All Roll Calls
Yes: 610 • No: 93
TexasSB 45789th Legislature Regular SessionSenate
Relating to the regulation of certain nursing facilities, including licensing requirements and Medicaid participation and reimbursement requirements.
Sponsored By: Giovanni Capriglione, James Frank, Lois Kolkhorst (Republican), Suleman Lalani
Signed by Governor
Health Care ProvidersHuman Services--Medical AssistanceNursing HomesMANAGED CAREMEDICAIDHEALTH & HUMAN SERVICES COMMISSION
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 0 benefits, 1 costs, 2 mixed.
Nursing homes face patient-care spending rules
Beginning September 1, 2025, non-state-owned nursing facilities must spend at least 80% of Medicaid reimbursement tied to patient care on qualifying care costs each year. Qualifying costs include specified staff pay and benefits, care supplies, ancillary services, and food and nutrition services. Unlisted administrative or operating costs and fixed capital costs do not count. Provider agreements must require compliance, but meeting the ratio cannot be a condition of Medicaid participation. Texas may take back some or all reimbursement for violations, within federal limits. Recovery is barred for facilities with at least four stars in three or more specified federal rating categories. It is also barred when average daily occupancy is 75% or less and qualifying care spending reaches 70%, or when facilities incur expenses related to a governor-declared disaster. The law adds managed-care contract requirements: new and renewed contracts must comply, while conflicting preexisting contract terms prevail. Texas must seek changes to existing contracts. By November 1, 2027, Texas must report on the ratio's effects on Medicaid care costs and quality during the preceding state fiscal biennium. The law also repeals three related Medicaid reimbursement subsections; the supplied information does not explain their prior requirements. Implementation can be delayed while needed federal approval is pending.
Nursing homes must disclose ownership details
Beginning September 1, 2025, nursing facility license applications must identify people with direct or indirect ownership interests of 5% or more. This covers interests in the facility, its parent or subsidiary, and the property where it operates. Applications must describe exact ownership interests and include relevant owners, common owners, tenants, and sublessees. License holders must report changes to that information in the form and manner Texas requires.
Nursing home payments continue during sales
Beginning September 1, 2025, Texas must keep Medicaid payments flowing while a nursing facility's ownership-change application is pending. The new owner must accept the prior Medicaid provider agreement and meet applicable legal and licensing requirements. The owner must also assume the prior services contract when that contract requires it and the parties agree. A state-approved agreement must require payment of state-identified outstanding contract liabilities, potentially including the former owner's debts regardless of service or claim dates. The new owner must also meet any additional state requirements. Supplemental and directed payment programs are excluded, and implementation can be delayed while needed federal approval is pending.
Sponsors & Cosponsors
Sponsors
Giovanni Capriglione
House
James Frank
House
Lois Kolkhorst
Republican • Senate
Suleman Lalani
House
Cosponsors
Carol Alvarado
Democratic • Senate
Donna Campbell
Republican • Senate
José Menéndez
Democratic • Senate
Charles Schwertner
Republican • Senate
Roll Call Votes
Senate vote • 5/31/2025
Record vote
Yes: 0 • No: 0
House vote • 5/31/2025
Record vote
Yes: 111 • No: 19
House vote • 5/28/2025
Record vote
Yes: 104 • No: 34
House vote • 5/27/2025
Record vote
Yes: 116 • No: 24
House vote • 5/27/2025
Record vote
Yes: 124 • No: 15
House vote • 5/27/2025
Record vote
Yes: 140 • No: 0
Senate vote • 5/1/2025
Record vote
Yes: 0 • No: 0
Senate vote • 5/1/2025
Record vote
Yes: 0 • No: 0
House vote • Unknown
Committee vote: Human Services
Yes: 6 • No: 1
Senate vote • Unknown
Committee vote: Health & Human Services
Yes: 9 • No: 0
Actions Timeline
Effective on 9/1/25
6/20/2025HouseSigned by the Governor
6/20/2025HouseSent to the Governor
6/2/2025HouseSigned in the House
6/2/2025HouseSigned in the Senate
6/1/2025SenateReported enrolled
6/1/2025SenateSenate adopts conf. comm. report-reported
5/31/2025HouseRecord vote
5/31/2025SenateSenate adopts conference committee report
5/31/2025SenateHouse adopts conf. comm. report-reported
5/31/2025SenateStatement(s) of vote recorded in Journal
5/31/2025HouseRecord vote (RV#4109)
5/31/2025HouseHouse adopts conference committee report
5/31/2025HouseConf. Comm. Report distributed
5/30/2025HouseHouse appoints conferees-reported
5/30/2025SenateHouse grants request for conf comm-reported
5/30/2025SenateConference committee report filed
5/30/2025SenateHouse appoints conferees
5/30/2025HouseHouse grants request for conference committee
5/30/2025HouseSenate appoints conferees-reported
5/29/2025HouseSenate requests conference committee-reported
5/29/2025HouseSenate refuses to concur-reported
5/29/2025HouseSenate appoints conferees
5/29/2025SenateSenate requests conference committee
5/29/2025SenateSenate refuses to concur
5/29/2025Senate
Bill Text
Engrossed
Enrolled
House Committee Report
Introduced
Senate Committee Report
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