As Reported by the House Health Committee

126th General Assembly Regular Session 2005-2006

Sub. S. B. No. 87

Senators Wachtmann, Hagan, Gardner, Mumper, Clancy, Amstutz, Austria, Carey, Niehaus, Padgett, Schuring, Jordan, Harris, Zurz, Schuler, Armbruster, Brady, Cates, Coughlin, Dann, Fedor, Fingerhut, Goodman, Grendell, Hottinger, Jacobson, Mallory, Miller, Prentiss, Roberts, Spada, Wilson 

Representatives Raussen, Barrett, Beatty, Brown, Martin, Smith, G., Combs, Smith, S., Schneider, Mason 

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A BILL

To amend sections 3721.011, 3721.04, 5111.971,

1

5126.15, and 5126.20 and to enact section 5126.201

2

of the Revised Code and to amend Section 206.66.53

3

of Am. Sub. H.B. 66 of the 126th General Assembly

4

regarding the provision of hospice care in

5

residential care facilities and the addition of

6

four legislators as non-voting members of the

7

Medicaid Administrative Study Council, regarding

8

the Medicaid voucher pilot program, to establish

9

minimum requirements to be a conditional status

10

service and support administrator, and to make a

11

change regarding who can supervise conditional

12

status service and support administrators.

13

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 3721.011, 3721.04, 5111.971,	14
5126.15, and 5126.20 be amended and section 5126.201 of the	15
Revised Code be enacted to read as follows:	16

Sec. 3721.011.  (A) In addition to providing accommodations,	17
supervision, and personal care services to its residents, a	18
residential care facility may provide skilled nursing care to its	19
residents as follows:	20

(1) Supervision of special diets;

21

(2) Application of dressings, in accordance with rules	22
adopted under section 3721.04 of the Revised Code;	23

(3) Providing for theSubject to division (B)(1) of this	24
section, administration of medication to residents, to the extent	25
authorized under division (B)(1) of this section;	26

(4) OtherSubject to division (C) of this section, other	27
skilled nursing care provided on a part-time, intermittent basis	28
pursuant to division (C) of this sectionfor not more than a total	29
of one hundred twenty days in a twelve-month period;	30

(5) Subject to division (D) of this section, skilled nursing	31
care provided for more than one hundred twenty days in a	32
twelve-month period to a hospice patient, as defined in section	33
3712.01 of the Revised Code.	34

A residential care facility may not admit or retain an	35
individual requiring skilled nursing care that is not authorized	36
by this section. A residential care facility may not provide	37
skilled nursing care beyond the limits established by this	38
section.	39

(B)(1) A residential care facility may admit or retain an	40
individual requiring medication, including biologicals, only if	41
the individual's personal physician has determined in writing that	42
the individual is capable of self-administering the medication or	43
the facility provides for the medication to be administered to the	44
individual by a home health agency certified under Title XVIII of	45
the "Social Security Act," 4979 Stat. 620 (19351965), 42	46
U.S.C.A. 3011395, as amended; a hospice care program licensed	47
under Chapter 3712. of the Revised Code; or a member of the staff	48
of the residential care facility who is qualified to perform	49
medication administration. Medication may be administered in a	50
residential care facility only by the following persons authorized	51
by law to administer medication:	52

(a) A registered nurse licensed under Chapter 4723. of the	53
Revised Code;	54

(b) A licensed practical nurse licensed under Chapter 4723.	55
of the Revised Code who holds proof of successful completion of a	56
course in medication administration approved by the board of	57
nursing and who administers the medication only at the direction	58
of a registered nurse or a physician authorized under Chapter	59
4731. of the Revised Code to practice medicine and surgery or	60
osteopathic medicine and surgery;	61

(c) A physician authorized under Chapter 4731. of the Revised	62
Code to practice medicine and surgery or osteopathic medicine and	63
surgery.	64

(2) In assisting a resident with self-administration of	65
medication, any member of the staff of a residential care facility	66
may do the following:	67

(a) Remind a resident when to take medication and watch to	68
ensure that the resident follows the directions on the container;	69

(b) Assist a resident by taking the medication from the	70
locked area where it is stored, in accordance with rules adopted	71
pursuant to section 3721.04 of the Revised Code, and handing it to	72
the resident. If the resident is physically unable to open the	73
container, a staff member may open the container for the resident.	74

(c) Assist a physically impaired but mentally alert resident,	75
such as a resident with arthritis, cerebral palsy, or Parkinson's	76
disease, in removing oral or topical medication from containers	77
and in consuming or applying the medication, upon request by or	78
with the consent of the resident. If a resident is physically	79
unable to place a dose of medicine to the resident's mouth without	80
spilling it, a staff member may place the dose in a container and	81
place the container to the mouth of the resident.	82

(C) A residential care facility may admit or retain	83
individuals who require skilled nursing care beyond the	84
supervision of special diets, application of dressings, or	85
administration of medication, only if the care will be provided on	86
a part-time, intermittent basis for not more than a total of one	87
hundred twenty days in any twelve-month period. In accordance with	88
Chapter 119. of the Revised Code, the public health council shall	89
adopt rules specifying what constitutes the need for skilled	90
nursing care on a part-time, intermittent basis. The council shall	91
adopt rules that are consistent with rules pertaining to home	92
health care adopted by the director of job and family services for	93
the medical assistance program established under Chapter 5111. of	94
the Revised Code. Skilled nursing care provided pursuant to this	95
division may be provided by a home health agency certified under	96
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42	97
U.S.C.A. 301, as amended, a hospice care program licensed under	98
Chapter 3712. of the Revised Code, or a member of the staff of a	99
residential care facility who is qualified to perform skilled	100
nursing care.	101

A residential care facility that provides skilled nursing	102
care pursuant to this division shall do both of the following:	103

(1) Evaluate each resident receiving the skilled nursing care	104
at least once every seven days to determine whether the resident	105
should be transferred to a nursing home;	106

(2) Meet the skilled nursing care needs of each resident	107
receiving the care.	108

(D) A residential care facility may admit or retain a hospice	109
patient who requires skilled nursing care for more than one	110
hundred twenty days in any twelve-month period only if the	111
facility has entered into a written agreement with a hospice care	112
program licensed under Chapter 3712. of the Revised Code. The	113
agreement between the residential care facility and hospice	114
program shall include all of the following provisions:	115

(1) That the hospice patient will be provided skilled nursing	116
care in the facility only if a determination has been made that	117
the patient's needs can be met at the facility;	118

(2) That the hospice patient will be retained in the facility	119
only if periodic redeterminations are made that the patient's	120
needs are being met at the facility;	121

(3) That the redeterminations will be made according to a	122
schedule specified in the agreement;	123

(4) That the hospice patient has been given an opportunity to	124
choose the hospice care program that best meets the patient's	125
needs.	126

(E) Notwithstanding any other provision of this chapter, a	127
residential care facility in which residents receive skilled	128
nursing care pursuant to this section is not a nursing home.	129

Sec. 3721.04.  (A) The public health council shall adopt and	130
publish rules governing the operation of homes, which shall have	131
uniform application throughout the state, and shall prescribe	132
standards for homes with respect to, but not limited to, the	133
following matters:	134

(1) The minimum space requirements for occupants and	135
equipping of the buildings in which homes are housed so as to	136
ensure healthful, safe, sanitary, and comfortable conditions for	137
all residents, so long as they are not inconsistent with Chapters	138
3781. and 3791. of the Revised Code or with any rules adopted by	139
the board of building standards and by the state fire marshal;	140

(2) The number and qualifications of personnel, including	141
management and nursing staff, for each class of home, and the	142
qualifications of nurse aides, as defined in section 3721.21 of	143
the Revised Code, used by long-term care facilities, as defined in	144
that section;	145

(3) The medical, rehabilitative, and recreational services to	146
be provided by each class of home;	147

(4) Dietetic services, including but not limited to	148
sanitation, nutritional adequacy, and palatability of food;	149

(5) The personal and social services to be provided by each	150
class of home;	151

(6) The business and accounting practices to be followed and	152
the type of patient and business records to be kept by such homes;	153

(7) The operation of adult day-care programs provided by and	154
on the same site as homes licensed under this chapter;	155

(8) The standards and procedures to be followed by	156
residential care facilities in admitting and retaining a resident	157
who requires the application of dressings, including requirements	158
for charting and evaluating on a weekly basis;	159

(9) The requirements for conducting weekly evaluations of	160
residents receiving skilled nursing care in residential care	161
facilities.	162

(B) The public health council may adopt whatever additional	163
rules are necessary to carry out or enforce the provisions of	164
sections 3721.01 to 3721.09 and 3721.99 of the Revised Code.	165

(C) The following apply to the public health council when	166
adopting rules under division (A)(2) of this section regarding the	167
number and qualifications of personnel in homes:	168

(1) When adopting rules applicable to residential care	169
facilities, the public health council shall take into	170
consideration the effect that the provisionfollowing may have on	171
the number of personnel needed:	172

(a) Provision of personal care services and;

173

(b) Provision of part-time, intermittent skilled nursing care	174
pursuant to division (C) of section 3721.011 of the Revised Code	175
may have on the number of personnel needed;	176

(c) Provision of skilled nursing care to hospice patients	177
pursuant to division (D) of section 3721.011 of the Revised Code.	178

(2) The rules prescribing qualifications of nurse aides used	179
by long-term care facilities, as those terms are defined in	180
section 3721.21 of the Revised Code, shall be no less stringent	181
than the requirements, guidelines, and procedures established by	182
the United States secretary of health and human services under	183
sections 1819 and 1919 of the "Social Security Act," 49 Stat. 620	184
(1935), 42 U.S.C.A. 301, as amended.	185

Sec. 5111.971.  (A) As used in this section, "long-term	186
medicaid waiver component" means any of the following:	187

(1) The PASSPORT program created under section 173.40 of the	188
Revised Code;	189

(2) The medicaid waiver component called the choices program	190
that the department of aging administers;	191

(3) A medicaid waiver component that the department of job	192
and family services administers.	193

(B) The director of job and family services shall submit a	194
request to the United States secretary of health and human	195
services for a waiver of federal medicaid requirements that would	196
be otherwise violated in the creation of a pilot program under	197
which not more than two hundred individuals who meet the pilot	198
program's eligibility requirements specified in division (D) of	199
this section receive a spending authorization to pay for the cost	200
of medically necessary health carehome and community-based	201
services that the pilot program covers. The spending authorization	202
shall be in an amount not exceeding seventy per cent of the	203
average cost under the medicaid program for providing nursing	204
facility services to an individual. An individual participating in	205
the pilot program shall also receive necessary support services,	206
including fiscal intermediary and other case management services,	207
that the pilot program covers.	208

(C) If the United States secretary of health and human	209
services approves the waiver submitted under division (B) of this	210
section, the department of job and family services shall enter	211
into a contract with the department of aging under section 5111.91	212
of the Revised Code that provides for the department of aging to	213
administer the pilot program that the waiver authorizes.	214

(D) To be eligible to participate in the pilot program	215
created under division (B) of this section, an individual must	216
meet all of the following requirements:	217

(1) Need at least an intermediate level of care as determined	218
under rule 5101:3-3-06 of the Administrative Code;	219

(2) At the time the individual applies to participate in the	220
pilot program, be one of the following:	221

(a) A nursing facility resident who is seeking to move to a	222
residential care facility or county or district home and who would	223
remain in a nursing facility if not for the pilot program;	224

(b) A participant of any long-term medicaid waiver component	225
who would move to a nursing facility if not for the pilot program.	226

(3) Meet all other eligibility requirements for the pilot	227
program established in rules adopted under section 5111.85 of the	228
Revised Code.	229

(E) The director of job and family services may adopt rules	230
under section 5111.85 of the Revised Code as the director	231
considers necessary to implement the pilot program created under	232
division (B) of this section. The director of aging may adopt	233
rules under Chapter 119. of the Revised Code as the director	234
considers necessary for the pilot program's implementation. The	235
rules may establish a list of medicaid-covered services not	236
covered by the pilot program that an individual participating in	237
the pilot program may not receive if the individual also receives	238
medicaid-covered services outside of the pilot program.	239

Sec. 5126.15.  (A) A county board of mental retardation and	240
developmental disabilities shall provide service and support	241
administration to each individual three years of age or older who	242
is eligible for service and support administration if the	243
individual requests, or a person on the individual's behalf	244
requests, service and support administration. A board shall	245
provide service and support administration to each individual	246
receiving home and community-based services. A board may provide,	247
in accordance with the service coordination requirements of 34	248
C.F.R. 303.23, service and support administration to an individual	249
under three years of age eligible for early intervention services	250
under 34 C.F.R. part 303. A board may provide service and support	251
administration to an individual who is not eligible for other	252
services of the board. Service and support administration shall be	253
provided in accordance with rules adopted under section 5126.08 of	254
the Revised Code.	255

A board may provide service and support administration by	256
directly employing service and support administrators or by	257
contracting with entities for the performance of service and	258
support administration. Individuals employed or under contract as	259
service and support administrators shall not be in the same	260
collective bargaining unit as employees who perform duties that	261
are not administrative.	262

Individuals employed by a board as service and support	263
administrators shall not be assigned responsibilities for	264
implementing other services for individuals and shall not be	265
employed by or serve in a decision-making or policy-making	266
capacity for any other entity that provides programs or services	267
to individuals with mental retardation or developmental	268
disabilities. An individual employed as a conditional status	269
service and support administrator shall perform the duties of	270
service and support administration only under the supervision of a	271
management employee who is a service and support administration	272
supervisor or a professional employee who is a service and support	273
administrator.	274

(B) The individuals employed by or under contract with a	275
board to provide service and support administration shall do all	276
of the following:	277

(1) Establish an individual's eligibility for the services of	278
the county board of mental retardation and developmental	279
disabilities;	280

(2) Assess individual needs for services;

281

(3) Develop individual service plans with the active	282
participation of the individual to be served, other persons	283
selected by the individual, and, when applicable, the provider	284
selected by the individual, and recommend the plans for approval	285
by the department of mental retardation and developmental	286
disabilities when services included in the plans are funded	287
through medicaid;	288

(4) Establish budgets for services based on the individual's	289
assessed needs and preferred ways of meeting those needs;	290

(5) Assist individuals in making selections from among the	291
providers they have chosen;	292

(6) Ensure that services are effectively coordinated and	293
provided by appropriate providers;	294

(7) Establish and implement an ongoing system of monitoring	295
the implementation of individual service plans to achieve	296
consistent implementation and the desired outcomes for the	297
individual;	298

(8) Perform quality assurance reviews as a distinct function	299
of service and support administration;	300

(9) Incorporate the results of quality assurance reviews and	301
identified trends and patterns of unusual incidents and major	302
unusual incidents into amendments of an individual's service plan	303
for the purpose of improving and enhancing the quality and	304
appropriateness of services rendered to the individual;	305

(10) Ensure that each individual receiving services has a	306
designated person who is responsible on a continuing basis for	307
providing the individual with representation, advocacy, advice,	308
and assistance related to the day-to-day coordination of services	309
in accordance with the individual's service plan. The service and	310
support administrator shall give the individual receiving services	311
an opportunity to designate the person to provide daily	312
representation. If the individual declines to make a designation,	313
the administrator shall make the designation. In either case, the	314
individual receiving services may change at any time the person	315
designated to provide daily representation.	316

(C) Subject to available funds, the department of mental	317
retardation and developmental disabilities shall pay a county	318
board an annual subsidy for service and support administration.	319
The amount of the subsidy shall be equal to the greater of twenty	320
thousand dollars or two hundred dollars times the board's	321
certified average daily membership. The payments shall be made in	322
quarterly installments of equal amounts, which shall be made no	323
later than the thirtieth day of September, the thirty-first day of	324
December, the thirty-first day of March, and the thirtieth day of	325
June. Funds received shall be used solely for service and support	326
administration.	327

Sec. 5126.20.  As used in this section and sections 5126.21	328
to 5126.29 of the Revised Code:	329

(A) "Service employee" means a person employed by a county	330
board of mental retardation and developmental disabilities in a	331
position which may require evidence of registration under section	332
5126.25 of the Revised Code but for which a bachelor's degree from	333
an accredited college or university is not required, and includes	334
employees in the positions listed in division (C) of section	335
5126.22 of the Revised Code.	336

(B)(1) "Professional employee" means aboth of the following:

337

(a) A person employed by a board in a position for which	338
either a bachelor's degree from an accredited college or	339
university or a license or certificate issued under Title XLVII of	340
the Revised Code is a minimum requirement, except in the case of a	341
person employed as a conditional status service and support	342
administrator for which an appropriate associate degree is the	343
minimum requirement, and;	344

(b) A person employed by a board as a conditional status	345
service and support administrator.	346

(2) "Professional employee" includes employees in the	347
positions listed in division (B) of section 5126.22 of the Revised	348
Code.	349

(C) "Management employee" means a person employed by a board	350
in a position having supervisory or managerial responsibilities	351
and duties, and includes employees in the positions listed in	352
division (A) of section 5126.22 of the Revised Code.	353

(D) "Limited contract" means a contract of limited duration	354
which is renewable at the discretion of the superintendent.	355

(E) "Continuing contract" means a contract of employment that	356
was issued prior to June 24, 1988, to a classified employee under	357
which the employee has completed the employee's probationary	358
period and under which the employee retains employment until the	359
employee retires or resigns, is removed pursuant to section	360
5126.23 of the Revised Code, or is laid off.	361

(F) "Supervisory responsibilities and duties" includes the	362
authority to hire, transfer, suspend, lay off, recall, promote,	363
discharge, assign, reward, or discipline other employees of the	364
board; to responsibly direct them; to adjust their grievances; or	365
to effectively recommend such action, if the exercise of that	366
authority is not of a merely routine or clerical nature but	367
requires the use of independent judgment.	368

(G) "Managerial responsibilities and duties" includes	369
formulating policy on behalf of the board, responsibly directing	370
the implementation of policy, assisting in the preparation for the	371
conduct of collective negotiations, administering collectively	372
negotiated agreements, or having a major role in personnel	373
administration.	374

(H) "Investigative agent" means an individual who conducts	375
investigations under section 5126.313 of the Revised Code.	376

Sec. 5126.201. A person may be employed by a county board of	377
mental retardation and developmental disabilities as a conditional	378
status service and support administrator only if either of the	379
following is true:	380

(A) The person has at least an appropriate associate degree;

381

(B) The person meets both of the following requirements:

382

(1) The person was employed by the county board and performed	383
service and support administration duties on June 30, 2005;	384

(2) The person holds a high school diploma or a general	385
educational development certificate of high school equivalence.	386

Section 2. That existing sections 3721.011, 3721.04,	387
5111.971, 5126.15, and 5126.20 of the Revised Code are hereby	388
repealed.	389

Section 3. That Section 206.66.53 of Am. Sub. H.B. 66 of the	390
126th General Assembly be amended to read as follows:	391

Sec. 206.66.53.  MEDICAID ADMINISTRATIVE STUDY COUNCIL

392

(A) There is hereby created the Medicaid Administrative Study	393
Council composed of the following:	394

(1) One member of the Ohio Commission to Reform Medicaid,	395
appointed by the Governor;	396

(2) One member of the staff of the Governor's office,	397
appointed by the Governor;	398

(3) One individual with expertise in health-care finance,	399
appointed by the Governor;	400

(4) One individual with expertise in health-care management,	401
appointed by the Governor;	402

(5) One individual with expertise in health-care information	403
technology, appointed by the Governor;	404

(6) One individual with expertise in health insurance,	405
appointed by the Governor;	406

(7) One individual with expertise in health care quality	407
assurance, appointed by the Governor;	408

(8) Two individuals with expertise in organizational change	409
representing the business community, one appointed by the	410
President of the Senate and one appointed by the Speaker of the	411
House of Representatives;	412

(9) The Director of Budget and Management or the Director's	413
designee;	414

(10) The State Chief Information Officer or the Officer's	415
designee;	416

(11) The Administrator of Workers' Compensation or the	417
Administrator's designee;	418

(12) The following non-voting members:

419

(a) The Director of Job and Family Services or the Director's	420
designee;	421

(b) The Director of Aging or the Director's designee;

422

(c) The Director of Drug and Alcohol Addiction Services or	423
the Director's designee;	424

(d) The Director of Health or the Director's designee;

425

(e) The Director of Mental Health or the Director's designee;

426

(f) The Director of Mental Retardation and Developmental	427
Disabilities or the Director's designee;	428

(g) Two members of the House of Representatives, one from	429
each of the political parties in the House, and both appointed by	430
the Speaker of the House;	431

(h) Two members of the Senate, one from each of the political	432
parties in the Senate, and both appointed by the President of the	433
Senate.	434

(B) The Governor shall appoint a member of the Council to	435
serve as the chairperson of the Council.	436

(C) The Council shall study the administration of the	437
Medicaid program. In conducting the study, the Council shall	438
operate under the assumption that the General Assembly will enact	439
by July 1, 2007, a law establishing a new cabinet level department	440
to administer the program. The Council shall examine and consider	441
all of the following as part of the study:	442

(1) Structuring the program's administration in a manner that	443
optimizes the program's fiscal and operational objectives;	444

(2) Centralizing financing and information technology	445
functions to coordinate the new department's activities with other	446
state agencies, if any, that assist in the program's	447
administration;	448

(3) Creating a unified budget for Medicaid-funded long-term	449
care services;	450

(4) The fiscal and operating impact that a new administrative	451
structure for the program would have on the Department of Job and	452
Family Services and other state agencies that currently assist in	453
the program's administration;	454

(5) The role of government entities that administer the	455
Medicaid program on the local level and the fiscal and operating	456
impact that a new administrative structure for the program would	457
have on those entities;	458

(6) The recommendations of the Ohio Commission to Reform	459
Medicaid.	460

(D) Beginning ninety days after the effective date of this	461
sectionJune 30, 2005, the Council shall submit written, quarterly	462
reports on the Council's progress to the Governor, the President	463
of the Senate, and the Speaker of the House of Representatives.	464
The Council shall submit a final written report of its study to	465
the Governor, the President of the Senate, and the Speaker of the	466
House of Representatives not later than December 31, 2006. The	467
final report shall include all of the following:	468

(1) Recommendations regarding the scope and structure of the	469
new department;	470

(2) A business plan that directs the transition of the	471
Medicaid program's administration from the Department of Job and	472
Family Services and the other state agencies that assist the	473
Department to the new department and addresses the transition's	474
fiscal and operational impact;	475

(3) Identification of the resources needed to implement the	476
business plan.	477

(E) The Council may hire staff, enter into contracts, and	478
take other actions the Council deems necessary to fulfill its	479
duties.	480

Section 4. That existing Section 206.66.53 of Am. Sub. H.B.	481
66 of the 126th General Assembly is hereby repealed.	482