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 2018 Cost Reporting Information
View 2017 Cost Reporting Information
View 2016 Cost Reporting Information

Rate Enhancement Reports

View 2019 Accountability Report
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 2020 Rate Enhancement - Attendant Compensation Information
View 2019 Rate Enhancement - Attendant Compensation Information
View 2018 Rate Enhancement - Attendant Compensation Information

Training Information

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

Nursing Facility Supplemental Payment Programs

View Nursing Facility Upper Payment Limit (UPL) Supplemental Payment Program
View Nursing Facility Minimum Payment Amount
View Quality Incentive Payment Program (QIPP)