H. B. No. 683 As Introduced

As Introduced

130th General Assembly

Regular Session

2013-2014

H. B. No. 683

Representative Gonzales

Cosponsors: Representatives Brenner, Foley, Rogers

A BILL

To amend sections 5162.01, 5162.36, 5162.361,

5162.363, 5162.364, 5162.54, and 5162.64; to

amend, for the purpose of adopting new section

numbers as indicated in parentheses, sections

5162.362 (5162.363), 5162.363 (5162.364), and

5162.364 (5162.369); and to enact new section

5162.362 and sections 5162.365, 5162.366,

5162.367, and 5162.368 of the Revised Code

regarding the Medicaid School Program.

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

Section 1. That sections 5162.01, 5162.36, 5162.361,	10
5162.363, 5162.364, 5162.54, and 5162.64 be amended; sections	11
5162.362 (5162.363), 5162.363 (5162.364), and 5162.364 (5162.369)	12
be amended for the purpose of adopting new section numbers as	13
indicated in parentheses; and new section 5162.362 and sections	14
5162.365, 5162.366, 5162.367, and 5162.368 of the Revised Code be	15
enacted to read as follows:	16

Sec. 5162.01. (A) As used in the Revised Code:

(1) "Medicaid" and "medicaid program" mean the program of	18
medical assistance established by Title XIX of the "Social	19
Security Act," 42 U.S.C. 1396 et seq., including any medical	20
assistance provided under the medicaid state plan or a federal	21
medicaid waiver granted by the United States secretary of health	22
and human services.	23

(2) "Medicare" and "medicare program" mean the federal health	24
insurance program established by Title XVIII of the "Social	25
Security Act," 42 U.S.C. 1395 et seq.	26

(B) As used in this chapter:

(1) "Dual eligible individual" has the same meaning as in	28
section 5160.01 of the Revised Code.	29

(2) "Exchange" has the same meaning as in 45 C.F.R. 155.20.

(3) "Federal financial participation" has the same meaning as	31
in section 5160.01 of the Revised Code.	32

(4) "Federal poverty line" means the official poverty line	33
defined by the United States office of management and budget based	34
on the most recent data available from the United States bureau of	35
the census and revised by the United States secretary of health	36
and human services pursuant to the "Omnibus Budget Reconciliation	37
Act of 1981," section 673(2), 42 U.S.C. 9902(2).	38

(5) "Healthy start component" means the component of the	39
medicaid program that covers pregnant women and children and is	40
identified in rules adopted under section 5162.02 of the Revised	41
Code as the healthy start component.	42

(6) "Home and community-based services" means services	43
provided under a home and community-based services medicaid waiver	44
component.	45

(7) "Home and community-based services medicaid waiver	46
component" has the same meaning as in section 5166.01 of the	47
Revised Code.	48

(8) "ICF/IID" has the same meaning as in section 5124.01 of	49
the Revised Code.	50

(9) "Individualized education program" has the same meaning	51
as in section 3323.011 of the Revised Code.	52

(10) "Medicaid managed care organization" has the same	53
meaning as in section 5167.01 of the Revised Code.	54

~~(10)~~(11) "Medicaid provider" has the same meaning as in	55
section 5164.01 of the Revised Code.	56

~~(11)~~(12) "Medicaid services" has the same meaning as in	57
section 5164.01 of the Revised Code.	58

~~(12)~~(13) "Nursing facility" and "nursing facility services"	59
have the same meanings as in section 5165.01 of the Revised Code.	60

~~(13)~~(14) "Personal care services" has the same meaning as in	61
42 C.F.R. 440.167.	62

(15) "Political subdivision" means a municipal corporation,	63
township, county, school district, or other body corporate and	64
politic responsible for governmental activities only in a	65
geographical area smaller than that of the state.	66

~~(14)~~(16) "Prescribed drug" has the same meaning as in section	67
5164.01 of the Revised Code.	68

~~(15)~~(17) "Provider agreement" has the same meaning as in	69
section 5164.01 of the Revised Code.	70

~~(16)~~(18) "Qualified medicaid school provider" means the board	71
of education of a city, local, or exempted village school	72
district, the governing authority of a community school	73
established under Chapter 3314. of the Revised Code, the state	74
school for the deaf, and the state school for the blind to which	75
both of the following apply:	76

(a) It holds a valid provider agreement.

(b) It meets all other conditions for participation in the	78
medicaid school component of the medicaid program established in	79
rules authorized by section ~~5162.364~~5162.369 of the Revised Code.	80

~~(17)~~(19) "State agency" means every organized body, office,	81
or agency, other than the department of medicaid, established by	82
the laws of the state for the exercise of any function of state	83
government.	84

~~(18)~~(20) "Vendor offset" means a reduction of a medicaid	85
payment to a medicaid provider to correct a previous, incorrect	86
medicaid payment to that provider.	87

Sec. 5162.36. ~~(A) (B)~~ The medicaid director shall create, in	88
accordance with sections 5162.36 to ~~5162.364~~5162.369 of the	89
Revised Code, the medicaid school component of the medicaid	90
program.	91

Sec. 5162.361. A qualified medicaid school provider	92
participating in the medicaid school component of the medicaid	93
program may submit a claim to the department of medicaid for	94
federal financial participation for providing~~, in schools,~~	95
services covered by the medicaid school component to medicaid	96
recipients who are eligible for the services. No qualified	97
medicaid school provider may submit such a claim before the	98
provider incurs the cost of providing the service.	99

The claim shall include certification of the qualified	100
medicaid school provider's expenditures for the service. The	101
certification shall show that the money the qualified medicaid	102
school provider used for the expenditures was nonfederal money the	103
provider may legally use for providing the service and that the	104
amount of the expenditures was sufficient to pay the full cost of	105
the service.	106

Except as otherwise provided in sections 5162.36 to ~~5162.364~~	107
5162.369 of the Revised Code and rules authorized by sections	108
~~5162.363~~5162.364 and ~~5162.364~~5162.369 of the Revised Code, a	109
qualified medicaid school provider is subject to all conditions of	110
participation in the medicaid program that generally apply to	111
providers of goods and services under the medicaid program,	112
including conditions regarding audits and recovery of	113
overpayments. A qualified medicaid school provider also must	114
annually submit to the department of education a report showing	115
the number of the provider's students who received special	116
education and related services provided pursuant to Chapter 3323.	117
of the Revised Code in the most recent previous October.	118

Sec. 5162.362. (A) A qualified medicaid school provider's	119
claim for a service covered by the medicaid school component of	120
the medicaid program shall be rejected if any of the following	121
applies:	122

(1) Unless the service is an initial assessment or evaluation	123
performed in the development of a medicaid recipient's	124
individualized education program, the service is not included in	125
the individualized education program developed for the recipient	126
to whom the service is provided.	127

(2) Except as provided in division (B) of this section, the	128
medicaid recipient who receives the service fails to show progress	129
in meeting the goals included in the recipient's individualized	130
education program over two consecutive three-month periods.	131

(3) Another reason for rejection specified in rules	132
authorized by section 5162.369 of the Revised Code applies to the	133
claim.	134

(B) A qualified medicaid school provider's claim for a	135
service covered by the medicaid school component may be paid even	136
though the circumstance described in division (A)(2) of this	137
section applies if either of the following is the case:	138

(1) There is documentation that a method or technique of the	139
service has been modified to help the medicaid recipient meet a	140
goal included in the recipient's individualized education program.	141

(2) It is not the purpose of the service to help the medicaid	142
recipient show progress in meeting the goals included in the	143
recipient's individualized education program.	144

~~Sec. 5162.362.~~ Sec. 5162.363. The department of medicaid shall	145
seek federal financial participation for each claim a qualified	146
medicaid school provider properly submits to the department under	147
section 5162.361 of the Revised Code. The department shall	148
disburse the federal financial participation the department	149
receives from the federal government for such a claim to the	150
qualified medicaid school provider that submitted the claim. The	151
department may not pay the qualified medicaid school provider the	152
nonfederal share of the cost of the services for which the claim	153
was submitted.	154

~~Sec. 5162.363.~~ Sec. 5162.364. The department of medicaid shall	155
enter into an interagency agreement with the department of	156
education under section 5162.35 of the Revised Code that provides	157
for the department of education to administer the medicaid school	158
component of the medicaid program other than the aspects of the	159
component that sections 5162.36 to ~~5162.364~~5162.369 of the	160
Revised Code require the department of medicaid to administer. The	161
interagency agreement may include a provision that provides for	162
the department of education to pay to the department of medicaid	163
the nonfederal share of a portion of the administrative expenses	164
the department of medicaid incurs in administering the aspects of	165
the medicaid school component that the department of medicaid	166
administers. The interagency agreement shall include a provision	167
that provides for the department of education to receive at least	168
three and one-half per cent of the federal financial participation	169
the state receives for the medicaid school component.	170

To the extent authorized by rules authorized by section	171
5162.021 of the Revised Code, the department of education shall	172
establish, in rules adopted under section 5162.02 of the Revised	173
Code, a process by which qualified medicaid school providers	174
participating in the medicaid school component pay to the	175
department of education the nonfederal share of the department's	176
expenses incurred in administering the component. The rules shall	177
be adopted in accordance with Chapter 119. of the Revised Code.	178

Sec. 5162.365. The department of medicaid and department of	179
education jointly shall prepare and annually update procedural	180
guidelines for, and other informational materials about, the	181
medicaid school component of the medicaid program that give	182
qualified medicaid school providers clear instructions for	183
participation in the component.	184

Sec. 5162.366. The medicaid school component of the medicaid	185
program shall cover nursing services provided by any of the	186
following:	187

(A) A registered nurse;

188

(B) A licensed practical nurse;

189

(C) An individual (including a school health aide),	190
regardless of whether the individual is licensed, certified, or	191
otherwise authorized by a board or other agency of the state to	192
provide a health care service, to whom all of the following apply:	193

(1) The individual is at least eighteen years of age.

194

(2) A registered nurse or licensed practical nurse has	195
delegated the nursing services to the individual in accordance	196
with rules adopted under section 4723.07 of the Revised Code.	197

(3) The individual and the registered nurse or licensed	198
practice nurse who delegated the nursing services to the	199
individual are employed by or under contract with the qualified	200
medicaid school provider that submits the claim to the department	201
of medicaid for the nursing services.	202

Sec. 5162.367. (A) Subject to divisions (B) and (C) of this	203
section, the medicaid school component of the medicaid program	204
shall cover personal care services.	205

(B) A medicaid recipient who is eligible for the medicaid	206
school component may receive personal care services covered by the	207
component if both of the following apply:	208

(1) The recipient needs the services because the recipient	209
either cannot perform one or more activities of daily living or	210
instrumental activities of daily living or has a limitation in	211
performing one or more such activities due to a functional,	212
cognitive, or behavioral impairment.	213

(2) The personal care services help the recipient benefit	214
from special education and related services provided pursuant to	215
Chapter 3323. of the Revised Code.	216

(C) Personal care services covered by the medicaid school	217
component may be provided by an individual who meets all of the	218
following requirements:	219

(1) The individual must be at least eighteen years of age.

220

(2) The individual must be trained to provide the personal	221
care services to the medicaid recipient who receives the services.	222

(3) The individual must provide the personal care services	223
under the direct supervision of a health care professional to whom	224
both of the following apply:	225

(a) The health care professional is licensed, certified, or	226
otherwise authorized by a board or other agency of the state to	227
provide a health care service.	228

(b) The health care professional is employed by or under	229
contract with the qualified medicaid school provider that submits	230
the claim to the department of medicaid for the personal care	231
services.	232

Sec. 5162.368. (A) Subject to divisions (B) to (E) of this	233
section, the medicaid school component of the medicaid program	234
shall cover specialized medical transportation services.	235

(B) A medicaid recipient eligible for the medicaid school	236
component may receive specialized medical transportation services	237
covered by the component if both of the following requirements are	238
met:	239

(1) Either of the following must apply to the recipient:

240

(a) School bus transportation to the school in which the	241
medicaid recipient is enrolled must not be provided to the	242
school's students who reside in the same area as the recipient.	243

(b) If school bus transportation to the school in which the	244
medicaid recipient is enrolled is provided to the school's	245
students who reside in the same area as the recipient, the school	246
bus used for the transportation must not have the adaptations that	247
the recipient needs to be able to be transported in the school	248
bus.	249

(2) On the same day that the medicaid recipient receives the	250
specialized medical transportation services, the recipient must	251
also receive at least one other service covered by the medicaid	252
school component. The other service may be personal care services	253
provided to the recipient while receiving the specialized medical	254
transportation services.	255

(C) Specialized medical transportation services covered by	256
the medicaid school component must be provided in a specially	257
adapted vehicle that has been physically modified in a manner that	258
enables the medicaid recipient receiving the services to be	259
transported in the vehicle. Modifications may include the addition	260
of a wheelchair lift, seatbelts, harnesses, child protective	261
seats, air conditioning, and similar modifications. The use of a	262
school bus monitor or other personnel who accompany students on a	263
school bus is not a modification.	264

(D) A medicaid recipient eligible to receive specialized	265
medical transportation services covered by the medicaid school	266
component may receive the services for any of the following	267
one-way trips:	268

(1) From the recipient's residence to the recipient's school;

269

(2) From the recipient's school to the recipient's residence;

270

(3) From the recipient's residence or school to a location to	271
receive a service covered by the medicaid school component from a	272
health care provider under contract with the qualified medicaid	273
school provider;	274

(4) From the location where a service specified in division	275
(D)(3) of this section is received to the recipient's residence or	276
school;	277

(5) From the recipient's school to another school operated by	278
a qualified medicaid school provider;	279

(6) From another school operated by a qualified medicaid	280
school provider to the recipient's school.	281

(E) A claim for specialized medical transportation services	282
provided to a medicaid recipient under the medicaid school	283
component shall show a separate charge for each one-way trip that	284
the recipient receives.	285

~~Sec. 5162.364.~~ Sec. 5162.369. The medicaid director shall adopt	286
rules under section 5162.02 of the Revised Code as necessary to	287
implement the medicaid school component of the medicaid program,	288
including rules that establish or specify all of the following:	289

(A) Conditions a board of education of a city, local, or	290
exempted school district, governing authority of a community	291
school established under Chapter 3314. of the Revised Code, the	292
state school for the deaf, and the state school for the blind must	293
meet to participate in the component;	294

(B) ~~Services~~In addition to the services specified in	295
sections 5162.366, 5162.367, and 5162.368 of the Revised Code,	296
services the component covers;	297

298

The rules shall be adopted in accordance with Chapter 119. of	299
the Revised Code.	300

Sec. 5162.54. (A) There is hereby created in the state	301
treasury the health care services administration fund. Except as	302
provided in division (C) of this section, all the following shall	303
be deposited into the fund:	304

(1) Amounts deposited into the fund pursuant to sections	305
5162.12, 5162.40, and 5162.41 of the Revised Code;	306

(2) The amount of the state share of all money the department	307
of medicaid recovers each fiscal year pursuant to a tort action	308
under the department's right of recovery under section 5160.37 of	309
the Revised Code that exceeds the state share of all money the	310
department, in fiscal year 2002, recovers pursuant to a tort	311
action under that right of recovery;	312

(3) Subject to division (B) of this section, the amount of	313
the state share of all money the department of medicaid, in fiscal	314
year 2003 and each fiscal year thereafter, recovers through audits	315
of medicaid providers that exceeds the state share of all money	316
the department, in fiscal year 2002, recovers through such audits;	317

(4) Amounts from assessments on hospitals under section	318
5168.06 of the Revised Code and intergovernmental transfers by	319
governmental hospitals under section 5168.07 of the Revised Code	320
that are deposited into the fund in accordance with the law;	321

(5) Amounts that the department of education pays to the	322
department of medicaid, if any, pursuant to an interagency	323
agreement authorized by section ~~5162.363~~5162.364 of the Revised	324
Code;	325

(6) The application fees charged to providers under section	326
5164.31 of the Revised Code;	327

(7) The fines collected under section 5165.1010 of the	328
Revised Code;	329

(8) Money the department receives in a fiscal year for	330
performing eligibility verification services necessary for	331
compliance with the independent, certified audit requirement of 42	332
C.F.R. 455.304, other than the amounts of such money that are to	333
be credited to the health care/medicaid support and recoveries	334
fund under section 5162.52 of the Revised Code.	335

(B) In determining under division (A)(3) of this section the	336
amount of money the department, in a fiscal year, recovers through	337
audits of medicaid providers, the amount recovered in the form of	338
vendor offset shall be excluded.	339

(C) The department of medicaid shall use funds available in	340
the health care services administration fund to pay for costs	341
associated with the administration of the medicaid program.	342

Sec. 5162.64. (A) There is hereby created in the state	343
treasury the medicaid school program administrative fund.	344

(B) Both of the following shall be deposited into the	345
medicaid school program administrative fund:	346

(1) The federal funds the department of education receives	347
for the expenses the department incurs in administering the	348
medicaid school component of the medicaid program created under	349
section 5162.36 of the Revised Code;	350

(2) The money the department collects from qualified medicaid	351
school providers in the process established in rules authorized by	352
section ~~5162.363~~5162.364 of the Revised Code.	353

(C) The department of education shall use money in the	354
medicaid school program administrative fund for both of the	355
following purposes:	356

(1) Paying for the expenses the department incurs in	357
administering the medicaid school component of the medicaid	358
program;	359

(2) Paying a qualified medicaid school provider a refund for	360
any overpayment the provider makes to the department under the	361
process established in rules authorized by section ~~5162.363~~	362
5162.364 of the Revised Code if the process results in an	363
overpayment.	364

Section 2. That existing sections 5162.01, 5162.36,	365
5162.361, 5162.362, 5162.363, 5162.364, 5162.54, and 5162.64 of	366
the Revised Code are hereby repealed.	367