As Reported by the Senate Health, Human Services and Aging Committee

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. 

Senator Morano 

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A BILL

To amend sections 3923.91 and 5111.242 and to enact

1

sections 185.01 to 185.12, 3333.611, and 3333.612

2

of the Revised Code, to amend Section 309.30.25 of

3

Am. Sub. H.B. 1 of the 128th General Assembly, and

4

to amend Section 5 of Sub. H.B. 125 of the 127th

5

General Assembly, as subsequently amended, to

6

establish the Patient Centered Medical Home

7

Education Pilot Project, to authorize

8

implementation of a primary care component of the

9

Choose Ohio First Scholarship Program, to extend

10

the moratorium concerning most favored nation

11

clauses in hospital contracts, to revise the law

12

governing the Medicaid reimbursement for nursing

13

facilities' tax costs, and to declare an

14

emergency.

15

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

Section 1. That sections 3923.91 and 5111.242 be amended and	16
sections 185.01, 185.02, 185.03, 185.04, 185.05, 185.06, 185.07,	17
185.08, 185.09, 185.10, 185.11, 185.12, 3333.611, and 3333.612 of	18
the Revised Code be enacted to read as follows:	19

Sec. 185.01.  As used in this chapter:

20

(A) "Advanced practice nurse" has the same meaning as in	21
section 4723.01 of the Revised Code.	22

(B) "Collaboration" has the same meaning as in section	23
4723.01 of the Revised Code.	24

(C) "Health care coverage and quality council" means the	25
entity established under section 3923.90 of the Revised Code.	26

(D) "Patient centered medical home education advisory group"	27
means the entity established under section 185.03 of the Revised	28
Code to implement and administer the patient centered medical home	29
education pilot project.	30

(E) "Patient centered medical home education pilot project"	31
means the pilot project established under section 185.02 of the	32
Revised Code.	33

Sec. 185.02. (A) There is hereby established the patient	34
centered medical home education pilot project. The pilot project	35
shall be implemented and administered by the patient centered	36
medical home education advisory group.	37

(B) The pilot project shall be operated to advance medical	38
education in the patient centered medical home model of care. The	39
patient centered medical home model of care is an enhanced model	40
of primary care in which care teams attend to the multifaceted	41
needs of patients, providing whole person comprehensive and	42
coordinated patient centered care.	43

(C) The pilot project shall not be operated in a manner that	44
requires a patient, unless otherwise required by the Revised Code,	45
to receive a referral from a physician in a practice selected for	46
inclusion in the pilot project under section 185.05 of the Revised	47
Code as a condition of being authorized to receive specialized	48
health care services from an individual licensed or certified	49
under Title XLVII of the Revised Code to provide those services.	50

Sec. 185.03. (A) The patient centered medical home education	51
advisory group is hereby created for the purpose of implementing	52
and administering the patient centered medical home pilot project.	53
The advisory group shall develop a set of expected outcomes for	54
the pilot project.	55

(B) The advisory group shall consist of the following voting	56
members:	57

(1) One individual with expertise in the training and	58
education of primary care physicians who is appointed by the dean	59
of the university of Toledo college of medicine;	60

(2) One individual with expertise in the training and	61
education of primary care physicians who is appointed by the dean	62
of the Boonshoft school of medicine at Wright state university;	63

(3) One individual with expertise in the training and	64
education of primary care physicians who is appointed by the	65
president and dean of the northeastern Ohio universities colleges	66
of medicine and pharmacy;	67

(4) One individual with expertise in the training and	68
education of primary care physicians who is appointed by the dean	69
of the Ohio university college of osteopathic medicine;	70

(5) Two individuals appointed by the governing board of the	71
Ohio academy of family physicians;	72

(6) One individual appointed by the governing board of the	73
Ohio chapter of the American college of physicians;	74

(7) One individual appointed by the governing board of the	75
American academy of pediatrics;	76

(8) One individual appointed by the governing board of the	77
Ohio osteopathic association;	78

(9) One individual with expertise in the training and	79
education of advanced practice nurses who is appointed by the	80
governing board of the Ohio council of deans and directors of	81
baccalaureate and higher degree programs in nursing;	82

(10) One individual appointed by the governing board of the	83
Ohio nurses association;	84

(11) One individual appointed by the governing board of the	85
Ohio association of advanced practice nurses;	86

(12) A member of the health care coverage and quality	87
council, other than the advisory group member specified in	88
division (C)(2) of this section, appointed by the superintendent	89
of insurance.	90

(C) The advisory group shall consist of the following	91
nonvoting, ex officio members:	92

(1) The executive director of the state medical board, or the	93
director's designee;	94

(2) The executive director of the board of nursing or the	95
director's designee;	96

(3) The chancellor of the Ohio board of regents, or the	97
chancellor's designee;	98

(4) The individual within the department of job and family	99
services who serves as the director of medicaid, or the director's	100
designee;	101

(5) The director of health or the director's designee.

102

(D) Advisory group members who are appointed shall serve at	103
the pleasure of their appointing authorities. Terms of office of	104
appointed members shall be three years, except that a member's	105
term ends if the pilot project ceases operation during the	106
member's term.	107

Vacancies shall be filled in the manner provided for original	108
appointments.	109

Members shall serve without compensation, except to the	110
extent that serving on the advisory group is considered part of	111
their regular employment duties.	112

(E) The advisory group shall select from among its members a	113
chairperson and vice-chairperson. The advisory group may select	114
any other officers it considers necessary to conduct its business.	115

A majority of the members of the advisory group constitutes a	116
quorum for the transaction of official business. A majority of a	117
quorum is necessary for the advisory group to take any action,	118
except that when one or more members of a quorum are required to	119
abstain from voting as provided in division (C)(1)(d) or (C)(2)(c)	120
of section 185.05 of the Revised Code, the number of members	121
necessary for a majority of a quorum shall be reduced accordingly.	122

The advisory group shall meet as necessary to fulfill its	123
duties. The times and places for the meetings shall be selected by	124
the chairperson.	125

(F) Sections 101.82 to 101.87 of the Revised Code do not	126
apply to the advisory group.	127

Sec. 185.04. The patient centered medical home education	128
advisory group may appoint an executive director and employ other	129
staff as it considers necessary to fulfill its duties. Until the	130
advisory group identifies an alternative, the Boonshoft school of	131
medicine at Wright state university shall provide administrative	132
support to the advisory group.	133

Sec. 185.05. (A) The patient centered medical home education	134
advisory group shall accept applications for inclusion in the	135
patient centered medical home education pilot project from primary	136
care practices with educational affiliations, as determined by the	137
advisory group, with one or more of the following:	138

(1) The Boonshoft school of medicine at Wright state	139
university;	140

(2) The university of Toledo college of medicine;

141

(3) The northeastern Ohio universities colleges of medicine	142
and pharmacy;	143

(4) The Ohio university college of osteopathic medicine;

144

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

145

(6) The Wright state university college of nursing and	146
health;	147

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

148

(8) The university of Akron college of nursing;

149

(9) The school of nursing at Ohio university.

150

(B)(1) Subject to division (C)(1) of this section, the	151
advisory group shall select for inclusion in the pilot project not	152
more than the following number of physician practices:	153

(a) Ten practices affiliated with the Boonshoft school of	154
medicine at Wright state university;	155

(b) Ten practices affiliated with the university of Toledo	156
college of medicine;	157

(c) Ten practices affiliated with the northeastern Ohio	158
universities colleges of medicine and pharmacy;	159

(d) Ten practices affiliated with the centers for osteopathic	160
research and education of the Ohio university college of	161
osteopathic medicine.	162

(2) Subject to division (C)(2) of this section, the advisory	163
group shall select for inclusion in the pilot project not less	164
than the following number of advanced practice nurse primary care	165
practices:	166

(a) One practice affiliated with the college of nursing at	167
the university of Toledo;	168

(b) One practice affiliated with the Wright state university	169
college of nursing and health;	170

(c) One practice affiliated with the college of nursing at	171
Kent state university or the university of Akron college of	172
nursing;	173

(d) One practice affiliated with the school of nursing at	174
Ohio university.	175

(C)(1) All of the following apply with respect to the	176
selection of physician practices under division (B) of this	177
section:	178

(a) The advisory group shall strive to select physician	179
practices in such a manner that the pilot project includes a	180
diverse range of primary care specialties, including practices	181
specializing in pediatrics, geriatrics, general internal medicine,	182
or family medicine.	183

(b) When evaluating an application, the advisory group shall	184
consider the percentage of patients in the physician practice who	185
are part of a medically underserved population, including medicaid	186
recipients and individuals without health insurance.	187

(c) The advisory group shall select not fewer than six	188
practices that serve rural areas of this state, as those areas are	189
determined by the advisory group.	190

(d) A member of the advisory group shall abstain from	191
participating in any vote taken regarding the selection of a	192
physician practice if the member would receive any financial	193
benefit from having the practice included in the pilot project.	194

(2) All of the following apply with respect to the selection	195
of advanced practice nurse primary care practices under division	196
(B) of this section:	197

(a) When evaluating an application, the advisory group shall	198
consider the percentage of patients in the advanced practice nurse	199
primary care practice who are part of a medically underserved	200
population, including medicaid recipients and individuals without	201
health insurance.	202

(b) If the advisory group determines that it has not received	203
an application from a sufficiently qualified advanced practice	204
nurse primary care practice affiliated with a particular	205
institution specified in division (B)(2) of this section, the	206
advisory group shall make the selections required under that	207
division in such a manner that the greatest possible number of	208
those institutions are represented in the pilot project. To be	209
selected in this manner, a practice remains subject to the	210
eligibility requirements specified in division (B) of section	211
185.06 of the Revised Code. As specified in division (B)(2) of	212
this section, the number of practices selected for inclusion in	213
the pilot project shall be at least four.	214

(c) A member of the advisory group shall abstain from	215
participating in any vote taken regarding the selection of an	216
advanced practice nurse primary care practice if the member would	217
receive any financial benefit from having the practice included in	218
the pilot project.	219

Sec. 185.06. (A) To be eligible for inclusion in the patient	220
centered medical home education pilot project, a physician	221
practice shall meet all of the following requirements:	222

(1) Consist of physicians who are board-certified in family	223
medicine, general pediatrics, or internal medicine, as those	224
designations are issued by a medical specialty certifying board	225
recognized by the American board of medical specialties or	226
American osteopathic association;	227

(2) Be capable of adapting the practice during the period in	228
which the practice receives funding from the patient centered	229
medical home education advisory group in such a manner that the	230
practice is fully compliant with the minimum standards for	231
operation of a patient centered medical home, as those standards	232
are established by the advisory group;	233

(3) Comply with any reporting requirements recommended by the	234
health care coverage and quality council under division (A)(12) of	235
section 3923.91 of the Revised Code;	236

(4) Meet any other criteria established by the advisory group	237
as part of the selection process.	238

(B) To be eligible for inclusion in the pilot project, an	239
advanced practice nurse primary care practice shall meet all of	240
the following requirements:	241

(1) Consist of advanced practice nurses who meet all of the	242
following requirements:	243

(a) Hold a certificate to prescribe issued under section	244
4723.48 of the Revised Code;	245

(b) Are board-certified as a family nurse practitioner or	246
adult nurse practitioner by the American academy of nurse	247
practitioners or American nurses credentialing center,	248
board-certified as a geriatric nurse practitioner or women's	249
health nurse practitioner by the American nurses credentialing	250
center, or is board-certified as a pediatric nurse practitioner by	251
the American nurses credentialing center or pediatric nursing	252
certification board;	253

(c) Has a collaboration agreement with a physician with board	254
certification as specified in division (A)(1) of this section and	255
who is an active participant on the health care team.	256

(2) Be capable of adapting the primary care practice during	257
the period in which the practice receives funding from the	258
advisory group in such a manner that the practice is fully	259
compliant with the minimum standards for operation of a patient	260
centered medical home, as those standards are established by the	261
advisory group;	262

(3) Comply with any reporting requirements recommended by the	263
health care coverage and quality council under division (A)(12) of	264
section 3923.91 of the Revised Code;	265

(4) Meet any other criteria established by the advisory group	266
as part of the selection process.	267

Sec. 185.07. The patient centered medical home education	268
advisory group shall enter into a contract with each primary care	269
practice selected for inclusion in the patient centered medical	270
home education pilot project. The contract shall specify the terms	271
and conditions for inclusion in the pilot project, including a	272
requirement that the practice provide primary care services to	273
patients and serve as the patients' medical home. The contract	274
shall also require the practice to participate in the training of	275
medical students, advanced practice nursing students, or primary	276
care residents.	277

Sec. 185.08. The patient centered medical home education	278
pilot project shall include the following services and supports	279
for each primary care practice included in the pilot project:	280

(A) Upon securing adequate funding, the patient centered	281
medical home education advisory group shall provide to each	282
participating primary care practice reimbursement for not more	283
than seventy-five per cent of the cost incurred in purchasing any	284
health information technology required to convert to the patient	285
centered medical home model of care, including the cost incurred	286
for appropriate training and technical support.	287

(B) The physicians, advanced practice nurses, and staff of	288
the practice shall receive comprehensive training on the operation	289
of a patient centered medical home, including assistance with	290
leadership training, scheduling changes, staff support, and care	291
management for chronic health conditions.	292

Sec. 185.09. (A) The patient centered medical home education	293
advisory group shall jointly work with all medical and nursing	294
schools in this state to develop appropriate curricula designed to	295
prepare primary care physicians and advanced practice nurses to	296
practice within the patient centered medical home model of care.	297
In developing the curricula, the advisory group, medical schools,	298
and nursing schools shall include all of the following:	299

(1) Components for use at the medical student, advanced	300
practice nursing student, and primary care resident training	301
levels;	302

(2) Components that reflect, as appropriate, the special	303
needs of patients who are part of a medically underserved	304
population, including medicaid recipients, individuals without	305
health insurance, individuals with disabilities, individuals with	306
chronic health conditions, and individuals within racial or ethnic	307
minority groups;	308

(3) Components that include training in interdisciplinary	309
cooperation between physicians and advanced practice nurses in the	310
patient centered medical home model of care, including curricula	311
ensuring that a common conception of a patient centered medical	312
home model of care is provided to medical students, advanced	313
practice nurses, and primary care residents.	314

(B) The advisory group shall work in association with the	315
medical and nursing schools to identify funding sources to ensure	316
that the curricula developed under division (A) of this section	317
are accessible to medical students, advanced practice nursing	318
students, and primary care residents. The advisory group shall	319
consider scholarship options or incentives provided to students in	320
addition to those provided under the choose Ohio first scholarship	321
program operated under section 3333.61 of the Revised Code.	322

Sec. 185.10. The patient centered medical home education	323
advisory group shall seek funding sources for the patient centered	324
medical home education pilot project. In doing so, the advisory	325
group may apply for grants, seek federal funds, seek private	326
donations, or seek any other type of funding that may be available	327
for the pilot project. To ensure that appropriate sources of and	328
opportunities for funding are identified and pursued, the advisory	329
group may ask for assistance from the health care coverage and	330
quality council.	331

Sec. 185.11. (A) All funds received on behalf of the patient	332
centered medical home education advisory group shall be deposited	333
into an account maintained in a financial institution for the	334
benefit of the patient centered medical home education pilot	335
project. The account shall be in the custody of the treasurer of	336
state, but shall not be part of the state treasury. All	337
disbursements from the account shall be released by the treasurer	338
of state only upon a request bearing the signature of the advisory	339
group's chairperson, another person designated by the advisory	340
group, or, if an executive director has been appointed, the	341
advisory group's executive director.	342

(B) The advisory group may use the funds deposited into the	343
account as it considers necessary to fulfill its duties in	344
implementing and administering the pilot project.	345

Sec. 185.12. (A) The patient centered medical home education	346
advisory group shall prepare reports of its findings and	347
recommendations from the patient centered medical home education	348
pilot project. Each report shall include an evaluation of the	349
learning opportunities generated by the pilot project, the	350
physicians and advanced practice nurses trained in the pilot	351
project, the costs of the pilot project, and the extent to which	352
the pilot project has met the set of expected outcomes developed	353
under division (A) of section 185.03 of the Revised Code.	354

(B) The reports shall be completed in accordance with the	355
following schedule:	356

(1) An interim report not later than six months after the	357
date on which the first funding is released pursuant to section	358
185.11 of the Revised Code;	359

(2) An update of the interim report not later than one year	360
after the date on which the first funding is released;	361

(3) A final report not later than two years after the date on	362
which the first funding is released.	363

(C) The advisory group shall submit each of the reports to	364
the governor and, in accordance with section 101.68 of the Revised	365
Code, to the general assembly.	366

Sec. 3333.611.  (A) All of the following individuals shall	367
jointly develop a proposal for the creation of a primary care	368
medical student component of the choose Ohio first scholarship	369
program operated under section 3333.61 of the Revised Code under	370
which scholarships are annually made available and awarded to	371
medical students who meet the requirements specified in division	372
(D) of this section:	373

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

374

(2) The dean of the Case western reserve university school of	375
medicine;	376

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

377

(4) The president and dean of the northeastern Ohio	378
universities colleges of medicine and pharmacy;	379

(5) The dean of the university of Cincinnati college of	380
medicine;	381

(6) The dean of the Boonshoft school of medicine at Wright	382
state university;	383

(7) The dean of the Ohio university college of osteopathic	384
medicine.	385

(B) The individuals specified in division (A) of this section	386
shall consider including the following provisions in the proposal:	387

(1) Establishing a scholarship of sufficient size to permit	388
annually not more than fifty medical students to receive	389
scholarships;	390

(2) Specifying that a scholarship, once granted, may be	391
provided to a medical student for not more than four years.	392

(C) The individuals specified in division (A) of this section	393
shall submit the proposal for the component to the chancellor of	394
the Ohio board of regents not later than six months after the	395
effective date of this section. The chancellor shall review the	396
proposal and determine whether to implement the component as part	397
of the program.	398

(D) To be eligible for a scholarship made available under the	399
component, a medical student shall meet all of the following	400
requirements:	401

(1) Participate in identified patient centered medical home	402
model training opportunities during medical school;	403

(2) Commit to a post-residency primary care practice in this	404
state for not less than three years;	405

(3) Accept medicaid recipients as patients, without	406
restriction and, as compared to other patients, in a proportion	407
that is specified in the scholarship.	408

Sec. 3333.612.  (A) All of the following individuals shall	409
jointly develop a proposal for the creation of a primary care	410
nursing student component of the choose Ohio first scholarship	411
program operated under section 3333.61 of the Revised Code under	412
which scholarships are annually made available and awarded to	413
advanced practice nursing students who meet the requirements	414
specified in division (D) of this section:	415

(1) The dean of the college of nursing at the university of	416
Toledo;	417

(2) The dean of the Wright state university college of	418
nursing and health;	419

(3) The dean of the college of nursing at Kent state	420
university;	421

(4) The dean of the university of Akron college of nursing;

422

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

423

(B) The individuals specified in division (A) of this section	424
shall consider including the following provisions in the proposal:	425

(1) Establishing a scholarship of sufficient size to permit	426
annually not more than thirty advanced practice nursing students	427
to receive scholarships;	428

(2) Specifying that a scholarship, once granted, may be	429
provided to an advanced practice nursing student for not more than	430
three years.	431

(C) The individuals specified in division (A) of this section	432
shall submit the proposal for the component to the chancellor of	433
the Ohio board of regents not later than six months after the	434
effective date of this section. The chancellor shall review the	435
proposal and determine whether to implement the component as part	436
of the program.	437

(D) To be eligible for a scholarship made available under the	438
component, an advanced practice nursing student shall meet all of	439
the following requirements:	440

(1) Participate in identified patient centered medical home	441
model training opportunities during nursing school;	442

(2) Commit to an advanced practice nursing primary care	443
practice in this state after completing nursing school for not	444
less than three years;	445

(3) Accept medicaid recipients as patients, without	446
restriction and, as compared to other patients, in a proportion	447
that is specified in the scholarship.	448

Sec. 3923.91. (A) The health care coverage and quality	449
council shall do all of the following:	450

(1) Advise the governor and general assembly on strategies to	451
improve health care programs and health insurance policies and	452
benefit plans;	453

(2) Monitor and evaluate implementation of strategies for	454
improving access to health insurance coverage and improving the	455
quality of the state's health care system, identify barriers to	456
implementing those strategies, and identify methods for overcoming	457
the barriers;	458

(3) Catalog existing health care data reporting efforts and	459
make recommendations to improve data reporting in a manner that	460
increases transparency and consistency in the health care and	461
insurance coverage systems;	462

(4) Study health care financing alternatives that will	463
increase access to health insurance coverage, promote disease	464
prevention and injury prevention, contain costs, and improve	465
quality;	466

(5) Evaluate the systems that individuals use to obtain or	467
otherwise become connected with health insurance and recommend	468
improvements to those systems or the use of alternative systems;	469

(6) Recommend minimum coverage standards for basic and	470
standard health insurance plans offered by insurance carriers;	471

(7) Recommend strategies, such as subsidies, to assist	472
individuals in being able to afford health insurance coverage;	473

(8) Recommend strategies to implement health information	474
technology to support improved access and quality and reduced	475
costs in the state's health care system;	476

(9) Study alternative care management options for medicaid	477
recipients who are not required to participate in the care	478
management system established under section 5111.16 of the Revised	479
Code;	480

(10) Review the medical home model of care concept, propose	481
the characteristics of a patient centered medical home model of	482
care, pursue appropriate funding opportunities for the development	483
of a patient centered medical home model of care, and propose	484
payment reforms that encourage implementation of a patient	485
centered medical home model of care;	486

(11) Collaborate with the chancellor of the Ohio board of	487
regents or any other entity the council considers appropriate to	488
review issues that may cause limitations on the use of a patient	489
centered medical home model of care;	490

(12) Recommend reporting requirements for any physician	491
practice or advanced practice nurse primary care practice using a	492
patient centered medical home model of care;	493

(13) Perform any other duties specified in rules adopted by	494
the superintendent of insurance.	495

(B) The council shall prepare and issue an annual report,	496
which may include recommendations, on or before the thirty-first	497
day of December of each year. The council may prepare and issue	498
other reports and recommendations at other times that the council	499
finds appropriate.	500

(C) The superintendent may adopt rules as necessary for the	501
council to carry out its duties. The rules shall be adopted under	502
Chapter 119. of the Revised Code. In adopting the rules, the	503
superintendent may consider any recommendations made by the	504
council.	505

Sec. 5111.242. (A) As used in this section:

506

(1) "Applicable calendar year" means the following:

507

(a) For the purpose of the department of job and family	508
services' initial determination under this section of nursing	509
facilities' rate for tax costs, calendar year 2003;	510

(b) For the purpose of the department's subsequent	511
determinations under division (D)(C) of this section of nursing	512
facilities' rate for tax costs, the calendar year the department	513
selects.	514

(2) "Tax costs" means the costs of taxes imposed under	515
Chapter 5751. of the Revised Code, real estate taxes, personal	516
property taxes, and corporate franchise taxes.	517

(B) The department of job and family services shall pay a	518
provider for each of the provider's eligible nursing facilities a	519
per resident per day rate for tax costs determined under division	520
(C) of this section.	521

(C) At least once every ten years, the department shall	522
determine the rate for tax costs for each nursing facility. The	523
rate for tax costs determined under this division for a nursing	524
facility shall be used for subsequent years until the department	525
redetermines it. To determine a nursing facility's rate for tax	526
costs and except as provided in division (D) of this section, the	527
department shall divide the nursing facility's desk-reviewed,	528
actual, allowable tax costs paid for the applicable calendar year	529
by the number of inpatient days the nursing facility would have	530
had if its occupancy rate had been one hundred per cent during the	531
applicable calendar year.	532

(D) If a nursing facility had a credit regarding its real	533
estate taxes reflected on its cost report for calendar year 2003,	534
the department shall determine its rate for tax costs for the	535
period beginning on July 1, 2010, and ending on the first day of	536
the fiscal year for which the department first redetermines all	537
nursing facilities' rate for tax costs under division (C) of this	538
section by dividing the nursing facility's desk-reviewed, actual,	539
allowable tax costs paid for calendar year 2004 by the number of	540
inpatient days the nursing facility would have had if its	541
occupancy rate had been one hundred per cent during calendar year	542
2004.	543

Section 2. That existing sections 3923.91 and 5111.242 of the	544
Revised Code are hereby repealed.	545

Section 3. That Section 309.30.25 of Am. Sub. H.B. 1 of the	546
128th General Assembly be amended to read as follows:	547

Sec. 309.30.25. FISCAL YEAR 2011 MEDICAID REIMBURSEMENT	548
SYSTEM FOR NURSING FACILITIES	549

(A) As used in this section:

550

"Fiscal year 2010 partial rate" means the total rate a	551
provider of a nursing facility is paid for nursing facility	552
services the nursing facility provides on June 30, 2010, less the	553
portion of that total rate that equals the sum of the workforce	554
development incentive payment and consolidated services rate	555
included in the total rate pursuant to divisions (D) and (E) of	556
Section 309.30.20 of this actAm. Sub. H.B. 1 of the 128th General	557
Assembly.	558

"Franchise permit fee," "inpatient days," "Medicaid days,"	559
"nursing facility," and "provider" have the same meanings as in	560
section 5111.20 of the Revised Code.	561

"Nursing facility services" means nursing facility services	562
covered by the Medicaid program that a nursing facility provides	563
to a resident of the nursing facility who is a Medicaid recipient	564
eligible for Medicaid-covered nursing facility services.	565

(B) Except as otherwise provided by this section, the	566
provider of a nursing facility that has a valid Medicaid provider	567
agreement on June 30, 2010, and a valid Medicaid provider	568
agreement during fiscal year 2011 shall be paid, for nursing	569
facility services the nursing facility provides during fiscal year	570
2011, the rate calculated for the nursing facility under sections	571
5111.20 to 5111.33 of the Revised Code with the following	572
adjustments:	573

(1) The cost per case mix-unit calculated under section	574
5111.231 of the Revised Code, the rate for ancillary and support	575
costs calculated under section 5111.24 of the Revised Code, the	576
rate for tax costs calculated under section 5111.242 of the	577
Revised Code, and the rate for capital costs calculated under	578
section 5111.25 of the Revised Code shall each be adjusted as	579
follows:	580

(a) Increase the cost and rates so calculated by two per	581
cent;	582

(b) Increase the cost and rates determined under division	583
(B)(1)(a) of this section by two per cent;	584

(c) Increase the cost and rates determined under division	585
(B)(1)(b) of this section by one per cent.	586

(2) The mean payment used in the calculation of the quality	587
incentive payment made under section 5111.244 of the Revised Code	588
shall be, weighted by Medicaid days, three dollars and three cents	589
per Medicaid day.	590

(3) The rate, after the adjustments under divisions (B)(1)	591
and (2) of this section are made, shall be further adjusted by a	592
percentage that the Department of Job and Family Services shall	593
determine in consultation with the Ohio Health Care Association;	594
Ohio Academy of Nursing Homes; and the Association of Ohio	595
Philanthropic Homes, Housing, and Services for the Aging. The	596
percentage shall be based on expending an amount equal to the	597
amount determined as follows:	598

(a) Determine how much of the revenue to be generated under	599
section 3721.51 of the Revised Code for fiscal year 2011 reflects	600
the calculations made under divisions (A)(1) to (4) of section	601
3721.50 of the Revised Code;	602

(b) From the amount determined under division (B)(3)(a) of	603
this section, subtract the portion of the amount to be expended	604
under division (E)(F) of this section that reflects the part of	605
the calculation made under division (E)(F)(2) of this section.	606

(C) Except as provided in division (F)(G) of this section, if	607
the rate determined for a nursing facility under division (B) of	608
this section for nursing facility services provided during fiscal	609
year 2011 is more than one hundred two and twenty-five hundredths	610
per cent of the nursing facility's fiscal year 2010 partial rate,	611
the Department of Job and Family Services shall reduce the nursing	612
facility's rate determined under division (B) of this section for	613
fiscal year 2011 so that the rate is not more than one hundred two	614
and twenty-five hundredths per cent of the nursing facility's	615
fiscal year 2010 partial rate. Except as provided in division	616
(F)(G) of this section, if the rate determined for a nursing	617
facility under division (B) of this section for nursing facility	618
services provided during fiscal year 2011 is less than ninety-nine	619
per cent of the nursing facility's fiscal year 2010 partial rate,	620
the Department shall increase the nursing facility's rate	621
determined under division (B) of this section for fiscal year 2011	622
so that the rate is not less than ninety-nine per cent of the	623
nursing facility's fiscal year 2010 partial rate.	624

(D) After the adjustments under divisions (B) and (C) of this	625
section are made to a nursing facility's fiscal year 2011 rate,	626
the Department of Job and Family Services shall increase the	627
nursing facility's fiscal year 2011 rate by the amount of real	628
estate taxes reported on the nursing facility's cost report for	629
calendar year 2004 divided by the number of inpatient days	630
reported on that cost report if the nursing facility had a credit	631
regarding its real estate taxes reflected on its cost report for	632
calendar year 2003.	633

(E) After the adjustments under divisions (B) and, (C), and	634
(D) of this section are made to a nursing facility's fiscal year	635
2011 rate, the Department of Job and Family Services shall	636
increase the nursing facility's fiscal year 2011 rate by five	637
dollars and seventy cents per Medicaid day. This increase shall be	638
known as the workforce development incentive payment. The total	639
amount of workforce development incentive payments paid to	640
providers of nursing facilities shall be used to improve nursing	641
facilities' employee retention and direct care staffing levels,	642
including by increasing wages paid to nursing facilities' direct	643
care staff. Not later than September 30, 2012, the Department	644
shall submit a report to the Governor and, in accordance with	645
section 101.68 of the Revised Code, the General Assembly detailing	646
the impact that the workforce development incentive payments have	647
on nursing facilities' employee retention, direct care staffing	648
levels, and direct care staff wages.	649

(E)(F) After the adjustment under division (D)(E) of this	650
section is made to a nursing facility's fiscal year 2011 rate, the	651
Department of Job and Family Services shall increase the nursing	652
facility's fiscal year 2011 rate by the consolidated services rate	653
per Medicaid day. The consolidated services rate shall equal the	654
sum of the following:	655

(1) Three dollars and ninety-one cents;

656

(2) The amount calculated under divisions (A)(1) to (4) of	657
section 3721.50 of the Revised Code for fiscal year 2011.	658

(F)(G) If the fiscal year 2010 rate for a nursing facility as	659
initially determined under division (B) of sectionSection	660
309.30.20 of this actAm. Sub. H.B. 1 of the 128th General	661
Assembly is not subject to an adjustment under division (C) of	662
that section, the nursing facility's fiscal year 2011 rate as	663
initially determined under division (B) of this section shall not	664
be subject to an adjustment under division (C) of this section	665
regardless of whether the nursing facility's fiscal year 2011 rate	666
as initially determined under division (B) of this section would,	667
if not for this division, be subject to the adjustment.	668

If the fiscal year 2011 rate for a nursing facility as	669
initially determined under division (B) of this section is not	670
subject to an adjustment under division (C) of this section, the	671
nursing facility's rate shall not be subject to an adjustment	672
under that division for the remainder of fiscal year 2011	673
regardless of any other adjustment made to the nursing facility's	674
fiscal year 2011 rate under sections 5111.20 to 5111.33 of the	675
Revised Code.	676

(G)(H) Not later than October 1, 2010, the Department of Job	677
and Family Services shall determine the rates to be paid providers	678
of nursing facilities under this section. Until the rates are	679
determined, the Department shall continue to pay a provider the	680
rate the provider is paid for nursing facility services the	681
provider's nursing facility provides on June 30, 2010. When the	682
Department determines the rates to be paid under this section, the	683
Department shall pay the rates retroactive to July 1, 2010.	684

(H)(I) If the United States Centers for Medicare and Medicaid	685
Services requires that the franchise permit fee be reduced or	686
eliminated, the Department of Job and Family Services shall reduce	687
the amount it pays providers of nursing facility services under	688
this section as necessary to reflect the loss to the state of the	689
revenue and federal financial participation generated from the	690
franchise permit fee.	691

(I)(J) The Department of Job and Family Services shall follow	692
this section in determining the rate to be paid to the provider of	693
a nursing facility that has a valid Medicaid provider agreement on	694
June 30, 2010, and a valid Medicaid provider agreement during	695
fiscal year 2011 notwithstanding anything to the contrary in	696
sections 5111.20 to 5111.33 of the Revised Code.	697

Section 4. That existing Section 309.30.25 of Am. Sub. H.B. 1	698
of the 128th General Assembly is hereby repealed.	699

Section 5. That Section 5 of Sub. H.B. 125 of the 127th	700
General Assembly, as amended by Sub. H.B. 493 of the 127th General	701
Assembly, be amended to read as follows:	702

Sec. 5. (A) As used in this section and Section 6 of Sub.	703
H.B. 125 of the 127th General Assembly:	704

(1) "Most favored nation clause" means a provision in a	705
health care contract that does any of the following:	706

(a) Prohibits, or grants a contracting entity an option to	707
prohibit, the participating provider from contracting with another	708
contracting entity to provide health care services at a lower	709
price than the payment specified in the contract;	710

(b) Requires, or grants a contracting entity an option to	711
require, the participating provider to accept a lower payment in	712
the event the participating provider agrees to provide health care	713
services to any other contracting entity at a lower price;	714

(c) Requires, or grants a contracting entity an option to	715
require, termination or renegotiation of the existing health care	716
contract in the event the participating provider agrees to provide	717
health care services to any other contracting entity at a lower	718
price;	719

(d) Requires the participating provider to disclose the	720
participating provider's contractual reimbursement rates with	721
other contracting entities.	722

(2) "Contracting entity," "health care contract," "health	723
care services," "participating provider," and "provider" have the	724
same meanings as in section 3963.01 of the Revised Code, as	725
enacted by Sub. H.B. 125 of the 127th General Assembly.	726

(B) With respect to a contracting entity and a provider other	727
than a hospital, no health care contract that includes a most	728
favored nation clause shall be entered into, and no health care	729
contract at the instance of a contracting entity shall be amended	730
or renewed to include a most favored nation clause, for a period	731
of three years after the effective date of Sub. H.B. 125 of the	732
127th General Assembly.	733

(C) With respect to a contracting entity and a hospital, no	734
health care contract that includes a most favored nation clause	735
shall be entered into, and no health care contract at the instance	736
of a contracting entity shall be amended or renewed to include a	737
most favored nation clause, for a period of twothree years after	738
the effective date of Sub. H.B. 125 of the 127th General Assembly,	739
subject to extension as provided in Section 6 of Sub. H.B. 125 of	740
the 127th General Assembly.	741

(D) This section does not apply to and does not prohibit the	742
continued use of a most favored nation clause in a health care	743
contract that is between a contracting entity and a hospital and	744
that is in existence on the effective date of Sub. H.B. 125 of the	745
127th General Assembly even if the health care contract is	746
materially amended with respect to any provision of the health	747
care contract other than the most favored nation clause during the	748
two-year period specified in this section or during any extended	749
period of time as provided in Section 6 of Sub. H.B. 125 of the	750
127th General Assembly.	751

Section 6. That existing Section 5 of Sub. H.B. 125 of the	752
127th General Assembly, as amended by Sub. H.B. 493 of the 127th	753
General Assembly, is hereby repealed.	754

Section 7. Sections 1 and 2 of this act, except for the	755
amendments to section 5111.242 of the Revised Code, shall take	756
effect on the ninetieth day after the effective date of this act.	757

Section 8. This act is hereby declared to be an emergency	758
measure necessary for the immediate preservation of the public	759
peace, health, and safety. The reason for such necessity is that	760
it establishes continuity for existing most favored nation clauses	761
in health care contracts and avoids the administrative expense of	762
recalculating a nursing facility's Medicaid reimbursement rate for	763
tax costs after fiscal year 2011 begins. Therefore, this act shall	764
go into immediate effect.	765