As Introduced

128th General Assembly Regular Session 2009-2010

S. B. No. 214

Senators Carey, Miller, D. 

Cosponsors: Senators Grendell, Schaffer, Seitz, Miller, R., Turner, Strahorn, Morano, Cafaro 

---

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 require the Director of

10

Budget and Management to make certain cash

11

transfers and expenditure authorizations

12

regarding long-term care budget services, to

13

revise the law governing the collection of

14

long-term care facilities' Medicaid debts, and to

15

revise the law governing the reasons for denying a

16

Certificate of Need application.

17

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

Section 1. That sections 173.401, 3702.51, 3702.59, 5111.65,	18
5111.651, 5111.68, 5111.681, 5111.685, 5111.686, 5111.688, and	19
5111.894 be amended; section 5111.688 (5111.689) be amended for	20
the purpose of adopting a new section number as indicated in	21
parentheses; and new section 5111.688 of the Revised Code be	22
enacted to read as follows:	23

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

24

"Area agency on aging" has the same meaning as in section	25
173.14 of the Revised Code.	26

"Long-term care consultation program" means the program the	27
department of aging is required to develop under section 173.42	28
of the Revised Code.	29

"Long-term care consultation program administrator" or	30
"administrator" means the department of aging or, if the	31
department contracts with an area agency on aging or other entity	32
to administer the long-term care consultation program for a	33
particular area, that agency or entity.	34

"Nursing facility" has the same meaning as in section	35
5111.20 of the Revised Code.	36

"PASSPORT waiver" means the federal medicaid waiver granted	37
by the United States secretary of health and human services that	38
authorizes the PASSPORT program.	39

(B) The director of job and family services shall submit to	40
the United States secretary of health and human services an	41
amendment to the PASSPORT waiver that authorizes additional	42
enrollments in the PASSPORT program pursuant to this section.	43
Beginning with the month following the month in which the United	44
States secretary approves the amendment and eachThe department of	45
aging may establish one or more waiting lists for the PASSPORT	46
program. Only individuals eligible for the PASSPORT program may be	47
placed on a waiting list.	48

(C) The department shall establish a home first component of	49
the PASSPORT program under which eligible individuals may be	50
enrolled in the PASSPORT program in accordance with this section.	51
An individual is eligible for the PASSPORT program's home first	52
component if the individual is on a PASSPORT program waiting list	53
and at least one of the following applies:	54

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

55

(2) A physician has determined and documented in writing that	56
the individual has a medical condition that, unless enrolled in	57
home and community-based services such as the PASSPORT program,	58
will require the individual to be admitted to a nursing facility	59
within thirty days of the physician's determination;	60

(3) The individual has been hospitalized and a physician has	61
determined and documented in writing that, unless the individual	62
is enrolled in home and community-based services such as the	63
PASSPORT program, the individual is to be transported directly	64
from the hospital to a nursing facility and admitted;	65

(4) Both of the following apply:

66

(a) The individual is the subject of a report made under	67
section 5101.61 of the Revised Code regarding abuse, neglect, or	68
exploitation or such a report referred to a county department of	69
job and family services under section 5126.31 of the Revised Code	70
or has made a request to a county department for protective	71
services as defined in section 5101.60 of the Revised Code;	72

(b) A county department of job and family services and an	73
area agency on aging have jointly documented in writing that,	74
unless the individual is enrolled in home and community-based	75
services such as the PASSPORT program, the individual should be	76
admitted to a nursing facility.	77

(D) Each month thereafter, each area agency on aging shall	78
determine whetheridentify individuals who resideresiding in the	79
area that the area agency on aging serves andwho are on a	80
waiting listeligible for the home first component of the PASSPORT	81
program have been admitted to a nursing facility. IfWhen an	82
area agency on aging determines thatidentifies such an	83
individual has been admitted to a nursing facility, the agency	84
shall notify the long-term care consultation program	85
administrator serving the area in which the individual resides	86
about the determination. The administrator shall determine	87
whether the PASSPORT program is appropriate for the individual	88
and whether the individual would rather participate in the	89
PASSPORT program than continue residingor begin to reside in	90
thea nursing facility. If the administrator determines that the	91
PASSPORT program is appropriate for the individual and the	92
individual would rather participate in the PASSPORT program than	93
continue residingor begin to reside in thea nursing facility,	94
the administrator shall so notify the department of aging. On	95
receipt of the notice from the administrator, the department of	96
aging shall approve the individual's enrollment in the PASSPORT	97
program regardless of the PASSPORT program's waiting list and	98
even though the enrollment causes enrollment in the program to	99
exceed the limit that would otherwise apply, unless the	100
enrollment would cause the PASSPORT program to exceed any limit on	101
the number of individuals who may be enrolled in the program as	102
set by the United States secretary of health and human services in	103
the PASSPORT waiver.	104

(E) Each quarter, the department of aging shall certify to	105
the director of budget and management the estimated increase in	106
costs of the PASSPORT program resulting from enrollment of	107
individuals in the PASSPORT program pursuant to this section.	108

Sec. 3702.51.  As used in sections 3702.51 to 3702.62 of the	109
Revised Code:	110

(A) "Applicant" means any person that submits an application	111
for a certificate of need and who is designated in the application	112
as the applicant.	113

(B) "Person" means any individual, corporation, business	114
trust, estate, firm, partnership, association, joint stock	115
company, insurance company, government unit, or other entity.	116

(C) "Certificate of need" means a written approval granted by	117
the director of health to an applicant to authorize conducting a	118
reviewable activity.	119

(D) "Health service area" means a geographic region	120
designated by the director of health under section 3702.58 of the	121
Revised Code.	122

(E) "Health service" means a clinically related service, such	123
as a diagnostic, treatment, rehabilitative, or preventive service.	124

(F) "Health service agency" means an agency designated to	125
serve a health service area in accordance with section 3702.58 of	126
the Revised Code.	127

(G) "Health care facility" means:

128

(1) A hospital registered under section 3701.07 of the	129
Revised Code;	130

(2) A nursing home licensed under section 3721.02 of the	131
Revised Code, or by a political subdivision certified under	132
section 3721.09 of the Revised Code;	133

(3) A county home or a county nursing home as defined in	134
section 5155.31 of the Revised Code that is certified under Title	135
XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 42	136
U.S.C.A. 301, as amended;	137

(4) A freestanding dialysis center;

138

(5) A freestanding inpatient rehabilitation facility;

139

(6) An ambulatory surgical facility;

140

(7) A freestanding cardiac catheterization facility;

141

(8) A freestanding birthing center;

142

(9) A freestanding or mobile diagnostic imaging center;

143

(10) A freestanding radiation therapy center.

144

A health care facility does not include the offices of	145
private physicians and dentists whether for individual or group	146
practice, residential facilities licensed under section 5123.19 of	147
the Revised Code, or an institution for the sick that is operated	148
exclusively for patients who use spiritual means for healing and	149
for whom the acceptance of medical care is inconsistent with their	150
religious beliefs, accredited by a national accrediting	151
organization, exempt from federal income taxation under section	152
501 of the Internal Revenue Code of 1986, 100 Stat. 2085, 26	153
U.S.C.A. 1, as amended, and providing twenty-four hour nursing	154
care pursuant to the exemption in division (E) of section 4723.32	155
of the Revised Code from the licensing requirements of Chapter	156
4723. of the Revised Code.	157

(H) "Medical equipment" means a single unit of medical	158
equipment or a single system of components with related functions	159
that is used to provide health services.	160

(I) "Third-party payer" means a health insuring corporation	161
licensed under Chapter 1751. of the Revised Code, a health	162
maintenance organization as defined in division (K) of this	163
section, an insurance company that issues sickness and accident	164
insurance in conformity with Chapter 3923. of the Revised Code, a	165
state-financed health insurance program under Chapter 3701.,	166
4123., or 5111. of the Revised Code, or any self-insurance plan.	167

(J) "Government unit" means the state and any county,	168
municipal corporation, township, or other political subdivision of	169
the state, or any department, division, board, or other agency of	170
the state or a political subdivision.	171

(K) "Health maintenance organization" means a public or	172
private organization organized under the law of any state that is	173
qualified under section 1310(d) of Title XIII of the "Public	174
Health Service Act," 87 Stat. 931 (1973), 42 U.S.C. 300e-9.	175

(L) "Existing health care facility" means either of the	176
following:	177

(1) A health care facility that is licensed or otherwise	178
authorized to operate in this state in accordance with applicable	179
law, including a county home or a county nursing home that is	180
certified as of February 1, 2008, under Title XVIII or Title XIX	181
of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301,	182
as amended, is staffed and equipped to provide health care	183
services, and is actively providing health services;	184

(2) A health care facility that is licensed or otherwise	185
authorized to operate in this state in accordance with applicable	186
law, including a county home or a county nursing home that is	187
certified as of February 1, 2008, under Title XVIII or Title XIX	188
of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301,	189
as amended, or that has beds registered under section 3701.07 of	190
the Revised Code as skilled nursing beds or long-term care beds	191
and has provided services for at least three hundred sixty-five	192
consecutive days within the twenty-four months immediately	193
preceding the date a certificate of need application is filed with	194
the director of health.	195

(M) "State" means the state of Ohio, including, but not	196
limited to, the general assembly, the supreme court, the offices	197
of all elected state officers, and all departments, boards,	198
offices, commissions, agencies, institutions, and other	199
instrumentalities of the state of Ohio. "State" does not include	200
political subdivisions.	201

(N) "Political subdivision" means a municipal corporation,	202
township, county, school district, and all other bodies corporate	203
and politic responsible for governmental activities only in	204
geographic areas smaller than that of the state to which the	205
sovereign immunity of the state attaches.	206

(O) "Affected person" means:

207

(1) An applicant for a certificate of need, including an	208
applicant whose application was reviewed comparatively with the	209
application in question;	210

(2) The person that requested the reviewability ruling in	211
question;	212

(3) Any person that resides or regularly uses health care	213
facilities within the geographic area served or to be served by	214
the health care services that would be provided under the	215
certificate of need or reviewability ruling in question;	216

(4) Any health care facility that is located in the health	217
service area where the health care services would be provided	218
under the certificate of need or reviewability ruling in question;	219

(5) Third-party payers that reimburse health care facilities	220
for services in the health service area where the health care	221
services would be provided under the certificate of need or	222
reviewability ruling in question;	223

(6) Any other person who testified at a public hearing held	224
under division (B) of section 3702.52 of the Revised Code or	225
submitted written comments in the course of review of the	226
certificate of need application in question.	227

(P) "Osteopathic hospital" means a hospital registered under	228
section 3701.07 of the Revised Code that advocates osteopathic	229
principles and the practice and perpetuation of osteopathic	230
medicine by doing any of the following:	231

(1) Maintaining a department or service of osteopathic	232
medicine or a committee on the utilization of osteopathic	233
principles and methods, under the supervision of an osteopathic	234
physician;	235

(2) Maintaining an active medical staff, the majority of	236
which is comprised of osteopathic physicians;	237

(3) Maintaining a medical staff executive committee that has	238
osteopathic physicians as a majority of its members.	239

(Q) "Ambulatory surgical facility" has the same meaning as in	240
section 3702.30 of the Revised Code.	241

(R) Except as provided in division (S) of this section,	242
"reviewable activity" means any of the following activities:	243

(1) The establishment, development, or construction of a new	244
long-term care facility;	245

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

246

(3) The renovation of a long-term care facility that involves	247
a capital expenditure of two million dollars or more, not	248
including expenditures for equipment, staffing, or operational	249
costs;	250

(4) Either of the following changes in long-term care bed	251
capacity:	252

(a) An increase in bed capacity;

253

(b) A relocation of beds from one physical facility or site	254
to another, excluding the relocation of beds within a long-term	255
care facility or among buildings of a long-term care facility at	256
the same site.	257

(5) Any change in the health services, bed capacity, or site,	258
or any other failure to conduct the reviewable activity in	259
substantial accordance with the approved application for which a	260
certificate of need concerning long-term care beds was granted, if	261
the change is made within five years after the implementation of	262
the reviewable activity for which the certificate was granted;	263

(6) The expenditure of more than one hundred ten per cent of	264
the maximum expenditure specified in a certificate of need	265
concerning long-term care beds.	266

(S) "Reviewable activity" does not include any of the	267
following activities:	268

(1) Acquisition of computer hardware or software;

269

(2) Acquisition of a telephone system;

270

(3) Construction or acquisition of parking facilities;

271

(4) Correction of cited deficiencies that are in violation of	272
federal, state, or local fire, building, or safety laws and rules	273
and that constitute an imminent threat to public health or safety;	274

(5) Acquisition of an existing health care facility that does	275
not involve a change in the number of the beds, by service, or in	276
the number or type of health services;	277

(6) Correction of cited deficiencies identified by	278
accreditation surveys of the joint commission on accreditation of	279
healthcare organizations or of the American osteopathic	280
association;	281

(7) Acquisition of medical equipment to replace the same or	282
similar equipment for which a certificate of need has been issued	283
if the replaced equipment is removed from service;	284

(8) Mergers, consolidations, or other corporate	285
reorganizations of health care facilities that do not involve a	286
change in the number of beds, by service, or in the number or type	287
of health services;	288

(9) Construction, repair, or renovation of bathroom	289
facilities;	290

(10) Construction of laundry facilities, waste disposal	291
facilities, dietary department projects, heating and air	292
conditioning projects, administrative offices, and portions of	293
medical office buildings used exclusively for physician services;	294

(11) Acquisition of medical equipment to conduct research	295
required by the United States food and drug administration or	296
clinical trials sponsored by the national institute of health. Use	297
of medical equipment that was acquired without a certificate of	298
need under division (S)(11) of this section and for which	299
premarket approval has been granted by the United States food and	300
drug administration to provide services for which patients or	301
reimbursement entities will be charged shall be a reviewable	302
activity.	303

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

304

Only that portion of a project that meets the requirements of	305
this division is not a reviewable activity.	306

(T) "Small rural hospital" means a hospital that is located	307
within a rural area, has fewer than one hundred beds, and to	308
which fewer than four thousand persons were admitted during the	309
most recent calendar year.	310

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

311

(1) A hospital registered under section 3701.07 of the	312
Revised Code that provides general pediatric medical and surgical	313
care, and in which at least seventy-five per cent of annual	314
inpatient discharges for the preceding two calendar years were	315
individuals less than eighteen years of age;	316

(2) A distinct portion of a hospital registered under section	317
3701.07 of the Revised Code that provides general pediatric	318
medical and surgical care, has a total of at least one hundred	319
fifty registered pediatric special care and pediatric acute care	320
beds, and in which at least seventy-five per cent of annual	321
inpatient discharges for the preceding two calendar years were	322
individuals less than eighteen years of age;	323

(3) A distinct portion of a hospital, if the hospital is	324
registered under section 3701.07 of the Revised Code as a	325
children's hospital and the children's hospital meets all the	326
requirements of division (U)(1) of this section.	327

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

328

(1) A nursing home licensed under section 3721.02 of the	329
Revised Code or by a political subdivision certified under section	330
3721.09 of the Revised Code;	331

(2) The portion of any facility, including a county home or	332
county nursing home, that is certified as a skilled nursing	333
facility or a nursing facility under Title XVIII or XIX of the	334
"Social Security Act";	335

(3) The portion of any hospital that contains beds registered	336
under section 3701.07 of the Revised Code as skilled nursing beds	337
or long-term care beds.	338

(W) "Long-term care bed" means a bed in a long-term care	339
facility.	340

(X) "Freestanding birthing center" means any facility in	341
which deliveries routinely occur, regardless of whether the	342
facility is located on the campus of another health care facility,	343
and which is not licensed under Chapter 3711. of the Revised Code	344
as a level one, two, or three maternity unit or a limited	345
maternity unit.	346

(Y)(1) "Reviewability ruling" means a ruling issued by the	347
director of health under division (A) of section 3702.52 of the	348
Revised Code as to whether a particular proposed project is or is	349
not a reviewable activity.	350

(2) "Nonreviewability ruling" means a ruling issued under	351
that division that a particular proposed project is not a	352
reviewable activity.	353

(Z)(1) "Metropolitan statistical area" means an area of this	354
state designated a metropolitan statistical area or primary	355
metropolitan statistical area in United States office of	356
management and budget bulletin no. 93-17, June 30, 1993, and its	357
attachments.	358

(2) "Rural area" means any area of this state not located	359
within a metropolitan statistical area.	360

(AA) "County nursing home" has the same meaning as in	361
section 5155.31 of the Revised Code.	362

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

363

(1) A person who has an ownership or controlling interest of	364
at least five per cent in an applicant, in a health care facility	365
that is the subject of an application for a certificate of need,	366
or in the owner or operator of the applicant or such a facility;	367

(2) An officer, director, trustee, or general partner of an	368
applicant, of a health care facility that is the subject of an	369
application for a certificate of need, or of the owner or operator	370
of the applicant or such a facility.	371

(CC) "Actual harm but not immediate jeopardy deficiency"	372
means a deficiency that, under 42 C.F.R. 488.404, either	373
constitutes a pattern of deficiencies resulting in actual harm	374
that is not immediate jeopardy or represents widespread	375
deficiencies resulting in actual harm that is not immediate	376
jeopardy.	377

(DD) "Immediate jeopardy deficiency" means a deficiency that,	378
under 42 C.F.R. 488.404, either constitutes a pattern of	379
deficiencies resulting in immediate jeopardy to resident health or	380
safety or represents widespread deficiencies resulting in	381
immediate jeopardy to resident health or safety.	382

Sec. 3702.59.  (A) The director of health shall accept for	383
review certificate of need applications as provided in sections	384
3702.592, 3702.593, and 3702.594 of the Revised Code.	385

(B)(1) The director shall not approve an application for a	386
certificate of need for the addition of long-term care beds to an	387
existing health care facility or for the development of a new	388
health care facility if any of the following apply:	389

(1)(a) The existing health care facility in which the beds	390
are being placed has one or more waivers for life safety code	391
deficiencies, one or more state fire code violations, or one or	392
more state building code violations, and the project	393
identified in the application does not propose to correct all	394
life safety code deficiencies for which a waiver has been	395
granted, all state fire code violations, and all state building	396
code violations at the existing health care facility in which	397
the beds are being placed;	398

(2)(b) During the sixty-month period preceding the filing of	399
the application, a notice of proposed license revocation was	400
issued under section 3721.03 of the Revised Code for the existing	401
health care facility in which the beds are being placed or a	402
nursing home owned or operated by the applicant or the	403
corporation or other business that operates or seeks to operate	404
the health care facility in which the beds are being placeda	405
principal participant.	406

(3)(c) During the period that precedes the filing of the	407
application and is encompassed by the three most recent standard	408
surveys of the existing health care facility in which the beds	409
are being placed, theany of the following occurred:	410

(i) The facility was cited on three or more separate	411
occasions for final, nonappealable actual harm but not immediate	412
jeopardy deficiencies that, under 42 C.F.R. 488.404, either	413
constitute a pattern of deficiencies resulting in actual harm	414
that is not immediate jeopardy or are widespread deficiencies	415
resulting in actual harm that is not immediate jeopardy.	416

(4) During the period that precedes the filing of the	417
application and is encompassed by the three most recent standard	418
surveys of the existing health care facility in which the beds are	419
being placed, the(ii) The facility was cited on two or more	420
separate occasions for final, nonappealable immediate jeopardy	421
deficiencies that, under 42 C.F.R. 488.404, either constitute a	422
pattern of deficiencies resulting in immediate jeopardy to	423
resident health or safety or are widespread deficiencies	424
resulting in immediate jeopardy to resident health or safety.	425

(5) During the period that precedes the filing of the	426
application and is encompassed by the three most recent standard	427
surveys of the existing health care facility in which the beds are	428
being placed, more(iii) The facility was cited on two separate	429
occasions for final, nonappealable actual harm but not immediate	430
jeopardy deficiencies and on one occasion for a final,	431
nonappealable immediate jeopardy deficiency.	432

(d) More than two nursing homes owned or operated in this	433
state by the applicant or the person who operates the facility in	434
which the beds are being placeda principal participant or, if	435
the applicant or persona principal participant owns or operates	436
more than twenty nursing homes in this state, more than ten per	437
cent of those nursing homes, were each cited onduring the period	438
that precedes the filing of the application for the certificate of	439
need and is encompassed by the three most recent standard surveys	440
of the nursing homes that were so cited in any of the following	441
manners:	442

(i) On three or more separate occasions for final,	443
nonappealable actual harm but not immediate jeopardy deficiencies	444
that, under 42 C.F.R. 488.404, either constitute a pattern of	445
deficiencies resulting in actual harm that is not immediate	446
jeopardy or are widespread deficiencies resulting in actual harm	447
that is not immediate jeopardy.	448

(6) During the period that precedes the filing of the	449
application and is encompassed by the three most recent standard	450
surveys of the existing health care facility in which the beds are	451
being placed, more than two nursing homes operated in this state	452
by the applicant or the person who operates the facility in which	453
the beds are being placed or, if the applicant or person operates	454
more than twenty nursing homes in this state, more than ten per	455
cent of those nursing homes, were each cited on;	456

(ii) On two or more separate occasions for final,	457
nonappealable immediate jeopardy deficiencies that, under 42	458
C.F.R. 488.404, either constitute a pattern of deficiencies	459
resulting in immediate jeopardy to resident health or safety or	460
are widespread deficiencies resulting in immediate jeopardy to	461
resident health or safety;	462

(iii) On two separate occasions for final, nonappealable	463
actual harm but not immediate jeopardy deficiencies and on one	464
occasion for a final, nonappealable immediate jeopardy deficiency.	465

(7) During the sixty-month period preceding the filing of	466
the application, the applicant has violated this chapter on two or	467
more separate occasions.	468

(2) In applying divisions (B)(1)(a) to (6)(d) of this	469
section, the director shall not consider deficiencies or	470
violations cited before the current operatorapplicant or a	471
principal participant acquired or began to own or operate the	472
health care facility at which the deficiencies or violations	473
were cited. The director may disregard deficiencies and	474
violations cited after the health care facility was acquired or	475
began to be operated by the current operatorapplicant or a	476
principal participant if the deficiencies or violations were	477
attributable to circumstances that arose under the previous	478
owner or operator and the current operatorapplicant or	479
principal participant has implemented measures to alleviate the	480
circumstances. In the case of an application proposing	481
development of a new health care facility by relocation of beds,	482
the director shall not consider deficiencies or violations that	483
were solely attributable to the physical plant of the existing	484
health care facility from which the beds are being relocated.	485

(C) The director also shall accept for review any application	486
for the conversion of infirmary beds to long-term care beds if	487
the infirmary meets all of the following conditions:	488

(1) Is operated exclusively by a religious order;

489

(2) Provides care exclusively to members of religious orders	490
who take vows of celibacy and live by virtue of their vows within	491
the orders as if related;	492

(3) Was providing care exclusively to members of such a	493
religious order on January 1, 1994.	494

At no time shall individuals other than those described in	495
division (C)(2) of this section be admitted to a facility to use	496
beds for which a certificate of need is approved under this	497
division.	498

Sec. 5111.65.  As used in sections 5111.65 to 5111.688	499
5111.689 of the Revised Code:	500

(A) "Affiliated operator" means an operator affiliated with	501
either of the following:	502

(1) The exiting operator for whom the affiliated operator is	503
to assume liability for the entire amount of the exiting	504
operator's debt under the medicaid program or the portion of the	505
debt that represents the franchise permit fee the exiting operator	506
owes;	507

(2) The entering operator involved in the change of operator	508
with the exiting operator specified in division (A)(1) of this	509
section.	510

(B) "Change of operator" means an entering operator becoming	511
the operator of a nursing facility or intermediate care facility	512
for the mentally retarded in the place of the exiting operator.	513

(1) Actions that constitute a change of operator include the	514
following:	515

(a) A change in an exiting operator's form of legal	516
organization, including the formation of a partnership or	517
corporation from a sole proprietorship;	518

(b) A transfer of all the exiting operator's ownership	519
interest in the operation of the facility to the entering	520
operator, regardless of whether ownership of any or all of the	521
real property or personal property associated with the facility is	522
also transferred;	523

(c) A lease of the facility to the entering operator or the	524
exiting operator's termination of the exiting operator's lease;	525

(d) If the exiting operator is a partnership, dissolution of	526
the partnership;	527

(e) If the exiting operator is a partnership, a change in	528
composition of the partnership unless both of the following apply:	529

(i) The change in composition does not cause the	530
partnership's dissolution under state law.	531

(ii) The partners agree that the change in composition does	532
not constitute a change in operator.	533

(f) If the operator is a corporation, dissolution of the	534
corporation, a merger of the corporation into another corporation	535
that is the survivor of the merger, or a consolidation of one or	536
more other corporations to form a new corporation.	537

(2) The following, alone, do not constitute a change of	538
operator:	539

(a) A contract for an entity to manage a nursing facility or	540
intermediate care facility for the mentally retarded as the	541
operator's agent, subject to the operator's approval of daily	542
operating and management decisions;	543

(b) A change of ownership, lease, or termination of a lease	544
of real property or personal property associated with a nursing	545
facility or intermediate care facility for the mentally retarded	546
if an entering operator does not become the operator in place of	547
an exiting operator;	548

(c) If the operator is a corporation, a change of one or more	549
members of the corporation's governing body or transfer of	550
ownership of one or more shares of the corporation's stock, if the	551
same corporation continues to be the operator.	552

(B)(C) "Effective date of a change of operator" means the day	553
the entering operator becomes the operator of the nursing facility	554
or intermediate care facility for the mentally retarded.	555

(C)(D) "Effective date of a facility closure" means the last	556
day that the last of the residents of the nursing facility or	557
intermediate care facility for the mentally retarded resides in	558
the facility.	559

(D)(E) "Effective date of a voluntary termination" means the	560
day the intermediate care facility for the mentally retarded	561
ceases to accept medicaid patients.	562

(E)(F) "Effective date of a voluntary withdrawal of	563
participation" means the day the nursing facility ceases to accept	564
new medicaid patients other than the individuals who reside in the	565
nursing facility on the day before the effective date of the	566
voluntary withdrawal of participation.	567

(F)(G) "Entering operator" means the person or government	568
entity that will become the operator of a nursing facility or	569
intermediate care facility for the mentally retarded when a change	570
of operator occurs.	571

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

572

(1) An operator that will cease to be the operator of a	573
nursing facility or intermediate care facility for the mentally	574
retarded on the effective date of a change of operator;	575

(2) An operator that will cease to be the operator of a	576
nursing facility or intermediate care facility for the mentally	577
retarded on the effective date of a facility closure;	578

(3) An operator of an intermediate care facility for the	579
mentally retarded that is undergoing or has undergone a voluntary	580
termination;	581

(4) An operator of a nursing facility that is undergoing or	582
has undergone a voluntary withdrawal of participation.	583

(H)(I)(1) "Facility closure" means discontinuance of the use	584
of the building, or part of the building, that houses the	585
facility as a nursing facility or intermediate care facility for	586
the mentally retarded that results in the relocation of all of	587
the facility's residents. A facility closure occurs regardless of	588
any of the following:	589

(a) The operator completely or partially replacing the	590
facility by constructing a new facility or transferring the	591
facility's license to another facility;	592

(b) The facility's residents relocating to another of the	593
operator's facilities;	594

(c) Any action the department of health takes regarding the	595
facility's certification under Title XIX of the "Social Security	596
Act," 79 Stat. 286 (1965), 42 U.S.C. 1396, as amended, that may	597
result in the transfer of part of the facility's survey findings	598
to another of the operator's facilities;	599

(d) Any action the department of health takes regarding the	600
facility's license under Chapter 3721. of the Revised Code;	601

(e) Any action the department of mental retardation and	602
developmental disabilities takes regarding the facility's license	603
under section 5123.19 of the Revised Code.	604

(2) A facility closure does not occur if all of the	605
facility's residents are relocated due to an emergency evacuation	606
and one or more of the residents return to a medicaid-certified	607
bed in the facility not later than thirty days after the	608
evacuation occurs.	609

(I)(J) "Fiscal year," "franchise permit fee," "intermediate	610
care facility for the mentally retarded," "nursing facility,"	611
"operator," "owner," and "provider agreement" have the same	612
meanings as in section 5111.20 of the Revised Code.	613

(J)(K) "Voluntary termination" means an operator's voluntary	614
election to terminate the participation of an intermediate care	615
facility for the mentally retarded in the medicaid program but to	616
continue to provide service of the type provided by a residential	617
facility as defined in section 5123.19 of the Revised Code.	618

(K)(L) "Voluntary withdrawal of participation" means an	619
operator's voluntary election to terminate the participation of a	620
nursing facility in the medicaid program but to continue to	621
provide service of the type provided by a nursing facility.	622

Sec. 5111.651. Sections 5111.65 to 5111.6885111.689 of the	623
Revised Code do not apply to a nursing facility or intermediate	624
care facility for the mentally retarded that undergoes a facility	625
closure, voluntary termination, voluntary withdrawal of	626
participation, or change of operator on or before September 30,	627
2005, if the exiting operator provided written notice of the	628
facility closure, voluntary termination, voluntary withdrawal of	629
participation, or change of operator to the department of job and	630
family services on or before June 30, 2005.	631

Sec. 5111.68. (A) On receipt of a written notice under	632
section 5111.66 of the Revised Code of a facility closure,	633
voluntary termination, or voluntary withdrawal of participation or	634
a written notice under section 5111.67 of the Revised Code of a	635
change of operator, the department of job and family services	636
shall determineestimate the amount of any overpayments made under	637
the medicaid program to the exiting operator, including	638
overpayments the exiting operator disputes, and other actual and	639
potential debts the exiting operator owes or may owe to the	640
department and United States centers for medicare and medicaid	641
services under the medicaid program, including a franchise permit	642
fee. In determining	643

(B) In estimating the exiting operator's other actual and	644
potential debts to the department and the United States centers	645
for medicare and medicaid services under the medicaid program,	646
the department shall includeuse a debt estimation methodology	647
the director of job and family services shall establish in rules	648
adopted under section 5111.689 of the Revised Code. The	649
methodology shall provide for estimating all of the following that	650
the department determines isare applicable:	651

(1) Refunds due the department under section 5111.27 of the	652
Revised Code;	653

(2) Interest owed to the department and United States centers	654
for medicare and medicaid services;	655

(3) Final civil monetary and other penalties for which all	656
right of appeal has been exhausted;	657

(4) Money owed the department and United States centers for	658
medicare and medicaid services from any outstanding final fiscal	659
audit, including a final fiscal audit for the last fiscal year or	660
portion thereof in which the exiting operator participated in the	661
medicaid program;	662

(5) Other amounts the department determines are applicable.

663

(B) If the department is unable to determine the amount of	664
the overpayments and other debts for any period before the	665
effective date of the entering operator's provider agreement or	666
the effective date of the facility closure, voluntary termination,	667
or voluntary withdrawal of participation, the department shall	668
make a reasonable estimate of the overpayments and other debts for	669
the period. The department shall make the estimate using	670
information available to the department, including prior	671
determinations of overpayments and other debts.	672

(C) The department shall provide the exiting operator written	673
notice of the department's estimate under division (A) of this	674
section not later than thirty days after the department receives	675
the notice under section 5111.66 of the Revised Code of the	676
facility closure, voluntary termination, or voluntary withdrawal	677
of participation or the notice under section 5111.67 of the	678
Revised Code of the change of operator. The department's written	679
notice shall include the basis for the estimate.	680

Sec. 5111.681. (A) Except as provided in divisiondivisions	681
(B) and (C) of this section, the department of job and family	682
services shallmay withhold the greater of the following from	683
payment due an exiting operator under the medicaid program:	684

(1) Thethe total amount of any overpayments made under the	685
medicaid program to the exiting operator, including overpayments	686
the exiting operator disputes, and other actual and potential	687
debts, including any unpaid penalties,specified in the notice	688
provided under division (C) of section 5111.68 of the Revised Code	689
that the exiting operator owes or may owe to the department and	690
United States centers for medicare and medicaid services under	691
the medicaid program;	692

(2) An amount equal to the average amount of monthly payments	693
to the exiting operator under the medicaid program for the	694
twelve-month period immediately preceding the month that includes	695
the last day the exiting operator's provider agreement is in	696
effect or, in the case of a voluntary withdrawal of participation,	697
the effective date of the voluntary withdrawal of participation.	698

(B) TheIn the case of a change of operator and subject to	699
division (D) of this section, the following shall apply regarding	700
a withholding under division (A) of this section if the exiting	701
operator or entering operator or an affiliated operator executes	702
a successor liability agreement meeting the requirements of	703
division (E) of this section:	704

(1) If the exiting operator, entering operator, or affiliated	705
operator assumes liability for the total, actual amount of debt	706
the exiting operator owes the department and the United States	707
centers for medicare and medicaid services under the medicaid	708
program as determined under section 5111.685 of the Revised Code,	709
the department may chooseshall not to make the withholding	710
under division (A) of this section if an entering operator does	711
both of the following:	712

(1) Enters into a nontransferable, unconditional, written	713
agreement with the department to pay the department any debt the	714
exiting operator owes the department under the medicaid program;	715

(2) Provides the department a copy of the entering operator's	716
balance sheet that assists the department in determining whether	717
to make the withholding under division (A) of this section.	718

(2) If the exiting operator, entering operator, or affiliated	719
operator assumes liability for only the portion of the amount	720
specified in division (B)(1) of this section that represents the	721
franchise permit fee the exiting operator owes, the department	722
shall withhold not more than the difference between the total	723
amount specified in the notice provided under division (C) of	724
section 5111.68 of the Revised Code and the amount for which the	725
entering operator or affiliated operator assumes liability.	726

(C) In the case of a voluntary termination, voluntary	727
withdrawal of participation, or facility closure and subject to	728
division (D) of this section, the following shall apply regarding	729
a withholding under division (A) of this section if the exiting	730
operator or an affiliated operator executes a successor	731
liability agreement meeting the requirements of division (E) of	732
this section:	733

(1) If the exiting operator or affiliated operator assumes	734
liability for the total, actual amount of debt the exiting	735
operator owes the department and the United States centers for	736
medicare and medicaid services under the medicaid program as	737
determined under section 5111.685 of the Revised Code, the	738
department shall not make the withholding.	739

(2) If the exiting operator or affiliated operator assumes	740
liability for only the portion of the amount specified in	741
division (C)(1) of this section that represents the franchise	742
permit fee the exiting operator owes, the department shall	743
withhold not more than the difference between the total amount	744
specified in the notice provided under division (C) of section	745
5111.68 of the Revised Code and the amount for which the exiting	746
operator or affiliated operator assumes liability.	747

(D) For an exiting operator or affiliated operator to be	748
eligible to enter into a successor liability agreement under	749
division (B) or (C) of this section, both of the following must	750
apply:	751

(1) The exiting operator or affiliated operator must have one	752
or more valid provider agreements, other than the provider	753
agreement for the nursing facility or intermediate care facility	754
for the mentally retarded that is the subject of the voluntary	755
termination, voluntary withdrawal of participation, facility	756
closure, or change of operator;	757

(2) During the twelve-month period preceding the month in	758
which the department receives the notice of the voluntary	759
termination, voluntary withdrawal of participation, or facility	760
closure under section 5111.66 of the Revised Code or the notice of	761
the change of operator under section 5111.67 of the Revised Code,	762
the average monthly medicaid payment made to the exiting operator	763
or affiliated operator pursuant to the exiting operator's or	764
affiliated operator's one or more provider agreements, other than	765
the provider agreement for the nursing facility or intermediate	766
care facility for the mentally retarded that is the subject of the	767
voluntary termination, voluntary withdrawal of participation,	768
facility closure, or change of operator, must equal at least	769
ninety per cent of the sum of the following:	770

(a) The average monthly medicaid payment made to the exiting	771
operator pursuant to the exiting operator's provider agreement for	772
the nursing facility or intermediate care facility for the	773
mentally retarded that is the subject of the voluntary	774
termination, voluntary withdrawal of participation, facility	775
closure, or change of operator;	776

(b) Whichever of the following apply:

777

(i) If the exiting operator or affiliated operator has	778
assumed liability under one or more other successor liability	779
agreements, the total amount for which the exiting operator or	780
affiliated operator has assumed liability under the other	781
successor liability agreements;	782

(ii) If the exiting operator or affiliated operator has not	783
assumed liability under any other successor liability agreements,	784
zero.	785

(E) A successor liability agreement executed under this	786
section must comply with all of the following:	787

(1) It must provide for the operator who executes the	788
successor liability agreement to assume liability for either of	789
the following as specified in the agreement:	790

(a) The total, actual amount of debt the exiting operator	791
owes the department and the United States centers for medicare and	792
medicaid services under the medicaid program as determined under	793
section 5111.685 of the Revised Code;	794

(b) The portion of the amount specified in division (E)(1)(a)	795
of this section that represents the franchise permit fee the	796
exiting operator owes.	797

(2) It may not require the operator who executes the	798
successor liability agreement to furnish a surety bond.	799

(3) It must provide that the department, after determining	800
under section 5111.685 of the Revised Code the actual amount of	801
debt the exiting operator owes the department and United States	802
centers for medicare and medicaid services under the medicaid	803
program, may deduct the lesser of the following from medicaid	804
payments made to the operator who executes the successor liability	805
agreement:	806

(a) The total, actual amount of debt the exiting operator	807
owes the department and the United States centers for medicare and	808
medicaid services under the medicaid program as determined under	809
section 5111.685 of the Revised Code;	810

(b) The amount for which the operator who executes the	811
successor liability agreement assumes liability under the	812
agreement.	813

(4) It must provide that the deductions authorized by	814
division (E)(3) of this section are to be made for a number of	815
months, not to exceed six, agreed to by the operator who executes	816
the successor liability agreement and the department or, if the	817
operator who executes the successor liability agreement and	818
department cannot agree on a number of months that is less than	819
six, a greater number of months determined by the attorney general	820
pursuant to a claims collection process authorized by statute of	821
this state.	822

(5) It must provide that, if the attorney general determines	823
the number of months for which the deductions authorized by	824
division (E)(3) of this section are to be made, the operator who	825
executes the successor liability agreement shall pay, in addition	826
to the amount collected pursuant to the attorney general's claims	827
collection process, the part of the amount so collected that, if	828
not for division (G) of this section, would be required by section	829
109.081 of the Revised Code to be paid into the attorney general	830
claims fund.	831

(F) Execution of a successor liability agreement does not	832
waive an exiting operator's right to contest the amount specified	833
in the notice the department provides the exiting operator under	834
division (C) of section 5111.68 of the Revised Code.	835

(G) Notwithstanding section 109.081 of the Revised Code, the	836
entire amount that the attorney general, whether by employees or	837
agents of the attorney general or by special counsel appointed	838
pursuant to section 109.08 of the Revised Code, collects under a	839
successor liability agreement, other than the additional amount	840
the operator who executes the agreement is required by division	841
(E)(5) of this section to pay, shall be paid to the department of	842
job and family services for deposit into the appropriate fund. The	843
additional amount that the operator is required to pay shall be	844
paid into the state treasury to the credit of the attorney general	845
claims fund created under section 109.081 of the Revised Code.	846

Sec. 5111.685. The department of job and family services	847
shall determine the actual amount of debt an exiting operator owes	848
the department and the United States centers for medicare and	849
medicaid services under the medicaid program by completing all	850
final fiscal audits not already completed and performing all	851
other appropriate actions the department determines to be	852
necessary. The department shall issue aan initial debt summary	853
report on this matter not later than ninetysixty days after the	854
date the exiting operator files the properly completed cost	855
report required by section 5111.682 of the Revised Code with the	856
department or, if the department waives the cost report	857
requirement for the exiting operator, ninetysixty days after the	858
date the department waives the cost report requirement. The	859
report shall include the department's findings and the amount of	860
debt the department determines the exiting operator owes the	861
department and United States centers for medicare and medicaid	862
services under the medicaid program. Only the parts of the report	863
that are subject to an adjudication as specified in section	864
5111.30 of the Revised Code are subject to an adjudication	865
conductedThe initial debt summary report becomes the final debt	866
summary report thirty-one days after the department issues the	867
initial debt summary report unless the exiting operator, or an	868
affiliated operator who executes a successor liability agreement	869
under section 5111.681 of the Revised Code, requests a review	870
before that date.	871

The exiting operator, and an affiliated operator who	872
executes a successor liability agreement under section 5111.681	873
of the Revised Code, may request a review to contest any of the	874
department's findings included in the initial debt summary	875
report. The request for the review must be submitted to the	876
department not later than thirty days after the date the	877
department issues the initial debt summary report. The department	878
shall conduct the review on receipt of a timely request and issue	879
a revised debt summary report. If the department has withheld	880
money from payment due the exiting operator under division (A) of	881
section 5111.681 of the Revised Code, the department shall issue	882
the revised debt summary report not later than ninety days after	883
the date the department receives the timely request for the	884
review unless the department and exiting operator or affiliated	885
operator agree to a later date. The exiting operator or	886
affiliated operator may submit information to the department	887
explaining what the operator contests before and during the	888
review, including documentation of the amount of any debt the	889
department owes the operator. The exiting operator or	890
affiliated operator may submit additional information to the	891
department not later than thirty days after the department issues	892
the revised debt summary report. The revised debt summary report	893
becomes the final debt summary report thirty-one days after the	894
department issues the revised debt summary report unless the	895
exiting operator or affiliated operator timely submits additional	896
information to the department. If the exiting operator or	897
affiliated operator timely submits additional information to the	898
department, the department shall consider the additional	899
information and issue a final debt summary report not later than	900
sixty days after the department issues the revised debt summary	901
report unless the department and exiting operator or affiliated	902
operator agree to a later date.	903

Each debt summary report the department issues under this	904
section shall include the department's findings and the amount	905
of debt the department determines the exiting operator owes the	906
department and United States centers for medicare and medicaid	907
services under the medicaid program. The department shall	908
explain its findings and determination in each debt summary	909
report.	910

The exiting operator, and an affiliated operator who	911
executes a successor liability agreement under section 5111.681	912
of the Revised Code, may request, in accordance with Chapter 119.	913
of the Revised Code, an adjudication regarding a finding in a	914
final debt summary report that pertains to an audit or alleged	915
overpayment made under the medicaid program to the exiting	916
operator. The adjudication shall be consolidated with any other	917
uncompleted adjudication that concerns a matter addressed in the	918
final debt summary report.	919

Sec. 5111.686. The department of job and family services	920
shall release the actual amount withheld under division (A) of	921
section 5111.681 of the Revised Code, less any amount the exiting	922
operator owes the department and United States centers for	923
medicare and medicaid services under the medicaid program, as	924
follows:	925

(A) Ninety-one days after the date the exiting operator files	926
a properly completed cost report required by section 5111.682 of	927
the Revised Code unlessUnless the department issues the initial	928
debt summary report required by section 5111.685 of the Revised	929
Code not later than ninetysixty days after the date the exiting	930
operator files the properly completed cost report required by	931
section 5111.682 of the Revised Code, sixty-one days after the	932
date the exiting operator files the properly completed cost	933
report;	934

(B) Not later than thirty days after the exiting operator	935
agrees to a final fiscal audit resulting from the report required	936
by section 5111.685 of the Revised Code ifIf the department	937
issues the initial debt summary report required by section	938
5111.685 of the Revised Code not later than ninetysixty days	939
after the date the exiting operator files a properly completed	940
cost report required by section 5111.682 of the Revised Code, not	941
later than the following:	942

(1) Thirty days after the deadline for requesting an	943
adjudication under section 5111.685 of the Revised Code regarding	944
the final debt summary report if the exiting operator, and an	945
affiliated operator who executes a successor liability	946
agreement under section 5111.681 of the Revised Code, fail to	947
request the adjudication on or before the deadline;	948

(2) Thirty days after the completion of an adjudication of	949
the final debt summary report if the exiting operator, or an	950
affiliated operator who executes a successor liability agreement	951
under section 5111.681 of the Revised Code, requests the	952
adjudication on or before the deadline for requesting the	953
adjudication.	954

(C) Ninety-one days after the date the department waives the	955
cost report requirement of section 5111.682 of the Revised Code	956
unlessUnless the department issues the initial debt summary	957
report required by section 5111.685 of the Revised Code not later	958
than ninetysixty days after the date the department waives the	959
cost report requirement of section 5111.682 of the Revised Code,	960
sixty-one days after the date the department waives the cost	961
report requirement;	962

(D) Not later than thirty days after the exiting operator	963
agrees to a final fiscal audit resulting from the report required	964
by section 5111.685 of the Revised Code ifIf the department	965
issues the initial debt summary report required by section	966
5111.685 of the Revised Code not later than ninetysixty days	967
after the date the department waives the cost report requirement	968
of section 5111.682 of the Revised Code, not later than the	969
following:	970

(1) Thirty days after the deadline for requesting an	971
adjudication under section 5111.685 of the Revised Code regarding	972
the final debt summary report if the exiting operator, and an	973
affiliated operator who executes a successor liability	974
agreement under section 5111.681 of the Revised Code, fail to	975
request the adjudication on or before the deadline;	976

(2) Thirty days after the completion of an adjudication of	977
the final debt summary report if the exiting operator, or an	978
affiliated operator who executes a successor liability agreement	979
under section 5111.681 of the Revised Code, requests the	980
adjudication on or before the deadline for requesting the	981
adjudication.	982

Sec. 5111.688. (A) All amounts withheld under section	983
5111.681 of the Revised Code from payment due an exiting operator	984
under the medicaid program shall be deposited into the medicaid	985
payment withholding fund created by the controlling board pursuant	986
to section 131.35 of the Revised Code. Money in the fund shall be	987
used as follows:	988

(1) To pay an exiting operator when a withholding is released	989
to the exiting operator under section 5111.686 or 5111.687 of the	990
Revised Code;	991

(2) To pay the department of job and family services and	992
United States centers for medicare and medicaid services the	993
amount an exiting operator owes the department and United States	994
centers under the medicaid program.	995

(B) Amounts paid from the medicaid payment withholding fund	996
pursuant to division (A)(2) of this section shall be deposited	997
into the appropriate department fund.	998

Sec. 5111.688.        Sec. 5111.689.  The director of job and family	999
services shall adopt rules under section 5111.02 of the Revised	1000
Code to implement sections 5111.65 to 5111.6885111.689 of the	1001
Revised Code, including rules applicable to an exiting operator	1002
that provides written notification under section 5111.66 of the	1003
Revised Code of a voluntary withdrawal of participation. Rules	1004
adopted under this section shall comply with section	1005
1919(c)(2)(F) of the "Social Security Act," 79 Stat. 286 (1965),	1006
42 U.S.C. 1396r(c)(2)(F), regarding restrictions on transfers or	1007
discharges of nursing facility residents in the case of a	1008
voluntary withdrawal of participation. The rules may prescribe a	1009
medicaid reimbursement methodology and other procedures that are	1010
applicable after the effective date of a voluntary withdrawal of	1011
participation that differ from the reimbursement methodology and	1012
other procedures that would otherwise apply.	1013

Sec. 5111.894. (A) The state administrative agency may	1014
establish one or more waiting lists for the assisted living	1015
program. Only individuals eligible for the medicaidassisted	1016
living program may be placed on a waiting list.	1017

(B) The state administrative agency shall establish a home	1018
first component of the assisted living program under which	1019
eligible individuals may be enrolled in the assisted living	1020
program in accordance with this section. An individual is eligible	1021
for the assisted living program's home first component if the	1022
individual is on an assisted living program waiting list and at	1023
least one of the following applies:	1024

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

1025

(2) A physician has determined and documented in writing that	1026
the individual has a medical condition that, unless enrolled in	1027
home and community-based services such as the assisted living	1028
program, will require the individual to be admitted to a nursing	1029
facility within thirty days of the physician's determination;	1030

(3) The individual has been hospitalized and a physician has	1031
determined and documented in writing that, unless the individual	1032
is enrolled in home and community-based services such as the	1033
assisted living program, the individual is to be transported	1034
directly from the hospital to a nursing facility admitted;	1035

(4) Both of the following apply:

1036

(a) The individual is the subject of a report made under	1037
section 5101.61 of the Revised Code regarding abuse, neglect, or	1038
exploitation or such a report referred to a county department of	1039
job and family services under section 5126.31 of the Revised Code	1040
or has made a request to a county department for protective	1041
services as defined in section 5101.60 of the Revised Code;	1042

(b) A county department of job and family services and an	1043
area agency on aging have jointly documented in writing that,	1044
unless the individual is enrolled in home and community-based	1045
services such as the assisted living program, the individual	1046
should be admitted to a nursing facility;	1047

(5) The individual resided in a residential care facility for	1048
at least six months immediately before applying for the assisted	1049
living program and is at risk of imminent admission to a nursing	1050
facility because the costs of residing in the residential care	1051
facility have depleted the individual's resources such that the	1052
individual is unable to continue to afford the cost of residing in	1053
the residential care facility.	1054

(C) Each month, each area agency on aging shall determine	1055
whether any individual who residesidentify individuals residing	1056
in the area that the area agency on aging serves and is on a	1057
waiting listwho are eligible for the home first component of the	1058
assisted living program has been admitted to a nursing	1059
facility. IfWhen an area agency on aging determines that	1060
identifies such an individual has been admitted to a nursing	1061
facility and determines that there is a vacancy in a residential	1062
care facility participating in the assisted living program that	1063
is acceptable to the individual, the agency shall notify the	1064
long-term care consultation program administrator serving the	1065
area in which the individual resides about the determination.	1066
The administrator shall determine whether the assisted living	1067
program is appropriate for the individual and whether the	1068
individual would rather participate in the assisted living	1069
program than continue residingor begin to reside in thea	1070
nursing facility. If the administrator determines that the	1071
assisted living program is appropriate for the individual and	1072
the individual would rather participate in the assisted living	1073
program than continue residingor begin to reside in thea	1074
nursing facility, the administrator shall so notify the state	1075
administrative agency.	1076

Onagency. On receipt of the notice from the administrator,	1077
the state administrative agency shall approve the individual's	1078
enrollment in the assisted living program regardless of any	1079
waiting list for the assisted living program, unless the	1080
enrollment would cause the assisted living program to exceed any	1081
limit on the number of individuals who may participate in the	1082
program as set by the United States secretary of health and human	1083
services when the medicaid waiver authorizing the program is	1084
approved. Each	1085

(D) Each quarter, the state administrative agency shall	1086
certify to the director of budget and management the estimated	1087
increase in costs of the assisted living program resulting from	1088
enrollment of individuals in the assisted living program	1089
pursuant to this section.	1090

Section 2. That existing sections 173.401, 3702.51, 3702.59,	1091
5111.65, 5111.651, 5111.68, 5111.681, 5111.685, 5111.686,	1092
5111.688, and 5111.894 of the Revised Code are hereby repealed.	1093

Section 3. That Section 209.20 of Am. Sub. H.B. 1 of the	1094
128th General Assembly be amended to read as follows:	1095

Sec. 209.20. LONG-TERM CARE

1096

Pursuant to an interagency agreement, the Department of Job	1097
and Family Services shall designate the Department of Aging to	1098
perform assessments under section 5111.204 of the Revised Code.	1099
The Department of Aging shall provide long-term care consultations	1100
under section 173.42 of the Revised Code to assist individuals in	1101
planning for their long-term health care needs. The foregoing	1102
appropriation items 490423, Long Term Care Budget – State, and	1103
490623, Long Term Care Budget, may be used to provide the	1104
preadmission screening and resident review (PASRR), which includes	1105
screening, assessments, and determinations made under sections	1106
5111.02, 5111.204, 5119.061, and 5123.021 of the Revised Code.	1107

The foregoing appropriation items 490423, Long Term Care	1108
Budget - State, and 490623, Long Term Care Budget, may be used to	1109
assess and provide long-term care consultations to clients	1110
regardless of Medicaid eligibility.	1111

The Director of Aging shall adopt rules under section 111.15	1112
of the Revised Code governing the nonwaiver funded PASSPORT	1113
program, including client eligibility. The foregoing appropriation	1114
item 490423, Long Term Care Budget - State, may be used by the	1115
Department of Aging to provide nonwaiver funded PASSPORT services	1116
to persons the Department has determined to be eligible to	1117
participate in the nonwaiver funded PASSPORT Program, including	1118
those persons not yet determined to be financially eligible to	1119
participate in the Medicaid waiver component of the PASSPORT	1120
Program by a county department of job and family services.	1121

The Department of Aging shall administer the Medicaid	1122
waiver-funded PASSPORT Home Care Program, the Choices Program, the	1123
Assisted Living Program, and the PACE Program as delegated by the	1124
Department of Job and Family Services in an interagency agreement.	1125
The foregoing appropriation item 490423, Long Term Care Budget -	1126
State, shall be used to provide the required state match for	1127
federal Medicaid funds supporting the Medicaid Waiver-funded	1128
PASSPORT Home Care Program, the Choices Program, the Assisted	1129
Living Program, and the PACE Program. The foregoing appropriation	1130
items 490423, Long Term Care Budget - State, and 490623, Long Term	1131
Care Budget, may also be used to support the Department of Aging's	1132
administrative costs associated with operating the PASSPORT,	1133
Choices, Assisted Living, and PACE programs.	1134

The foregoing appropriation item 490623, Long Term Care	1135
Budget, shall be used to provide the federal matching share for	1136
all program costs determined by the Department of Job and Family	1137
Services to be eligible for Medicaid reimbursement.	1138

HOME FIRST PROGRAM

1139

(A) As used in this section, "Long Term Care Budget Services"	1140
includes the following existing programs: PASSPORT, Assisted	1141
Living, Residential State Supplement, and PACE.	1142

(B) On a quarterly basis, on receipt of the certified	1143
expenditures related to sections 173.401, 173.351, and 5111.894 of	1144
the Revised Code during fiscal years 2010 and 2011, the Director	1145
of Budget and Management may do all of the following for fiscal	1146
years 2010 and 2011:	1147

(1) Transfershall transfer cash on a quarterly basis from	1148
the Nursing Facility Stabilization Fund (Fund 5R20), used by the	1149
Department of Job and Family Services, to the	1150
PASSPORT/Residential State Supplement Fund (Fund 4J40), used by	1151
the Department of Aging. The	1152

The transferred cash is hereby appropriated to appropriation	1153
item 490610, PASSPORT/Residential State Supplement.	1154

(2) If receipts credited to the PASSPORT Fund (Fund 3C40)	1155
exceed the amounts appropriated from the fund, the Director of	1156
Aging mayshall request the Director of Budget and Management to	1157
authorize expenditures from the fund in excess of the amounts	1158
appropriated. The Director of Budget and Management shall	1159
authorize the expenditures on receipt of the Director of Aging's	1160
request. Upon the approvalauthorization of the Director of Budget	1161
and Management, the additional amounts are hereby appropriated.	1162

(3) If receipts credited to the Interagency Reimbursement	1163
Fund (Fund 3G50) exceed the amounts appropriated from the fund,	1164
the Director of Job and Family Services mayshall request the	1165
Director of Budget and Management to authorize expenditures from	1166
the fund in excess of the amounts appropriated. The Director of	1167
Budget and Management shall authorize the expenditures on receipt	1168
of the Director of Job and Family Services' request. Upon the	1169
approvalauthorization of the Director of Budget and Management,	1170
the additional amounts are hereby appropriated.	1171

(C) The individuals placed in Long Term Care Budget Services	1172
pursuant to this section shall be in addition to the individuals	1173
placed in Long Term Care Budget Services during fiscal years 2010	1174
and 2011 before any transfers to appropriation item 490423, Long	1175
Term Care Budget-State, are made under this section.	1176

ALLOCATION OF PACE SLOTS

1177

In order to effectively administer and manage growth within	1178
the PACE Program, the Director of Aging may, as the director deems	1179
appropriate and to the extent funding is available, expand the	1180
PACE Program to regions of Ohio beyond those currently served by	1181
the PACE Program. In implementing the expansion, the Director may	1182
not decrease the number of residents of Cuyahoga and Hamilton	1183
counties and parts of Butler, Clermont, and Warren counties who	1184
are participating in the PACE Program below the number of	1185
residents of those counties and parts of counties who were	1186
enrolled in the PACE Program on July 1, 2008.	1187

Section 4. That existing Section 209.20 of Am. Sub. H.B. 1 of	1188
the 128th General Assembly is hereby repealed.	1189