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1 TEXAS HEALTH AND HUMAN SERVICES COMMISSION Nursing Facility Minimum Payment Amount Program (MPA) - Tentative Eligibility Determinations as of 3/20/15 Eligibility 2 September 1, August 31, 2016 Eligibility 2A December 1, August 31, 2016 Vendor Fac ID Legal Entity Name Facility Name Dallam Hartley Counties Hospital District Coon Memorial Home West Coke County Hospital District Robert Lee Care Center Kent County Kent County Nursing Home Muleshoe Area Hospital District Park View Nursing Care Center Mitchell County Hospital District Valley Fair Lodge Sterling County Nursing Home Sterling County Nursing Home East Coke County Hospital District Bronte Health and Rehab Center Farwell Hospital District dba Farwell Care and Rehab CenterFarwell Care and Rehab Center Stratford Hospital District Coldwater Hansford County Hospital District Hansford Manor Booker Hospital District dba: Twin Oaks Manor Twin Oaks Manor Moore County Hospital District Memorial Nursing and Rehabilitation Center Seminole Hospital District Memorial Health Care Center Coryell County Memorial Hospital Authority The Meadows Andrews County Hospital District Permian Residential Care Center Stonewall Memorial Hospital District Gibson Care Center County of Yoakum Shinnery Oaks Community County of LaSalle Las Palmas Knox County Hospital District Munday Nursing Center Goodall-Witcher Hospital Authority Goodall-Witcher Nursing Facility Childress County Hospital District Lockney Health and Rehabilitation Childress County Hospital District Tulia Health and Rehabilitation Jack County Hospital District Arlington Health and Rehabilitation Center Coryell County Memorial Hospital Authority Copperas Hollow Nursing and Rehabilitation Goodall-Witcher Hospital Authority Sunset Home Gonzales Healthcare Systems The Heights of Gonzales Citizens Medical Center County of Victoria Wharton Nursing and Rehabilitation Center Citizens Medical Center County of Victoria Cuero Nursing and Rehabilitation Center Coryell County Memorial Hospital Authority Westview Manor Citizens Medical Center County of Victoria Port Lavaca Nursing and Rehabilitation Center Citizens Medical Center County of Victoria Stevens Nursing and Rehabilitation Center of Hallettsville Citizens Medical Center County of Victoria Soluthbrooke Manor Nursing and Rehabilitation Center Citizens Medical Center County of Victoria Yoakum Nursing and Rehabilitation Center Citizens Medical Center County of Victoria Shady Oak Nursing and Rehabilitation Citizens Medical Center County of Victoria Twin Pines Nursing and Rehabilitation Citizens Medical Center County of Victoria Ganado Nursing and Rehabilitation Center Citizens Medical Center County of Victoria Matagorda Nursing & Rehabilitation Burleson County Hospital District Burleson St. Joseph Manor Burleson County Hospital District St. Joseph Manor 2

2 Stratford Hospital District Lubbock Hospital Nursing and Rehab Center McCulloch County Hospital District Crane Nursing and Rehabilitation Center Uvalde County Hospital Authority Cedar Hills Geriatric Center Medina County Hospital District Guadalupe Valley Nursing Center Medina County Hospital District Town and Country Manor Hopkins County Hospital District Clairmont Tyler Childress County Hospital District Hale Center Health and Rehabilitation Uvalde County Hospital Authority Southwood Care Center Chambers County Public Hospital District #1 Stoneybrook Residence and Rehabilitation Center Uvalde County Hospital Authority Oak Crest Nursing Center Hopkins County Hospital District Clairmont Longview Uvalde County Hospital Authority Live Oak Nursing Center Hopkins County Hospital District Colonial Tyler Care Center Winnie-Stowell Hospital District The Woodlands Healthcare Center Medina County Hospital District Medina Valley Health & Rehabilitation Center Decatur Hospital Authority Fort Worth Center of Rehabilitation Winnie-Stowell Hospital District Spring Branch Transitional Care Center Winnie-Stowell Hospital District Monument Hill Rehabilitation and Nursing Center Winnie-Stowell Hospital District Hallettsville Rehabilitation and Nursing Center Uvalde County Hospital Authority Briarcliff Nursing and Rehabilitation Center Stratford Hospital District Arbor Terrace Healthcare Center Stratford Hospital District Sweetwater Healthcare Center Winnie-Stowell Hospital District Marshall Manor West Winnie-Stowell Hospital District Rose Haven Retreat Decatur Hospital Authority Cityview Care Center Nocona Hospital District Grace Care Center of Henrietta Stratford Hospital District Borger Healthcare Center Eastland Memorial Hospital District Coronado Nursing Center Seminole Hospital District Sagecrest Alzheimers Care Center Stratford Hospital District Texas Heritage Oaks Nursing and Rehabilitation Center Coryell County Memorial Hospital Authority Granbury Rehab & Nursing McCulloch County Hospital District Brady West Rehab & Nursing Stamford Hospital District Stamford Residence and Rehabilitation Center Winnie-Stowell Hospital District Oakland Manor Nursing Center Winnie-Stowell Hospital District Clairmont Beaumont County of Throckmorton Haskell Healthcare Center Uvalde County Hospital Authority Snyder Oaks Care Center DeWitt Medical District Victoria Residence and Rehabilitation Center Olney-Hamilton Hospital District Grace Care Center of Olney Winnie-Stowell Hospital District Marshall Manor Nursing and Rehabilitation Center Winnie-Stowell Hospital District Oak Manor Nursing Center Winnie-Stowell Hospital District Highland Park Care Center Coryell County Memorial Hospital Authority The Manor Healthcare Residence Coryell County Memorial Hospital Authority Western Hills Healthcare Residence Coryell County Memorial Hospital Authority Crestview Healthcare Residence 2

3 Coryell County Memorial Hospital Authority Windsor Healthcare Residence Coryell County Memorial Hospital Authority Fairview Healthcare Residence Winnie-Stowell Hospital District Garrison Nursing Home & Rehabilitation Center Winnie-Stowell Hospital District Golden Villa Healthcare, LLC Stratford Hospital District Coronado Healthcare Center Goodall-Witcher Hospital Authority Regency Manor Healthcare Center Childress County Hospital District Childress Nursing Center Coryell County Memorial Hospital Authority Colonial Manor Nursing Center Coryell County Memorial Hospital Authority Walnut Hills Nursing and Rehabilitation Ballinger Memorial Hospital District Coleman Healthcare Center Coryell County Memorial Hospital Authority Quality Care of Waco Palo Pinto County Hospital District Palo Pinto Nursing Center Palo Pinto County Hospital District Wedgewood Nursing Home Nocona Hospital District Grace Care Center of Nocona Palo Pinto County Hospital District White Settlement Nursing Center Seminole Hospital District Pampa Nursing Center Seminole Hospital District Golden Years Nursing and Rehabilitation Center Seminole Hospital District Levelland Nursing & Rehabilitation Center County of Throckmorton Garden Terrace Healthcare Center Seminole Hospital District Lake Shore Village Healthcare Center Jack County Hospital District Jacksboro Healthcare Center DeWitt Medical District Floresville Residence and Rehabilitation Center Seminole Hospital District Weatherford Health Care Center Seminole Hospital District Peach Tree Place Seminole Hospital District Greenview Manor Palo Pinto County Hospital District Santa Fe Health & Rehabilitation Center DeWitt Medical District Brookshire and Rehabilitation Center Palo Pinto County Hospital District Heritage House at Keller Rehab & Nursing Baylor County Hospital District Baylor Seymour Rehabilitation and Healthcare Stamford Hospital District Home Place Manor Baylor County Hospital District River Oaks Care Center Goodall-Witcher Hospital Authority Jeffrey Place Healthcare Center DeWitt Medical District Stockdale Residence and Rehabilitation Baylor County Hospital District Monterey Care Center Jack County Hospital District Park View Care Center Baylor County Hospital District Vernon Care Center Nocona Hospital District Advanced Rehabilitation and Healthcare of Bowie Stratford Hospital District Sage Healthcare Center Stratford Hospital District Plainview Healthcare Center Decatur Hospital Authority Kindred Transitional Care and Rehabilitation - Grapevine Stratford Hospital District Hillside Heights Rehabilitation Suites Nocona Hospital District Evergreen Healthcare Center Stratford Hospital District Snyder Healthcare Center Decatur Hospital Authority Kindred Transitional Care and Rehabilitation - Ridgmar County of Throckmorton Olney Healthcare Center 2

4 Stratford Hospital District Lakeside Rehabilitation and Care Center Val Verde County Hospital District Pearsall Nursing and Rehabilitation Center - North Childress County Hospital District Apex Secure Care Val Verde County Hospital District Val Verde Nursing and Rehabilitation Center Val Verde County Hospital District Windsor Nursing and Rehabilitation Center of Seguin Sweeny Hospital District Lake Jackson Healthcare Center Hamilton County Hospital District Hamilton Healthcare Center Childress County Hospital District Ralls Nursing Home Decatur Hospital Authority Kindred Transitional Care and Rehabilitation - Mansfield Plaza DeWitt Medical District Corpus Christi Nursing and Rehabilitation Center Nocona Hospital District Electra Healthcare Center Hemphill County Hospital District Edward Abraham Memorial Home Parker County Hospital District College Park Rehabilitation and Care Center Liberty County Hospital District No. 1 College Street Health Care Center DeWitt Medical District Kingsville Nursing and Rehabilitation center Val Verde County Hospital District Windsor Mission Oaks Liberty County Hospital District No. 1 Senior Rehabilitation & Skilled Nursing Center Fannin County Hospital Authority Palestine Healthcare Center Fannin County Hospital Authority Lindale Healthcare Center Fannin County Hospital Authority Carthage Healthcare Center Fannin County Hospital Authority Overton Healthcare Center Liberty County Hospital District No. 1 Jefferson Nursing and Rehabilitation Center Decatur Hospital Authority DFW Nursing & Rehab Fannin County Hospital Authority Canton Healthcare Center Smithville Hospital Authority Bastrop Lost Pines Nursing and Rehabilitation Center Tyler County Hospital District Magnolia Manor Memorial Medical Center Ashford Gardens Uvalde County Hospital Authority Coronado at Stone Oak Uvalde County Hospital Authority Palma Real Gonzales Healthcare Systems Magnolia Living and Rehabilitation Memorial Medical Center The Broadmoor at Creekside Park Tyler County Hospital District Woodville Health and Rehabilitation Center Decatur Hospital Authority The Harrison at Heritage Gonzales Healthcare Systems Texan Nursing & Rehab of Gonzales DeWitt Medical District Winsor Nursing and Rehabilitation Center of Corpus Christi Dallas County Hospital District Crestview Court Dallas County Hospital District The Madison on Marsh Eastland Memorial Hospital District Golden Acres Living and Rehabilitation Center Stratford Hospital District Legacy Rehabilitation and Living Dallas County Hospital District The Villa at Mountain View Eastland Memorial Hospital District Northern Oaks Living & Rehabilitation Center Sweeny Hospital District The Colonnades at Reflection Bay Uvalde County Hospital Authority La Paloma Nursing Center Dallas County Hospital District Ashford Hall County of Throckmorton Graham Oaks Care Center 2

5 Uvalde County Hospital Authority Retama Manor Nursing Center / Laredo-West Dimmit Regional Hospital District Retama Manor Nursing Center/Pleasanton South Uvalde County Hospital Authority Retama Manor / Laredo South Uvalde County Hospital Authority Laredo Nursing and Rehabilitation Center Memorial Medical Center The Crescent Memorial Medical Center Solera at West Houston Memorial Medical Center Fort Bend Healthcare Center Hamilton County Hospital District Bel Air at Teravista Decatur Hospital Authority The Carlyle at Stonebridge Park Uvalde County Hospital Authority Hilltop Village Nursing and Rehabilitation Center Parker County Hospital District Willow Park Rehabilitation and Care Center South Limestone Hospital District Garnet Hill Rehabilitation and Skilled Care South Limestone Hospital District Woodland Springs Nursing Center Eastland Memorial Hospital District Wisteria Place Tyler County Hospital District Silsbee Convalescent Center Val Verde County Hospital District Maverick Nursing and Rehabilitation Center Fannin County Hospital Authority Jacksonville Healthcare Center Ballinger Memorial Hospital District Cross Country Healthcare Center Smithville Hospital Authority Elgin Nursing and Rehabilitation Center Fannin County Hospital Authority Paris Healthcare Center Smithville Hospital Authority Southpark Meadows Nursing and Rehabilitation Center Parker County Hospital District Hilltop Park Rehabilitation and Care Center Bexar County Hospital District The Heights on Huebner Dallas County Hospital District Duncanville Healthcare and Rehabilitation Center Uvalde County Hospital Authority Deer Creek of Wimberley Stephens Memorial Hospital District Mulberry Manor South Limestone Hospital District The Villages on MacArthur Eastland Memorial Hospital District Eastland Nursing & Rehabilitation Coryell County Memorial Hospital Authority Brentwood Place Three Oak Bend Medical Center Montebello Wellness Center Val Verde County Hospital District Amistad Nursing and Rehabilitation Center Dallas County Hospital District The Plaza at Richardson Dallas County Hospital District Williamsburg Village Healthcare Campus Uvalde County Hospital Authority Alpine Terrace Uvalde County Hospital Authority Northgate Health and Rehabilitation Center Hopkins County Hospital District Reunion Plaza Senior Care and Rehabilitation Center Val Verde County Hospital District Del Rio Nursing and Rehabilitation Center Decatur Hospital Authority Hollymead Dallas County Hospital District Windsor Gardens Decatur Hospital Authority San Remo Dallas County Hospital District Brentwood Place Four Uvalde County Hospital Authority Retama Manor Nursing Center/Alice Hemphill County Hospital District Windflower Health Center Sweeny Hospital District Laurel Court Uvalde County Hospital Authority Retama Manor Nursing Center / San Antonio North 2

6 Dimmit Regional Hospital District Retama Manor Nursing Center/Pleasanton North Dallas County Hospital District Town East Rehabilitation and Healthcare Center South Limestone Hospital District Settlers Ridge Care Center Bexar County Hospital District Country Care Manor Bexar County Hospital District The Heights Uvalde County Hospital Authority Kirkwood Manor Dallas County Hospital District Prairie Estates Oak Bend Medical Center The Westbury Place Oak Bend Medical Center First Colony Health & Rehabilitation Center Oak Bend Medical Center Brenham Nursing & Rehabilitation Center DeWitt Medical District Winsor Nursing and Rehabilitation Center of Duval Nocona Hospital District Sunny Springs Nursing & Rehab South Limestone Hospital District Accel at Willow Bend Decatur Hospital Authority Renaissance Care Center Coryell County Memorial Hospital Authority Ft. Worth Southwest Nursing Center Eastland Memorial Hospital District Willowbend Nursing and Rehabilitation Center Decatur Hospital Authority The Belmont at Twin Creeks Hansford County Hospital District The Plaza at Lubbock Chambers County Arboretum Nursing and Rehabilitation Center of Winnie Decatur Hospital Authority Beacon Hill Dallas County Hospital District The Manor at Seagoville Menard County Hospital District Menard Manor Likely Coryell County Memorial Hospital Authority Giddings Residence and Rehabilitation Center Likely 2 On IGT Contract XI.A not filled out. Certification of Debarment not filled out properly. On IGT Contract XI.A not filled out. Certification of Debarment not filled out properly Seminole Hospital District Elsie Gayer Health Care Center Likely 2 On IGT Contract XI.A not filled out. Certification of Debarment not filled out properly. No facility addresses Coryell County Memorial Hospital Authority Gardendale Rehabilitation & Nursing Center Likely 2 On IGT Contract XI.A not filled out Childress County Hospital District Prairie House Living Center Likely 2 On IGT Contract XI.A not filled out Palo Pinto County Hospital District Clyde Nursing Center Likely 2 On IGT Contract XI.A not filled out Palo Pinto County Hospital District Benbrook Nursing & Rehab Likely Childress County Hospital District Palo Duro Nursing Home Likely Oak Bend Medical Center Cambridge Health & Rehabilitation Center Coryell County Memorial Hospital Authority Regal Healthcare Residence 2A McCulloch County Hospital District Pecan Valley Healthcare Residence 2A Starr County Hospital District Rio Grande City Nursing and Rehabilitation Center 2A Hopkins County Hospital District Heritage Plaza Nursing Center 2A Guadalupe Regional Medical Center Nesbit Living & Recovery Center 2A IGT Contract XI.A not filled out. No documents Received. Need documents in order to be eligible for period 2. IGT Contract XI.A not filled out. No documents Received. Need documents in order to be eligible for period 2.

7 Uvalde County Hospital Authority Carechoice of Boerne 2A Coryell County Memorial Hospital Authority Retirement and Nursing Center Austin 2A Nocona Hospital District Park Haven Nursing and Rehabilitation 2A Oak Bend Medical Center Westchase Health & Rehabilitation Center 2A Hopkins County Hospital District Briarcliff Skilled Nursing Facility 2A Hopkins County Hospital District Pine Grove Nursing Center 2A Dimmit Regional Hospital District Retama Manor Nursing Center / Jourdanton 2A DeWitt Medical District Pflugerville Nursing and Rehabilitation Center 2A Nocona Hospital District Senior care Health & Rehabilitation Center - Wichita Falls 2A Eastland Memorial Hospital District Cisco Nursing & Rehabilitation 2A Oak Bend Medical Center Heritage Park Rehabilitation & Skilled Nursing Center' 2A Liberty County Hospital District No. 1 Southland Rehabilitation and Healthcare 2A Oak Bend Medical Center Brazosview Healthcare Center 2A Uvalde County Hospital Authority Edgewater Care Center 2A Liberty County Hospital District No. 1 Oceanview Healthcare and Rehabilitation 2A Coryell County Memorial Hospital Authority West Side Campus of Care 2A Hopkins County Hospital District Colonial Pines Healthcare Center 2A Coryell County Memorial Hospital Authority Brentwood Place One 2A Coryell County Memorial Hospital Authority Brentwood Place Two 2A South Limestone Hospital District Baybrooke Village Care and Rehab Center 2A Hopkins County Hospital District South Place Nursing Center 2A McCulloch County Hospital District Oaks Nursing Center 2A Oak Bend Medical Center Windsor Houston 2A Ector County Hospital District Parks Health Center 2A McCulloch County Hospital District Rosewood Rehabilitation and Care Center 2A South Limestone Hospital District Villa Toscana at Cypress Woods 2A Oak Bend Medical Center Windsor Quail Valley Post-Acute Healthcare 2A Childress County Hospital District Hackberry Creek Care Center Likely 2A Need Elig. Form South Limestone Hospital District High Hope Care Center of Brenham Likely 2A Hopkins County Hospital District Treviso Transitional Care Likely 2A Liberty County Hospital District No. 1 Timberwood Nursing and Rehabilitation Center Likely 2A Contract number not correct on certification of eligibility form Childress County Hospital District Plum Creek Healthcare Residence Likely 2A Need Elig. Form

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