Medicaid Nursing Home Rules in Texas

The Texas Department of Human Services provides additional certification for nursing homes that meets Medicaid standards. Those that qualify receive reimbursement for services provided to Medicaid recipients at both a state and federal level. Nursing homes must maintain specific standards to maintain their certification, and it can be revoked if the Department of Aging and Disability Services (DADS) finds that the nursing home is in violation of Medicaid-specific regulations.

Admission and Transfer Rules

• In order to retain their contract as a Medicaid-certified nursing home, facilities in Texas must refrain from requesting that residents either not apply for or waive their Medicaid benefits. During the admission process, the nursing home cannot insist on a third-party payment guarantee. If payment is coming from someone who has legal access to the resident's income and resources, the nursing home can request a contract ensuring payment so long as it doesn't infringe on the other party's income. If a resident must be transferred to a hospital or goes on a therapeutic leave, the nursing home must provide the resident and a family member with a copy of its policy explaining how long residents may be absent without losing their placement.

Equal Treatment Rules

• Medicaid-certified nursing homes must treat Medicaid and non-Medicaid residents the same. Medicaid residents are only covered for services eligible under the state plan. Any additional services are paid at the resident's own expense provided that the nursing home presents notice of the availability and cost of the services. A nursing home's Medicaid contract can be terminated if the facility charges residents for services they don't require and haven't signed up for.

Quality of Life Rules

• Quality of life is very important in Texas nursing homes. All Medicaid-certified facilities must maintain the dignity of all residents. Residents should be respected and allowed to participate in whatever programs and activities they choose within acceptable limits of their plan of care. The nursing home cannot prohibit residents from taking part in community or religious activities. Within the facility itself, the nursing home needs to provide medically-related social services that promote the highest practicable levels of well-being for each resident.

Certification Restriction Rules

• Nursing homes cannot enforce restrictive policies if they want to operate as a Medicaid-certified facility. These policies include asking residents to sign a life insurance policy that names the nursing home as the beneficiary, any policy that controls or restricts residents' personal needs allowance, or denying residents appropriate care for any reason. Nursing homes may voluntarily withdraw from the program. When withdrawing from the program, the nursing home's administrator must send a formal request to the DHS at least 30 days in advance.