As Passed by the House

128th General Assembly Regular Session 2009-2010

Sub. H. B. No. 198

Representatives Lehner, Ujvagi 

Cosponsors: Representatives Grossman, Harris, Jones, Weddington, Foley, Domenick, Hackett, Burke, Bacon, Blair, Ruhl, Martin, Yuko, Derickson, Newcomb, Harwood, Letson, Moran, Winburn, Fende, Garland, McGregor, Bolon, Sears, Patten, Williams, B., Balderson, Batchelder, Beck, Blessing, Boyd, Brown, Carney, Celeste, Combs, Driehaus, Dyer, Evans, Garrison, Gerberry, Goyal, Hagan, Koziura, Luckie, Lundy, Maag, McClain, Morgan, Murray, Phillips, Pillich, Pryor, Reece, Slesnick, Stebelton, Stewart, Williams, S. 

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A BILL

To amend section 3923.91 and to enact sections 185.01

1

to 185.12, 3333.611, and 3333.612 of the Revised

2

Code to establish the Patient Centered Medical

3

Home Education Pilot Project and to authorize

4

implementation of a primary care component of the

5

Choose Ohio First Scholarship Program.

6

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

Section 1. That section 3923.91 be amended and sections	7
185.01, 185.02, 185.03, 185.04, 185.05, 185.06, 185.07, 185.08,	8
185.09, 185.10, 185.11, 185.12, 3333.611, and 3333.612 of the	9
Revised Code be enacted to read as follows:	10

Sec. 185.01.  As used in this chapter:

11

(A) "Advanced practice nurse" has the same meaning as in	12
section 4723.01 of the Revised Code.	13

(B) "Collaboration" or "collaborating" has the same meaning	14
as in section 4723.01 of the Revised Code.	15

(C) "Health care coverage and quality council" means the	16
entity established under section 3923.90 of the Revised Code.	17

(D) "Patient centered medical home education advisory group"	18
means the entity established under section 185.03 of the Revised	19
Code to implement and administer the patient centered medical home	20
education pilot project.	21

(E) "Patient centered medical home education pilot project"	22
means the pilot project established under section 185.02 of the	23
Revised Code.	24

Sec. 185.02. (A) There is hereby established the patient	25
centered medical home education pilot project. The pilot project	26
shall be implemented and administered by the patient centered	27
medical home education advisory group.	28

(B) The pilot project shall be operated to advance medical	29
education in the patient centered medical home model of care. The	30
patient centered medical home model of care is an enhanced model	31
of primary care in which care teams attend to the multifaceted	32
needs of patients, providing whole person comprehensive and	33
coordinated patient centered care.	34

(C) The pilot project shall not be operated in a manner that	35
requires a patient, unless otherwise required by the Revised Code,	36
to receive a referral from a physician in a practice selected for	37
inclusion in the pilot project under section 185.05 of the Revised	38
Code as a condition of being authorized to receive specialized	39
health care services from an individual licensed or certified	40
under Title XLVII of the Revised Code to provide those services.	41

Sec. 185.03. (A) The patient centered medical home education	42
advisory group is hereby created for the purpose of implementing	43
and administering the patient centered medical home pilot project.	44
The advisory group shall develop a set of expected outcomes for	45
the pilot project.	46

(B) The advisory group shall consist of the following voting	47
members:	48

(1) One individual with expertise in the training and	49
education of primary care physicians who is appointed by the dean	50
of the university of Toledo college of medicine;	51

(2) One individual with expertise in the training and	52
education of primary care physicians who is appointed by the dean	53
of the Boonshoft school of medicine at Wright state university;	54

(3) One individual with expertise in the training and	55
education of primary care physicians who is appointed by the	56
president and dean of the northeastern Ohio universities colleges	57
of medicine and pharmacy;	58

(4) One individual with expertise in the training and	59
education of primary care physicians who is appointed by the dean	60
of the Ohio university college of osteopathic medicine;	61

(5) Two individuals appointed by the governing board of the	62
Ohio academy of family physicians;	63

(6) One individual appointed by the governing board of the	64
Ohio chapter of the American college of physicians;	65

(7) One individual appointed by the governing board of the	66
American academy of pediatrics;	67

(8) One individual appointed by the governing board of the	68
Ohio osteopathic association;	69

(9) One individual with expertise in the training and	70
education of advanced practice nurses who is appointed by the	71
governing board of the Ohio council of deans and directors of	72
baccalaureate and higher degree programs in nursing;	73

(10) One individual appointed by the governing board of the	74
Ohio nurses association;	75

(11) One individual appointed by the governing board of the	76
Ohio association of advanced practice nurses;	77

(12) A member of the health care coverage and quality	78
council, other than the advisory group member specified in	79
division (C)(2) of this section, appointed by the superintendent	80
of insurance.	81

(C) The advisory group shall consist of the following	82
nonvoting, ex officio members:	83

(1) The executive director of the state medical board, or the	84
director's designee;	85

(2) The executive director of the board of nursing or the	86
director's designee;	87

(3) The chancellor of the Ohio board of regents, or the	88
chancellor's designee;	89

(4) The individual within the department of job and family	90
services who serves as the director of medicaid, or the director's	91
designee.	92

(D) Advisory group members who are appointed shall serve at	93
the pleasure of their appointing authorities. Terms of office of	94
appointed members shall be three years, except that a member's	95
term ends if the pilot project ceases operation during the	96
member's term.	97

Vacancies shall be filled in the manner provided for original	98
appointments.	99

Members shall serve without compensation, except to the	100
extent that serving on the advisory group is considered part of	101
their regular employment duties.	102

(E) The advisory group shall select from among its members a	103
chairperson and vice-chairperson. The advisory group may select	104
any other officers it considers necessary to conduct its business.	105

A majority of the members of the advisory group constitutes a	106
quorum for the transaction of official business. A majority of a	107
quorum is necessary for the advisory group to take any action,	108
except that when one or more members of a quorum are required to	109
abstain from voting as provided in division (C)(1)(d) or (C)(2)(c)	110
of section 185.05 of the Revised Code, the number of members	111
necessary for a majority of a quorum shall be reduced accordingly.	112

The advisory group shall meet as necessary to fulfill its	113
duties. The times and places for the meetings shall be selected by	114
the chairperson.	115

(F) Sections 101.82 to 101.87 of the Revised Code do not	116
apply to the advisory group.	117

Sec. 185.04. The patient centered medical home education	118
advisory group may appoint an executive director and employ other	119
staff as it considers necessary to fulfill its duties. Until the	120
advisory group identifies an alternative, the Boonshoft school of	121
medicine at Wright state university shall provide administrative	122
support to the advisory group.	123

Sec. 185.05. (A) The patient centered medical home education	124
advisory group shall accept applications for inclusion in the	125
patient centered medical home education pilot project from primary	126
care practices with educational affiliations, as determined by the	127
advisory group, with one or more of the following:	128

(1) The Boonshoft school of medicine at Wright state	129
university;	130

(2) The university of Toledo college of medicine;

131

(3) The northeastern Ohio universities colleges of medicine	132
and pharmacy;	133

(4) The Ohio university college of osteopathic medicine;

134

(5) The college of nursing at the university of Toledo;

135

(6) The Wright state university college of nursing and	136
health;	137

(7) The college of nursing at Kent state university;

138

(8) The school of nursing at Ohio university.

139

(B)(1) Subject to division (C)(1) of this section, the	140
advisory group shall select for inclusion in the pilot project not	141
more than the following number of physician practices:	142

(a) Ten practices affiliated with the Boonshoft school of	143
medicine at Wright state university;	144

(b) Ten practices affiliated with the university of Toledo	145
college of medicine;	146

(c) Ten practices affiliated with the northeastern Ohio	147
universities colleges of medicine and pharmacy;	148

(d) Ten practices affiliated with the centers for osteopathic	149
research and education of the Ohio university college of	150
osteopathic medicine.	151

(2) Subject to division (C)(2) of this section, the advisory	152
group shall select for inclusion in the pilot project not less	153
than the following number of advanced practice nurse primary care	154
practices:	155

(a) One practice affiliated with the college of nursing at	156
the university of Toledo;	157

(b) One practice affiliated with the Wright state university	158
college of nursing and health;	159

(c) One practice affiliated with the college of nursing at	160
Kent state university;	161

(d) One practice affiliated with the school of nursing at	162
Ohio university.	163

(C)(1) All of the following apply with respect to the	164
selection of physician practices under division (B) of this	165
section:	166

(a) The advisory group shall strive to select physician	167
practices in such a manner that the pilot project includes a	168
diverse range of primary care specialties, including practices	169
specializing in pediatrics, geriatrics, general internal medicine,	170
or family medicine.	171

(b) When evaluating an application, the advisory group shall	172
consider the percentage of patients in the physician practice who	173
are part of a medically underserved population, including medicaid	174
recipients and individuals without health insurance.	175

(c) The advisory group shall select not fewer than six	176
practices that serve rural areas of this state, as those areas are	177
determined by the advisory group.	178

(d) A member of the advisory group shall abstain from	179
participating in any vote taken regarding the selection of a	180
physician practice if the member would receive any financial	181
benefit from having the practice included in the pilot project.	182

(2) All of the following apply with respect to the selection	183
of advanced practice nurse primary care practices under division	184
(B) of this section:	185

(a) When evaluating an application, the advisory group shall	186
consider the percentage of patients in the advanced practice nurse	187
primary care practice who are part of a medically underserved	188
population, including medicaid recipients and individuals without	189
health insurance.	190

(b) If the advisory group determines that it has not received	191
an application from a sufficiently qualified advanced practice	192
nurse primary care practice affiliated with a particular	193
institution specified in division (B)(2) of this section, the	194
advisory group shall make the selections required under that	195
division in such a manner that the greatest possible number of	196
those institutions are represented in the pilot project. To be	197
selected in this manner, a practice remains subject to the	198
eligibility requirements specified in division (B) of section	199
185.06 of the Revised Code. As specified in division (B)(2) of	200
this section, the number of practices selected for inclusion in	201
the pilot project shall be at least four.	202

(c) A member of the advisory group shall abstain from	203
participating in any vote taken regarding the selection of an	204
advanced practice nurse primary care practice if the member would	205
receive any financial benefit from having the practice included in	206
the pilot project.	207

Sec. 185.06. (A) To be eligible for inclusion in the patient	208
centered medical home education pilot project, a physician	209
practice shall meet all of the following requirements:	210

(1) Consist of physicians who are board-certified in family	211
medicine, general pediatrics, or internal medicine, as those	212
designations are issued by a medical specialty certifying board	213
recognized by the American board of medical specialties or	214
American osteopathic association;	215

(2) Be capable of adapting the practice during the period in	216
which the practice receives funding from the patient centered	217
medical home education advisory group in such a manner that the	218
practice is fully compliant with the minimum standards for	219
operation of a patient centered medical home, as those standards	220
are established by the advisory group;	221

(3) Comply with any reporting requirements recommended by the	222
health care coverage and quality council under division (A)(12) of	223
section 3923.91 of the Revised Code;	224

(4) Meet any other criteria established by the advisory group	225
as part of the selection process.	226

(B) To be eligible for inclusion in the pilot project, an	227
advanced practice nurse primary care practice shall meet all of	228
the following requirements:	229

(1) Consist of advanced practice nurses who meet all of the	230
following requirements:	231

(a) Hold a certificate to prescribe issued under section	232
4723.48 of the Revised Code;	233

(b) Are board-certified as a family nurse practitioner or	234
adult nurse practitioner by the American academy of nurse	235
practitioners or American nurses credentialing center,	236
board-certified as a geriatric nurse practitioner or women's	237
health nurse practitioner by the American nurses credentialing	238
center, or is board-certified as a pediatric nurse practitioner by	239
the American nurses credentialing center or pediatric nursing	240
certification board;	241

(c) Has a collaboration agreement with a physician with board	242
certification as specified in division (A)(1) of this section and	243
who is an active participant on the health care team.	244

(2) Be capable of adapting the primary care practice during	245
the period in which the practice receives funding from the	246
advisory group in such a manner that the practice is fully	247
compliant with the minimum standards for operation of a patient	248
centered medical home, as those standards are established by the	249
advisory group;	250

(3) Comply with any reporting requirements recommended by the	251
health care coverage and quality council under division (A)(12) of	252
section 3923.91 of the Revised Code;	253

(4) Meet any other criteria established by the advisory group	254
as part of the selection process.	255

Sec. 185.07. The patient centered medical home education	256
advisory group shall enter into a contract with each primary care	257
practice selected for inclusion in the patient centered medical	258
home education pilot project. The contract shall specify the terms	259
and conditions for inclusion in the pilot project, including a	260
requirement that the practice provide primary care services to	261
patients and serve as the patients' medical home. The contract	262
shall also require the practice to participate in the training of	263
medical students, advanced practice nursing students, or primary	264
care residents.	265

Sec. 185.08. The patient centered medical home education	266
pilot project shall include the following services and supports	267
for each primary care practice included in the pilot project:	268

(A) Upon securing adequate funding, the patient centered	269
medical home education advisory group shall provide to each	270
participating primary care practice reimbursement for not more	271
than seventy-five per cent of the cost incurred in purchasing any	272
health information technology required to convert to the patient	273
centered medical home model of care, including the cost incurred	274
for appropriate training and technical support.	275

(B) The physicians, advanced practice nurses, and staff of	276
the practice shall receive comprehensive training on the operation	277
of a patient centered medical home, including assistance with	278
leadership training, scheduling changes, staff support, and care	279
management for chronic health conditions.	280

Sec. 185.09. (A) The patient centered medical home education	281
advisory group shall jointly work with all medical and nursing	282
schools in this state to develop appropriate curricula designed to	283
prepare primary care physicians and advanced practice nurses to	284
practice within the patient centered medical home model of care.	285
In developing the curricula, the advisory group, medical schools,	286
and nursing schools shall include all of the following:	287

(1) Components for use at the medical student, advanced	288
practice nursing student, and primary care resident training	289
levels;	290

(2) Components that reflect, as appropriate, the special	291
needs of patients who are part of a medically underserved	292
population, including medicaid recipients, individuals without	293
health insurance, individuals with disabilities, individuals with	294
chronic health conditions, and individuals within racial or ethnic	295
minority groups;	296

(3) Components that include training in interdisciplinary	297
cooperation between physicians and advanced practice nurses in the	298
patient centered medical home model of care, including curricula	299
ensuring that a common conception of a patient centered medical	300
home model of care is provided to medical students, advanced	301
practice nurses, and primary care residents.	302

(B) The advisory group shall work in association with the	303
medical and nursing schools to identify funding sources to ensure	304
that the curricula developed under division (A) of this section	305
are accessible to medical students, advanced practice nursing	306
students, and primary care residents. The advisory group shall	307
consider scholarship options or incentives provided to students in	308
addition to those provided under the choose Ohio first scholarship	309
program operated under section 3333.61 of the Revised Code.	310

Sec. 185.10. The patient centered medical home education	311
advisory group shall seek funding sources for the patient centered	312
medical home education pilot project. In doing so, the advisory	313
group may apply for grants, seek federal funds, seek private	314
donations, or seek any other type of funding that may be available	315
for the pilot project. To ensure that appropriate sources of and	316
opportunities for funding are identified and pursued, the advisory	317
group may ask for assistance from the health care coverage and	318
quality council.	319

Sec. 185.11. (A) All funds received on behalf of the patient	320
centered medical home education advisory group shall be deposited	321
into an account maintained in a financial institution for the	322
benefit of the patient centered medical home education pilot	323
project. The account shall be in the custody of the treasurer of	324
state, but shall not be part of the state treasury. All	325
disbursements from the account shall be released by the treasurer	326
of state only upon a request bearing the signature of the advisory	327
group's chairperson, another person designated by the advisory	328
group, or, if an executive director has been appointed, the	329
advisory group's executive director.	330

(B) The advisory group may use the funds deposited into the	331
account as it considers necessary to fulfill its duties in	332
implementing and administering the pilot project.	333

Sec. 185.12. (A) The patient centered medical home education	334
advisory group shall prepare reports of its findings and	335
recommendations from the patient centered medical home education	336
pilot project. Each report shall include an evaluation of the	337
learning opportunities generated by the pilot project, the	338
physicians and advanced practice nurses trained in the pilot	339
project, the costs of the pilot project, and the extent to which	340
the pilot project has met the set of expected outcomes developed	341
under division (A) of section 185.03 of the Revised Code.	342

(B) The reports shall be completed in accordance with the	343
following schedule:	344

(1) An interim report not later than six months after the	345
date on which the first funding is released pursuant to section	346
185.11 of the Revised Code;	347

(2) An update of the interim report not later than one year	348
after the date on which the first funding is released;	349

(3) A final report not later than two years after the date on	350
which the first funding is released.	351

(C) The advisory group shall submit each of the reports to	352
the governor and, in accordance with section 101.68 of the Revised	353
Code, to the general assembly.	354

Sec. 3333.611.  (A) All of the following individuals shall	355
jointly develop a proposal for the creation of a primary care	356
medical student component of the choose Ohio first scholarship	357
program operated under section 3333.61 of the Revised Code under	358
which scholarships are annually made available and awarded to	359
medical students who meet the requirements specified in division	360
(D) of this section:	361

(1) The dean of the Ohio state university school of medicine;

362

(2) The dean of the Case western reserve university school of	363
medicine;	364

(3) The dean of the university of Toledo college of medicine;

365

(4) The president and dean of the northeastern Ohio	366
universities colleges of medicine and pharmacy;	367

(5) The dean of the university of Cincinnati college of	368
medicine;	369

(6) The dean of the Boonshoft school of medicine at Wright	370
state university;	371

(7) The dean of the Ohio university college of osteopathic	372
medicine.	373

(B) The individuals specified in division (A) of this section	374
shall consider including the following provisions in the proposal:	375

(1) Establishing a scholarship of sufficient size to permit	376
annually not more than fifty medical students to receive	377
scholarships;	378

(2) Specifying that a scholarship, once granted, may be	379
provided to a medical student for not more than four years.	380

(C) The individuals specified in division (A) of this section	381
shall submit the proposal for the component to the chancellor of	382
the Ohio board of regents not later than six months after the	383
effective date of this section. The chancellor shall review the	384
proposal and determine whether to implement the component as part	385
of the program.	386

(D) To be eligible for a scholarship made available under the	387
component, a medical student shall meet all of the following	388
requirements:	389

(1) Participate in identified patient centered medical home	390
model training opportunities during medical school;	391

(2) Commit to a post-residency primary care practice in this	392
state for not less than three years;	393

(3) Accept medicaid recipients as patients, without	394
restriction and, as compared to other patients, in a proportion	395
that is specified in the scholarship.	396

Sec. 3333.612.  (A) All of the following individuals shall	397
jointly develop a proposal for the creation of a primary care	398
nursing student component of the choose Ohio first scholarship	399
program operated under section 3333.61 of the Revised Code under	400
which scholarships are annually made available and awarded to	401
advanced practice nursing students who meet the requirements	402
specified in division (D) of this section:	403

(1) The dean of the college of nursing at the university of	404
Toledo;	405

(2) The dean of the Wright state university college of	406
nursing and health;	407

(3) The dean of the college of nursing at Kent state	408
university;	409

(4) The director of the school of nursing at Ohio university.

410

(B) The individuals specified in division (A) of this section	411
shall consider including the following provisions in the proposal:	412

(1) Establishing a scholarship of sufficient size to permit	413
annually not more than thirty advanced practice nursing students	414
to receive scholarships;	415

(2) Specifying that a scholarship, once granted, may be	416
provided to an advanced practice nursing student for not more than	417
three years.	418

(C) The individuals specified in division (A) of this section	419
shall submit the proposal for the component to the chancellor of	420
the Ohio board of regents not later than six months after the	421
effective date of this section. The chancellor shall review the	422
proposal and determine whether to implement the component as part	423
of the program.	424

(D) To be eligible for a scholarship made available under the	425
component, an advanced practice nursing student shall meet all of	426
the following requirements:	427

(1) Participate in identified patient centered medical home	428
model training opportunities during nursing school;	429

(2) Commit to an advanced practice nursing primary care	430
practice in this state after completing nursing school for not	431
less than three years;	432

(3) Accept medicaid recipients as patients, without	433
restriction and, as compared to other patients, in a proportion	434
that is specified in the scholarship.	435

Sec. 3923.91. (A) The health care coverage and quality	436
council shall do all of the following:	437

(1) Advise the governor and general assembly on strategies to	438
improve health care programs and health insurance policies and	439
benefit plans;	440

(2) Monitor and evaluate implementation of strategies for	441
improving access to health insurance coverage and improving the	442
quality of the state's health care system, identify barriers to	443
implementing those strategies, and identify methods for overcoming	444
the barriers;	445

(3) Catalog existing health care data reporting efforts and	446
make recommendations to improve data reporting in a manner that	447
increases transparency and consistency in the health care and	448
insurance coverage systems;	449

(4) Study health care financing alternatives that will	450
increase access to health insurance coverage, promote disease	451
prevention and injury prevention, contain costs, and improve	452
quality;	453

(5) Evaluate the systems that individuals use to obtain or	454
otherwise become connected with health insurance and recommend	455
improvements to those systems or the use of alternative systems;	456

(6) Recommend minimum coverage standards for basic and	457
standard health insurance plans offered by insurance carriers;	458

(7) Recommend strategies, such as subsidies, to assist	459
individuals in being able to afford health insurance coverage;	460

(8) Recommend strategies to implement health information	461
technology to support improved access and quality and reduced	462
costs in the state's health care system;	463

(9) Study alternative care management options for medicaid	464
recipients who are not required to participate in the care	465
management system established under section 5111.16 of the Revised	466
Code;	467

(10) Review the medical home model of care concept, propose	468
the characteristics of a patient centered medical home model of	469
care, pursue appropriate funding opportunities for the development	470
of a patient centered medical home model of care, and propose	471
payment reforms that encourage implementation of a patient	472
centered medical home model of care;	473

(11) Collaborate with the chancellor of the Ohio board of	474
regents or any other entity the council considers appropriate to	475
review issues that may cause limitations on the use of a patient	476
centered medical home model of care;	477

(12) Recommend reporting requirements for any physician	478
practice or advanced practice nurse primary care practice using a	479
patient centered medical home model of care;	480

(13) Perform any other duties specified in rules adopted by	481
the superintendent of insurance.	482

(B) The council shall prepare and issue an annual report,	483
which may include recommendations, on or before the thirty-first	484
day of December of each year. The council may prepare and issue	485
other reports and recommendations at other times that the council	486
finds appropriate.	487

(C) The superintendent may adopt rules as necessary for the	488
council to carry out its duties. The rules shall be adopted under	489
Chapter 119. of the Revised Code. In adopting the rules, the	490
superintendent may consider any recommendations made by the	491
council.	492

Section 2. That existing section 3923.91 of the Revised Code	493
is hereby repealed.	494