SB7 Protections - Legend HealthCare

Issues for the 84th Legislative Session
Legend is a leading independent owner and operator of skilled nursing
facilities in Texas, with 17 facilities across the state. The company is
consistently regarded as one of the top owner/operators in Texas and within
each of its individual markets.
Preserve the nursing facility protections of Senate Bill 7 to ensure a smooth
transition to managed care in STAR+PLUS.
SB7 (83R) created certain protections for Nursing Facility (NF) providers and patients
entering the STAR+PLUS Medicaid managed care program beginning on March 1, 2015.
Preserving and extending the NF Medicaid rate protection and additional NF protections
will be vital to ensuring providers can continue to deliver the highest quality healthcare,
and patients can continue receiving necessary services.
The Facts
In the 83rd Legislature, Regular Session, 2013, SB7 was passed. SB7 directed the Health
and Human Services Commission (HHSC) to provide nursing facility services through
the STAR+PLUS Medicaid Managed Care Program.
Beginning March 1, 2015, NF services will be provided through STAR+PLUS statewide.
This transition will move about 50,000-60,000 nursing facility residents into one of the
five Managed Care Organizations (MCO) contracted with the State of Texas.
SB7 created necessary protections for NFs that are set to expire September 1, 2019.
These include protecting the Medicaid rate NFs receive from MCOs, not requiring prior
MCO approval for patients in need of an emergency transfer to the hospital, and ensuring
MCOs promptly pay providers for services in 10 days.
The Solutions
Preserve and extend the Medicaid rate protection for NF services provided under
managed care. It is vital MCOs are not able to negotiate reimbursements to NFs, and
funds are not diverted from patient care to managed care profits through unwarranted
Medicaid provider payment cuts.
Continue to mandate that prior approval is not needed for patients needing emergency
transportation to a hospital. In an emergency situation, it is critical a patient is able to
immediately seek necessary acute care and the MCO properly reimburses for the service.
Safeguard the 10-day prompt pay requirement of MCOs. NFs operate under very small
margins, in fact, the higher the share of Medicaid patient days is in a facility, the lower its
total margins. With Medicaid-dependent patients making up 60% of an average NF, NFs
cannot sustain daily operations without being quickly reimbursed by insurers for services.
It is crucial NFs can rely on timely payment from MCOs.
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San Antonio, TX 78216