As Introduced

127th General Assembly
Regular Session
2007-2008
H. B. No. 236


Representative Williams, S. 

Cosponsors: Representatives Boyd, Budish, Domenick, Hagan, R., Koziura, Miller, Skindell, Strahorn, Sykes, Williams, B., Yuko, Mallory 

A BILL
To amend sections 5111.019 and 5111.16 and to enact 1
sections 5111.84, 5111.841, 5111.842, 5112.22, 2
5112.23, 5112.24, 5112.25, 5112.26, and 5112.27 of 3
the Revised Code to require the Director of Job 4
and Family Services to seek federal permission to 5
establish the Family Health Plus component of the 6
Medicaid program, to impose a new assessment on 7
hospitals, and to earmark the proceeds from the 8
new assessment for the Family Health Plus 9
component.10


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

       Section 1.  That sections 5111.019 and 5111.16 be amended and 11
sections 5111.84, 5111.841, 5111.842, 5112.22, 5112.23, 5112.24, 12
5112.25, 5112.26, and 5112.27 of the Revised Code be enacted to 13
read as follows:14

       Sec. 5111.019.  (A) The director of job and family services15
shall submit to the United States secretary of health and human16
services an amendment to the state medicaid plan to make an17
individual who meets all of the following requirements eligible18
for medicaid for the amount of time provided by division (B) of19
this section:20

       (1) The individual is the parent of a child under nineteen21
years of age and resides with the child;22

       (2) The individual's family income does not exceed ninety 23
per cent of the federal poverty guidelines;24

       (3) The individual is not otherwise eligible for medicaid;25

       (4) The individual satisfies all relevant requirements26
established by rules adopted under division (D) of section 5111.0127
of the Revised Code.28

       (B) An individual is eligible to receive medicaid under this29
section for a period that does not exceed two years beginning on30
the date on which eligibility is established.31

       (C) The director shall terminate this component of the 32
medicaid program on the date that all individuals who would 33
qualify for the medicaid program under the component can instead 34
qualify for the medicaid program by participating in the family 35
health plus component established under section 5111.84 of the 36
Revised Code.37

       Sec. 5111.16. (A) As part of the medicaid program, the 38
department of job and family services shall establish a care 39
management system. The department shall submit, if necessary, 40
applications to the United States department of health and human 41
services for waivers of federal medicaid requirements that would 42
otherwise be violated in the implementation of the system.43

       (B) The department shall implement the care management system 44
in some or all counties and shall designate the medicaid 45
recipients who are required or permitted to participate in the 46
system. In the department's implementation of the system and 47
designation of participants, all of the following apply:48

       (1) In the case of individuals who receive medicaid on the 49
basis of being included in the category identified by the 50
department as covered families and children or on the basis of 51
participation in the family health plus component established 52
under section 5111.84 of the Revised Code, the department shall 53
implement the care management system in all counties. All 54
individuals included in the category or participating in the 55
component shall be designated for participation in the care 56
management system, except for indivdualsindividuals included in 57
one or more of the medicaid recipient groups specified in 42 58
C.F.R. 438.50(d). The department shall designate the participants 59
not later than January 1, 2006. Beginning not later than December 60
31, 2006, theThe department shall ensure that all such61
participants of the care management system are enrolled in health 62
insuring corporations under contract with the department pursuant 63
to section 5111.17 of the Revised Code.64

       (2) In the case of individuals who receive medicaid on the 65
basis of being aged, blind, or disabled, as specified in division 66
(A)(2) of section 5111.01 of the Revised Code, the department 67
shall implement the care management system in all counties. All 68
individuals included in the category shall be designated for 69
participation, except for the individuals specified in divisions 70
(B)(2)(a) to (e) of this section. Beginning not later than 71
December 31, 2006, the department shall ensure that all 72
participants are enrolled in health insuring corporations under 73
contract with the department pursuant to section 5111.17 of the 74
Revised Code.75

        In designating participants who receive medicaid on the basis 76
of being aged, blind, or disabled, the department shall not 77
include any of the following:78

        (a) Individuals who are under twenty-one years of age;79

        (b) Individuals who are institutionalized;80

        (c) Individuals who become eligible for medicaid by spending 81
down their income or resources to a level that meets the medicaid 82
program's financial eligibility requirements;83

        (d) Individuals who are dually eligible under the medicaid 84
program and the medicare program established under Title XVIII of 85
the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1395, as 86
amended;87

        (e) Individuals to the extent that they are receiving 88
medicaid services through a medicaid waiver component, as defined 89
in section 5111.85 of the Revised Code.90

       (3) Alcohol, drug addiction, and mental health services 91
covered by medicaid shall not be included in any component of the 92
care management system when the nonfederal share of the cost of 93
those services is provided by a board of alcohol, drug adiction94
addiction, and mental health services or a state agency other than 95
the department of job and family services, but the recipients of 96
those services may otherwise be designated for participation in 97
the system.98

        (C) Subject to division (B) of this section, the department 99
may do both of the following under the care management system:100

       (1) Require or permit participants in the system to obtain 101
health care services from providers designated by the department;102

       (2) Require or permit participants in the system to obtain 103
health care services through managed care organizations under 104
contract with the department pursuant to section 5111.17 of the 105
Revised Code.106

       (D)(1) The department shall prepare an annual report on the 107
care management system. The report shall address the department's 108
ability to implement the system, including all of the following 109
components:110

        (a) The required designation of participants included in the 111
category identified by the department as covered families and 112
children;113

       (b) The required designation of participants included in the 114
aged, blind, or disabled category of medicaid recipients;115

       (c) The conduct of the pilot program for chronically ill 116
children established under section 5111.163 of the Revised Code;117

       (d) The use of any programs for enhanced care management.118

       (2) The department shall submit each annual report to the 119
general assembly. The first report shall be submitted not later 120
than October 1, 2007.121

       (E) The director of job and family services may adopt rules 122
in accordance with Chapter 119. of the Revised Code to implement 123
this section.124

       Sec. 5111.84.  The director of job and family services shall 125
submit a request to the United States secretary of health and 126
human services for a federal medicaid waiver that authorizes the 127
family health plus component of the medicaid program. The director 128
shall implement the family health plus component if the United 129
States secretary issues a federal medicaid waiver authorizing the 130
component. In implementing the family health plus component, the 131
director shall do all of the following:132

       (A) Provide for an individual to qualify to participate in 133
the family health plus component if the individual meets all of 134
the following requirements:135

       (1) The individual resides in this state.136

       (2) The individual is at least eighteen years of age but less 137
than sixty-five years of age.138

       (3) The individual is ineligible for all other components of 139
the medicaid program solely due to having income or resources 140
exceeding the other components' eligibility requirements.141

       (4) The individual does not have equivalent health care 142
coverage under insurance or equivalent mechanisms as determined in 143
accordance with rules adopted under section 5111.85 of the Revised 144
Code.145

       (5) The individual is not a federal, state, county, municipal 146
corporation, or school district employee who is eligible for 147
health care coverage through the individual's employer.148

       (6) Subject to division (B) of this section, the individual 149
was not covered by a group health plan offered by the employer of 150
the individual or a family member of the individual during the 151
nine-month period preceding the date the individual applies to 152
participate in the family health plus component unless the 153
individual lost coverage under the group health plan due to any of 154
the following circumstances:155

       (a) Except as otherwise provided by division (A)(6) of this 156
section, the individual or family member ceased to work for the 157
employer for any reason other than voluntary separation.158

       (b) The individual or family member ceased to work for the 159
employer to care for a child or disabled household member or 160
relative.161

       (c) The family member's death;162

       (d) The individual or family member moved to a new residence.163

       (e) The individual or family member obtained new employment 164
with a different employer and the new employer does not offer 165
comprehensive health benefits coverage as defined in rules adopted 166
under section 5111.85 of the Revised Code.167

       (f) The employer of the individual or family member 168
terminated comprehensive health benefits coverage for all the 169
employer's employees.170

       (g) The individual's eligibility for continuation of coverage 171
under Title X of the "Consolidated Omnibus Budget Reconciliation 172
Act of 1985," 100 Stat. 227, 29 U.S.C. 1161, as amended, expired.173

       (h) The individual's or family member's wages were reduced or 174
the cost of coverage under the group health plan increased making 175
the coverage no longer affordable or available.176

       (i) The individual's or family member's long-term disability.177

       (7) The individual has gross family income not exceeding two 178
hundred per cent of the federal poverty guidelines.179

       (8) The individual meets all other eligibility requirements 180
for the family health plus component established in rules adopted 181
under section 5111.85 of the Revised Code, including the resource 182
eligibility requirement.183

       (B) Provide that no individual shall be denied eligibility to 184
participate in the family health plus component on the basis of 185
division (A)(6) of this section unless the director determines 186
that medical assistance provided under the component is 187
substituting for coverage under group health plans in excess of a 188
percentage specified by the United States secretary of health and 189
human services.190

       (C) Permit an individual who ceases to meet the eligibility 191
requirements for the family health plus component not later than 192
six months after initially beginning to participate in the 193
component to continue to participate in the component until the 194
date that is six months after the date the individual initially 195
began to participate in the component.196

       (D) Provide for the family health plus component to cover all 197
of the following in an amount, duration, and scope specified in 198
rules adopted under section 5111.85 of the Revised Code:199

       (1) Inpatient and outpatient physician services;200

       (2) Inpatient and outpatient nursing services;201

       (3) Inpatient and outpatient services of other health-care 202
professionals specified in the rules;203

       (4) Inpatient hospital services;204

       (5) Hospital emergency department services;205

       (6) Prehospital emergency medical services by ambulance 206
service providers;207

       (7) Laboratory tests;208

       (8) Diagnostic x-rays;209

       (9) Prescription drugs;210

       (10) Nonprescription smoking cessation products and devices;211

       (11) Durable medical equipment;212

       (12) Radiation therapy;213

       (13) Chemotherapy;214

       (14) Hemodialysis;215

       (15) Diabetic supplies and equipment;216

       (16) Inpatient and outpatient mental health, alcohol, and 217
substance abuse services;218

       (17) Emergency, preventive, and routine dental care to the 219
extent offered by a health insuring corporation under contract 220
with the department pursuant to section 5111.17 of the Revised 221
Code to provide, or arrange the provision of, health care services 222
to participants of the family health plus component who are 223
enrolled in the health insuring corporation, but excluding 224
orthodontia and cosmetic surgery;225

       (18) Emergency vision care;226

       (19) Preventive and routine vision care as limited to the 227
following in a twenty-four month period:228

       (a) One eye examination;229

       (b) Either of the following:230

       (i) One pair of prescription eyeglass lenses and a frame;231

       (ii) When medically necessary, prescription contact lenses.232

       (c) One pair of medically necessary occupational eyeglasses.233

       (20) Speech and hearing services;234

       (21) Hospice services;235

       (22) Services as necessary to comply with 42 U.S.C. 236
1396d(a)(4)(B) and (r).237

       (E) Establish locally tailored outreach strategies targeted 238
to individuals who may qualify to participate in the family health 239
plus component, including outreach strategies that inform the 240
public about the family health plus component.241

       (F) Adopt rules under section 5111.85 of the Revised Code 242
that do all of the following:243

       (1) For the purpose of division (A)(4) of this section, 244
establish the process for determining whether an individual has 245
equivalent health care coverage under insurance or equivalent 246
mechanisms;247

       (2) Define "comprehensive health benefits coverage" for the 248
purpose of division (A)(6)(e) and (f) of this section;249

       (3) For the purpose of division (A)(9) of this section, 250
establish additional eligibility requirements for the family 251
health plus component, including a resource requirement.252

       Sec. 5111.841.  There is hereby created in the state treasury 253
the family health plus fund. The fund shall consist of money 254
deposited into the fund pursuant to section 5112.25 of the Revised 255
Code. The department of job and family services shall use money in 256
the fund to pay the state share of the costs of the family health 257
plus component of the medicaid program established under section 258
5111.84 of the Revised Code.259

       Sec. 5111.842.  Each year, the director of job and family 260
services shall determine the total amount of money needed to pay 261
the state's share of the cost of the family health plus component.262

       Sec. 5112.22.  (A) As used in sections 5112.22 to 5112.27 of 263
the Revised Code:264

       (1)(a) "Hospital" means a nonfederal hospital to which either 265
of the following applies:266

       (i) The hospital is registered under section 3701.07 of the 267
Revised Code as a general medical and surgical hospital or a 268
pediatric general hospital and provides inpatient hospital 269
services as defined in 42 C.F.R. 440.10;270

       (ii) The hospital is recognized under the medicare program 271
established by Title XVIII of the "Social Security Act of 1935" as 272
a cancer hospital and is exempt from the medicare prospective 273
payment system.274

       (b) "Hospital" does not include a hospital operated by a 275
health insuring corporation that has been issued a certificate of 276
authority under section 1751.05 of the Revised Code or a hospital 277
that does not charge patients for services.278

       (2) "Program year" means a period of time specified in rules 279
adopted under section 5112.26 of the Revised Code.280

       (B) For the purpose of funding the family health plus 281
component of the medicaid program established under section 282
5111.84 of the Revised Code and subject to section 5112.27 of the 283
Revised Code, there is hereby imposed an assessment on all 284
hospitals. Each hospital's assessment under this section shall be 285
determined in accordance with rules adopted under section 5112.26 286
of the Revised Code. In assessing hospitals under this section, 287
the department of job and family services shall do both of the 288
following:289

       (1) Comply with 42 U.S.C. 1396b(w) and federal regulations 290
adopted thereunder;291

       (2) Set the amount of each hospital's assessment at an amount 292
that yields, when the total of all hospital assessments under this 293
section is combined, a sufficient amount of funds to pay the state 294
share of the costs of the family health plus component as 295
determined under section 5111.842 of the Revised Code.296

       Sec. 5112.23.  (A) Except as provided in division (B) of this 297
section, each hospital shall pay the assessment imposed under 298
section 5112.22 of the Revised Code in periodic installments in 299
accordance with a schedule established in rules adopted under 300
section 5112.26 of the Revised Code. The installments shall be 301
equal in amount, unless the director of job and family services 302
determines that adjustments in the amounts of installments are 303
necessary for the administration of sections 5112.22 to 5112.27 of 304
the Revised Code and that unequal installments will not create 305
cash flow difficulties for hospitals.306

       (B) The director may adopt rules under section 5112.26 of the 307
Revised Code establishing alternate schedules for hospitals to pay 308
assessments imposed under section 5112.22 of the Revised Code in 309
order to reduce hospitals' cash flow difficulties.310

       Sec. 5112.24.  (A) Before or during each program year, the 311
department of job and family services shall mail to each hospital 312
by certified mail, return receipt requested, the preliminary 313
determination of the amount that the hospital is assessed under 314
section 5112.22 of the Revised Code during the program year. The 315
preliminary determination of a hospital's assessment shall be 316
calculated for a cost reporting period that is specified in rules 317
adopted under section 5112.26 of the Revised Code.318

       The department shall consult with hospitals each year when 319
determining the date on which it will mail the preliminary 320
determinations in order to minimize hospitals' cash flow 321
difficulties.322

       If no hospital submits a request for reconsideration under 323
division (B) of this section, the preliminary determination 324
constitutes the final reconciliation of each hospital's assessment 325
under section 5112.22 of the Revised Code. 326

       (B) Not later than fourteen days after the preliminary 327
determinations are mailed, any hospital may submit to the 328
department a written request to reconsider the preliminary 329
determinations. The request shall be accompanied by written 330
materials setting forth the basis for the reconsideration. If one 331
or more hospitals submit a request, the department shall hold a 332
public hearing not later than thirty days after the preliminary 333
determinations are mailed to reconsider the preliminary 334
determinations. The department shall mail to each hospital a 335
written notice of the date, time, and place of the hearing at 336
least ten days prior to the hearing. On the basis of the evidence 337
submitted to the department or presented at the public hearing, 338
the department shall reconsider and may adjust the preliminary 339
determinations. The result of the reconsideration is the final 340
reconciliation of the hospital's assessment under section 5112.22 341
of the Revised Code. 342

       (C) The department shall mail to each hospital a written 343
notice of its assessment for the program year under the final 344
reconciliation. A hospital may appeal the final reconciliation of 345
its assessment to the court of common pleas of Franklin county. 346
While a judicial appeal is pending, the hospital shall pay, in 347
accordance with the schedules required by section 5112.23 of the 348
Revised Code, any amount of its assessment that is not in dispute.349

       Sec. 5112.25.  All payments of assessments imposed on 350
hospitals by section 5112.22 of the Revised Code shall be 351
deposited into the family health plus fund created by section 352
5111.841 of the Revised Code.353

       Sec. 5112.26.  The director of job and family services shall 354
adopt, and may amend and rescind, rules in accordance with Chapter 355
119. of the Revised Code as necessary to implement sections 356
5112.22 to 5112.27 of the Revised Code, including rules that do 357
the following:358

       (A) Specify the period of time that a program year shall be 359
for the purpose of the assessment imposed by section 5112.22 of 360
the Revised Code;361

       (B) For the purpose of section 5112.22 of the Revised Code, 362
establish the method of determining the amount of the assessment;363

       (C) For the purpose of section 5112.23 of the Revised Code, 364
establish schedules for hospitals to pay installments on their 365
assessments;366

       (D) For the purpose of section 5112.24 of the Revised Code, 367
specify the cost reporting period for calculating hospitals' 368
assessments.369

       Sec. 5112.27.  The department of job and family services 370
shall cease implementation of sections 5112.22 to 5112.27 of the 371
Revised Code if the United States secretary of health and human 372
services determines that the assessment imposed on hospitals by 373
section 5112.22 of the Revised Code is an impermissible health 374
care-related tax under 42 U.S.C. 1396b(w). 375

       Section 2.  That existing sections 5111.019 and 5111.16 of 376
the Revised Code are hereby repealed.377