residing in the facility on the day before the effective withdrawal date and who is eligible for Medicaid or who later becomes eligible for Medicaid.(C) The facility must: (i) provide oral and written notice to an individual who is admitted after withdrawal from Medicaid that: (I) the facility is not participating in the Medicaid program with respect to new residents; and(II) the facility may transfer or discharge a resident if the resident does not pay the facility charges even though the resident may have become eligible for Medicaid nursing facility services;(ii) provide the written notice in a prominent manner on a separate page of the admission agreement when the resident is admitted; and(iii) have the resident sign a written receipt, separate from other signed documents, that the resident received the information in the written notice.26 Tex. Admin. Code § 554.2310
The provisions of this §19.2310 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective August 1, 2000, 25 TexReg 6779; amended to be effective October 31, 2013, 38 TexReg 7465; Amended by Texas Register, Volume 43, Number 13, March 30, 2018, TexReg 2026, eff. 4/5/2018; Entire chapter transferred from Title 40, Pt. 1, Ch. 19 by Texas Register, Volume 45, Number 50, December 11, 2020, TexReg 8871, eff. 1/15/2021