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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 |
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) | 40 |
41 | |
42 | |
43 | |
44 | |
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 | 78 |
79 | |
area that the | 80 |
81 | |
program | 82 |
area agency on aging | 83 |
individual | 84 |
shall notify the long-term care consultation program | 85 |
administrator serving the area in which the individual resides | 86 |
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 | 90 |
91 | |
PASSPORT program is appropriate for the individual and the | 92 |
individual would rather participate in the PASSPORT program than | 93 |
continue | 94 |
the administrator shall so notify the department of aging. On | 95 |
receipt of the notice from the
administrator, the department | 96 |
97 | |
program regardless of the
PASSPORT program's waiting list | 98 |
99 | |
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 |
| 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 |
| 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 | 403 |
404 | |
405 | |
principal participant. | 406 |
| 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, | 410 |
(i) The facility was cited on three or more separate | 411 |
occasions for final, nonappealable actual harm but not immediate | 412 |
jeopardy deficiencies | 413 |
414 | |
415 | |
416 |
| 417 |
418 | |
419 | |
420 | |
separate occasions for final, nonappealable immediate jeopardy | 421 |
deficiencies | 422 |
423 | |
424 | |
425 |
| 426 |
427 | |
428 | |
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 | 434 |
435 | |
the applicant or | 436 |
more than twenty nursing homes in this state, more than ten per | 437 |
cent of those nursing homes, were each cited | 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 |
445 | |
446 | |
447 | |
448 |
| 449 |
450 | |
451 | |
452 | |
453 | |
454 | |
455 | |
456 |
(ii) On two or more separate occasions for final, | 457 |
nonappealable immediate jeopardy deficiencies
| 458 |
459 | |
460 | |
461 | |
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 |
| 466 |
467 | |
468 |
(2) In applying divisions (B)(1)(a) to | 469 |
section, the director shall not consider deficiencies or | 470 |
violations cited before the
| 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 | 476 |
principal participant if the deficiencies or violations were | 477 |
attributable to circumstances that arose under the previous | 478 |
owner or operator and the
| 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 | 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 |
| 553 |
the entering operator becomes the operator of the nursing facility | 554 |
or intermediate care facility for the mentally retarded. | 555 |
| 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 |
| 560 |
day the intermediate care facility for the mentally retarded | 561 |
ceases to accept medicaid patients. | 562 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 | 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 | 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. | 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 | 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 | 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 |
| 664 |
665 | |
666 | |
667 | |
668 | |
669 | |
670 | |
671 | |
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 | 681 |
(B) and (C) of this section, the department of job and family | 682 |
services | 683 |
payment
due an exiting operator under the medicaid program | 684 |
| 685 |
686 | |
687 | |
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 |
| 693 |
694 | |
695 | |
696 | |
697 | |
698 |
(B) | 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 | 710 |
711 | |
712 |
| 713 |
714 | |
715 |
| 716 |
717 | |
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 | 853 |
report on
this matter not
later than | 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, | 858 |
date the department waives the cost report requirement.
| 859 |
860 | |
861 | |
862 | |
863 | |
864 | |
865 | |
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) | 926 |
927 | |
928 | |
debt summary report required by section 5111.685 of the Revised | 929 |
Code not later than | 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) | 935 |
936 | |
937 | |
issues the initial debt summary report required by section | 938 |
5111.685 of the Revised Code not later than | 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) | 955 |
956 | |
957 | |
report required by section 5111.685 of the Revised Code not later | 958 |
than | 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) | 963 |
964 | |
965 | |
issues the initial debt summary report required by section | 966 |
5111.685 of the Revised Code not later than | 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 |
| 999 |
services shall adopt rules under section 5111.02 of the Revised | 1000 |
Code
to
implement sections 5111.65 to | 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 | 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 | 1055 |
1056 | |
in the area
that the area
agency on aging serves | 1057 |
1058 | |
assisted
living program | 1059 |
1060 | |
identifies such
an
individual | 1061 |
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 | 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
| 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
| 1074 |
nursing facility, the administrator shall so notify the state | 1075 |
administrative | 1076 |
| 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. | 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 | 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 | 1146 |
1147 |
| 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 |
| 1153 |
item 490610, PASSPORT/Residential State Supplement. | 1154 |
| 1155 |
exceed the amounts appropriated from the fund, the Director of | 1156 |
Aging | 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 | 1161 |
and Management, the additional amounts are hereby appropriated. | 1162 |
| 1163 |
Fund (Fund 3G50) exceed the amounts appropriated from the fund, | 1164 |
the Director of Job and Family Services | 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 |
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 |