NF Medicaid Bed Allocation Rules & Policies

Bed allocation rules and policies improve the quality of resident care by selecting and limiting the allocation of Medicaid beds thereby prompting competition and controlling the number of Medicaid beds for which HHSC contracts. The number of Medicaid beds in a facility can be increased only through waivers and exemptions.

Medicaid Bed Allocation Waiver Application for Nursing Facilities

Types of Waivers

The following can be found in the Texas Administrative Code, Title 26, Part 1, Chapter 554, Subchapter X, Rule Section 554.2322

  • High occupancy waiver — 26 TAC Section 554.2322(h)(1)
  • Community needs waiver — 26 TAC Section 554.2322(h)(2)
  • Criminal justice waiver — 26 TAC Section 554.2322(h)(3)
  • Economically disadvantaged waiver — 26 TAC Section 554.2322(h)(4)
  • Alzheimer's waiver — 26 TAC Section 554.2322(h)(5)
  • Teaching nursing facility waiver — 26 TAC Section 554.2322(h)(6)
  • Rural county waiver — 26 TAC Section 554.2322(h)(7)
  • State veterans waiver — 26 TAC Section 554.2322(h)(8)
  • Small house waiver — 26 TAC Section 554.2322(h)(9)

List of nursing facility waiver applications submitted (Excel)

Types of Exemptions

The following can be found in the Texas Administrative Code, Title 26, Part 1, Chapter 554, Subchapter X, Rule Section 554.2322

  • Replacement — 26 TAC Section 554.2322(f)(1)
  • Transfer — 26 TAC Section 554.2322(f)(2)
  • High occupancy (10 percent) — 26 TAC Section 554.2322(f)(3)
  • Non-certified nursing facilities (Licensed-only) — 26 TAC Section 554.2322(f)(4)
  • Low capacity facilities (Up to 60) — 26 TAC Section 554.2322(f)(5)
  • Spend-down Medicaid beds — 26 TAC Section 554.2322(f)(6)

List of nursing facility replacement applications (Excel)

Form 3712, Temporary Medicaid Spend-Down Bed Request (PDF)

Medicaid Bed Allocation Requirements

Click here for information on rules and regulations pertaining to Medicaid beds.

Bed Change Procedures

A change in bed count constitutes an increase or decrease in the facility's Medicare and/or Medicaid bed count.

Loss of Medicaid Beds Based on Low Occupancy (Annual Decertification Project)

HHSC may review Medicaid bed occupancy rates annually to de-allocate and decertify unused Medicaid beds. Medicaid beds will be de-allocated and decertified in facilities that have an average occupancy rate below 70 percent. See 26 TAC Section 554.2322(l).