As Introduced

128th General Assembly Regular Session 2009-2010

H. B. No. 398

Representatives Newcomb, Lehner 

Cosponsors: Representatives Harwood, Derickson, Domenick, Grossman, Garland, Hagan, Evans, Snitchler, Phillips, Williams, B., Dyer, Fende, Wachtmann, Ruhl, Hackett, Letson, Stebelton, Harris, Bubp, Hottinger, Stautberg, Pillich, Murray, Driehaus, Brown, McClain, Weddington, Mallory, Goyal, Baker, Blessing, Dolan, Yuko, Okey, Foley 

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A BILL

To amend sections 173.401, 3702.51, 3702.59, 5111.65,

1

5111.651, 5111.68, 5111.681, 5111.685, 5111.686,

2

5111.688, and 5111.894; to amend, for the purpose

3

of adopting a new section number as indicated in

4

parentheses, section 5111.688 (5111.689); and to

5

enact new section 5111.688 of the Revised Code;

6

and to amend Section 209.20 of Am. Sub. H.B. 1 of

7

the 128th General Assembly to revise the waiting

8

list provisions of the PASSPORT and Assisted

9

Living programs, to revise the law governing the

10

collection of long-term care facilities' Medicaid

11

debts, and to revise the law governing the reasons

12

for denying a Certificate of Need application.

13

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

Section 1. That sections 173.401, 3702.51, 3702.59, 5111.65,	14
5111.651, 5111.68, 5111.681, 5111.685, 5111.686, 5111.688, and	15
5111.894 be amended; section 5111.688 (5111.689) be amended for	16
the purpose of adopting a new section number as indicated in	17
parentheses; and new section 5111.688 of the Revised Code be	18
enacted to read as follows:	19

Sec. 173.401.  (A) As used in this section:

20

"Area agency on aging" has the same meaning as in section	21
173.14 of the Revised Code.	22

"Long-term care consultation program" means the program the	23
department of aging is required to develop under section 173.42 of	24
the Revised Code.	25

"Long-term care consultation program administrator" or	26
"administrator" means the department of aging or, if the	27
department contracts with an area agency on aging or other entity	28
to administer the long-term care consultation program for a	29
particular area, that agency or entity.	30

"Nursing facility" has the same meaning as in section 5111.20	31
of the Revised Code.	32

"PASSPORT waiver" means the federal medicaid waiver granted	33
by the United States secretary of health and human services that	34
authorizes the PASSPORT program.	35

(B) The director of job and family services shall submit to	36
the United States secretary of health and human services an	37
amendment to the PASSPORT waiver that authorizes additional	38
enrollments in the PASSPORT program pursuant to this section.	39
Beginning with the month following the month in which the United	40
States secretary approves the amendment and eachThe department of	41
aging may establish one or more waiting lists for the PASSPORT	42
program. Only individuals eligible for the PASSPORT program may be	43
placed on a waiting list.	44

(C) The department shall establish a home first component of	45
the PASSPORT program under which eligible individuals may be	46
enrolled in the PASSPORT program in accordance with this section.	47
An individual is eligible for the PASSPORT program's home first	48
component if the individual is on a PASSPORT program waiting list	49
and at least one of the following applies:	50

(1) The individual has been admitted to a nursing facility;

51

(2) A physician has determined and documented in writing that	52
the individual has a medical condition that, unless enrolled in	53
home and community-based services such as the PASSPORT program,	54
will require the individual to be admitted to a nursing facility	55
within thirty days of the physician's determination;	56

(3) The individual has been hospitalized and a physician has	57
determined and documented in writing that, unless the individual	58
is enrolled in home and community-based services such as the	59
PASSPORT program, the individual is to be transported directly	60
from the hospital to a nursing facility and admitted;	61

(4) Both of the following apply:

62

(a) The individual is the subject of a report made under	63
section 5101.61 of the Revised Code regarding abuse, neglect, or	64
exploitation or such a report referred to a county department of	65
job and family services under section 5126.31 of the Revised Code	66
or has made a request to a county department for protective	67
services as defined in section 5101.60 of the Revised Code;	68

(b) A county department of job and family services and an	69
area agency on aging have jointly documented in writing that,	70
unless the individual is enrolled in home and community-based	71
services such as the PASSPORT program, the individual should be	72
admitted to a nursing facility.	73

(D) Each month thereafter, each area agency on aging shall	74
determine whetheridentify individuals who resideresiding in the	75
area that the area agency on aging serves andwho are on a waiting	76
listeligible for the home first component of the PASSPORT program	77
have been admitted to a nursing facility. IfWhen an area agency	78
on aging determines thatidentifies such an individual has been	79
admitted to a nursing facility, the agency shall notify the	80
long-term care consultation program administrator serving the area	81
in which the individual resides about the determination. The	82
administrator shall determine whether the PASSPORT program is	83
appropriate for the individual and whether the individual would	84
rather participate in the PASSPORT program than continue residing	85
or begin to reside in thea nursing facility. If the	86
administrator determines that the PASSPORT program is appropriate	87
for the individual and the individual would rather participate in	88
the PASSPORT program than continue residingor begin to reside in	89
thea nursing facility, the administrator shall so notify the	90
department of aging. On receipt of the notice from the	91
administrator, the department of aging shall approve the	92
individual's enrollment in the PASSPORT program regardless of the	93
PASSPORT program's waiting list and even though the enrollment	94
causes enrollment in the program to exceed the limit that would	95
otherwise apply, unless the enrollment would cause the PASSPORT	96
program to exceed any limit on the number of individuals who may	97
be enrolled in the program as set by the United States secretary	98
of health and human services in the PASSPORT waiver.	99

(E) Each quarter, the department of aging shall certify to	100
the director of budget and management the estimated increase in	101
costs of the PASSPORT program resulting from enrollment of	102
individuals in the PASSPORT program pursuant to this section.	103

Sec. 3702.51.  As used in sections 3702.51 to 3702.62 of the	104
Revised Code:	105

(A) "Applicant" means any person that submits an application	106
for a certificate of need and who is designated in the application	107
as the applicant.	108

(B) "Person" means any individual, corporation, business	109
trust, estate, firm, partnership, association, joint stock	110
company, insurance company, government unit, or other entity.	111

(C) "Certificate of need" means a written approval granted by	112
the director of health to an applicant to authorize conducting a	113
reviewable activity.	114

(D) "Health service area" means a geographic region	115
designated by the director of health under section 3702.58 of the	116
Revised Code.	117

(E) "Health service" means a clinically related service, such	118
as a diagnostic, treatment, rehabilitative, or preventive service.	119

(F) "Health service agency" means an agency designated to	120
serve a health service area in accordance with section 3702.58 of	121
the Revised Code.	122

(G) "Health care facility" means:

123

(1) A hospital registered under section 3701.07 of the	124
Revised Code;	125

(2) A nursing home licensed under section 3721.02 of the	126
Revised Code, or by a political subdivision certified under	127
section 3721.09 of the Revised Code;	128

(3) A county home or a county nursing home as defined in	129
section 5155.31 of the Revised Code that is certified under Title	130
XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 42	131
U.S.C.A. 301, as amended;	132

(4) A freestanding dialysis center;

133

(5) A freestanding inpatient rehabilitation facility;

134

(6) An ambulatory surgical facility;

135

(7) A freestanding cardiac catheterization facility;

136

(8) A freestanding birthing center;

137

(9) A freestanding or mobile diagnostic imaging center;

138

(10) A freestanding radiation therapy center.

139

A health care facility does not include the offices of	140
private physicians and dentists whether for individual or group	141
practice, residential facilities licensed under section 5123.19 of	142
the Revised Code, or an institution for the sick that is operated	143
exclusively for patients who use spiritual means for healing and	144
for whom the acceptance of medical care is inconsistent with their	145
religious beliefs, accredited by a national accrediting	146
organization, exempt from federal income taxation under section	147
501 of the Internal Revenue Code of 1986, 100 Stat. 2085, 26	148
U.S.C.A. 1, as amended, and providing twenty-four hour nursing	149
care pursuant to the exemption in division (E) of section 4723.32	150
of the Revised Code from the licensing requirements of Chapter	151
4723. of the Revised Code.	152

(H) "Medical equipment" means a single unit of medical	153
equipment or a single system of components with related functions	154
that is used to provide health services.	155

(I) "Third-party payer" means a health insuring corporation	156
licensed under Chapter 1751. of the Revised Code, a health	157
maintenance organization as defined in division (K) of this	158
section, an insurance company that issues sickness and accident	159
insurance in conformity with Chapter 3923. of the Revised Code, a	160
state-financed health insurance program under Chapter 3701.,	161
4123., or 5111. of the Revised Code, or any self-insurance plan.	162

(J) "Government unit" means the state and any county,	163
municipal corporation, township, or other political subdivision of	164
the state, or any department, division, board, or other agency of	165
the state or a political subdivision.	166

(K) "Health maintenance organization" means a public or	167
private organization organized under the law of any state that is	168
qualified under section 1310(d) of Title XIII of the "Public	169
Health Service Act," 87 Stat. 931 (1973), 42 U.S.C. 300e-9.	170

(L) "Existing health care facility" means either of the	171
following:	172

(1) A health care facility that is licensed or otherwise	173
authorized to operate in this state in accordance with applicable	174
law, including a county home or a county nursing home that is	175
certified as of February 1, 2008, under Title XVIII or Title XIX	176
of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301,	177
as amended, is staffed and equipped to provide health care	178
services, and is actively providing health services;	179

(2) A health care facility that is licensed or otherwise	180
authorized to operate in this state in accordance with applicable	181
law, including a county home or a county nursing home that is	182
certified as of February 1, 2008, under Title XVIII or Title XIX	183
of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301,	184
as amended, or that has beds registered under section 3701.07 of	185
the Revised Code as skilled nursing beds or long-term care beds	186
and has provided services for at least three hundred sixty-five	187
consecutive days within the twenty-four months immediately	188
preceding the date a certificate of need application is filed with	189
the director of health.	190

(M) "State" means the state of Ohio, including, but not	191
limited to, the general assembly, the supreme court, the offices	192
of all elected state officers, and all departments, boards,	193
offices, commissions, agencies, institutions, and other	194
instrumentalities of the state of Ohio. "State" does not include	195
political subdivisions.	196

(N) "Political subdivision" means a municipal corporation,	197
township, county, school district, and all other bodies corporate	198
and politic responsible for governmental activities only in	199
geographic areas smaller than that of the state to which the	200
sovereign immunity of the state attaches.	201

(O) "Affected person" means:

202

(1) An applicant for a certificate of need, including an	203
applicant whose application was reviewed comparatively with the	204
application in question;	205

(2) The person that requested the reviewability ruling in	206
question;	207

(3) Any person that resides or regularly uses health care	208
facilities within the geographic area served or to be served by	209
the health care services that would be provided under the	210
certificate of need or reviewability ruling in question;	211

(4) Any health care facility that is located in the health	212
service area where the health care services would be provided	213
under the certificate of need or reviewability ruling in question;	214

(5) Third-party payers that reimburse health care facilities	215
for services in the health service area where the health care	216
services would be provided under the certificate of need or	217
reviewability ruling in question;	218

(6) Any other person who testified at a public hearing held	219
under division (B) of section 3702.52 of the Revised Code or	220
submitted written comments in the course of review of the	221
certificate of need application in question.	222

(P) "Osteopathic hospital" means a hospital registered under	223
section 3701.07 of the Revised Code that advocates osteopathic	224
principles and the practice and perpetuation of osteopathic	225
medicine by doing any of the following:	226

(1) Maintaining a department or service of osteopathic	227
medicine or a committee on the utilization of osteopathic	228
principles and methods, under the supervision of an osteopathic	229
physician;	230

(2) Maintaining an active medical staff, the majority of	231
which is comprised of osteopathic physicians;	232

(3) Maintaining a medical staff executive committee that has	233
osteopathic physicians as a majority of its members.	234

(Q) "Ambulatory surgical facility" has the same meaning as in	235
section 3702.30 of the Revised Code.	236

(R) Except as provided in division (S) of this section,	237
"reviewable activity" means any of the following activities:	238

(1) The establishment, development, or construction of a new	239
long-term care facility;	240

(2) The replacement of an existing long-term care facility;

241

(3) The renovation of a long-term care facility that involves	242
a capital expenditure of two million dollars or more, not	243
including expenditures for equipment, staffing, or operational	244
costs;	245

(4) Either of the following changes in long-term care bed	246
capacity:	247

(a) An increase in bed capacity;

248

(b) A relocation of beds from one physical facility or site	249
to another, excluding the relocation of beds within a long-term	250
care facility or among buildings of a long-term care facility at	251
the same site.	252

(5) Any change in the health services, bed capacity, or site,	253
or any other failure to conduct the reviewable activity in	254
substantial accordance with the approved application for which a	255
certificate of need concerning long-term care beds was granted, if	256
the change is made within five years after the implementation of	257
the reviewable activity for which the certificate was granted;	258

(6) The expenditure of more than one hundred ten per cent of	259
the maximum expenditure specified in a certificate of need	260
concerning long-term care beds.	261

(S) "Reviewable activity" does not include any of the	262
following activities:	263

(1) Acquisition of computer hardware or software;

264

(2) Acquisition of a telephone system;

265

(3) Construction or acquisition of parking facilities;

266

(4) Correction of cited deficiencies that are in violation of	267
federal, state, or local fire, building, or safety laws and rules	268
and that constitute an imminent threat to public health or safety;	269

(5) Acquisition of an existing health care facility that does	270
not involve a change in the number of the beds, by service, or in	271
the number or type of health services;	272

(6) Correction of cited deficiencies identified by	273
accreditation surveys of the joint commission on accreditation of	274
healthcare organizations or of the American osteopathic	275
association;	276

(7) Acquisition of medical equipment to replace the same or	277
similar equipment for which a certificate of need has been issued	278
if the replaced equipment is removed from service;	279

(8) Mergers, consolidations, or other corporate	280
reorganizations of health care facilities that do not involve a	281
change in the number of beds, by service, or in the number or type	282
of health services;	283

(9) Construction, repair, or renovation of bathroom	284
facilities;	285

(10) Construction of laundry facilities, waste disposal	286
facilities, dietary department projects, heating and air	287
conditioning projects, administrative offices, and portions of	288
medical office buildings used exclusively for physician services;	289

(11) Acquisition of medical equipment to conduct research	290
required by the United States food and drug administration or	291
clinical trials sponsored by the national institute of health. Use	292
of medical equipment that was acquired without a certificate of	293
need under division (S)(11) of this section and for which	294
premarket approval has been granted by the United States food and	295
drug administration to provide services for which patients or	296
reimbursement entities will be charged shall be a reviewable	297
activity.	298

(12) Removal of asbestos from a health care facility.

299

Only that portion of a project that meets the requirements of	300
this division is not a reviewable activity.	301

(T) "Small rural hospital" means a hospital that is located	302
within a rural area, has fewer than one hundred beds, and to which	303
fewer than four thousand persons were admitted during the most	304
recent calendar year.	305

(U) "Children's hospital" means any of the following:

306

(1) A hospital registered under section 3701.07 of the	307
Revised Code that provides general pediatric medical and surgical	308
care, and in which at least seventy-five per cent of annual	309
inpatient discharges for the preceding two calendar years were	310
individuals less than eighteen years of age;	311

(2) A distinct portion of a hospital registered under section	312
3701.07 of the Revised Code that provides general pediatric	313
medical and surgical care, has a total of at least one hundred	314
fifty registered pediatric special care and pediatric acute care	315
beds, and in which at least seventy-five per cent of annual	316
inpatient discharges for the preceding two calendar years were	317
individuals less than eighteen years of age;	318

(3) A distinct portion of a hospital, if the hospital is	319
registered under section 3701.07 of the Revised Code as a	320
children's hospital and the children's hospital meets all the	321
requirements of division (U)(1) of this section.	322

(V) "Long-term care facility" means any of the following:

323

(1) A nursing home licensed under section 3721.02 of the	324
Revised Code or by a political subdivision certified under section	325
3721.09 of the Revised Code;	326

(2) The portion of any facility, including a county home or	327
county nursing home, that is certified as a skilled nursing	328
facility or a nursing facility under Title XVIII or XIX of the	329
"Social Security Act";	330

(3) The portion of any hospital that contains beds registered	331
under section 3701.07 of the Revised Code as skilled nursing beds	332
or long-term care beds.	333

(W) "Long-term care bed" means a bed in a long-term care	334
facility.	335

(X) "Freestanding birthing center" means any facility in	336
which deliveries routinely occur, regardless of whether the	337
facility is located on the campus of another health care facility,	338
and which is not licensed under Chapter 3711. of the Revised Code	339
as a level one, two, or three maternity unit or a limited	340
maternity unit.	341

(Y)(1) "Reviewability ruling" means a ruling issued by the	342
director of health under division (A) of section 3702.52 of the	343
Revised Code as to whether a particular proposed project is or is	344
not a reviewable activity.	345

(2) "Nonreviewability ruling" means a ruling issued under	346
that division that a particular proposed project is not a	347
reviewable activity.	348

(Z)(1) "Metropolitan statistical area" means an area of this	349
state designated a metropolitan statistical area or primary	350
metropolitan statistical area in United States office of	351
management and budget bulletin no. 93-17, June 30, 1993, and its	352
attachments.	353

(2) "Rural area" means any area of this state not located	354
within a metropolitan statistical area.	355

(AA) "County nursing home" has the same meaning as in section	356
5155.31 of the Revised Code.	357

(BB) "Principal participant" means both of the following:

358

(1) A person who has an ownership or controlling interest of	359
at least five per cent in an applicant, in a health care facility	360
that is the subject of an application for a certificate of need,	361
or in the owner or operator of the applicant or such a facility;	362

(2) An officer, director, trustee, or general partner of an	363
applicant, of a health care facility that is the subject of an	364
application for a certificate of need, or of the owner or operator	365
of the applicant or such a facility.	366

(CC) "Actual harm but not immediate jeopardy deficiency"	367
means a deficiency that, under 42 C.F.R. 488.404, either	368
constitutes a pattern of deficiencies resulting in actual harm	369
that is not immediate jeopardy or represents widespread	370
deficiencies resulting in actual harm that is not immediate	371
jeopardy.	372

(DD) "Immediate jeopardy deficiency" means a deficiency that,	373
under 42 C.F.R. 488.404, either constitutes a pattern of	374
deficiencies resulting in immediate jeopardy to resident health or	375
safety or represents widespread deficiencies resulting in	376
immediate jeopardy to resident health or safety.	377

Sec. 3702.59.  (A) The director of health shall accept for	378
review certificate of need applications as provided in sections	379
3702.592, 3702.593, and 3702.594 of the Revised Code.	380

(B)(1) The director shall not approve an application for a	381
certificate of need for the addition of long-term care beds to an	382
existing health care facility or for the development of a new	383
health care facility if any of the following apply:	384

(1)(a) The existing health care facility in which the beds	385
are being placed has one or more waivers for life safety code	386
deficiencies, one or more state fire code violations, or one or	387
more state building code violations, and the project identified in	388
the application does not propose to correct all life safety code	389
deficiencies for which a waiver has been granted, all state fire	390
code violations, and all state building code violations at the	391
existing health care facility in which the beds are being placed;	392

(2)(b) During the sixty-month period preceding the filing of	393
the application, a notice of proposed license revocation was	394
issued under section 3721.03 of the Revised Code for the existing	395
health care facility in which the beds are being placed or a	396
nursing home owned or operated by the applicant or the corporation	397
or other business that operates or seeks to operate the health	398
care facility in which the beds are being placeda principal	399
participant.	400

(3)(c) During the period that precedes the filing of the	401
application and is encompassed by the three most recent standard	402
surveys of the existing health care facility in which the beds are	403
being placed, theany of the following occurred:	404

(i) The facility was cited on three or more separate	405
occasions for final, nonappealable actual harm but not immediate	406
jeopardy deficiencies that, under 42 C.F.R. 488.404, either	407
constitute a pattern of deficiencies resulting in actual harm that	408
is not immediate jeopardy or are widespread deficiencies resulting	409
in actual harm that is not immediate jeopardy.	410

(4) During the period that precedes the filing of the	411
application and is encompassed by the three most recent standard	412
surveys of the existing health care facility in which the beds are	413
being placed, the(ii) The facility was cited on two or more	414
separate occasions for final, nonappealable immediate jeopardy	415
deficiencies that, under 42 C.F.R. 488.404, either constitute a	416
pattern of deficiencies resulting in immediate jeopardy to	417
resident health or safety or are widespread deficiencies resulting	418
in immediate jeopardy to resident health or safety.	419

(5) During the period that precedes the filing of the	420
application and is encompassed by the three most recent standard	421
surveys of the existing health care facility in which the beds are	422
being placed, more(iii) The facility was cited on two separate	423
occasions for final, nonappealable actual harm but not immediate	424
jeopardy deficiencies and on one occasion for a final,	425
nonappealable immediate jeopardy deficiency.	426

(d) More than two nursing homes owned or operated in this	427
state by the applicant or the person who operates the facility in	428
which the beds are being placeda principal participant or, if the	429
applicant or persona principal participant owns or operates more	430
than twenty nursing homes in this state, more than ten per cent of	431
those nursing homes, were each cited onduring the period that	432
precedes the filing of the application for the certificate of need	433
and is encompassed by the three most recent standard surveys of	434
the nursing homes that were so cited in any of the following	435
manners:	436

(i) On three or more separate occasions for final,	437
nonappealable actual harm but not immediate jeopardy deficiencies	438
that, under 42 C.F.R. 488.404, either constitute a pattern of	439
deficiencies resulting in actual harm that is not immediate	440
jeopardy or are widespread deficiencies resulting in actual harm	441
that is not immediate jeopardy.	442

(6) During the period that precedes the filing of the	443
application and is encompassed by the three most recent standard	444
surveys of the existing health care facility in which the beds are	445
being placed, more than two nursing homes operated in this state	446
by the applicant or the person who operates the facility in which	447
the beds are being placed or, if the applicant or person operates	448
more than twenty nursing homes in this state, more than ten per	449
cent of those nursing homes, were each cited on;	450

(ii) On two or more separate occasions for final,	451
nonappealable immediate jeopardy deficiencies that, under 42	452
C.F.R. 488.404, either constitute a pattern of deficiencies	453
resulting in immediate jeopardy to resident health or safety or	454
are widespread deficiencies resulting in immediate jeopardy to	455
resident health or safety;	456

(iii) On two separate occasions for final, nonappealable	457
actual harm but not immediate jeopardy deficiencies and on one	458
occasion for a final, nonappealable immediate jeopardy deficiency.	459

(7) During the sixty-month period preceding the filing of the	460
application, the applicant has violated this chapter on two or	461
more separate occasions.	462

(2) In applying divisions (B)(1)(a) to (6)(d) of this	463
section, the director shall not consider deficiencies or	464
violations cited before the current operatorapplicant or a	465
principal participant acquired or began to own or operate the	466
health care facility at which the deficiencies or violations were	467
cited. The director may disregard deficiencies and violations	468
cited after the health care facility was acquired or began to be	469
operated by the current operatorapplicant or a principal	470
participant if the deficiencies or violations were attributable to	471
circumstances that arose under the previous owner or operator and	472
the current operatorapplicant or principal participant has	473
implemented measures to alleviate the circumstances. In the case	474
of an application proposing development of a new health care	475
facility by relocation of beds, the director shall not consider	476
deficiencies or violations that were solely attributable to the	477
physical plant of the existing health care facility from which the	478
beds are being relocated.	479

(C) The director also shall accept for review any application	480
for the conversion of infirmary beds to long-term care beds if the	481
infirmary meets all of the following conditions:	482

(1) Is operated exclusively by a religious order;

483

(2) Provides care exclusively to members of religious orders	484
who take vows of celibacy and live by virtue of their vows within	485
the orders as if related;	486

(3) Was providing care exclusively to members of such a	487
religious order on January 1, 1994.	488

At no time shall individuals other than those described in	489
division (C)(2) of this section be admitted to a facility to use	490
beds for which a certificate of need is approved under this	491
division.	492

Sec. 5111.65.  As used in sections 5111.65 to 5111.688	493
5111.689 of the Revised Code:	494

(A) "Affiliated operator" means an operator affiliated with	495
either of the following:	496

(1) The exiting operator for whom the affiliated operator is	497
to assume liability for the entire amount of the exiting	498
operator's debt under the medicaid program or the portion of the	499
debt that represents the franchise permit fee the exiting operator	500
owes;	501

(2) The entering operator involved in the change of operator	502
with the exiting operator specified in division (A)(1) of this	503
section.	504

(B) "Change of operator" means an entering operator becoming	505
the operator of a nursing facility or intermediate care facility	506
for the mentally retarded in the place of the exiting operator.	507

(1) Actions that constitute a change of operator include the	508
following:	509

(a) A change in an exiting operator's form of legal	510
organization, including the formation of a partnership or	511
corporation from a sole proprietorship;	512

(b) A transfer of all the exiting operator's ownership	513
interest in the operation of the facility to the entering	514
operator, regardless of whether ownership of any or all of the	515
real property or personal property associated with the facility is	516
also transferred;	517

(c) A lease of the facility to the entering operator or the	518
exiting operator's termination of the exiting operator's lease;	519

(d) If the exiting operator is a partnership, dissolution of	520
the partnership;	521

(e) If the exiting operator is a partnership, a change in	522
composition of the partnership unless both of the following apply:	523

(i) The change in composition does not cause the	524
partnership's dissolution under state law.	525

(ii) The partners agree that the change in composition does	526
not constitute a change in operator.	527

(f) If the operator is a corporation, dissolution of the	528
corporation, a merger of the corporation into another corporation	529
that is the survivor of the merger, or a consolidation of one or	530
more other corporations to form a new corporation.	531

(2) The following, alone, do not constitute a change of	532
operator:	533

(a) A contract for an entity to manage a nursing facility or	534
intermediate care facility for the mentally retarded as the	535
operator's agent, subject to the operator's approval of daily	536
operating and management decisions;	537

(b) A change of ownership, lease, or termination of a lease	538
of real property or personal property associated with a nursing	539
facility or intermediate care facility for the mentally retarded	540
if an entering operator does not become the operator in place of	541
an exiting operator;	542

(c) If the operator is a corporation, a change of one or more	543
members of the corporation's governing body or transfer of	544
ownership of one or more shares of the corporation's stock, if the	545
same corporation continues to be the operator.	546

(B)(C) "Effective date of a change of operator" means the day	547
the entering operator becomes the operator of the nursing facility	548
or intermediate care facility for the mentally retarded.	549

(C)(D) "Effective date of a facility closure" means the last	550
day that the last of the residents of the nursing facility or	551
intermediate care facility for the mentally retarded resides in	552
the facility.	553

(D)(E) "Effective date of a voluntary termination" means the	554
day the intermediate care facility for the mentally retarded	555
ceases to accept medicaid patients.	556

(E)(F) "Effective date of a voluntary withdrawal of	557
participation" means the day the nursing facility ceases to accept	558
new medicaid patients other than the individuals who reside in the	559
nursing facility on the day before the effective date of the	560
voluntary withdrawal of participation.	561

(F)(G) "Entering operator" means the person or government	562
entity that will become the operator of a nursing facility or	563
intermediate care facility for the mentally retarded when a change	564
of operator occurs.	565

(G)(H) "Exiting operator" means any of the following:

566

(1) An operator that will cease to be the operator of a	567
nursing facility or intermediate care facility for the mentally	568
retarded on the effective date of a change of operator;	569

(2) An operator that will cease to be the operator of a	570
nursing facility or intermediate care facility for the mentally	571
retarded on the effective date of a facility closure;	572

(3) An operator of an intermediate care facility for the	573
mentally retarded that is undergoing or has undergone a voluntary	574
termination;	575

(4) An operator of a nursing facility that is undergoing or	576
has undergone a voluntary withdrawal of participation.	577

(H)(I)(1) "Facility closure" means discontinuance of the use	578
of the building, or part of the building, that houses the facility	579
as a nursing facility or intermediate care facility for the	580
mentally retarded that results in the relocation of all of the	581
facility's residents. A facility closure occurs regardless of any	582
of the following:	583

(a) The operator completely or partially replacing the	584
facility by constructing a new facility or transferring the	585
facility's license to another facility;	586

(b) The facility's residents relocating to another of the	587
operator's facilities;	588

(c) Any action the department of health takes regarding the	589
facility's certification under Title XIX of the "Social Security	590
Act," 79 Stat. 286 (1965), 42 U.S.C. 1396, as amended, that may	591
result in the transfer of part of the facility's survey findings	592
to another of the operator's facilities;	593

(d) Any action the department of health takes regarding the	594
facility's license under Chapter 3721. of the Revised Code;	595

(e) Any action the department of mental retardation and	596
developmental disabilities takes regarding the facility's license	597
under section 5123.19 of the Revised Code.	598

(2) A facility closure does not occur if all of the	599
facility's residents are relocated due to an emergency evacuation	600
and one or more of the residents return to a medicaid-certified	601
bed in the facility not later than thirty days after the	602
evacuation occurs.	603

(I)(J) "Fiscal year," "franchise permit fee," "intermediate	604
care facility for the mentally retarded," "nursing facility,"	605
"operator," "owner," and "provider agreement" have the same	606
meanings as in section 5111.20 of the Revised Code.	607

(J)(K) "Voluntary termination" means an operator's voluntary	608
election to terminate the participation of an intermediate care	609
facility for the mentally retarded in the medicaid program but to	610
continue to provide service of the type provided by a residential	611
facility as defined in section 5123.19 of the Revised Code.	612

(K)(L) "Voluntary withdrawal of participation" means an	613
operator's voluntary election to terminate the participation of a	614
nursing facility in the medicaid program but to continue to	615
provide service of the type provided by a nursing facility.	616

Sec. 5111.651. Sections 5111.65 to 5111.6885111.689 of the	617
Revised Code do not apply to a nursing facility or intermediate	618
care facility for the mentally retarded that undergoes a facility	619
closure, voluntary termination, voluntary withdrawal of	620
participation, or change of operator on or before September 30,	621
2005, if the exiting operator provided written notice of the	622
facility closure, voluntary termination, voluntary withdrawal of	623
participation, or change of operator to the department of job and	624
family services on or before June 30, 2005.	625

Sec. 5111.68. (A) On receipt of a written notice under	626
section 5111.66 of the Revised Code of a facility closure,	627
voluntary termination, or voluntary withdrawal of participation or	628
a written notice under section 5111.67 of the Revised Code of a	629
change of operator, the department of job and family services	630
shall determineestimate the amount of any overpayments made under	631
the medicaid program to the exiting operator, including	632
overpayments the exiting operator disputes, and other actual and	633
potential debts the exiting operator owes or may owe to the	634
department and United States centers for medicare and medicaid	635
services under the medicaid program, including a franchise permit	636
fee. In determining	637

(B) In estimating the exiting operator's other actual and	638
potential debts to the department and the United States centers	639
for medicare and medicaid services under the medicaid program, the	640
department shall includeuse a debt estimation methodology the	641
director of job and family services shall establish in rules	642
adopted under section 5111.689 of the Revised Code. The	643
methodology shall provide for estimating all of the following that	644
the department determines isare applicable:	645

(1) Refunds due the department under section 5111.27 of the	646
Revised Code;	647

(2) Interest owed to the department and United States centers	648
for medicare and medicaid services;	649

(3) Final civil monetary and other penalties for which all	650
right of appeal has been exhausted;	651

(4) Money owed the department and United States centers for	652
medicare and medicaid services from any outstanding final fiscal	653
audit, including a final fiscal audit for the last fiscal year or	654
portion thereof in which the exiting operator participated in the	655
medicaid program;	656

(5) Other amounts the department determines are applicable.

657

(B) If the department is unable to determine the amount of	658
the overpayments and other debts for any period before the	659
effective date of the entering operator's provider agreement or	660
the effective date of the facility closure, voluntary termination,	661
or voluntary withdrawal of participation, the department shall	662
make a reasonable estimate of the overpayments and other debts for	663
the period. The department shall make the estimate using	664
information available to the department, including prior	665
determinations of overpayments and other debts.	666

(C) The department shall provide the exiting operator written	667
notice of the department's estimate under division (A) of this	668
section not later than thirty days after the department receives	669
the notice under section 5111.66 of the Revised Code of the	670
facility closure, voluntary termination, or voluntary withdrawal	671
of participation or the notice under section 5111.67 of the	672
Revised Code of the change of operator. The department's written	673
notice shall include the basis for the estimate.	674

Sec. 5111.681. (A) Except as provided in divisiondivisions	675
(B) and (C) of this section, the department of job and family	676
services shallmay withhold the greater of the following from	677
payment due an exiting operator under the medicaid program:	678

(1) Thethe total amount of any overpayments made under the	679
medicaid program to the exiting operator, including overpayments	680
the exiting operator disputes, and other actual and potential	681
debts, including any unpaid penalties,specified in the notice	682
provided under division (C) of section 5111.68 of the Revised Code	683
that the exiting operator owes or may owe to the department and	684
United States centers for medicare and medicaid services under the	685
medicaid program;	686

(2) An amount equal to the average amount of monthly payments	687
to the exiting operator under the medicaid program for the	688
twelve-month period immediately preceding the month that includes	689
the last day the exiting operator's provider agreement is in	690
effect or, in the case of a voluntary withdrawal of participation,	691
the effective date of the voluntary withdrawal of participation.	692

(B) TheIn the case of a change of operator and subject to	693
division (D) of this section, the following shall apply regarding	694
a withholding under division (A) of this section if the exiting	695
operator or entering operator or an affiliated operator executes a	696
successor liability agreement meeting the requirements of division	697
(E) of this section:	698

(1) If the exiting operator, entering operator, or affiliated	699
operator assumes liability for the total, actual amount of debt	700
the exiting operator owes the department and the United States	701
centers for medicare and medicaid services under the medicaid	702
program as determined under section 5111.685 of the Revised Code,	703
the department may chooseshall not to make the withholding under	704
division (A) of this section if an entering operator does both of	705
the following:	706

(1) Enters into a nontransferable, unconditional, written	707
agreement with the department to pay the department any debt the	708
exiting operator owes the department under the medicaid program;	709

(2) Provides the department a copy of the entering operator's	710
balance sheet that assists the department in determining whether	711
to make the withholding under division (A) of this section.	712

(2) If the exiting operator, entering operator, or affiliated	713
operator assumes liability for only the portion of the amount	714
specified in division (B)(1) of this section that represents the	715
franchise permit fee the exiting operator owes, the department	716
shall withhold not more than the difference between the total	717
amount specified in the notice provided under division (C) of	718
section 5111.68 of the Revised Code and the amount for which the	719
entering operator or affiliated operator assumes liability.	720

(C) In the case of a voluntary termination, voluntary	721
withdrawal of participation, or facility closure and subject to	722
division (D) of this section, the following shall apply regarding	723
a withholding under division (A) of this section if the exiting	724
operator or an affiliated operator executes a successor liability	725
agreement meeting the requirements of division (E) of this	726
section:	727

(1) If the exiting operator or affiliated operator assumes	728
liability for the total, actual amount of debt the exiting	729
operator owes the department and the United States centers for	730
medicare and medicaid services under the medicaid program as	731
determined under section 5111.685 of the Revised Code, the	732
department shall not make the withholding.	733

(2) If the exiting operator or affiliated operator assumes	734
liability for only the portion of the amount specified in division	735
(C)(1) of this section that represents the franchise permit fee	736
the exiting operator owes, the department shall withhold not more	737
than the difference between the total amount specified in the	738
notice provided under division (C) of section 5111.68 of the	739
Revised Code and the amount for which the exiting operator or	740
affiliated operator assumes liability.	741

(D) For an exiting operator or affiliated operator to be	742
eligible to enter into a successor liability agreement under	743
division (B) or (C) of this section, both of the following must	744
apply:	745

(1) The exiting operator or affiliated operator must have one	746
or more valid provider agreements, other than the provider	747
agreement for the nursing facility or intermediate care facility	748
for the mentally retarded that is the subject of the voluntary	749
termination, voluntary withdrawal of participation, facility	750
closure, or change of operator;	751

(2) During the twelve-month period preceding the month in	752
which the department receives the notice of the voluntary	753
termination, voluntary withdrawal of participation, or facility	754
closure under section 5111.66 of the Revised Code or the notice of	755
the change of operator under section 5111.67 of the Revised Code,	756
the average monthly medicaid payment made to the exiting operator	757
or affiliated operator pursuant to the exiting operator's or	758
affiliated operator's one or more provider agreements, other than	759
the provider agreement for the nursing facility or intermediate	760
care facility for the mentally retarded that is the subject of the	761
voluntary termination, voluntary withdrawal of participation,	762
facility closure, or change of operator, must equal at least	763
ninety per cent of the sum of the following:	764

(a) The average monthly medicaid payment made to the exiting	765
operator pursuant to the exiting operator's provider agreement for	766
the nursing facility or intermediate care facility for the	767
mentally retarded that is the subject of the voluntary	768
termination, voluntary withdrawal of participation, facility	769
closure, or change of operator;	770

(b) Whichever of the following apply:

771

(i) If the exiting operator or affiliated operator has	772
assumed liability under one or more other successor liability	773
agreements, the total amount for which the exiting operator or	774
affiliated operator has assumed liability under the other	775
successor liability agreements;	776

(ii) If the exiting operator or affiliated operator has not	777
assumed liability under any other successor liability agreements,	778
zero.	779

(E) A successor liability agreement executed under this	780
section must comply with all of the following:	781

(1) It must provide for the operator who executes the	782
successor liability agreement to assume liability for either of	783
the following as specified in the agreement:	784

(a) The total, actual amount of debt the exiting operator	785
owes the department and the United States centers for medicare and	786
medicaid services under the medicaid program as determined under	787
section 5111.685 of the Revised Code;	788

(b) The portion of the amount specified in division (E)(1)(a)	789
of this section that represents the franchise permit fee the	790
exiting operator owes.	791

(2) It may not require the operator who executes the	792
successor liability agreement to furnish a surety bond.	793

(3) It must provide that the department, after determining	794
under section 5111.685 of the Revised Code the actual amount of	795
debt the exiting operator owes the department and United States	796
centers for medicare and medicaid services under the medicaid	797
program, may deduct the lesser of the following from medicaid	798
payments made to the operator who executes the successor liability	799
agreement:	800

(a) The total, actual amount of debt the exiting operator	801
owes the department and the United States centers for medicare and	802
medicaid services under the medicaid program as determined under	803
section 5111.685 of the Revised Code;	804

(b) The amount for which the operator who executes the	805
successor liability agreement assumes liability under the	806
agreement.	807

(4) It must provide that the deductions authorized by	808
division (E)(3) of this section are to be made for a number of	809
months, not to exceed six, agreed to by the operator who executes	810
the successor liability agreement and the department or, if the	811
operator who executes the successor liability agreement and	812
department cannot agree on a number of months that is less than	813
six, a greater number of months determined by the attorney general	814
pursuant to a claims collection process authorized by statute of	815
this state.	816

(5) It must provide that, if the attorney general determines	817
the number of months for which the deductions authorized by	818
division (E)(3) of this section are to be made, the operator who	819
executes the successor liability agreement shall pay, in addition	820
to the amount collected pursuant to the attorney general's claims	821
collection process, the part of the amount so collected that, if	822
not for division (G) of this section, would be required by section	823
109.081 of the Revised Code to be paid into the attorney general	824
claims fund.	825

(F) Execution of a successor liability agreement does not	826
waive an exiting operator's right to contest the amount specified	827
in the notice the department provides the exiting operator under	828
division (C) of section 5111.68 of the Revised Code.	829

(G) Notwithstanding section 109.081 of the Revised Code, the	830
entire amount that the attorney general, whether by employees or	831
agents of the attorney general or by special counsel appointed	832
pursuant to section 109.08 of the Revised Code, collects under a	833
successor liability agreement, other than the additional amount	834
the operator who executes the agreement is required by division	835
(E)(5) of this section to pay, shall be paid to the department of	836
job and family services for deposit into the appropriate fund. The	837
additional amount that the operator is required to pay shall be	838
paid into the state treasury to the credit of the attorney general	839
claims fund created under section 109.081 of the Revised Code.	840

Sec. 5111.685. The department of job and family services	841
shall determine the actual amount of debt an exiting operator owes	842
the department and the United States centers for medicare and	843
medicaid services under the medicaid program by completing all	844
final fiscal audits not already completed and performing all other	845
appropriate actions the department determines to be necessary. The	846
department shall issue aan initial debt summary report on this	847
matter not later than ninetysixty days after the date the exiting	848
operator files the properly completed cost report required by	849
section 5111.682 of the Revised Code with the department or, if	850
the department waives the cost report requirement for the exiting	851
operator, ninetysixty days after the date the department waives	852
the cost report requirement. The report shall include the	853
department's findings and the amount of debt the department	854
determines the exiting operator owes the department and United	855
States centers for medicare and medicaid services under the	856
medicaid program. Only the parts of the report that are subject to	857
an adjudication as specified in section 5111.30 of the Revised	858
Code are subject to an adjudication conductedThe initial debt	859
summary report becomes the final debt summary report thirty-one	860
days after the department issues the initial debt summary report	861
unless the exiting operator, or an affiliated operator who	862
executes a successor liability agreement under section 5111.681 of	863
the Revised Code, requests a review before that date.	864

The exiting operator, and an affiliated operator who executes	865
a successor liability agreement under section 5111.681 of the	866
Revised Code, may request a review to contest any of the	867
department's findings included in the initial debt summary report.	868
The request for the review must be submitted to the department not	869
later than thirty days after the date the department issues the	870
initial debt summary report. The department shall conduct the	871
review on receipt of a timely request and issue a revised debt	872
summary report. If the department has withheld money from payment	873
due the exiting operator under division (A) of section 5111.681 of	874
the Revised Code, the department shall issue the revised debt	875
summary report not later than ninety days after the date the	876
department receives the timely request for the review unless the	877
department and exiting operator or affiliated operator agree to a	878
later date. The exiting operator or affiliated operator may submit	879
information to the department explaining what the operator	880
contests before and during the review, including documentation of	881
the amount of any debt the department owes the operator. The	882
exiting operator or affiliated operator may submit additional	883
information to the department not later than thirty days after the	884
department issues the revised debt summary report. The revised	885
debt summary report becomes the final debt summary report	886
thirty-one days after the department issues the revised debt	887
summary report unless the exiting operator or affiliated operator	888
timely submits additional information to the department. If the	889
exiting operator or affiliated operator timely submits additional	890
information to the department, the department shall consider the	891
additional information and issue a final debt summary report not	892
later than sixty days after the department issues the revised debt	893
summary report unless the department and exiting operator or	894
affiliated operator agree to a later date.	895

Each debt summary report the department issues under this	896
section shall include the department's findings and the amount of	897
debt the department determines the exiting operator owes the	898
department and United States centers for medicare and medicaid	899
services under the medicaid program. The department shall explain	900
its findings and determination in each debt summary report.	901

The exiting operator, and an affiliated operator who executes	902
a successor liability agreement under section 5111.681 of the	903
Revised Code, may request, in accordance with Chapter 119. of the	904
Revised Code, an adjudication regarding a finding in a final debt	905
summary report that pertains to an audit or alleged overpayment	906
made under the medicaid program to the exiting operator. The	907
adjudication shall be consolidated with any other uncompleted	908
adjudication that concerns a matter addressed in the final debt	909
summary report.	910

Sec. 5111.686. The department of job and family services	911
shall release the actual amount withheld under division (A) of	912
section 5111.681 of the Revised Code, less any amount the exiting	913
operator owes the department and United States centers for	914
medicare and medicaid services under the medicaid program, as	915
follows:	916

(A) Ninety-one days after the date the exiting operator files	917
a properly completed cost report required by section 5111.682 of	918
the Revised Code unlessUnless the department issues the initial	919
debt summary report required by section 5111.685 of the Revised	920
Code not later than ninetysixty days after the date the exiting	921
operator files the properly completed cost report required by	922
section 5111.682 of the Revised Code, sixty-one days after the	923
date the exiting operator files the properly completed cost	924
report;	925

(B) Not later than thirty days after the exiting operator	926
agrees to a final fiscal audit resulting from the report required	927
by section 5111.685 of the Revised Code ifIf the department	928
issues the initial debt summary report required by section	929
5111.685 of the Revised Code not later than ninetysixty days	930
after the date the exiting operator files a properly completed	931
cost report required by section 5111.682 of the Revised Code, not	932
later than the following:	933

(1) Thirty days after the deadline for requesting an	934
adjudication under section 5111.685 of the Revised Code regarding	935
the final debt summary report if the exiting operator, and an	936
affiliated operator who executes a successor liability agreement	937
under section 5111.681 of the Revised Code, fail to request the	938
adjudication on or before the deadline;	939

(2) Thirty days after the completion of an adjudication of	940
the final debt summary report if the exiting operator, or an	941
affiliated operator who executes a successor liability agreement	942
under section 5111.681 of the Revised Code, requests the	943
adjudication on or before the deadline for requesting the	944
adjudication.	945

(C) Ninety-one days after the date the department waives the	946
cost report requirement of section 5111.682 of the Revised Code	947
unlessUnless the department issues the initial debt summary	948
report required by section 5111.685 of the Revised Code not later	949
than ninetysixty days after the date the department waives the	950
cost report requirement of section 5111.682 of the Revised Code,	951
sixty-one days after the date the department waives the cost	952
report requirement;	953

(D) Not later than thirty days after the exiting operator	954
agrees to a final fiscal audit resulting from the report required	955
by section 5111.685 of the Revised Code ifIf the department	956
issues the initial debt summary report required by section	957
5111.685 of the Revised Code not later than ninetysixty days	958
after the date the department waives the cost report requirement	959
of section 5111.682 of the Revised Code, not later than the	960
following:	961

(1) Thirty days after the deadline for requesting an	962
adjudication under section 5111.685 of the Revised Code regarding	963
the final debt summary report if the exiting operator, and an	964
affiliated operator who executes a successor liability agreement	965
under section 5111.681 of the Revised Code, fail to request the	966
adjudication on or before the deadline;	967

(2) Thirty days after the completion of an adjudication of	968
the final debt summary report if the exiting operator, or an	969
affiliated operator who executes a successor liability agreement	970
under section 5111.681 of the Revised Code, requests the	971
adjudication on or before the deadline for requesting the	972
adjudication.	973

Sec. 5111.688. (A) All amounts withheld under section	974
5111.681 of the Revised Code from payment due an exiting operator	975
under the medicaid program shall be deposited into the medicaid	976
payment withholding fund created by the controlling board pursuant	977
to section 131.35 of the Revised Code. Money in the fund shall be	978
used as follows:	979

(1) To pay an exiting operator when a withholding is released	980
to the exiting operator under section 5111.686 or 5111.687 of the	981
Revised Code;	982

(2) To pay the department of job and family services and	983
United States centers for medicare and medicaid services the	984
amount an exiting operator owes the department and United States	985
centers under the medicaid program.	986

(B) Amounts paid from the medicaid payment withholding fund	987
pursuant to division (A)(2) of this section shall be deposited	988
into the appropriate department fund.	989

Sec. 5111.688.        Sec. 5111.689.  The director of job and family	990
services shall adopt rules under section 5111.02 of the Revised	991
Code to implement sections 5111.65 to 5111.6885111.689 of the	992
Revised Code, including rules applicable to an exiting operator	993
that provides written notification under section 5111.66 of the	994
Revised Code of a voluntary withdrawal of participation. Rules	995
adopted under this section shall comply with section 1919(c)(2)(F)	996
of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C.	997
1396r(c)(2)(F), regarding restrictions on transfers or discharges	998
of nursing facility residents in the case of a voluntary	999
withdrawal of participation. The rules may prescribe a medicaid	1000
reimbursement methodology and other procedures that are applicable	1001
after the effective date of a voluntary withdrawal of	1002
participation that differ from the reimbursement methodology and	1003
other procedures that would otherwise apply.	1004

Sec. 5111.894. (A) The state administrative agency may	1005
establish one or more waiting lists for the assisted living	1006
program. Only individuals eligible for the medicaidassisted	1007
living program may be placed on a waiting list.	1008

(B) The state administrative agency shall establish a home	1009
first component of the assisted living program under which	1010
eligible individuals may be enrolled in the assisted living	1011
program in accordance with this section. An individual is eligible	1012
for the assisted living program's home first component if the	1013
individual is on an assisted living program waiting list and at	1014
least one of the following applies:	1015

(1) The individual has been admitted to a nursing facility;

1016

(2) A physician has determined and documented in writing that	1017
the individual has a medical condition that, unless enrolled in	1018
home and community-based services such as the assisted living	1019
program, will require the individual to be admitted to a nursing	1020
facility within thirty days of the physician's determination;	1021

(3) The individual has been hospitalized and a physician has	1022
determined and documented in writing that, unless the individual	1023
is enrolled in home and community-based services such as the	1024
assisted living program, the individual is to be transported	1025
directly from the hospital to a nursing facility admitted;	1026

(4) Both of the following apply:

1027

(a) The individual is the subject of a report made under	1028
section 5101.61 of the Revised Code regarding abuse, neglect, or	1029
exploitation or such a report referred to a county department of	1030
job and family services under section 5126.31 of the Revised Code	1031
or has made a request to a county department for protective	1032
services as defined in section 5101.60 of the Revised Code;	1033

(b) A county department of job and family services and an	1034
area agency on aging have jointly documented in writing that,	1035
unless the individual is enrolled in home and community-based	1036
services such as the assisted living program, the individual	1037
should be admitted to a nursing facility;	1038

(5) The individual resided in a residential care facility for	1039
at least six months immediately before applying for the assisted	1040
living program and is at risk of imminent admission to a nursing	1041
facility because the costs of residing in the residential care	1042
facility have depleted the individual's resources such that the	1043
individual is unable to continue to afford the cost of residing in	1044
the residential care facility.	1045

(C) Each month, each area agency on aging shall determine	1046
whether any individual who residesidentify individuals residing	1047
in the area that the area agency on aging serves and is on a	1048
waiting listwho are eligible for the home first component of the	1049
assisted living program has been admitted to a nursing facility.	1050
IfWhen an area agency on aging determines thatidentifies such	1051
an individual has been admitted to a nursing facility and	1052
determines that there is a vacancy in a residential care facility	1053
participating in the assisted living program that is acceptable to	1054
the individual, the agency shall notify the long-term care	1055
consultation program administrator serving the area in which the	1056
individual resides about the determination. The administrator	1057
shall determine whether the assisted living program is appropriate	1058
for the individual and whether the individual would rather	1059
participate in the assisted living program than continue residing	1060
or begin to reside in thea nursing facility. If the administrator	1061
determines that the assisted living program is appropriate for	1062
the individual and the individual would rather participate in the	1063
assisted living program than continue residingor begin to reside	1064
in thea nursing facility, the administrator shall so notify the	1065
state administrative agency.	1066

Onagency. On receipt of the notice from the administrator,	1067
the state administrative agency shall approve the individual's	1068
enrollment in the assisted living program regardless of any	1069
waiting list for the assisted living program, unless the	1070
enrollment would cause the assisted living program to exceed any	1071
limit on the number of individuals who may participate in the	1072
program as set by the United States secretary of health and human	1073
services when the medicaid waiver authorizing the program is	1074
approved. Each	1075

(D) Each quarter, the state administrative agency shall	1076
certify to the director of budget and management the estimated	1077
increase in costs of the assisted living program resulting from	1078
enrollment of individuals in the assisted living program pursuant	1079
to this section.	1080

Section 2. That existing sections 173.401, 3702.51, 3702.59,	1081
5111.65, 5111.651, 5111.68, 5111.681, 5111.685, 5111.686,	1082
5111.688, and 5111.894 of the Revised Code are hereby repealed.	1083

Section 3. That Section 209.20 of Am. Sub. H.B. 1 of the	1084
128th General Assembly be amended to read as follows:	1085

Sec. 209.20. LONG-TERM CARE

1086

Pursuant to an interagency agreement, the Department of Job	1087
and Family Services shall designate the Department of Aging to	1088
perform assessments under section 5111.204 of the Revised Code.	1089
The Department of Aging shall provide long-term care consultations	1090
under section 173.42 of the Revised Code to assist individuals in	1091
planning for their long-term health care needs. The foregoing	1092
appropriation items 490423, Long Term Care Budget – State, and	1093
490623, Long Term Care Budget, may be used to provide the	1094
preadmission screening and resident review (PASRR), which includes	1095
screening, assessments, and determinations made under sections	1096
5111.02, 5111.204, 5119.061, and 5123.021 of the Revised Code.	1097

The foregoing appropriation items 490423, Long Term Care	1098
Budget - State, and 490623, Long Term Care Budget, may be used to	1099
assess and provide long-term care consultations to clients	1100
regardless of Medicaid eligibility.	1101

The Director of Aging shall adopt rules under section 111.15	1102
of the Revised Code governing the nonwaiver funded PASSPORT	1103
program, including client eligibility. The foregoing appropriation	1104
item 490423, Long Term Care Budget - State, may be used by the	1105
Department of Aging to provide nonwaiver funded PASSPORT services	1106
to persons the Department has determined to be eligible to	1107
participate in the nonwaiver funded PASSPORT Program, including	1108
those persons not yet determined to be financially eligible to	1109
participate in the Medicaid waiver component of the PASSPORT	1110
Program by a county department of job and family services.	1111

The Department of Aging shall administer the Medicaid	1112
waiver-funded PASSPORT Home Care Program, the Choices Program, the	1113
Assisted Living Program, and the PACE Program as delegated by the	1114
Department of Job and Family Services in an interagency agreement.	1115
The foregoing appropriation item 490423, Long Term Care Budget -	1116
State, shall be used to provide the required state match for	1117
federal Medicaid funds supporting the Medicaid Waiver-funded	1118
PASSPORT Home Care Program, the Choices Program, the Assisted	1119
Living Program, and the PACE Program. The foregoing appropriation	1120
items 490423, Long Term Care Budget - State, and 490623, Long Term	1121
Care Budget, may also be used to support the Department of Aging's	1122
administrative costs associated with operating the PASSPORT,	1123
Choices, Assisted Living, and PACE programs.	1124

The foregoing appropriation item 490623, Long Term Care	1125
Budget, shall be used to provide the federal matching share for	1126
all program costs determined by the Department of Job and Family	1127
Services to be eligible for Medicaid reimbursement.	1128

HOME FIRST PROGRAM

1129

(A) As used in this section, "Long Term Care Budget Services"	1130
includes the following existing programs: PASSPORT, Assisted	1131
Living, Residential State Supplement, and PACE.	1132

(B) On a quarterly basis, on receipt of the certified	1133
expenditures related to sections 173.401, 173.351, 173.501, and	1134
5111.894 of the Revised Code, the Director of Budget and	1135
Management may do all of the following for fiscal years 2010 and	1136
2011:	1137

(1) Transfer cash from the Nursing Facility Stabilization	1138
Fund (Fund 5R20), used by the Department of Job and Family	1139
Services, to the PASSPORT/Residential State Supplement Fund (Fund	1140
4J40), used by the Department of Aging. The	1141

The transferred cash is hereby appropriated to appropriation	1142
item 490610, PASSPORT/Residential State Supplement.	1143

(2) If receipts credited toAuthorize expenditures from the	1144
PASSPORT Fund (Fund 3C40) for amounts that exceed the amounts	1145
appropriated from receipts credited to the fund, the Director of	1146
Aging may request the Director of Budget and Management to	1147
authorize expenditures from the fund in excess of the amounts	1148
appropriated. Upon the approval of the Director of Budget and	1149
Management, theAny additional authorized amounts are hereby	1150
appropriated.	1151

(3) If receipts credited toAuthorize expenditures from the	1152
Interagency Reimbursement Fund (Fund 3G50) for amounts that exceed	1153
the amounts appropriated from receipts credited to the fund, the	1154
Director of Job and Family Services may request the Director of	1155
Budget and Management to authorize expenditures from the fund in	1156
excess of the amounts appropriated. Upon the approval of the	1157
Director of Budget and Management, theAny additional authorized	1158
amounts are hereby appropriated.	1159

(C) Not later than thirty days after the Director of Budget	1160
and Management receives certification of expenditures specified in	1161
division (B) of this section, the Executive Director of Executive	1162
Medicaid Management Administration shall submit a report to the	1163
General Assembly in accordance with section 101.68 of the Revised	1164
Code and to the chairs and ranking minority members of the	1165
committees of the House of Representatives and Senate to which the	1166
biennial budget bill is referred. The report shall describe and	1167
document the criteria and data the Office of Budget and Management	1168
uses to justify a transfer of funds under division (B) of this	1169
section, including spending and utilization trends for PASSPORT,	1170
assisted living, and nursing facility services. In addition to	1171
providing the information for the transfer of funds, the report	1172
shall include the following:	1173

(1) In the case of reports for transfers that occur during	1174
fiscal year 2010, the descriptions and documents of the criteria	1175
and data used to justify other such transfers that previously	1176
occurred during that fiscal year;	1177

(2) In the case of reports for transfers that occur during	1178
fiscal year 2011, the descriptions and documents of the criteria	1179
and data used to justify other such transfers that previously	1180
occurred during that fiscal year and fiscal year 2010.	1181

The Director of Budget and Management shall provide the	1182
Executive Director of the Executive Medicaid Management	1183
Administration with all information the Executive Director needs	1184
to prepare the reports required by this division.	1185

(D) The individuals placed in Long Term Care Budget Services	1186
pursuant to this section shall be in addition to the individuals	1187
placed in Long Term Care Budget Services during fiscal years 2010	1188
and 2011 before any transfers to appropriation item 490423, Long	1189
Term Care Budget-State, are made under this section.	1190

ALLOCATION OF PACE SLOTS

1191

In order to effectively administer and manage growth within	1192
the PACE Program, the Director of Aging may, as the director deems	1193
appropriate and to the extent funding is available, expand the	1194
PACE Program to regions of Ohio beyond those currently served by	1195
the PACE Program. In implementing the expansion, the Director may	1196
not decrease the number of residents of Cuyahoga and Hamilton	1197
counties and parts of Butler, Clermont, and Warren counties who	1198
are participating in the PACE Program below the number of	1199
residents of those counties and parts of counties who were	1200
enrolled in the PACE Program on July 1, 2008.	1201

Section 4. That existing Section 209.20 of Am. Sub. H.B. 1 of	1202
the 128th General Assembly is hereby repealed.	1203

Section 5. During fiscal years 2012 and 2013, on receipt of	1204
certified expenditures related to sections 173.401, 173.351,	1205
173.501, and 5111.894 of the Revised Code, the Director of Budget	1206
and Management shall transfer cash from the Nursing Facility	1207
Stabilization Fund (Fund 5R20), used by the Department of Job and	1208
Family Services, to the PASSPORT/Residential State Supplement Fund	1209
(Fund 4J40), used by the Department of Aging.	1210

If receipts credited to the PASSPORT Fund (Fund 3C40) exceed	1211
the amounts appropriated from the fund in fiscal years 2012 and	1212
2013, the Director of Aging shall request the Director of Budget	1213
and Management to authorize expenditures from the fund in excess	1214
of the amounts appropriated.	1215

If receipts credited to the Interagency Reimbursement Fund	1216
(Fund 3G50) exceed the amounts appropriated from the fund in	1217
fiscal years 2012 and 2013, the Director of Job and Family	1218
Services shall request the Director of Budget and Management to	1219
authorize expenditures from the fund in excess of the amounts	1220
appropriated.	1221