Texas Nursing Home Coalition Looks to Keep Momentum Going

Eddie Parades, executive director, Texas Nursing Home Coalition, is feeling positive for the year ahead as the Coalition comes off its uber popular first annual convention last month and eyes a legislative session full of opportunities for the now-unified nursing home sector.

In a conversation with Park Place, he said the legislative priorities for 2027 are based on three areas:

• Safety - Ensuring families have confidence that nursing homes are prepared during emergencies.

• Accountability - Texas seniors deserve the Medicare Advantage coverage they were promised.

• Sustainability - Optimizing existing funding streams.

Parades said over the last two legislative sessions the legislature has made major investments in the health and safety of Texas seniors, and as a result, Texas nursing homes have risen from 42nd to now tied for 7th best in the nursing home CMS Quality Measure state ranking (CMS June 2026).

In Session for ‘27

Texas, which sees its legislature meet every other year, will see a 2027 session that presents the following opportunities for the Coalition and its members to protect residents and continue working on a sustainable funding mechanism.

Safety – This area concerns generators. The Coalition will seek action on measures to improve generator safety by codifying existing rules into law, address the fuel requirement, and add new public information requirements.

“A higher fuel requirement means longer generator run times during emergencies, and new disclosures mean better informed families,” the Coalition said.

During hurricanes, ice storms, tornadoes, and other emergencies, reliable backup power is critical to protecting vulnerable nursing home residents. Parades said Texas has adopted generator requirements through agency rule, but the key provisions are not clearly established in state law. Providers also need greater flexibility in meeting fuel requirements, and residents deserve clear information about a facility's emergency power capabilities.

The Coalition proposes to:

-              Codify existing generator requirements in state law.

-              Increase the on-site fuel requirement from four hours to 12 hours while allowing facilities to meet the requirement through contracted fuel delivery.

-              Require every facility to disclose its emergency generator capabilities during the admission process.

-              Clarify that state generator requirements preempt conflicting local ordinances.

Why It Matters? The Coalition said if measures are enacted, they would improve emergency preparedness for nursing home residents, give families greater transparency when selecting a nursing facility, provide providers with clear, consistent statewide standards, reduce regulatory uncertainty by preventing conflicting local requirements, and balance stronger resident protections with operational flexibility.

Accountability (Medicare Advantage - MA) – Parades said nursing homes will seek to improve patient protections to ensure MA delivers the coverage that seniors were promised. Providers say seniors are experiencing excessive delays and denials for nursing home care. The legislature needs to bring accountability and transparency that will improve access to much-needed care, they said.

The Coalition said every year, more Texas seniors choose MA plans with the expectation that they will receive the Medicare-covered benefits they have earned. “Too often, however, those patients encounter unnecessary prior authorization requirements, coverage denials, delayed approvals, and payment delays that postpone medically necessary nursing home care,” the association said.

The Coalition proposes to:

-              Prohibit prior authorization requirements or clinical criteria that are more restrictive than Traditional Medicare.

-              Recognize a qualified physician's order as sufficient authorization for an approved SNF admission.

-              Require clean claims to be processed within 14 days and reimbursement of no less than 100 percent of the applicable equivalent CMS Medicare fee schedule.

-              Require annual public reporting on denials, appeals, payment timeliness, and claims processing to improve transparency and accountability.

Why It Matters? The Coalition said these steps would help ensure seniors receive timely access to medically necessary nursing home care, restore physicians—not insurance companies—to the center of clinical decision-making, improve transparency and accountability for MA plans, provide providers with greater certainty and more timely reimbursement, and give seniors and their families greater confidence that the coverage they selected will perform as promised.

Sustainability (Funding) – Parades said the Coalition wants to leverage an existing funding stream to support the legislature’s recent investments in Texas seniors.

“We want to protect those investments from eroding due to rising cost of care. And help reimbursement keep better pace with inflation and reduce the need for additional state general revenue,” he said.

Method of Finance Change (MOF) – Providers want the legislature to make an adjustment to the current flow of funding that will assist with keeping pace with inflation and reduce the need for future additional state general revenue.

Texas nursing home residents receive an annual federal Social Security Cost-of-Living Adjustment (COLA), and as per state law, this increase in their monthly Social Security checks automatically raises the residents’ share and required monthly payment for the cost of their nursing home care, the Coalition said.

The increase is intended to support residents where they live. In this case, in a nursing home. “However, instead of strengthening the Medicaid payment that supports their care, the state reduces its share of the payment by an equal offsetting amount. Residents pay more, but the Medicaid base rate does not increase. Those dollars should strengthen the Medicaid payment supporting their care—not simply replace existing state funding,” the Coalition said.

But a simple change in the way these funds are handled in the budget process would allow these dollars to flow to the residents’ care, as intended, they note.

The Coalition proposes to:

-              Allow the annual increase in the residents’ required Medicaid contribution to remain in the Medicaid base rate for their care, rather than being used to offset the state's share of the payment. The residents’ increased contribution continues to support their care, while the existing state and federal investment remains unchanged.

This makes sense, Parades said, because the change optimizes and strengthens the Medicaid payment supporting resident care, creates a predictable annual increase in the Medicaid base rate, and helps reimbursement better keep pace with inflation and rising operating costs.

In addition, it reduces pressure for future General Revenue appropriations, makes better use of existing funding without creating a new funding source.

The Coalition said the bottom line is that the proposal does not require residents to pay more than they already do under current law, nor does it require the state to create a new funding source.

“It simply allows the annual increase already generated by the residents’ federal Social Security COLA to strengthen the Medicaid payment supporting their care instead of replacing existing state funding. The result is a sustainable, predictable funding mechanism that better supports quality nursing home care while helping reduce future pressure on the state budget,” the Coalition said.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.