86th LEGISLATURE INTERIM CHARGE PRIORITIES
> Solve the nursing home Medicaid funding shortfall to enhance quality care
Texas nursing facilities lose an average of $36 per patient per day on Medicaid residents. This gap impacts quality care because it contributes to staffing issues and an inability to maintain modern facilities. In fact, the largest provider of long term care in the state recently declared bankruptcy.
Study the impact of the Centers for Medicare & Medicaid Services (CMS) Medicare reimbursement methodology for skilled nursing care and its impact on the current Texas Medicaid rate methodology. Make recommendations on how Medicaid should pivot to a rate methodology aimed at maintaining access to quality skilled nursing care in Texas.
Review and make recommendations on the current Value Based Payments made by MCOs to skill nursing home providers, including the total paid, the requirements measured and the benefits to the state.
> Improve the Medicaid Star+Plus Program for nursing home providers and residents
Since starting in 2015, Medicaid Managed Care has been a significant challenge, both administratively and financially for providers. Medicaid Managed Care has raised costs for providers because of delayed payments, additional billing/administrative costs, lack of standardization and other expenses. Continuous efforts by THCA and other providers to improve MCO services have led to some improvements—but too many issues persist.
Examine potential efficiencies in the operations of Medicaid managed care, including movement to a single portal for providers to submit and receive information across multiple managed care organizations.
> Caring for residents with Behavioral Health Needs
The total number of Texans age 65 and older with Alzheimers dementia estimated at 400,000 for 2020. At age 80, approximately 75 percent of people living with Alzheimer’s are expected to live in a nursing home compared with only 4 percent of the general population at age 80.
Examine the growth in behavioral health care in the skilled nursing facilities. Study the current population growth in the over 65 population to include the composition of residents with impaired cognition, or have been diagnosed with Alzheimer’s disease or dementia to review and recommend care delivery and resource requirements for both current care needs and future needs based upon population growth.
> The Workforce Crisis
Evaluate the need for BSN, RN, LVN, CNA, and additional direct care staff in long term care. Identify opportunities and strategies specifically for long term care settings recruitment and retention. Review the limitations, if any, within the schools of nursing and curriculum requirements to address the nursing shortage in long term care.