Nursing Facility (NF)

Overview

The Nursing Facility program provides institutional care to Medicaid recipients whose medical condition regularly requires the skills of licensed nurses. The nursing facility must provide for the total medical, social and psychological needs of each client, including room and board, social services, over-the-counter drugs, medical supplies and equipment, and personal needs items.

Reporting Information

Cost Reports

View 2017 Cost Reporting Information
View 2016 Cost Reporting Information
View 2015 Cost Reporting Information

Rate Enhancement Reports

View 2018 Accountability Report - Multipurpose Information
View 2017 Accountability Report - Multipurpose Information

Liability Insurance Coverage Certification

House Bill (HB) 154, approved by the 77th Texas legislature, requires the Texas Health and Human Services Commission (HHSC) to ensure that the rate determination rules for nursing facilities "provide for the rate component derived from reported liability insurance costs to be paid only to those homes that purchase liability insurance acceptable to the commission". To comply with HB 154, the portion of the general and administrative rate component derived from reported liability insurance costs has been excluded from nursing facility rates effective September 1, 2001. The funds withheld from the rates due to HB 154 will be distributed to facilities that verify liability insurance coverage acceptable to the HHSC.

Liability Insurance Coverage Add-On
Adopted Rules (Effective 10/28/2007)
Coverage Certification Form (.xls)
Requirements for Insurance Reimbursement Add-On (.pdf)
Independently Procured Insured Affidavit (.pdf)
Captive Insurance Affidavit (.pdf)

Methodology / Rules

The Texas Medicaid Nursing Facility (program-specific) Cost-Finding Methodology is located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, Subchapter C, Rules 306, 307, 308, 401-403. These rules explain in detail how the daily RUG payment rates are calculated.

Cost Determination Process Rules applicable to the Texas Medicaid Nursing Facility Program are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, Subchapter A, Rules 101-110.

Rules pertaining to the maintenance of contractor records for the Texas Medicaid Nursing Facility Program are located at Title 40 of the Texas Administrative Code, Part 1, Chapter 49, Subchapter C, Rule §49.305 and Rule §49.307.

Rules pertaining to the Direct Care Staff Compensation Rate Enhancement are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, Subchapter C, Rule 308.

Payment Rate Information

Effective September 1, 2014 to current (.pdf)
Effective September 1, 2013 (.pdf)
Effective February 1, 2011 (.pdf)
Effective September 1, 2010 (.pdf)
Effective September 1, 2009 (.pdf)
Effective September 1, 2008 (.pdf)
Effective September 1, 2007 (.pdf)
Effective September 1, 2006 (.pdf)
Effective January 1, 2006 (.pdf)
Effective September 1, 2005 (.pdf)
Effective September 1, 2004 (.pdf)
Effective September 1, 2003 (.pdf)
Effective September 1, 2002 (.pdf)
Effective September 1, 2001 (.pdf)
Effective September 1, 2000 (.pdf)

Rate Enhancement - Direct Care Staff Compensation

View 2019 Rate Enhancement - Attendant Compensation Information
View 2018 Rate Enhancement - Attendant Compensation Information
View 2017 Rate Enhancement - Attendant Compensation Information

Training Information

View Cost Report Training information
View Rate Enhancement Report Training information
View Rate Enhancement Enrollment Training information

 

Quality Incentive Payment Program (QIPP)

During the 83rd Legislative Session, the Texas Legislature outlined its goals for adding managed care to nursing facilities. The Texas Health and Human Services Commission was directed to encourage transformative efforts in the delivery of nursing facility services, including "efforts to promote a resident-centered care culture through facility design and services provided."

In 2014, HHSC established the Minimum Payment Amount Program, which became effective in 2015. MPAP establishes minimum payment amounts for qualified nursing facilities in STAR+PLUS. The STAR+PLUS managed care organizations pay the minimum payment amounts to qualified nursing facilities based on state direction. The program was intended to be a short-term program that would ultimately transition to a performance-based initiative.

HHSC Budget Rider 97 in the 2016-2017 budget directs HHSC to transition the Minimum Payment Amount Program to the Quality Incentive Payment Program (QIPP).

The Quality Incentive Payment Program encourages nursing facilities to improve the quality and innovation of their services, using the Centers for Medicare & Medicaid five star rating system as its measure of success.

View information regarding the Quality Incentive Payment Program (QIPP)