Current through Reg. 49, No. 38; September 20, 2024
(a) Basis. The Texas Department of Human
Services, hereinafter referred to as TDHS, the Texas Department of Health,
hereinafter referred to as TDH, and the Texas Department of Mental Health and
Mental Retardation, hereinafter referred to as TDMHMR, are required under the
provisions of Human Resources Code, §
22.014,
to enter into a memorandum of understanding regarding responsibilities,
procedures, and standards involved in the provision, regulation, and/or funding
of services in hospitals or long term care institutions. However, this
agreement does not apply to state hospitals or to any TDMHMR service not funded
under Title XIX of the Social Security Act.
(b) Provision of services.
(1) Hospital and long term care services are
provided by facilities under contract to TDHS as the Title XIX designated
single state agency. TDHS contracts for intermediate care provided by
facilities for the mentally retarded (ICF-MR) in community-based settings and
in state schools and state centers, and for intermediate care (ICF) and skilled
nursing facility (SNF) care in nursing homes.
(2) TDHS is also responsible for reimbursing
Title XIX participating hospitals and long term care facilities for covered
Title XIX services provided to Title XIX eligible individuals. Reimbursement is
subject to the specifications, conditions, limitations, and requirements
established by the department or its designee.
(c) Regulation of service/standards and
procedures of operations.
(1) TDHS
promulgates standards and policies, appropriate to complement and support
federal regulations, to govern the participation of acute care hospitals and
the operation of intermediate care and skilled nursing facility care in nursing
homes. TDMHMR develops, with the approval of TDHS, standards and policies,
appropriate to complement and support federal regulations, to govern the
operation of community-based IFC-MR facilities and state schools for the
mentally retarded.
(2) TDH, under
contract to TDHS, surveys, certifies, and monitors facilities providing
services to ICF-MR clients and to ICF-SNF clients. TDH develops and publishes
licensure requirements for all facilities providing health care. Consonant with
federal regulations, TDH develops and publishes the certification procedures
which govern the certification of facilities desiring to enter into contracts
with TDHS as providers of ICF/SNF service. TDH has administrative penalties
which provide sanctions for nursing home facilities who fail to provide
acceptable care and to maintain compliance with state licensure requirements.
TDHS' standards for participation contain sanctions requirements for facilities
who fail to carry out their contractual responsibilities.
(3) TDHS and TDH entered into contracts in
1972, whereby TDH agreed to survey and certify as meeting state and federal
standards, all nursing facilities wishing to contract or continue to contract
with TDHS as ICFs and SNFs under Title XIX. These contracts have been in force
continuously since 1972. In 1977, pursuant to State Bill 9, 65th Legislature,
1st Called Session 1977, TDHS and TDH entered into a contract whereby TDH
agreed to be responsible for monitoring and evaluating the quality of care
provided by ICF, SNF, and ICF-MR facilities.
(4) TDHS and TDMHMR, pursuant to House Bill
656, 67th Legislature, 1981, agreed that TDMHMR would develop and recommend
policy and standards, and that TDMHMR would assume the responsibility for
monitoring TDH's activities regarding quality of care review in community-based
ICF-MR facilities and state schools.
(d) Funding of services.
(1) TDHS requests state funds and matching
federal funds in support of the Medicaid program in Title XIX participating
hospitals and long term care facilities. TDHS also requests federal matching
funds for expenditures made by TDH and TDMHMR on behalf of Medicaid.
(2) TDMHMR requests state funds for its
activities and certifies expenditures to TDHS for the purpose of drawing down
federal matching funds under Title XIX. TDH requests state funds for its
activities and certifies expenditures to TDHS for the purpose of drawing down
federal matching funds as they relate to survey and certification of nursing
facilities for Title XIX participation and quality of care in such
facilities.
(e)
Promulgation of rules.
(1) TDHS, TDH, and
TDMHMR agree that no new rules or regulations that would increase the cost of
providing the required services or increase the number of personnel in
hospitals or long term care facilities will be promulgated by the agencies
unless:
(A) the commissioner of health
certifies that the new rules or regulations are urgent and necessary to protect
the health or safety of recipients of hospital or long term care services;
or
(B) TDHS provides written
verification that funds are available to adequately reimburse hospital or long
term care service providers for any increased costs resulting from the rule or
regulation and establishes reimbursement rates that are sufficient to cover the
increased costs; or
(C) the rules
are required by state or federal law or federal regulations.
(2) TDHS, TDH, and TDMHMR agree
that any rules or regulations proposed by the agencies which would increase the
costs of providing the required services or increase the number of personnel in
hospital or long term care facilities will be accompanied by a preliminary
fiscal note prepared for the agency promulgating the rules. The fiscal note
will be submitted to TDHS and will state the expected impact on the cost of
providing the required service and the anticipated impact on the number of
personnel in hospital or long term care facilities. For a rule to be finally
adopted, TDHS must provide written verification that funds are available to
adequately reimburse hospital or long term care service providers for any
increased costs resulting from the rule or regulation. Written verification is
not required if the commissioner of health certifies that the new rule or
regulation is urgent and necessary to protect the health or safety of
recipients of hospital or long term care services. The provisions of this
paragraph do not apply if the rules are required by state or federal law or
federal regulations.
(f)
Termination. In the event that federal and/or state laws or other requirements
should be amended or judicially interpreted so as to render continued
fulfillment of this agreement substantially unreasonable or impossible, or if
the parties should be unable to agree upon any amendment which would therefore
be needed to enable the substantial continuation of services contemplated
herein, then, and in that event, the parties shall be discharged from any
further obligation created under the terms of this agreement, except for the
equitable settlement of the respective accrued interests or obligations
incurred up to the date of termination.
(g) Annual review. TDHS, TDH, and TDMHMR
shall review and, if necessary, update this memorandum of understanding prior
to the close of each fiscal year.
(h) Effective date. For the faithful
performance of this agreement, this agreement is executed by the commissioners
of TDHS, TDMHMR, and TDH, to be effective January 1, 1988.
