Revision 14-0; Effective April 11, 2014

 

1010 Purpose

Revision 14-0 Effective April 11, 2014

 

This manual is a complement to the state rules in the Texas Administrative Code (TAC), Title 40, Part 1, Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification; however, in all cases where discrepancies exist between the information provided in this manual and the rules in Chapter 19 or the federal regulations, the rules or regulations apply.

 

1020 Basis, Scope and Definitions

Revision 14-0;Effective April 11 2014

Rules:

  • 40 TAC, Chapter 19, §19.1, Basis and Scope
  • 40 TAC, Chapter 19, §19.101, Definitions

 

1030 Role of the (DADS)

Revision 14-0; Effective April 11 2014

 

DADS works directly with nursing facility (NF) providers in the following areas:

  • DADS staff conduct inspections and grant licenses to facilities that comply with Chapter 242 of the Health and Safety Code and the standards in 40 TAC, Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification.
  • DADS staff conduct inspections to determine if facilities meet federal requirements and state standards for participation in the Medicaid NF program and Medicare skilled nursing facility (SNF) program.
  • DADS issues Medicaid contracts to NFs that have met Medicaid participation requirements.
  • DADS staff conduct unannounced, on-site visits to each NF to determine if the quality of care provided meets state and federal standards and is appropriate for each recipient's particular needs.
  • DADS staff conduct inspections to determine whether an NF meets construction and Life Safety Code requirements.
  • DADS limits the number of Medicaid-certified NF beds and determines whether to approve additional Medicaid beds.
  • DADS staff who are separate from DADS regulatory staff disseminate evidence-based best practices through the Quality Monitoring Program to improve positive outcomes and the quality of services for individuals served by DADS.
  • Through the DADS Culture Change Initiative, DADS seeks to promote and support nursing home providers as they transform from a traditional system-directed culture to one that is person-directed and person-centered.

 

1031 Medicaid

Revision 14-0; Effective April 11 2014

 

Medicaid is a joint program (state and federally funded) created by Title XIX of the Social Security Act to provide medical assistance for individuals who meet financial eligibility and service-specific criteria. NF services are one of the options provided under Medicaid. An NF provider must meet federal requirements and any state requirements to participate in Medicaid. Section 1902(a)(33)(B) of the Social Security Act requires the state agency responsible for licensing health institutions to determine whether an NF meets the requirements for participation in Medicaid. DADS, as the designated state NF licensing agency, manages this function, as well as performing the survey tasks for NFs to determine if they comply with Medicaid regulations. For additional information about certification requirements, refer to 40 TAC, Chapter 19, Subchapter X, Requirements for Medicaid-Certified Facilities.

 

1032 Medicare

Revision 14-0; Effective April 11 2014

 

Medicare is a federal health insurance program created by Title XVIII of the Social Security Act to provide health care for the aged and individuals with disabilities. Medicare covers a wide range of benefits for specific periods of time through providers and suppliers that participate in the program. Providers must meet the standards established by the Centers for Medicare & Medicaid Services (CMS) to be certified to participate in the program. Section 1864(a) of the Social Security Act authorizes the secretary of the U.S. Department of Health and Human Services to enter into agreements with state survey agencies to determine if an NF meets the federal requirements to participate in Medicare as an SNF. DADS, as the state survey agency, has an 1864 agreement with the secretary of the U.S. Department of Health and Human Services.

 

1033 Dually Certified Facilities

Revision 14-0; Effective April 11 2014

 

A dually certified facility is an NF that elects to participate in both the Medicaid and Medicare programs. A dually certified facility must adhere to both Medicaid and Medicare requirements to be certified as eligible to participate in the programs.

 

1040 Resources

Revision 14-0; Effective April 11 2014

 

  • Licensing rules and state rules for participation in Medicaid are available on the Texas Secretary of State website under 40 TAC, Chapter 19, Nursing Facility Requirements for Licensure and Medicaid Certification.
  • Federal regulations are located in the State Operations Manual, Publication #100-07 on the CMS website.
  • Federal Survey and Certification (S&C) letters are available on the DADS website.
  • Federal requirements for participation in Medicaid are located in the Code of Federal Regulations, Title 42, Part 483, Subpart B, Requirements for Long Term Care Facilities.
  • State rules regarding the NF Preadmission Screening and Resident Review process are located in 40 TAC, Chapter 17, Preadmission Screening and Resident Review (PASRR).