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To amend sections 5162.01, 5162.20, 5165.15, and | 1 |
5167.01, to enact sections 103.41, 103.411, | 2 |
103.412, 103.413, 5162.70, 5162.71, 5163.04, | 3 |
5164.16, 5164.882, 5164.94, 5167.15, and 6301.15, | 4 |
and to repeal sections 101.39 and 101.391 of the | 5 |
Revised Code to revise the law governing the | 6 |
Medicaid program, to create the Joint Medicaid | 7 |
Oversight Committee, to abolish the Joint | 8 |
Legislative Committee on Health Care Oversight and | 9 |
the Joint Legislative Committee on Medicaid | 10 |
Technology and Reform, and to make appropriations. | 11 |
Section 1. That sections 5162.01, 5162.20, 5165.15, and | 12 |
5167.01 be amended and sections 103.41, 103.411, 103.412, 103.413, | 13 |
5162.70, 5162.71, 5163.04, 5164.16, 5164.882, 5164.94, 5167.15, | 14 |
and 6301.15 of the Revised Code be enacted to read as follows: | 15 |
Sec. 103.41. (A) In this section: | 16 |
"Rule" includes a new rule or the amendment or rescission of | 17 |
an existing rule. If a state agency revises a proposed rule, the | 18 |
revised rule is a "rule" for purposes of this section. | 19 |
"Workforce development activity" has the same meaning as in | 20 |
section 6301.01 of the Revised Code. | 21 |
(B) On the same day that a state agency files a rule under | 22 |
division (D) of section 111.15 or division (H) of section 119.03 | 23 |
of the Revised Code, the state agency also shall file a copy of | 24 |
the rule with the joint medicaid oversight committee if the rule | 25 |
concerns either of the following: | 26 |
(1) The administration of, eligibility requirements for, | 27 |
services covered by, service delivery methods of, or other aspects | 28 |
of the medicaid program; | 29 |
(2) A workforce development activity that could reasonably be | 30 |
expected to impact medicaid recipients. | 31 |
(C) The joint medicaid oversight committee, not later than | 32 |
thirty days after it receives the original version of a proposed | 33 |
rule or not later than fifteen days after it receives a revised | 34 |
version of a proposed rule, shall review the rule and determine | 35 |
whether the rule is likely to improve the administration of the | 36 |
medicaid program or the ability of medicaid recipients to achieve | 37 |
greater financial independence. The committee, based on its | 38 |
determination, shall form an opinion whether it views the rule | 39 |
favorably, unfavorably, or neutrally. The committee shall prepare | 40 |
a memorandum that states the committee's opinion and includes a | 41 |
concise explanation of the committee's reasoning that supports its | 42 |
opinion. The committee promptly shall transmit a copy of the rule | 43 |
and the memorandum to the state agency and joint committee on | 44 |
agency rule review. | 45 |
The committee may give notice of and conduct a public hearing | 46 |
in the course of its review of a rule. | 47 |
Sec. 103.411. (A) As used in this section, "medicaid waiver" | 48 |
means the authority, granted by the United States department of | 49 |
health and human services, for the medicaid director to implement, | 50 |
and receive federal financial participation for, a component of | 51 |
the medicaid program for which federal financial participation is | 52 |
not available without the waiver. "Medicaid waiver" includes all | 53 |
of the following: | 54 |
(1) A waiver for the medicaid program issued under section | 55 |
1115, 1115A, or 1915 of the "Social Security Act," 42 U.S.C. 1315, | 56 |
1315a, or 1396n, or any other federal statute; | 57 |
(2) An amendment to a medicaid waiver; (3) An application for | 58 |
renewal, with or without changes, of an existing medicaid waiver. | 59 |
(B) Before the medicaid director submits a request for a | 60 |
medicaid waiver to the United States department of health and | 61 |
human services, the director shall submit a copy of the requested | 62 |
medicaid waiver to the joint medicaid oversight committee. The | 63 |
committee may recommend that the director revise a medicaid waiver | 64 |
request. | 65 |
Sec. 103.412. There is a joint medicaid oversight committee. | 66 |
The committee is comprised of ten members. The president of the | 67 |
senate and the speaker of the house of representatives each shall | 68 |
appoint five members to the committee from their respective | 69 |
houses, three of whom are members of the majority party and two of | 70 |
whom are members of the minority party. Vacancies on the committee | 71 |
shall be filled in the same manner as the original appointment. | 72 |
In odd-numbered years, the president shall designate the | 73 |
chairperson of the committee from among the senate members of the | 74 |
committee. In even-numbered years, the speaker shall designate the | 75 |
chairperson of the committee from among the house members of the | 76 |
committee. In odd-numbered years, the speaker shall designate one | 77 |
of the minority members from the house as ranking minority member. | 78 |
In even-numbered years, the president shall designate one of the | 79 |
minority members from the senate as ranking minority member. | 80 |
In appointing members from the minority, and in designating | 81 |
ranking minority members, the president and speaker shall consult | 82 |
with the minority leader of their respective houses. | 83 |
The committee shall meet at the call of the chairperson, but | 84 |
not less often than once each calendar month. | 85 |
The committee shall employ professional, technical, and | 86 |
clerical employees as are necessary for the committee to be able | 87 |
successfully and efficiently to perform its duties. The employees | 88 |
are in the unclassified service and serve at the pleasure of the | 89 |
committee. | 90 |
The committee may contract for the services of persons who | 91 |
are qualified by education and experience to advise, consult with, | 92 |
or otherwise assist the committee in the performance of its | 93 |
duties. | 94 |
The chairperson of the committee, when authorized by the | 95 |
committee and by the president and speaker, may issue subpoenas | 96 |
and subpoenas duces tecum in aid of the committee's performance of | 97 |
its duties. A subpoena may require a witness in any part of the | 98 |
state to appear before the committee at a time and place | 99 |
designated in the subpoena to testify. A subpoena duces tecum may | 100 |
require witnesses or other persons in any part of the state to | 101 |
produce books, papers, records, and other tangible evidence before | 102 |
the committee at a time and place designated in the subpoena duces | 103 |
tecum. A subpoena or subpoena duces tecum shall be issued, served, | 104 |
and returned, and has consequences, as specified in sections | 105 |
101.41 to 101.45 of the Revised Code. | 106 |
The chairperson of the committee may administer oaths to | 107 |
witnesses appearing before the committee. | 108 |
Sec. 103.413. The joint medicaid oversight committee shall | 109 |
conduct a continuing study of the medicaid program and workforce | 110 |
development activities related to the medicaid program. | 111 |
The committee may plan, advertise, organize, and conduct | 112 |
forums, conferences, and other meetings at which representatives | 113 |
of state agencies and other individuals having expertise in the | 114 |
medicaid program and workforce development activities may | 115 |
participate to increase knowledge and understanding of, and to | 116 |
develop and propose improvements in, the medicaid program and | 117 |
workforce development activities. The director of job and family | 118 |
services shall submit to the committee relevant statistics on | 119 |
workforce development activities to assist the committee. | 120 |
The committee may prepare and issue reports on its continuing | 121 |
studies. The committee may solicit written comments on, and may | 122 |
conduct public hearings at which persons may offer verbal comments | 123 |
on, drafts of its reports. | 124 |
The committee may recommend improvements in rules affecting | 125 |
the medicaid program and workforce development activities related | 126 |
to the medicaid program, and may recommend legislation for | 127 |
improvement of statutes regarding those issues. | 128 |
Sec. 5162.01. (A) As used in the Revised Code: | 129 |
(1) "Medicaid" and "medicaid program" mean the program of | 130 |
medical assistance established by Title XIX of the "Social | 131 |
Security Act," 42 U.S.C. 1396 et seq., including any medical | 132 |
assistance provided under the medicaid state plan or a federal | 133 |
medicaid waiver granted by the United States secretary of health | 134 |
and human services. | 135 |
(2) "Medicare" and "medicare program" mean the federal health | 136 |
insurance program established by Title XVIII of the "Social | 137 |
Security Act," 42 U.S.C. 1395 et seq. | 138 |
(B) As used in this chapter: | 139 |
(1) "CPI inflation rate" means the inflation rate as | 140 |
specified in the consumer price index for all urban consumers as | 141 |
published by the United States bureau of labor statistics. | 142 |
(2) "Dual eligible individual" has the same meaning as in | 143 |
section 5160.01 of the Revised Code. | 144 |
| 145 |
as in section 5160.01 of the Revised Code. | 146 |
| 147 |
defined by the United States office of management and budget based | 148 |
on the most recent data available from the United States bureau of | 149 |
the census and revised by the United States secretary of health | 150 |
and human services pursuant to the "Omnibus Budget Reconciliation | 151 |
Act of 1981," section 673(2), 42 U.S.C. 9902(2). | 152 |
| 153 |
medicaid program that covers pregnant women and children and is | 154 |
identified in rules adopted under section 5162.02 of the Revised | 155 |
Code as the healthy start component. | 156 |
| 157 |
of the Revised Code. | 158 |
| 159 |
meaning as in section 5167.01 of the Revised Code. | 160 |
| 161 |
5164.01 of the Revised Code. | 162 |
| 163 |
5164.01 of the Revised Code. | 164 |
| 165 |
following: | 166 |
(a) Medicaid recipients whose countable family incomes are | 167 |
within the top twenty-five percentage points of the income | 168 |
eligibility threshold for the eligibility group under which they | 169 |
qualify for medicaid; | 170 |
(b) Medicaid recipients whose countable family incomes are | 171 |
not less than the federal poverty line. | 172 |
(11) "Nursing facility" has the same meaning as in section | 173 |
5165.01 of the Revised Code. | 174 |
| 175 |
corporation, township, county, school district, or other body | 176 |
corporate and politic responsible for governmental activities only | 177 |
in a geographical area smaller than that of the state. | 178 |
| 179 |
5164.01 of the Revised Code. | 180 |
| 181 |
section 5164.01 of the Revised Code. | 182 |
| 183 |
of education of a city, local, or exempted village school | 184 |
district, the governing authority of a community school | 185 |
established under Chapter 3314. of the Revised Code, the state | 186 |
school for the deaf, and the state school for the blind to which | 187 |
both of the following apply: | 188 |
(a) It holds a valid provider agreement. | 189 |
(b) It meets all other conditions for participation in the | 190 |
medicaid school component of the medicaid program established in | 191 |
rules authorized by section 5162.364 of the Revised Code. | 192 |
| 193 |
or agency, other than the department of medicaid, established by | 194 |
the laws of the state for the exercise of any function of state | 195 |
government. | 196 |
| 197 |
payment to a medicaid provider to correct a previous, incorrect | 198 |
medicaid payment to that provider. | 199 |
Sec. 5162.20. (A) The department of medicaid shall institute | 200 |
cost-sharing requirements for the medicaid program in a manner | 201 |
consistent with the "Social Security Act," sections 1916 and | 202 |
1916A, 42 U.S.C. 1396o and 1396o-1. | 203 |
instituting the requirements the department shall | 204 |
205 | |
206 | |
207 |
(1) Apply the requirements to all medicaid recipients to whom | 208 |
the requirements may be applied; | 209 |
(2) Apply the requirements to all medicaid services to which | 210 |
the requirements may be applied; | 211 |
(3) Establish premiums, deductibles, copayments, coinsurance, | 212 |
and all other types of cost-sharing charges that may be | 213 |
established; | 214 |
(4) Set the amounts of the premiums, deductibles, copayments, | 215 |
coinsurance, and all other types of cost-sharing charges at the | 216 |
maximum amounts permitted. | 217 |
218 | |
219 |
(B)(1) No provider shall refuse to provide a service to a | 220 |
medicaid recipient who is unable to pay a required copayment for | 221 |
the service. | 222 |
(2) Division (B)(1) of this section shall not be considered | 223 |
to do either of the following with regard to a medicaid recipient | 224 |
who is unable to pay a required copayment: | 225 |
(a) Relieve the medicaid recipient from the obligation to pay | 226 |
a copayment; | 227 |
(b) Prohibit the provider from attempting to collect an | 228 |
unpaid copayment. | 229 |
(C) Except as provided in division (F) of this section, no | 230 |
provider shall waive a medicaid recipient's obligation to pay the | 231 |
provider a copayment. | 232 |
(D) No provider or drug manufacturer, including the | 233 |
manufacturer's representative, employee, independent contractor, | 234 |
or agent, shall pay any copayment on behalf of a medicaid | 235 |
recipient. | 236 |
(E) If it is the routine business practice of a provider to | 237 |
refuse service to any individual who owes an outstanding debt to | 238 |
the provider, the provider may consider an unpaid copayment | 239 |
imposed by the cost-sharing requirements as an outstanding debt | 240 |
and may refuse service to a medicaid recipient who owes the | 241 |
provider an outstanding debt. If the provider intends to refuse | 242 |
service to a medicaid recipient who owes the provider an | 243 |
outstanding debt, the provider shall notify the recipient of the | 244 |
provider's intent to refuse service. | 245 |
(F) In the case of a provider that is a hospital, the | 246 |
cost-sharing program shall permit the hospital to take action to | 247 |
collect a copayment by providing, at the time services are | 248 |
rendered to a medicaid recipient, notice that a copayment may be | 249 |
owed. If the hospital provides the notice and chooses not to take | 250 |
any further action to pursue collection of the copayment, the | 251 |
prohibition against waiving copayments specified in division (C) | 252 |
of this section does not apply. | 253 |
(G) The department of medicaid may collaborate with a state | 254 |
agency that is administering, pursuant to a contract entered into | 255 |
under section 5162.35 of the Revised Code, one or more components, | 256 |
or one or more aspects of a component, of the medicaid program as | 257 |
necessary for the state agency to apply the cost-sharing | 258 |
requirements to the components or aspects of a component that the | 259 |
state agency administers. | 260 |
Sec. 5162.70. (A) The medicaid director shall implement | 261 |
reforms to the medicaid program that do all of the following: | 262 |
(1) Provide for the growth in the per member per month cost | 263 |
of the medicaid program, as determined on an aggregate basis for | 264 |
all eligibility groups, for the six-month period immediately | 265 |
preceding the first day of each January and the six-month period | 266 |
immediately preceding the first day of each July to be not more | 267 |
than the average annual increase in the CPI inflation rate for | 268 |
medical care for the most recent three-year period for which the | 269 |
necessary data is available as of that first day of January or | 270 |
July; | 271 |
(2) Achieve the limit in the growth of the per member per | 272 |
month cost of the medicaid program required by division (A)(1) of | 273 |
this section in a manner that does all of the following: | 274 |
(a) Improves the physical and mental health of medicaid | 275 |
recipients; | 276 |
(b) Provides for medicaid recipients to receive medicaid | 277 |
services in the most cost-effective and sustainable manner; | 278 |
(c) Removes barriers that impede medicaid recipients' ability | 279 |
to transfer to lower cost, and more appropriate, medicaid | 280 |
services. | 281 |
(3) Reduce the relative number of individuals who need | 282 |
medicaid that is achieved in a manner that utilizes both of the | 283 |
following: | 284 |
(a) Programs that have been demonstrated to be effective and | 285 |
have one or more of the following features: | 286 |
(i) Have low costs; | 287 |
(ii) Utilize volunteers; | 288 |
(iii) Utilize incentives; | 289 |
(iv) Are led by peers. | 290 |
(b) The identification and elimination of medicaid | 291 |
eligibility requirements that are barriers to achieving greater | 292 |
financial independence. | 293 |
(4) Provide medicaid recipients with information about the | 294 |
actual costs of medicaid services and the amounts the medicaid | 295 |
program pays for the services so that recipients are able to use | 296 |
this information when choosing medicaid providers; | 297 |
(5) Reduce the number of times that medicaid recipients are | 298 |
readmitted to hospitals or utilize emergency department services | 299 |
when the readmissions or utilizations are avoidable; | 300 |
(6) Reduce a nursing facility's medicaid payment rate if its | 301 |
residents utilize hospital emergency department services at higher | 302 |
than average rates; | 303 |
(7) Reduce a nursing facility's medicaid payment rate if its | 304 |
residents who are dual eligible individuals have higher than | 305 |
average hospital admission rates; | 306 |
(8) Establish standards for medicaid managed care | 307 |
organizations to promote compliance with primary care requirements | 308 |
applicable to medicaid recipients for whom the organizations | 309 |
provide, or arrange for the provision of, medicaid services; | 310 |
(9) Provide for medicaid managed care organizations to | 311 |
receive, beginning not later than December 31, 2014, medicaid | 312 |
payments based on reductions in medicaid costs that they help | 313 |
achieve; | 314 |
(10) Require managed care organizations, as a condition of | 315 |
becoming medicaid managed care organizations, to do both of the | 316 |
following: | 317 |
(a) Obtain accreditation from the national committee for | 318 |
quality assurance or another accrediting organization the director | 319 |
determines has accreditation standards that are similar to the | 320 |
national committee for quality assurance's accreditation | 321 |
standards; | 322 |
(b) Utilize the healthcare effectiveness data and information | 323 |
set established by the national committee for quality assurance or | 324 |
a similar performance measuring tool that the director determines | 325 |
is similar to the healthcare effectiveness data and information | 326 |
set. | 327 |
(11) Gather data about the medicaid transition population's | 328 |
utilization of workforce development activities administered by | 329 |
the department of job and family services to determine all of the | 330 |
following: | 331 |
(a) The length of time they utilize the activities; | 332 |
(b) When their employment status changes; | 333 |
(c) The events that cause them to cease to be eligible for | 334 |
medicaid. | 335 |
(B) The reforms implemented under this section shall, without | 336 |
making the medicaid program's eligibility requirements more | 337 |
restrictive, reduce the relative number of individuals enrolled in | 338 |
the medicaid program who have the greatest potential to obtain the | 339 |
income and resources that would enable them to cease enrollment in | 340 |
medicaid and instead obtain health care coverage through | 341 |
employer-sponsored health insurance or the health insurance | 342 |
marketplace. | 343 |
(C) Each quarter, the medicaid director shall transmit the | 344 |
data gathered under the reform implemented pursuant to division | 345 |
(A)(11) of this section to the joint medicaid oversight committee. | 346 |
The director also shall submit an annual report to the committee | 347 |
regarding the findings made from the data. | 348 |
Sec. 5162.71. The medicaid director shall implement within | 349 |
the medicaid program systems that have the goal of reducing both | 350 |
of the following: | 351 |
(A) Health disparities among medicaid recipients who are | 352 |
members of minority populations; | 353 |
(B) The incidence among medicaid recipients of alcoholism, | 354 |
drug addiction, tobacco use, and abuse of other substances the | 355 |
director specifies in rules adopted under section 5162.02 of the | 356 |
Revised Code. | 357 |
Sec. 5163.04. The medicaid program shall not cover the group | 358 |
described in the "Social Security Act," section | 359 |
1902(a)(10)(A)(i)(VIII), 42 U.S.C. 1396a(a)(10)(A)(i)(VIII), | 360 |
unless the federal medical assistance percentage for expenditures | 361 |
for medicaid services provided to the group is at least the amount | 362 |
specified in the "Social Security Act," section 1905(y), 42 U.S.C. | 363 |
1396d(y), as of March 30, 2010. If the medicaid program covers the | 364 |
group and the federal medical assistance percentage for such | 365 |
expenditures is reduced below the amount so specified, the | 366 |
medicaid program shall cease to cover the group. Notwithstanding | 367 |
section 5160.31 of the Revised Code, an individual's disenrollment | 368 |
from the medicaid program is not subject to appeal under that | 369 |
section when the disenrollment is the result of the medicaid | 370 |
program ceasing to cover the individual's group under this | 371 |
section. | 372 |
Sec. 5164.16. As used in this section, "telemedicine" means | 373 |
the delivery of a medicaid service to a medicaid recipient through | 374 |
the use of an interactive, electronic communication device that | 375 |
enables the medicaid provider to communicate in an audible or | 376 |
visual manner, or both manners, with the medicaid recipient or | 377 |
another medicaid provider of the medicaid recipient from a site | 378 |
other than the site at which the medicaid recipient or other | 379 |
medicaid provider is located. | 380 |
The medicaid program may cover telemedicine to the extent, | 381 |
and in the manner, authorized by rules adopted under section | 382 |
5164.02 of the Revised Code. | 383 |
Sec. 5164.882. The medicaid director shall implement within | 384 |
the medicaid program a system designed to reduce the rate of | 385 |
chronic conditions among medicaid recipients. The system | 386 |
implemented under this section shall be in addition to the systems | 387 |
required by sections 5164.88 and 5164.881 of the Revised Code. The | 388 |
system shall include features that enable medicaid providers to | 389 |
share with the medicaid program savings achieved by reducing rates | 390 |
of chronic conditions among medicaid recipients. | 391 |
Sec. 5164.94. The medicaid director shall establish a system | 392 |
within the medicaid program that encourages medicaid providers to | 393 |
provide medicaid services to medicaid recipients in culturally and | 394 |
linguistically appropriate manners. | 395 |
Sec. 5165.15. (A) Except as otherwise provided by sections | 396 |
5162.70, 5165.151 to 5165.156, and 5165.34 of the Revised Code, | 397 |
the total per medicaid day payment rate that the department of | 398 |
medicaid shall pay a nursing facility provider for nursing | 399 |
facility services the provider's nursing facility provides during | 400 |
a fiscal year shall equal the sum of all of the following: | 401 |
(1) The per medicaid day payment rate for ancillary and | 402 |
support costs determined for the nursing facility under section | 403 |
5165.16 of the Revised Code; | 404 |
(2) The per medicaid day payment rate for capital costs | 405 |
determined for the nursing facility under section 5165.17 of the | 406 |
Revised Code; | 407 |
(3) The per medicaid day payment rate for direct care costs | 408 |
determined for the nursing facility under section 5165.19 of the | 409 |
Revised Code; | 410 |
(4) The per medicaid day payment rate for tax costs | 411 |
determined for the nursing facility under section 5165.21 of the | 412 |
Revised Code; | 413 |
(5) If the nursing facility qualifies as a critical access | 414 |
nursing facility, the nursing facility's critical access incentive | 415 |
payment paid under section 5165.23 of the Revised Code; | 416 |
(6) The quality incentive payment paid to the nursing | 417 |
facility under section 5165.25 of the Revised Code. | 418 |
(B) In addition to paying a nursing facility provider the | 419 |
nursing facility's total rate determined under division (A) of | 420 |
this section for a fiscal year, the department shall pay the | 421 |
provider a quality bonus under section 5165.26 of the Revised Code | 422 |
for that fiscal year if the provider's nursing facility is a | 423 |
qualifying nursing facility, as defined in that section, for that | 424 |
fiscal year. The quality bonus shall not be part of the total | 425 |
rate. | 426 |
Sec. 5167.01. As used in this chapter: | 427 |
| 428 |
3719.01 of the Revised Code. | 429 |
| 430 |
section 5160.01 of the Revised Code. | 431 |
| 432 |
"Social Security Act," section 1932(b)(2), 42 U.S.C. | 433 |
1396u-2(b)(2). | 434 |
| 435 |
component" has the same meaning as in section 5166.01 of the | 436 |
Revised Code. | 437 |
| 438 |
organization under contract with the department of medicaid | 439 |
pursuant to section 5167.10 of the Revised Code. | 440 |
| 441 |
in section 5162.01 of the Revised Code. | 442 |
"Medicaid waiver component" has the same meaning as in | 443 |
section 5166.01 of the Revised Code. | 444 |
| 445 |
5165.01 of the Revised Code. | 446 |
| 447 |
5164.01 of the Revised Code. | 448 |
| 449 |
furnishes services to a medicaid recipient enrolled in a medicaid | 450 |
managed care organization, regardless of whether the person or | 451 |
entity has a provider agreement. | 452 |
| 453 |
5164.01 of the Revised Code. | 454 |
"Workforce development activity" has the same meaning as in | 455 |
section 6301.01 of the Revised Code. | 456 |
Sec. 5167.15. (A) Each contract the department of medicaid | 457 |
enters into with a managed care organization under section 5167.10 | 458 |
of the Revised Code shall require the managed care organization to | 459 |
provide, or arrange for the provision of, case management services | 460 |
to all medicaid recipients who enroll in the managed care | 461 |
organization and are part of the medicaid transition population. | 462 |
The case management services shall include all of the following: | 463 |
(1) A clinical assessment of the recipient to determine | 464 |
whether the recipient has a medical or other condition to which | 465 |
both of the following apply: | 466 |
(a) The condition may impede the recipient's ability to gain | 467 |
or maintain employment or improve the recipient's employment | 468 |
situation; | 469 |
(b) The condition may be reasonably remediated through | 470 |
medical, mental health, or substance abuse treatment. | 471 |
(2) A care plan for the recipient that includes services | 472 |
designed to address the barriers to self-sufficiency that the | 473 |
recipient has been identified as having; | 474 |
(3) Referrals to employment-related programs that will assist | 475 |
the recipient in gaining access to, and maintaining, optimal | 476 |
employment, including the following programs: | 477 |
(a) On-the-job training programs; | 478 |
(b) Workforce investment activities; | 479 |
(c) Programs that enable individuals seeking employment to | 480 |
find employment opportunities listed on internet web sites; | 481 |
(d) Other programs administered by the department of job and | 482 |
family services or the opportunities for Ohioans with disabilities | 483 |
agency. | 484 |
(4) Referrals from employment-related programs that are | 485 |
administered by the department of job and family services, the | 486 |
opportunities for Ohioans with disabilities agency, or workforce | 487 |
investment boards and provide services designed to treat any | 488 |
medical or other problems the recipient has that hinder the | 489 |
recipient's ability to gain or maintain employment or improve the | 490 |
recipient's employment situation. | 491 |
(B) The department of job and family services shall provide | 492 |
workforce investment boards any technical guidance the boards need | 493 |
for the purpose of the referrals made under division (B)(4) of | 494 |
this section. | 495 |
Sec. 6301.15. The director of job and family services shall | 497 |
implement reforms to workforce development activities that do both | 498 |
of the following: | 499 |
(A) Reduce the relative number of individuals who need | 500 |
medicaid that is achieved in a manner that utilizes all of the | 501 |
following: | 502 |
(1) Programs that have been demonstrated to be effective and | 503 |
have one or more of the following features: | 504 |
(a) Have low costs; | 505 |
(b) Utilize volunteers; | 506 |
(c) Utilize incentives; | 507 |
(d) Are led by peers. | 508 |
(2) Educational and training opportunities; | 509 |
(3) Employment opportunities; | 510 |
(4) Other initiatives the director considers appropriate. | 511 |
(B) Enhance the relationship between educational facilities, | 512 |
workforce development activities, and employers. | 513 |
Section 2. That existing sections 5162.01, 5162.20, 5165.15, | 514 |
and 5167.01 of the Revised Code are hereby repealed. | 515 |
Section 3. That sections 101.39 and 101.391 of the Revised | 516 |
Code are repealed. | 517 |
Section 4. The Joint Medicaid Oversight Committee shall | 518 |
prepare a report with recommendations for legislation regarding | 519 |
Medicaid payment rates for Medicaid services. The goal of the | 520 |
recommendations shall be to provide the Medicaid Director | 521 |
statutory authority to implement innovative methodologies for | 522 |
setting Medicaid payment rates that limit the growth in Medicaid | 523 |
costs and protect, and establish guiding principles for, Medicaid | 524 |
providers and recipients. The Medicaid Director shall assist the | 525 |
Committee with the report. The Committee shall submit the report | 526 |
to the General Assembly in accordance with section 101.68 of the | 527 |
Revised Code not later than January 1, 2014. | 528 |
Section 5. (A) As used in this section, "Medicaid transition | 529 |
population" has the same meaning as in section 5162.01 of the | 530 |
Revised Code. | 531 |
(B) The Joint Medicaid Oversight Committee shall prepare a | 532 |
report with recommendations for legislation that would create a | 533 |
comprehensive pilot program under which peer mentors assist | 534 |
Medicaid recipients who are part of the Medicaid transition | 535 |
population, and the families of such recipients, to develop and | 536 |
implement plans for overcoming barriers to both achieving greater | 537 |
financial independence and successfully accessing employment | 538 |
opportunities. The recommendations shall provide for the pilot | 539 |
program to have all of the following features: | 540 |
(1) A mechanism under which local, nonprofit community | 541 |
organizations compete to participate in the pilot program in a | 542 |
manner that is similar to the manner in which entities compete to | 543 |
serve as navigators under a grant program established by an | 544 |
Exchange under the "Patient Protection and Affordable Care Act," | 545 |
section 1311(i), 42 U.S.C. 18031(i); | 546 |
(2) Requirements for the local, nonprofit community | 547 |
organizations participating in the pilot program to do both of the | 548 |
following: | 549 |
(a) Provide for individuals who are to serve as peer mentors | 550 |
under the pilot program to be trained in a uniform manner across | 551 |
the state on at least both of the following: | 552 |
(i) Workforce development activity eligibility requirements | 553 |
and opportunities; | 554 |
(ii) Methods for peer mentors to work with Medicaid | 555 |
recipients who are part of the Medicaid transition population and | 556 |
the families of such recipients in culturally competent ways. | 557 |
(b) Make the trained peer mentors available to work with | 558 |
Medicaid recipients who are part of the Medicaid transition | 559 |
population and the families of such recipients. | 560 |
(C) The Committee's report shall recommend that the pilot | 561 |
program do all of the following: | 562 |
(1) Begin operation not later than January 1, 2015; | 563 |
(2) Continue operation for not less than six months; | 564 |
(3) Be operated in urban, suburban, and rural counties; | 565 |
(4) Provide for the Medicaid Director to submit to the | 566 |
General Assembly, in accordance with section 101.68 of the Revised | 567 |
Code, recommendations for adjustments that should be made before | 568 |
the pilot program is expanded statewide. | 569 |
(D) The Committee shall submit the report to the General | 570 |
Assembly in accordance with section 101.68 of the Revised Code not | 571 |
later than June 30, 2014. | 572 |
Section 6. (A) The Joint Medicaid Oversight Committee shall | 573 |
prepare a report regarding all of the following: | 574 |
(1) The appropriate roles of the different types of health | 575 |
care professionals in the Medicaid program and different service | 576 |
delivery systems within the Medicaid program; | 577 |
(2) Regulatory models for all health care professionals who | 578 |
must obtain a license, certificate, or other form of approval from | 579 |
the state to practice in this state; | 580 |
(3) Other issues regarding health care professionals that the | 581 |
Committee considers appropriate for the report. | 582 |
(B) The Executive Director of the Governor's Office of Health | 583 |
Transformation, Medicaid Director, Director of Mental Health and | 584 |
Addiction Services, Director of Health, Director of Aging, and | 585 |
Director of Developmental Disabilities shall assist the Committee | 586 |
with the report. The Committee may request that members of the | 587 |
public and interested parties with expertise in the issue of | 588 |
health care professionals also assist the Committee with the | 589 |
report. The Committee shall submit the report to the General | 590 |
Assembly in accordance with section 101.68 of the Revised Code not | 591 |
later than March 1, 2014. | 592 |
Section 7. All items in this section are hereby appropriated | 593 |
as designated out of any moneys in the state treasury to the | 594 |
credit of the designated fund. For all appropriations made in this | 595 |
act, those in the first column are for fiscal year 2014 and those | 596 |
in the second column are for fiscal year 2015. The appropriations | 597 |
made in this act are in addition to any other appropriations made | 598 |
for the FY 2014-FY 2015 biennium. | 599 |
Appropriations |
600 | |
General Revenue Fund | 601 |
GRF | 048321 | Operating Expenses | $ | 350,000 | $ | 500,000 | 602 | ||||
TOTAL GRF General Revenue Fund | $ | 350,000 | $ | 500,000 | 603 | ||||||
TOTAL ALL BUDGET FUND GROUPS | $ | 350,000 | $ | 500,000 | 604 |
OPERATING EXPENSES | 605 |
The foregoing appropriation item 048321, Operating Expenses, | 606 |
shall be used to support expenses related to the Joint Medicaid | 607 |
Oversight Committee established in section 103.412 of the Revised | 608 |
Code. | 609 |
Appropriations |
610 | |
General Revenue Fund | 611 |
GRF | 651525 | Medicaid/Health Care Services | 612 | ||||||||
State | $ | 0 | $ | 0 | 613 | ||||||
Federal | $ | 499,665,563 | $ | 1,815,000,192 | 614 | ||||||
Medicaid/Health Care Services Total | $ | 499,665,563 | $ | 1,815,000,192 | 615 | ||||||
TOTAL GRF General Revenue Fund | 616 | ||||||||||
State | $ | 0 | $ | 0 | 617 | ||||||
Federal | $ | 499,665,563 | $ | 1,815,000,192 | 618 | ||||||
Total | $ | 499,665,563 | $ | 1,815,000,192 | 619 | ||||||
TOTAL ALL BUDGET FUND GROUPS | $ | 499,665,563 | $ | 1,815,000,192 | 620 |
MEDICAID/HEALTH CARE SERVICES | 621 |
Of the foregoing appropriation item 651525, Medicaid/Health | 622 |
Care Services, $499,665,563 in fiscal year 2014 and $1,815,000,192 | 623 |
in fiscal year 2015 shall be used to cover the eligibility | 624 |
expansion group authorized by the Patient Protection and | 625 |
Affordable Care Act. | 626 |
Section 8. Within the limits set forth in this act, the | 627 |
Director of Budget and Management shall establish accounts | 628 |
indicating the source and amount of funds for each appropriation | 629 |
made in this act, and shall determine the form and manner in which | 630 |
appropriation accounts shall be maintained. Expenditures from | 631 |
appropriations contained in this act shall be accounted for as | 632 |
though made in the main operating appropriations act of the 130th | 633 |
General Assembly. | 634 |
The appropriations made in this act are subject to all | 635 |
provisions of the main operating appropriations act of the 130th | 636 |
General Assembly that are generally applicable to such | 637 |
appropriations. | 638 |