As Introduced

128th General Assembly Regular Session 2009-2010

H. B. No. 125

Representative Williams, S. 

Cosponsors: Representatives Luckie, Hagan, Mallory, Harris, Pryor, Foley 

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A BILL

To amend sections 5111.019 and 5111.16 and to enact

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sections 5111.83, 5111.831, 5111.832, 5112.22,

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5112.23, 5112.24, 5112.25, 5112.26, and 5112.27 of

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the Revised Code to require the Director of Job

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and Family Services to seek federal permission to

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establish the Family Health Plus component of the

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Medicaid program, to impose a new assessment on

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hospitals, and to earmark the proceeds from the

8

new assessment for the Family Health Plus

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component.

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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 5111.83, 5111.831, 5111.832, 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 services	15
shall submit to the United States secretary of health and human	16
services an amendment to the state medicaid plan to make an	17
individual eligible for medicaid who meets all of the following	18
requirements:	19

(A)(1) The individual is the parent of a child under nineteen	20
years of age and resides with the child;	21

(B)(2) The individual's family income does not exceed	22
ninety per cent of the federal poverty guidelines;	23

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

24

(D)(4) The individual satisfies all relevant requirements	25
established by rules adopted under division (D) of section 5111.01	26
of the Revised Code.	27

(B) The director shall terminate this component of the	28
medicaid program on the date that all individuals who would	29
qualify for the medicaid program under the component can instead	30
qualify for the medicaid program by participating in the family	31
health plus component established under section 5111.83 of the	32
Revised Code.	33

Sec. 5111.16. (A) As part of the medicaid program, the	34
department of job and family services shall establish a care	35
management system. The department shall submit, if necessary,	36
applications to the United States department of health and human	37
services for waivers of federal medicaid requirements that would	38
otherwise be violated in the implementation of the system.	39

(B) The department shall implement the care management system	40
in some or all counties and shall designate the medicaid	41
recipients who are required or permitted to participate in the	42
system. In the department's implementation of the system and	43
designation of participants, all of the following apply:	44

(1) In the case of individuals who receive medicaid on the	45
basis of being included in the category identified by the	46
department as covered families and children or on the basis of	47
participation in the family health plus component established	48
under section 5111.83 of the Revised Code, the department shall	49
implement the care management system in all counties. All	50
individuals included in the category or participating in the	51
component shall be designated for participation in the care	52
management system, except for indivdualsindividuals included in	53
one or more of the medicaid recipient groups specified in 42	54
C.F.R. 438.50(d). The department shall designate the participants	55
not later than January 1, 2006. Beginning not later than December	56
31, 2006, theThe department shall ensure that all such	57
participants of the care management system are enrolled in health	58
insuring corporations under contract with the department pursuant	59
to section 5111.17 of the Revised Code.	60

(2) In the case of individuals who receive medicaid on the	61
basis of being aged, blind, or disabled, as specified in division	62
(A)(2) of section 5111.01 of the Revised Code, the department	63
shall implement the care management system in all counties. All	64
individuals included in the category shall be designated for	65
participation, except for the individuals specified in divisions	66
(B)(2)(a) to (e) of this section. Beginning not later than	67
December 31, 2006, the department shall ensure that all	68
participants are enrolled in health insuring corporations under	69
contract with the department pursuant to section 5111.17 of the	70
Revised Code.	71

In designating participants who receive medicaid on the basis	72
of being aged, blind, or disabled, the department shall not	73
include any of the following:	74

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

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(b) Individuals who are institutionalized;

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(c) Individuals who become eligible for medicaid by spending	77
down their income or resources to a level that meets the medicaid	78
program's financial eligibility requirements;	79

(d) Individuals who are dually eligible under the medicaid	80
program and the medicare program established under Title XVIII of	81
the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1395, as	82
amended;	83

(e) Individuals to the extent that they are receiving	84
medicaid services through a medicaid waiver component, as defined	85
in section 5111.85 of the Revised Code.	86

(3) Alcohol, drug addiction, and mental health services	87
covered by medicaid shall not be included in any component of the	88
care management system when the nonfederal share of the cost of	89
those services is provided by a board of alcohol, drug adiction	90
addiction, and mental health services or a state agency other than	91
the department of job and family services, but the recipients of	92
those services may otherwise be designated for participation in	93
the system.	94

(C) Subject to division (B) of this section, the department	95
may do both of the following under the care management system:	96

(1) Require or permit participants in the system to obtain	97
health care services from providers designated by the department;	98

(2) Require or permit participants in the system to obtain	99
health care services through managed care organizations under	100
contract with the department pursuant to section 5111.17 of the	101
Revised Code.	102

(D)(1) The department shall prepare an annual report on the	103
care management system. The report shall address the department's	104
ability to implement the system, including all of the following	105
components:	106

(a) The required designation of participants included in the	107
category identified by the department as covered families and	108
children;	109

(b) The required designation of participants included in the	110
aged, blind, or disabled category of medicaid recipients;	111

(c) The conduct of the pilot program for chronically ill	112
children established under section 5111.163 of the Revised Code;	113

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

114

(2) The department shall submit each annual report to the	115
general assembly. The first report shall be submitted not later	116
than October 1, 2007.	117

(E) The director of job and family services may adopt rules	118
in accordance with Chapter 119. of the Revised Code to implement	119
this section.	120

Sec. 5111.83.  The director of job and family services shall	121
submit a request to the United States secretary of health and	122
human services for a federal medicaid waiver that authorizes the	123
family health plus component of the medicaid program. The director	124
shall implement the family health plus component if the United	125
States secretary issues a federal medicaid waiver authorizing the	126
component. In implementing the family health plus component, the	127
director shall do all of the following:	128

(A) Provide for an individual to qualify to participate in	129
the family health plus component if the individual meets all of	130
the following requirements:	131

(1) The individual resides in this state.

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(2) The individual is at least eighteen years of age but less	133
than sixty-five years of age.	134

(3) The individual is ineligible for all other components of	135
the medicaid program solely due to having income or resources	136
exceeding the other components' eligibility requirements.	137

(4) The individual does not have equivalent health care	138
coverage under insurance or equivalent mechanisms as determined in	139
accordance with rules adopted under section 5111.85 of the Revised	140
Code.	141

(5) The individual is not a federal, state, county, municipal	142
corporation, or school district employee who is eligible for	143
health care coverage through the individual's employer.	144

(6) Subject to division (B) of this section, the individual	145
was not covered by a group health plan offered by the employer of	146
the individual or a family member of the individual during the	147
nine-month period preceding the date the individual applies to	148
participate in the family health plus component unless the	149
individual lost coverage under the group health plan due to any of	150
the following circumstances:	151

(a) Except as otherwise provided by division (A)(6) of this	152
section, the individual or family member ceased to work for the	153
employer for any reason other than voluntary separation.	154

(b) The individual or family member ceased to work for the	155
employer to care for a child or disabled household member or	156
relative.	157

(c) The family member's death;

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

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(e) The individual or family member obtained new employment	160
with a different employer and the new employer does not offer	161
comprehensive health benefits coverage as defined in rules adopted	162
under section 5111.85 of the Revised Code.	163

(f) The employer of the individual or family member	164
terminated comprehensive health benefits coverage for all the	165
employer's employees.	166

(g) The individual's eligibility for continuation of coverage	167
under Title X of the "Consolidated Omnibus Budget Reconciliation	168
Act of 1985," 100 Stat. 227, 29 U.S.C. 1161, as amended, expired.	169

(h) The individual's or family member's wages were reduced or	170
the cost of coverage under the group health plan increased making	171
the coverage no longer affordable or available.	172

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

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(7) The individual has gross family income not exceeding two	174
hundred per cent of the federal poverty guidelines.	175

(8) The individual meets all other eligibility requirements	176
for the family health plus component established in rules adopted	177
under section 5111.85 of the Revised Code, including the resource	178
eligibility requirement.	179

(B) Provide that no individual shall be denied eligibility to	180
participate in the family health plus component on the basis of	181
division (A)(6) of this section unless the director determines	182
that medical assistance provided under the component is	183
substituting for coverage under group health plans in excess of a	184
percentage specified by the United States secretary of health and	185
human services.	186

(C) Permit an individual who ceases to meet the eligibility	187
requirements for the family health plus component not later than	188
six months after initially beginning to participate in the	189
component to continue to participate in the component until the	190
date that is six months after the date the individual initially	191
began to participate in the component.	192

(D) Provide for the family health plus component to cover all	193
of the following in an amount, duration, and scope specified in	194
rules adopted under section 5111.85 of the Revised Code:	195

(1) Inpatient and outpatient physician services;

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(2) Inpatient and outpatient nursing services;

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(3) Inpatient and outpatient services of other health-care	198
professionals specified in the rules;	199

(4) Inpatient hospital services;

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(5) Hospital emergency department services;

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(6) Prehospital emergency medical services by ambulance	202
service providers;	203

(7) Laboratory tests;

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(8) Diagnostic x-rays;

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(9) Prescription drugs;

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(10) Nonprescription smoking cessation products and devices;

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(11) Durable medical equipment;

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(12) Radiation therapy;

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(13) Chemotherapy;

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(14) Hemodialysis;

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(15) Diabetic supplies and equipment;

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(16) Inpatient and outpatient mental health, alcohol, and	213
substance abuse services;	214

(17) Emergency, preventive, and routine dental care to the	215
extent offered by a health insuring corporation under contract	216
with the department pursuant to section 5111.17 of the Revised	217
Code to provide, or arrange the provision of, health care services	218
to participants of the family health plus component who are	219
enrolled in the health insuring corporation, but excluding	220
orthodontia and cosmetic surgery;	221

(18) Emergency vision care;

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(19) Preventive and routine vision care as limited to the	223
following in a twenty-four month period:	224

(a) One eye examination;

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(b) Either of the following:

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

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(ii) When medically necessary, prescription contact lenses.

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(c) One pair of medically necessary occupational eyeglasses.

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(20) Speech and hearing services;

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(21) Hospice services;

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(22) Services as necessary to comply with 42 U.S.C.	232
1396d(a)(4)(B) and (r).	233

(E) Establish locally tailored outreach strategies targeted	234
to individuals who may qualify to participate in the family health	235
plus component, including outreach strategies that inform the	236
public about the family health plus component.	237

(F) Adopt rules under section 5111.85 of the Revised Code	238
that do all of the following:	239

(1) For the purpose of division (A)(4) of this section,	240
establish the process for determining whether an individual has	241
equivalent health care coverage under insurance or equivalent	242
mechanisms;	243

(2) Define "comprehensive health benefits coverage" for the	244
purpose of division (A)(6)(e) and (f) of this section;	245

(3) For the purpose of division (A)(9) of this section,	246
establish additional eligibility requirements for the family	247
health plus component, including a resource requirement.	248

Sec. 5111.831.  There is hereby created in the state treasury	249
the family health plus fund. The fund shall consist of money	250
deposited into the fund pursuant to section 5112.25 of the Revised	251
Code. The department of job and family services shall use money in	252
the fund to pay the state share of the costs of the family health	253
plus component of the medicaid program established under section	254
5111.83 of the Revised Code.	255

Sec. 5111.832.  Each year, the director of job and family	256
services shall determine the total amount of money needed to pay	257
the state's share of the cost of the family health plus component.	258

Sec. 5112.22.  (A) As used in sections 5112.22 to 5112.27 of	259
the Revised Code:	260

(1)(a) "Hospital" means a nonfederal hospital to which either	261
of the following applies:	262

(i) The hospital is registered under section 3701.07 of the	263
Revised Code as a general medical and surgical hospital or a	264
pediatric general hospital and provides inpatient hospital	265
services as defined in 42 C.F.R. 440.10.	266

(ii) The hospital is recognized under the medicare program	267
established by Title XVIII of the "Social Security Act of 1935" as	268
a cancer hospital and is exempt from the medicare prospective	269
payment system.	270

(b) "Hospital" does not include a hospital operated by a	271
health insuring corporation that has been issued a certificate of	272
authority under section 1751.05 of the Revised Code or a hospital	273
that does not charge patients for services.	274

(2) "Program year" means a period of time specified in rules	275
adopted under section 5112.26 of the Revised Code.	276

(B) For the purpose of funding the family health plus	277
component of the medicaid program established under section	278
5111.83 of the Revised Code and subject to section 5112.27 of the	279
Revised Code, there is hereby imposed an assessment on all	280
hospitals. Each hospital's assessment under this section shall be	281
determined in accordance with rules adopted under section 5112.26	282
of the Revised Code. In assessing hospitals under this section,	283
the department of job and family services shall do both of the	284
following:	285

(1) Comply with 42 U.S.C. 1396b(w) and federal regulations	286
adopted thereunder;	287

(2) Set the amount of each hospital's assessment at an amount	288
that yields, when the total of all hospital assessments under this	289
section is combined, a sufficient amount of funds to pay the state	290
share of the costs of the family health plus component as	291
determined under section 5111.832 of the Revised Code.	292

Sec. 5112.23.  (A) Except as provided in division (B) of this	293
section, each hospital shall pay the assessment imposed under	294
section 5112.22 of the Revised Code in periodic installments in	295
accordance with a schedule established in rules adopted under	296
section 5112.26 of the Revised Code. The installments shall be	297
equal in amount, unless the director of job and family services	298
determines that adjustments in the amounts of installments are	299
necessary for the administration of sections 5112.22 to 5112.27 of	300
the Revised Code and that unequal installments will not create	301
cash flow difficulties for hospitals.	302

(B) The director may adopt rules under section 5112.26 of the	303
Revised Code establishing alternate schedules for hospitals to pay	304
assessments imposed under section 5112.22 of the Revised Code in	305
order to reduce hospitals' cash flow difficulties.	306

Sec. 5112.24.  (A) Before or during each program year, the	307
department of job and family services shall mail to each hospital	308
by certified mail, return receipt requested, the preliminary	309
determination of the amount that the hospital is assessed under	310
section 5112.22 of the Revised Code during the program year. The	311
preliminary determination of a hospital's assessment shall be	312
calculated for a cost reporting period that is specified in rules	313
adopted under section 5112.26 of the Revised Code.	314

The department shall consult with hospitals each year when	315
determining the date on which it will mail the preliminary	316
determinations in order to minimize hospitals' cash flow	317
difficulties.	318

If no hospital submits a request for reconsideration under	319
division (B) of this section, the preliminary determination	320
constitutes the final reconciliation of each hospital's assessment	321
under section 5112.22 of the Revised Code.	322

(B) Not later than fourteen days after the preliminary	323
determinations are mailed, any hospital may submit to the	324
department a written request to reconsider the preliminary	325
determinations. The request shall be accompanied by written	326
materials setting forth the basis for the reconsideration. If one	327
or more hospitals submit a request, the department shall hold a	328
public hearing not later than thirty days after the preliminary	329
determinations are mailed to reconsider the preliminary	330
determinations. The department shall mail to each hospital a	331
written notice of the date, time, and place of the hearing at	332
least ten days prior to the hearing. On the basis of the evidence	333
submitted to the department or presented at the public hearing,	334
the department shall reconsider and may adjust the preliminary	335
determinations. The result of the reconsideration is the final	336
reconciliation of the hospital's assessment under section 5112.22	337
of the Revised Code.	338

(C) The department shall mail to each hospital a written	339
notice of its assessment for the program year under the final	340
reconciliation. A hospital may appeal the final reconciliation of	341
its assessment to the court of common pleas of Franklin county.	342
While a judicial appeal is pending, the hospital shall pay, in	343
accordance with the schedules required by section 5112.23 of the	344
Revised Code, any amount of its assessment that is not in dispute.	345

Sec. 5112.25.  All payments of assessments imposed on	346
hospitals by section 5112.22 of the Revised Code shall be	347
deposited into the family health plus fund created by section	348
5111.831 of the Revised Code.	349

Sec. 5112.26.  The director of job and family services shall	350
adopt, and may amend and rescind, rules in accordance with Chapter	351
119. of the Revised Code as necessary to implement sections	352
5112.22 to 5112.27 of the Revised Code, including rules that do	353
the following:	354

(A) Specify the period of time that a program year shall be	355
for the purpose of the assessment imposed by section 5112.22 of	356
the Revised Code;	357

(B) For the purpose of section 5112.22 of the Revised Code,	358
establish the method of determining the amount of the assessment;	359

(C) For the purpose of section 5112.23 of the Revised Code,	360
establish schedules for hospitals to pay installments on their	361
assessments;	362

(D) For the purpose of section 5112.24 of the Revised Code,	363
specify the cost reporting period for calculating hospitals'	364
assessments.	365

Sec. 5112.27.  The department of job and family services	366
shall cease implementation of sections 5112.22 to 5112.27 of the	367
Revised Code if the United States secretary of health and human	368
services determines that the assessment imposed on hospitals by	369
section 5112.22 of the Revised Code is an impermissible health	370
care-related tax under 42 U.S.C. 1396b(w).	371

Section 2.  That existing sections 5111.019 and 5111.16 of	372
the Revised Code are hereby repealed.	373