Section 1. That section 109.02 be amended and sections | 7 |
3922.01, 3922.02, 3922.03, 3922.04, 3922.05, 3922.06, 3922.07, | 8 |
3922.08, 3922.09, 3922.10, 3922.11, 3922.12, 3922.13, 3922.14, | 9 |
3922.15, 3922.21, 3922.22, 3922.23, 3922.24, 3922.25, 3922.26, | 10 |
3922.27, 3922.28, 3922.31, 3922.32, and 3922.33 of the Revised | 11 |
Code be enacted to read as follows: | 12 |
Sec. 109.02. The attorney general is the chief law officer | 13 |
for the state and all its departments and shall be provided with | 14 |
adequate office space in Columbus. Except as provided in division | 15 |
(E) of section 120.06 and in sections 3517.152 to 3517.157 and | 16 |
3922.04 of the Revised Code, no state officer or board, or head of | 17 |
a department or institution of the state shall employ, or be | 18 |
represented by, other counsel or attorneys at law. The attorney | 19 |
general shall appear for the state in the trial and argument of | 20 |
all civil and criminal causes in the supreme court in which the | 21 |
state is directly or indirectly interested. When required by the | 22 |
governor or the general assembly, the attorney general shall | 23 |
appear for the state in any court or tribunal in a cause in which | 24 |
the state is a party, or in which the state is directly | 25 |
interested. Upon the written request of the governor, the attorney | 26 |
general shall prosecute any person indicted for a crime. | 27 |
(B) "Health care facility" means any facility, except a | 34 |
health care practitioner's office, that provides preventive, | 35 |
diagnostic, therapeutic, acute convalescent, rehabilitation, | 36 |
mental health, mental retardation, intermediate care, or skilled | 37 |
nursing services. | 38 |
(C) "Provider" means a hospital or other health care | 39 |
facility, and physicians, podiatrists, dentists, pharmacists, | 40 |
chiropractors, and other health care personnel, licensed, | 41 |
certified, accredited, or otherwise authorized in this state to | 42 |
furnish health care services. | 43 |
(2) The Ohio health care plan shall provide universal and | 47 |
affordable health care coverage for all Ohio residents, consisting | 48 |
of a comprehensive benefit package that includes benefits for | 49 |
prescription drugs. The Ohio health care plan shall work | 50 |
simultaneously to control health care costs, control health care | 51 |
spending, achieve measurable improvement in health care outcomes, | 52 |
increase all parties' satisfaction with the health care system, | 53 |
implement policies that strengthen and improve culturally and | 54 |
linguistically sensitive care, and develop an integrated health | 55 |
care database to support health care planning. | 56 |
(B) There is hereby created the Ohio health care agency. The | 57 |
Ohio health care agency shall administer the Ohio health care plan | 58 |
and is the sole agency authorized to accept applicable | 59 |
grants-in-aid from the federal and state government, using the | 60 |
funds in order to secure full compliance with provisions of state | 61 |
and federal law and to carry out the purposes of sections 3922.01 | 62 |
to 3922.33 of the Revised Code. All grants-in-aid accepted by the | 63 |
Ohio health care agency shall be deposited into the Ohio health | 64 |
care fund established under section 3922.09 of the Revised Code. | 65 |
(2) Region 2: Allen, Auglaize, Defiance, Erie, Fulton, | 76 |
Hancock, Henry, Huron, Lucas, Mercer, Ottawa, Paulding, Putnam, | 77 |
Sandusky, Seneca, Van Wert, Williams, Wood; | 78 |
(3) Region 3: Athens, Belmont, Coshocton, Gallia, Guernsey, | 79 |
Harrison, Hocking, Jackson, Jefferson, Lawrence, Meigs, Monroe, | 80 |
Morgan, Muskingum, Noble, Perry, Pike, Ross, Scioto, Vinton, | 81 |
Washington; | 82 |
(5) Region 5: Crawford, Delaware, Fairfield, Fayette, | 85 |
Franklin, Hardin, Knox, Licking, Logan, Madison, Marion, Morrow, | 86 |
Pickaway, Union, Wyandot; | 87 |
(C)(1) The health commissioner of the most populous county in | 93 |
each region shall convene a meeting of all county and city health | 94 |
commissioners in the region within ninety days following the | 95 |
effective date of this section. If there are two or more health | 96 |
districts located wholly or partially in the most populous county | 97 |
of the region, the health commissioner of the health district with | 98 |
the largest territorial jurisdiction in that county shall convene | 99 |
the meeting of all county and city health commissioners within | 100 |
ninety days following the effective date of this section. | 101 |
(2) At the meeting called pursuant to division (C)(1) of this | 102 |
section, the county and city health commissioners in each region | 103 |
shall elect one resident from each county in the region to | 104 |
represent the county on a regional health advisory committee | 105 |
established for that region. The county and city health | 106 |
commissioners also shall set a date, not sooner than one hundred | 107 |
days and not later than one hundred ten days after the effective | 108 |
date of this section, for the initial meeting of the regional | 109 |
health advisory committee. | 110 |
(D)(1) Each of the seven regional health advisory committees | 124 |
shall elect a chairperson from among the representatives to their | 125 |
committees. Each chairperson shall convene and preside over the | 126 |
initial meeting of that regional health advisory committee on the | 127 |
date set pursuant to division (C) of this section. At the initial | 128 |
meeting of the regional health advisory committees, the | 129 |
committees' representatives shall elect two residents from the | 130 |
region to represent that region as members of the Ohio health care | 131 |
board. One of the two residents elected from each region to serve | 132 |
on the Ohio health care board shall be a resident of the region's | 133 |
most populous county and the other shall be a resident of any | 134 |
county in the region other than the region's most populous county. | 135 |
(2) Annually, beginning in the second year following the | 142 |
initial elections to the Ohio health care board, the chairperson | 143 |
of each regional health advisory committee shall convene a meeting | 144 |
within five calendar days of the same date of the same month as | 145 |
the initial meeting of that regional health advisory committee to | 146 |
elect a resident from the region to serve as a member of the Ohio | 147 |
health care board. The regional health advisory committee shall | 148 |
elect a resident of a county as is necessary to meet the | 149 |
representation requirements set by division (D)(1) of this | 150 |
section. No individual may serve as a member of the Ohio health | 151 |
care board for more than four consecutive terms. | 152 |
(2) The members of the Ohio health care board annually shall | 170 |
elect a member of the board to serve as chairperson at meetings of | 171 |
the board. Meetings shall be held upon the call of the chairperson | 172 |
and as provided by procedures prescribed by the Ohio health care | 173 |
board. Two-thirds of the members of the Ohio health care board | 174 |
shall constitute a quorum for the conduct of business at meetings | 175 |
of the board. Decisions at meetings of the Ohio health care board | 176 |
shall be reached by majority vote. | 177 |
(3) All meetings of the Ohio health care board are open to | 178 |
the public unless questions of patient confidentiality arise. The | 179 |
Ohio health care board may go into closed executive session with | 180 |
regard to issues related to confidential patient information. The | 181 |
fourteen members of the Ohio health care board elected by the | 182 |
regional health advisory committees shall receive an annual salary | 183 |
and benefits established in accordance with division (J) of | 184 |
section 124.15 of the Revised Code. | 185 |
(F) The seven regional health advisory committees shall act | 186 |
as advisory bodies to the Ohio health care board, representing | 187 |
their individual regions. The regional health advisory committees | 188 |
shall oversee the management of consumer and provider complaints | 189 |
originating in their respective regions and shall hold a hearing | 190 |
on all such complaints. The regional health advisory committees | 191 |
shall offer assistance to resolve consumer and provider disputes | 192 |
and shall seek the agreement of all parties to the dispute to | 193 |
submit the dispute to negotiation or binding arbitration. A | 194 |
regional health advisory committee shall transfer any dispute that | 195 |
is not resolved at the regional level to the director of the Ohio | 196 |
health care agency's department of consumer affairs within six | 197 |
months; however, the committee may vote to transfer individual | 198 |
disputes at an earlier date. | 199 |
(G)(1) If a vacancy occurs on the Ohio health care board for | 200 |
any reason, resulting in a region being without full | 201 |
representation on the board, that region's health advisory | 202 |
committee shall elect a resident of that region to fill the | 203 |
vacancy. Any resident elected to fill a vacancy shall serve the | 204 |
remainder of the departing member's term. The health advisory | 205 |
committee shall elect a resident of a county as necessary to meet | 206 |
the representation requirements set by division (D)(1) of this | 207 |
section. | 208 |
(H)(1) The members and staff of the Ohio health care board | 213 |
and employees of the Ohio health care agency, and their immediate | 214 |
families, are prohibited from having any pecuniary interest in any | 215 |
business with a contract, or in negotiation for a contract, with | 216 |
either the Ohio health care board or Ohio health care agency, or | 217 |
that is subject to the Ohio health care board's oversight. The | 218 |
members and staff of the Ohio health care board and employees of | 219 |
the Ohio health care agency shall not receive remuneration for | 220 |
health care service of any kind during their term of service or | 221 |
employment. The members and staff of the Ohio health care board | 222 |
and employees of the Ohio health care agency, and their immediate | 223 |
families, shall not receive consulting fees of any kind from any | 224 |
source that is directly or indirectly related to the delivery of | 225 |
health care services pursuant to the Ohio health care plan. The | 226 |
members and staff of the Ohio health care board and employees of | 227 |
the Ohio health care agency, and their immediate families, are | 228 |
prohibited from owning stock in, and from investing in mutual | 229 |
funds holding stock in, pharmaceutical companies, health | 230 |
maintenance organizations, or other businesses that relate | 231 |
directly or indirectly to the delivery of health care services, | 232 |
unless the stock or mutual funds are in a blind trust. | 233 |
(3) The chairperson of the Ohio health care board may conduct | 240 |
hearings to determine if a violation of this division has | 241 |
occurred. Notice of any hearing, the conduct of the hearing, and | 242 |
all other matters relating to the holding of the hearing shall be | 243 |
governed by Chapter 119. of the Revised Code. If a member of the | 244 |
Ohio health care board, or of the member's immediate family, is | 245 |
found to have violated this division, the chairperson of the Ohio | 246 |
health care board of health shall remove the member from the Ohio | 247 |
health care board. If a staffer of the Ohio health care board or | 248 |
an employee of the Ohio health care agency, or a member of the | 249 |
staffer's or employee's immediate family, is found to have | 250 |
violated this division, the Ohio health care board or Ohio health | 251 |
care agency shall take appropriate disciplinary action against the | 252 |
staffer or employee, which action may include termination of | 253 |
employment. | 254 |
Sec. 3922.04. (A) The Ohio health care board is responsible | 258 |
for directing the Ohio health care agency in the performance of | 259 |
all duties, the exercise of all powers, and the assumption and | 260 |
discharge of all functions vested in the Ohio health care agency. | 261 |
The Ohio health care board shall adopt rules in accordance with | 262 |
Chapter 119. of the Revised Code as needed to carry out the | 263 |
purposes of, and to enforce, Chapter 3922. of the Revised Code. | 264 |
(10) Reporting annually to the general assembly and the | 292 |
governor, on or before the first day of October, on the | 293 |
performance of the Ohio health care plan, the fiscal condition of | 294 |
the Ohio health care plan, any need for rate adjustments, | 295 |
recommendations for statutory changes, the receipt of payments | 296 |
from the federal government, whether current year goals and | 297 |
priorities were met, future goals and priorities, and major new | 298 |
technology or prescription drugs that may affect the cost of the | 299 |
health care services provided by the Ohio health care plan; | 300 |
(g) Establishing methods for the recovery of costs for health | 331 |
care services provided pursuant to the Ohio health care plan to a | 332 |
participant that are covered under the terms of a policy of | 333 |
insurance, a health benefit plan, or other collateral source | 334 |
available to the participant under which the participant has a | 335 |
right of action for compensation. Receipt of health care services | 336 |
pursuant to the Ohio health care plan shall be deemed an | 337 |
assignment by the participant of any right to payment for services | 338 |
from any policy, plan, or other source. The other source of health | 339 |
care benefits shall pay to the Ohio health care fund all amounts | 340 |
it is obligated to pay to the participant for covered health care | 341 |
services. The Ohio health care board may commence any action | 342 |
necessary to recover the amounts due. | 343 |
(16) Appointing a technical and medical advisory board. The | 344 |
members of the technical and medical advisory board shall | 345 |
represent a cross section of the medical and provider community | 346 |
and consumers, and shall include two persons, one being a provider | 347 |
and the other representing consumers, from each region designated | 348 |
in section 3922.03 of the Revised Code. The members of the | 349 |
technical and medical advisory board shall be reimbursed for | 350 |
actual and necessary expenses incurred in the performance of their | 351 |
duties. The technical and medical advisory board's duties include: | 352 |
(C) The Ohio health care board shall employ and fix the | 364 |
compensation of Ohio health care agency personnel, with the | 365 |
approval of the department of administrative services, as needed | 366 |
by the agency to properly discharge the agency's duties. The | 367 |
employment of personnel by the Ohio health care board is subject | 368 |
to the civil service laws of this state. The Ohio health care | 369 |
board shall employ personnel including, but not limited to, the | 370 |
following: | 371 |
(a) Developing educational and informational guides for | 414 |
consumers that describe consumer rights and responsibilities and | 415 |
that inform consumers of effective ways to exercise consumer | 416 |
rights to obtain health care services. The guides shall be easy to | 417 |
read and understand and available in English and in other | 418 |
languages. The Ohio health care agency shall make the guides | 419 |
available to the public through public outreach and educational | 420 |
programs and through the internet web site of the Ohio health care | 421 |
agency. | 422 |
(2) The administrator of consumer affairs shall work closely | 446 |
with the seven regional health advisory committees on the | 447 |
resolution of complaints. In the discharge of the administrator's | 448 |
duties, the administrator shall have unlimited access to all | 449 |
nonconfidential and nonprivileged documents in the custody and | 450 |
control of the agency. Nothing in Chapter 3922. of the Revised | 451 |
Code prohibits a consumer or class of consumers, or the | 452 |
administrator of consumer affairs, from seeking relief through the | 453 |
courts. | 454 |
Sec. 3922.07. (A) All Ohio residents and individuals | 479 |
employed in Ohio, including the homeless and migrant workers, are | 480 |
eligible for coverage under the Ohio health care plan. The Ohio | 481 |
health care board shall establish standards and a simplified | 482 |
procedure to demonstrate proof of residency. The Ohio health care | 483 |
board shall establish a procedure to enroll eligible residents and | 484 |
employees and to provide each individual covered under the Ohio | 485 |
health care plan with identification that providers may use to | 486 |
determine eligibility for health care services under the Ohio | 487 |
health care plan. | 488 |
(B) If waivers are not obtained under sections 3922.31 to | 489 |
3922.33 of the Revised Code from the medical assistance and | 490 |
medicare programs operated under Title XVIII or XIX of the "Social | 491 |
Security Act," 49 Stat. 20 (1935), 42 U.S.C. 301, as amended, or | 492 |
whenever a necessary waiver is not in effect, the medical | 493 |
assistance and medicare programs shall act as the primary insurers | 494 |
for Ohio residents and individuals employed in this state for | 495 |
health coverage and the Ohio health care plan shall serve as the | 496 |
secondary or supplemental plan of health coverage. When the Ohio | 497 |
health care plan serves as a secondary or supplemental plan of | 498 |
health coverage the Ohio health care plan shall not provide | 499 |
coverage to an Ohio resident or individual employed in this state | 500 |
for any covered health care service that the resident or worker is | 501 |
then eligible to receive under the medical assistance or medicare | 502 |
program. | 503 |
(2) Emergency services, as defined in division (A) of section | 535 |
3923.65 of the Revised Code, twenty-four hours each day on a | 536 |
prudent layperson standard. Residents who are temporarily out of | 537 |
state may receive benefits for emergency services rendered in that | 538 |
state. The Ohio health care agency shall make timely emergency | 539 |
services, including hospital care and triage, available to all | 540 |
Ohio residents, including all residents not enrolled in the Ohio | 541 |
health care plan. | 542 |
(E) The Ohio health care board, with the consent of the | 574 |
technical and medical advisory board, shall remove or exclude | 575 |
procedures and treatments, equipment, and prescription drugs from | 576 |
the Ohio health care plan's benefit package that the board finds | 577 |
unsafe, experimental, of no proven value, or that add no | 578 |
therapeutic value. | 579 |
(F) The Ohio health care board shall exclude coverage for any | 580 |
surgical, orthodontic, or other medical procedure, or prescription | 581 |
drug, that the technical and medical advisory board determines was | 582 |
or will be provided primarily for cosmetic purposes, unless | 583 |
required to correct a congenital defect, to restore or correct | 584 |
disfigurements resulting from injury or disease, or that is | 585 |
determined to be medically necessary by a qualified, licensed | 586 |
provider. | 587 |
(I) The Ohio health care plan and the providers participating | 594 |
in the plan shall not discriminate on the basis of race, color, | 595 |
national origin, gender, age, religion, sexual orientation, health | 596 |
status, mental or physical disability, employment status, veteran | 597 |
status, or occupation. | 598 |
Sec. 3922.09. (A) The Ohio health care fund is hereby | 599 |
established in the state treasury. The administrator of finance of | 600 |
the Ohio health care agency shall administer and monitor the Ohio | 601 |
health care fund. All moneys collected and received by the Ohio | 602 |
health care plan shall be transmitted to the treasurer of state | 603 |
for deposit into the Ohio health care fund, to be used to finance | 604 |
the Ohio health care plan and to pay the costs of compensation and | 605 |
training for displaced workers pursuant to section 3922.11 of the | 606 |
Revised Code. | 607 |
(D) All payments for health care services rendered under the | 618 |
Ohio health care plan shall be disbursed from the Ohio health care | 619 |
fund. The administrator of finance of the Ohio health care agency | 620 |
shall establish a reserve account within the Ohio health care | 621 |
fund. When the revenue available to the Ohio health care plan in | 622 |
any biennium exceeds the total amount expended or obligated during | 623 |
that biennium, the excess revenue shall be transferred to the | 624 |
reserve account. The Ohio health care board may use the money in | 625 |
the reserve account for expenses of the Ohio health care agency or | 626 |
the Ohio health care plan. | 627 |
(E) The administrator of finance of the Ohio health care | 628 |
agency shall notify the Ohio health care board when the annual | 629 |
expenditures or anticipated future expenditures of the Ohio health | 630 |
care plan appear to be in excess of the revenues or anticipated | 631 |
revenues for the same period. The Ohio health care board shall | 632 |
implement appropriate cost control measures based on the | 633 |
notification. The Ohio health care board shall seek a special | 634 |
appropriation for the Ohio health care fund if the cost control | 635 |
measures implemented do not reduce the Ohio health care plan's | 636 |
expenditures to an amount that may be covered by its revenue. | 637 |
Sec. 3922.11. (A) The department of job and family services | 656 |
shall determine which residents of this state employed by a health | 657 |
care insurer, health insuring corporation, or other health care | 658 |
related business, have lost employment as a result of the | 659 |
implementation and operation of the Ohio health care plan. The | 660 |
department also shall determine the amount of monthly wages that | 661 |
the resident lost due to the plan's implementation. The department | 662 |
shall attempt to position these displaced workers in comparable | 663 |
positions of employment with the Ohio health care agency. | 664 |
(B) The department of job and family services shall forward | 665 |
the information on the amount of monthly wages lost by Ohio | 666 |
residents due to the implementation of the Ohio health care plan | 667 |
to the Ohio health care agency. The Ohio health care agency shall | 668 |
determine the amount of compensation and training that each | 669 |
displaced worker shall receive and shall submit a claim to the | 670 |
Ohio health care fund for payment. A displaced worker, however, | 671 |
shall not receive compensation from the Ohio health care fund in | 672 |
excess of sixty thousand dollars per year for two years. | 673 |
Compensation paid to the displaced worker under this section shall | 674 |
serve as a supplement to any compensation the worker receives from | 675 |
the department of job and family services. | 676 |
Sec. 3922.12. (A) Any employer operating in this state and | 677 |
providing employees with benefits under a public or private health | 678 |
care policy, plan, or agreement as of the date that benefits are | 679 |
initially provided pursuant to Chapter 3922. of the Revised Code, | 680 |
which benefits are less valuable than those provided by the Ohio | 681 |
health care plan, may participate in the Ohio health care plan or | 682 |
shall provide additional benefits so that, until the expiration of | 683 |
the policy, plan, or agreement, the benefits provided by the | 684 |
employer at least equal the amount and scope of the benefits | 685 |
provided by the Ohio health care plan. If an employer chooses to | 686 |
provide additional benefits to match or exceed the benefits | 687 |
provided by the Ohio health care plan the additional benefits | 688 |
shall include the employer's payment of any employee premium | 689 |
contributions, copayments, and deductible payments called for by | 690 |
the policy, contract, or agreement. Employers are exempt from all | 691 |
health taxes imposed under Chapter 3922. of the Revised Code until | 692 |
the expiration of the policy, plan, or agreement, at which point | 693 |
the employer and the employer's employees become participants in | 694 |
the Ohio health care plan. | 695 |
(B) A person covered by a health care policy, plan, or | 696 |
agreement that has its premiums paid for in any part with public | 697 |
money, including money from the state, a political subdivision, | 698 |
state educational institution, public school, or other entity, | 699 |
shall be covered by the Ohio health care plan on the day that | 700 |
benefits become available under the Ohio health care plan. | 701 |
(C) Health care insurers, health insuring corporations, and | 702 |
other persons selling or providing health care benefits may | 703 |
deliver, issue for delivery, renew, or provide health benefit | 704 |
packages that do not duplicate the health benefit package provided | 705 |
by the Ohio health care plan, but shall not, except as provided by | 706 |
division (A) of this section, deliver, issue for delivery, renew, | 707 |
or provide health benefit packages that duplicate the health | 708 |
benefit package provided by the Ohio health care plan. | 709 |
(D) The Ohio health care board, with the advice of the | 729 |
technical and medical advisory board and the administrator of | 730 |
quality assurance, shall define performance criteria and goals for | 731 |
the Ohio health care plan and shall report to the general assembly | 732 |
at least annually on the plan's performance. The Ohio health care | 733 |
board shall establish a system to monitor the quality of health | 734 |
care and patient and provider satisfaction with that care and a | 735 |
system to devise improvements to the provision of health care | 736 |
services. | 737 |
Sec. 3922.15. In the absence of fraud or bad faith, county | 747 |
and city health commissioners, regional health advisory | 748 |
committees, and the Ohio health care board and Ohio health care | 749 |
agency and their members and employees, shall incur no liability | 750 |
in relation to the performance of their duties and | 751 |
responsibilities under sections 3922.01 to 3922.15 of the Revised | 752 |
Code. The state shall incur no liability in relation to the | 753 |
implementation and operation of the Ohio health care plan. | 754 |
(B) In preparing the budget, the Ohio health care board shall | 773 |
consider anticipated increased expenditures and savings, | 774 |
including, but not limited to, projected increases in expenditures | 775 |
due to improved access for underserved populations and improved | 776 |
reimbursement for primary care, projected administrative savings | 777 |
under the single-payer mechanism, projected savings in | 778 |
prescription drug expenditures under competitive bidding and a | 779 |
single buyer, and projected savings due to provision of primary | 780 |
care rather than emergency room treatment. | 781 |
The Ohio health care board shall limit administrative costs | 788 |
to five per cent of the system budget and shall annually evaluate | 789 |
methods to reduce administrative costs and report the results of | 790 |
that evaluation to the general assembly. The board shall also | 791 |
limit growth of health care costs in the system budget by | 792 |
reference to changes in state gross domestic product, population, | 793 |
employment rates, and other demographic indicators, as | 794 |
appropriate. Moneys in the reserve account of the Ohio health care | 795 |
fund shall not be considered as available revenues for purposes of | 796 |
preparing the system budget. | 797 |
Sec. 3922.23. (A) The provider budgets referred to in | 818 |
division (A)(2) of section 3922.21 of the Revised Code shall | 819 |
include allocations for fee-for-service providers and capitated | 820 |
providers. These allocations shall consider the relative usage of | 821 |
fee-for-service providers and capitated providers. Each annual | 822 |
provider budget shall include adjustments to reflect changes in | 823 |
the utilization of services and the addition or exclusion of | 824 |
covered services made by the Ohio health care board upon the | 825 |
recommendation of the technical and medical advisory board and its | 826 |
staff. | 827 |
(1) The budget for fee-for-service providers shall be divided | 831 |
among categories of licensed health care providers in order to | 832 |
establish a total annual budget for each category. Each of these | 833 |
category budgets shall be sufficient to cover all included | 834 |
services anticipated to be required by eligible individuals | 835 |
choosing fee-for-service at the rates negotiated or set by the | 836 |
Ohio health care board, except as necessary for cost containment | 837 |
purposes pursuant to section 3922.22 of the Revised Code. | 838 |
(2) The budget shall detail all operating expenses for health | 844 |
care facilities or clinics that are not part of a capitated | 845 |
provider network. In establishing a health care facility budget, | 846 |
the Ohio health care board shall develop and utilize separate | 847 |
formulas that reflect the differences in cost of primary, | 848 |
secondary, and tertiary care services and health care services | 849 |
provided by academic medical centers. The board shall negotiate | 850 |
reimbursement rates with facilities and clinics. Reimbursement | 851 |
rates shall reflect the goals of the system. | 852 |
(C)(1) The budget for capitated providers shall be sufficient | 853 |
to cover all included services anticipated to be required by | 854 |
eligible individuals choosing an integrated health care delivery | 855 |
system at the rates negotiated or set by the Ohio health care | 856 |
board. All health care facilities, group practices, and integrated | 857 |
health care systems shall submit annual operating budget requests | 858 |
to the board and may choose to be reimbursed through a global | 859 |
facility budget or on a capitated basis. The board shall adjust | 860 |
budgets on the basis of the health risk of enrollees; the scope of | 861 |
services provided; proposed innovative programs that improve | 862 |
quality, workplace safety, or consumer, provider, or employee | 863 |
satisfaction; costs of providing care for nonmembers; and an | 864 |
appropriate operating margin. | 865 |
(2) Providers that choose to operate a health care facility | 866 |
on a capitated basis shall not be paid additionally on a | 867 |
fee-for-service basis unless they are providing services in a | 868 |
separate private medical practice or health care facility. | 869 |
Providers and health care facilities that operate on a capitated | 870 |
basis shall report immediately any projected operating deficits to | 871 |
the Ohio health care board. The board shall determine whether the | 872 |
projected deficits reflect appropriate increases in health care | 873 |
needs, in which case the board shall adjust the provider or health | 874 |
care facility budget appropriately. If the board determines that | 875 |
the deficit is not justifiable, no adjustment shall be made. | 876 |
Sec. 3922.24. (A) The capital investment budget referred to | 889 |
in division (A)(3) of section 3922.21 of the Revised Code shall be | 890 |
established by the Ohio health care board, with the advice of the | 891 |
technical and medical advisory board and its staff, and shall | 892 |
provide for capital maintenance and development. In preparing the | 893 |
budget, the Ohio health care board shall determine capital | 894 |
investment priorities and evaluate whether the capital investment | 895 |
program has improved access to services and has eliminated | 896 |
redundant capital investments. | 897 |
(B) All capital investments valued at five hundred thousand | 898 |
dollars or greater, including the costs of studies, surveys, | 899 |
design plans and working drawing specifications, and other | 900 |
activities essential to planning and execution of capital | 901 |
investment, and all capital investments that change the bed | 902 |
capacity of a health care facility or add a new service or license | 903 |
category incurred by any health system entity, shall require the | 904 |
approval of the Ohio health care board. When a health care | 905 |
facility, or individual acting on behalf of a health care | 906 |
facility, or any other purchaser, obtains by lease or comparable | 907 |
arrangement any health care facility or part of a health care | 908 |
facility, or any equipment for a health care facility, the market | 909 |
value of which would have been a capital expenditure, the lease or | 910 |
arrangement shall be considered a capital expenditure for purposes | 911 |
of sections 3922.01 to 3922.15 of the Revised Code. | 912 |
Sec. 3922.26. The research and innovation budget referred to | 928 |
in division (A)(5) of section 3922.21 of the Revised Code shall | 929 |
support research and innovation that has been recommended by the | 930 |
Ohio health care board, the technical and medical advisory board, | 931 |
and the administrator of consumer affairs. This research and | 932 |
innovation includes, but is not limited to, methods for improving | 933 |
the administration of the system, improving the quality of health | 934 |
care, educating patients, and improving communication among health | 935 |
care providers. | 936 |
Sec. 3922.27. The Ohio health care board shall establish a | 937 |
capital account in the Ohio health care fund as part of the Ohio | 938 |
health care plan. Moneys in the account shall be used solely to | 939 |
pay for the establishment and maintenance of a loan program for | 940 |
health care facilities and equipment for use by health care | 941 |
professionals who desire to establish practices in areas of the | 942 |
state in which, according to criteria established by the board, | 943 |
the level of health care services is inadequate. | 944 |
(B) At the request of the Ohio health care board, the Ohio | 981 |
health care agency's executive director shall seek federal | 982 |
financial participation in the Ohio health care plan, including | 983 |
funding otherwise available under medicare, medicaid, CHIP, and | 984 |
the federal employees health benefits program. The executive | 985 |
director shall request that the amount of the federal financial | 986 |
participation be at least equal to the medicaid federal financial | 987 |
participation rate in effect for this state on the effective date | 988 |
of this section. The executive director shall periodically seek | 989 |
adjustments to the federal financial participation rate for the | 990 |
Ohio health care plan to reflect changes in the state domestic | 991 |
gross product, the state's population, including changes in age | 992 |
groups, and the number of residents with income below the federal | 993 |
poverty guidelines. | 994 |
Sec. 3922.32. At the request of the Ohio health care board, | 995 |
the Ohio health care agency's executive director shall negotiate | 996 |
with the United States office of personnel management to have | 997 |
included in the Ohio health care plan residents of this state who | 998 |
would otherwise be covered by the federal employees health | 999 |
benefits program. As part of the negotiations, the executive | 1000 |
director shall seek to have the federal government provide the | 1001 |
Ohio health care plan with amounts equal to the amount federal | 1002 |
employees participating in the Ohio health care plan would | 1003 |
otherwise pay as premiums under the federal employees health | 1004 |
benefits program. | 1005 |
Sec. 3922.33. At the request of the Ohio health care board, | 1006 |
the director of job and family services shall seek any federal | 1007 |
waivers necessary for the Ohio health care plan to receive federal | 1008 |
financial participation under section 3922.31 of the Revised Code | 1009 |
otherwise available under the medicaid and CHIP programs. | 1010 |
Notwithstanding sections 5101.50 to 5101.5110 of the Revised Code | 1011 |
and Chapter 5111. of the Revised Code, the director of job and | 1012 |
family services shall cease to implement the medicaid and CHIP | 1013 |
programs on implementation of federal waivers authorizing the use | 1014 |
of federal medicaid and CHIP funds for the Ohio health care plan, | 1015 |
if necessary due to the implementation of the waivers. | 1016 |
Section 3. In the first two years following the effective | 1019 |
date of sections 3922.01 to 3922.33 of the Revised Code, the Ohio | 1020 |
Health Care Board shall prepare for the delivery of universal, | 1021 |
affordable health care coverage to all eligible Ohio residents and | 1022 |
individuals employed in Ohio. The Ohio Health Care Board shall | 1023 |
appoint a Transition Advisory Group to assist with the transition | 1024 |
to the provision of care under the Ohio Health Care Plan. The | 1025 |
transition group shall include, but is not limitedto, a broad | 1026 |
selection of experts in health care finance and administration, | 1027 |
providers from a variety of medical fields, representatives of | 1028 |
Ohio's counties, employers and employees, representatives of | 1029 |
hospitals and clinics, and representatives from state regulatory | 1030 |
bodies. Members of the Transition Advisory Group shall be | 1031 |
reimbursed by the Ohio Health Care Agency for necessary and actual | 1032 |
expenses incurred in the performance of their duties as members. | 1033 |