As Passed by the House

130th General Assembly
Regular Session
2013-2014
Am. Sub. S. B. No. 206


Senators Burke, Cafaro 

Cosponsors: Senators Coley, LaRose, Tavares, Bacon, Balderson, Beagle, Eklund, Jones, Lehner, Manning, Peterson, Schaffer, Widener 

Representatives Amstutz, Hackett, McClain, McGregor, Sears 

A BILL
To amend sections 191.02, 5162.01, 5162.13, 5162.131, 1
5162.132, 5162.20, 5163.01, 5163.06, 5163.09, 2
5163.0910, and 5164.911; to amend, for the purpose 3
of adopting a new section number as indicated in 4
parentheses, section 5163.0910 (5162.133); to 5
enact sections 103.41, 103.411, 103.412, 103.413, 6
103.414, 103.415, 191.08, 355.01, 355.02, 355.03, 7
355.04, 5162.134, 5162.70, 5162.71, and 5164.94; 8
and to repeal sections 101.39, 101.391, and 9
5163.099 of the Revised Code; to amend Section 10
323.90 of Am. Sub. H.B. 59 of the 130th General 11
Assembly; to require implementation of certain 12
Medicaid revisions, reform systems, and program 13
oversight; to provide for government programs that 14
provide public benefits to prioritize employment 15
goals; to permit a board of county commissioners 16
to establish a county Healthier Buckeye council; 17
and to make an appropriation.18


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

       Section 1. That sections 191.02, 5162.01, 5162.13, 5162.131, 19
5162.132, 5162.20, 5163.01, 5163.06, 5163.09, 5163.0910, and 20
5164.911 be amended; section 5163.0910 (5162.133) be amended for 21
the purpose of adopting a new section number as indicated in 22
parentheses; and sections 103.41, 103.411, 103.412, 103.413, 23
103.414, 103.415, 191.08, 355.01, 355.02, 355.03, 355.04, 24
5162.134, 5162.70, 5162.71, and 5164.94 of the Revised Code be 25
enacted to read as follows:26

       Sec. 103.41.  (A) As used in sections 103.41 to 103.415 of 27
the Revised Code:28

       (1) "JMOC" means the joint medicaid oversight committee 29
created under this section.30

       (2) "State and local government medicaid agency" means all of 31
the following:32

        (a) The department of medicaid;33

        (b) The office of health transformation;34

        (c) Each state agency and political subdivision with which 35
the department of medicaid contracts under section 5162.35 of the 36
Revised Code to have the state agency or political subdivision 37
administer one or more components of the medicaid program, or one 38
or more aspects of a component, under the department's 39
supervision;40

        (d) Each agency of a political subdivision that is 41
responsible for administering one or more components of the 42
medicaid program, or one or more aspects of a component, under the 43
supervision of the department or a state agency or political 44
subdivision described in division (A)(2)(c) of this section.45

       (B) There is hereby created the joint medicaid oversight 46
committee. JMOC shall consist of the following members:47

       (1) Five members of the senate appointed by the president of 48
the senate, three of whom are members of the majority party and 49
two of whom are members of the minority party;50

       (2) Five members of the house of representatives appointed by 51
the speaker of the house of representatives, three of whom are 52
members of the majority party and two of whom are members of the 53
minority party.54

       (C) The term of each JMOC member shall begin on the day of 55
appointment to JMOC and end on the last day that the member serves 56
in the house (in the case of a member appointed by the speaker) or 57
senate (in the case of a member appointed by the president) during 58
the general assembly for which the member is appointed to JMOC. 59
The president and speaker shall make the initial appointments not 60
later than fifteen days after the effective date of this section. 61
However, if this section takes effect before January 1, 2014, the 62
president and speaker shall make the initial appointments during 63
the period beginning January 1, 2014, and ending January 15, 2014. 64
The president and speaker shall make subsequent appointments not 65
later than fifteen days after the commencement of the first 66
regular session of each general assembly. JMOC members may be 67
reappointed. A vacancy on JMOC shall be filled in the same manner 68
as the original appointment.69

       (D) In odd-numbered years, the speaker shall designate one of 70
the majority members from the house as the JMOC chairperson and 71
the president shall designate one of the minority members from the 72
senate as the JMOC ranking minority member. In even-numbered 73
years, the president shall designate one of the majority members 74
from the senate as the JMOC chairperson and the speaker shall 75
designate one of the minority members from the house as the JMOC 76
ranking minority member.77

       (E) In appointing members from the minority, and in 78
designating ranking minority members, the president and speaker 79
shall consult with the minority leader of their respective houses.80

       (F) JMOC shall meet at the call of the JMOC chairperson. The 81
chairperson shall call JMOC to meet not less often than once each 82
calendar month, unless the chairperson and ranking minority member 83
agree that the chairperson should not call JMOC to meet for a 84
particular month.85

       (G) JMOC may employ professional, technical, and clerical 86
employees as are necessary for JMOC to be able successfully and 87
efficiently to perform its duties. All such employees are in the 88
unclassified service and serve at JMOC's pleasure. JMOC may 89
contract for the services of persons who are qualified by 90
education and experience to advise, consult with, or otherwise 91
assist JMOC in the performance of its duties.92

       (H) The JMOC chairperson, when authorized by JMOC and the 93
president and speaker, may issue subpoenas and subpoenas duces 94
tecum in aid of JMOC's performance of its duties. A subpoena may 95
require a witness in any part of the state to appear before JMOC 96
at a time and place designated in the subpoena to testify. A 97
subpoena duces tecum may require witnesses or other persons in any 98
part of the state to produce books, papers, records, and other 99
tangible evidence before JMOC at a time and place designated in 100
the subpoena duces tecum. A subpoena or subpoena duces tecum shall 101
be issued, served, and returned, and has consequences, as 102
specified in sections 101.41 to 101.45 of the Revised Code.103

       (I) The JMOC chairperson may administer oaths to witnesses 104
appearing before JMOC.105

       Sec. 103.411.  The JMOC chairperson may request that the 106
medicaid director appear before JMOC to provide information and 107
answer questions about the medicaid program. If so requested, the 108
medicaid director shall appear before JMOC at the time and place 109
specified in the request.110

       Sec. 103.412.  (A) JMOC shall oversee the medicaid program on 111
a continuing basis. As part of its oversight, JMOC shall do all of 112
the following:113

       (1) Review how the medicaid program relates to the public and 114
private provision of health care coverage in this state and the 115
United States;116

       (2) Review the reforms implemented under section 5162.70 of 117
the Revised Code and evaluate the reforms' successes in achieving 118
their objectives;119

       (3) Recommend policies and strategies to encourage both of 120
the following:121

       (a) Medicaid recipients being physically and mentally able to 122
join and stay in the workforce and ultimately becoming 123
self-sufficient;124

       (b) Less use of the medicaid program.125

       (4) Recommend, to the extent JMOC determines appropriate, 126
improvements in statutes and rules concerning the medicaid 127
program;128

       (5) Develop a plan of action for the future of the medicaid 129
program;130

       (6) Receive and consider reports submitted by county 131
healthier buckeye councils under section 355.04 of the Revised 132
Code.133

       (B) JMOC may do all of the following:134

       (1) Plan, advertise, organize, and conduct forums, 135
conferences, and other meetings at which representatives of state 136
agencies and other individuals having expertise in the medicaid 137
program may participate to increase knowledge and understanding 138
of, and to develop and propose improvements in, the medicaid 139
program;140

       (2) Prepare and issue reports on the medicaid program;141

       (3) Solicit written comments on, and conduct public hearings 142
at which persons may offer verbal comments on, drafts of its 143
reports.144

       Sec. 103.413.  (A) JMOC may investigate state and local 145
government medicaid agencies. Subject to division (B) of this 146
section, all of the following apply to an investigation:147

       (1) JMOC, including its employees, may inspect the offices of 148
a state and local government medicaid agency as necessary for the 149
conduct of the investigation.150

       (2) No person shall deny JMOC or a JMOC employee access to 151
such an office when access is needed for such an inspection.152

       (3) Neither JMOC nor a JMOC employee is required to give 153
advance notice of, or to make prior arrangements before, such an 154
inspection.155

       (B) Neither JMOC nor a JMOC employee shall conduct an 156
inspection under this section unless the JMOC chairperson grants 157
prior approval for the inspection. The chairperson shall not grant 158
such approval unless JMOC, the president of the senate, and the 159
speaker of the house of representatives authorize the chairperson 160
to grant the approval. Each inspection shall be conducted during 161
the normal business hours of the office being inspected, unless 162
the chairperson determines that the inspection must be conducted 163
outside of normal business hours. The chairperson may make such a 164
determination only due to an emergency circumstance or other 165
justifiable cause that furthers JMOC's mission. If the chairperson 166
makes such a determination, the chairperson shall specify the 167
reason for the determination in the grant of prior approval for 168
the inspection.169

       Sec. 103.414.  Before the beginning of each fiscal biennium, 170
JMOC shall contract with an actuary to determine the projected 171
medical inflation rate for the upcoming fiscal biennium. The 172
contract shall require the actuary to make the determination using 173
the same types of classifications and sub-classifications of 174
medical care that the United States bureau of labor statistics 175
uses in determining the inflation rate for medical care in the 176
consumer price index. The contract also shall require the actuary 177
to provide JMOC a report with its determination at least one 178
hundred twenty days before the governor is required to submit a 179
state budget for the fiscal biennium to the general assembly under 180
section 107.03 of the Revised Code.181

       On receipt of the actuary's report, JMOC shall determine 182
whether it agrees with the actuary's projected medical inflation 183
rate. If JMOC disagrees with the actuary's projected medical 184
inflation rate, JMOC shall determine a different projected medical 185
inflation rate for the upcoming fiscal biennium.186

       The actuary and, if JMOC determines a different projected 187
medical inflation rate, JMOC shall determine the projected medical 188
inflation rate for the state unless that is not practicable in 189
which case the determination shall be made for the midwest region.190

        Regardless of whether it agrees with the actuary's projected 191
medical inflation rate or determines a different projected medical 192
inflation rate, JMOC shall complete a report regarding the 193
projected medical inflation rate. JMOC shall include a copy of the 194
actuary's report in JMOC's report. JMOC's report shall state 195
whether JMOC agrees with the actuary's projected medical inflation 196
rate and, if JMOC disagrees, the reason why JMOC disagrees and the 197
different medical inflation rate JMOC determined. At least ninety 198
days before the governor is required to submit a state budget for 199
the upcoming fiscal biennium to the general assembly under section 200
107.03 of the Revised Code, JMOC shall submit a copy of the report 201
to the general assembly in accordance with section 101.68 of the 202
Revised Code and to the governor and medicaid director.203

       Sec. 103.415.  JMOC may review bills and resolutions 204
regarding the medicaid program that are introduced in the general 205
assembly. JMOC may submit a report of its review of a bill or 206
resolution to the general assembly in accordance with section 207
101.68 of the Revised Code. The report may include JMOC's 208
determination regarding the bill's or resolution's desirability as 209
a matter of public policy.210

        JMOC's decision on whether and when to review a bill or 211
resolution has no effect on the general assembly's authority to 212
act on the bill or resolution. 213

       Sec. 191.02.  The executive director of the office of health 214
transformation, in consultation with all of the following 215
individuals, shall identify each government program administered 216
by a state agency that is to be considered a government program 217
providing public benefits for purposes of sectionsections 191.04 218
and 191.08 of the Revised Code:219

       (A) The director of administrative services;220

       (B) The director of aging;221

       (C) The director of development services;222

       (D) The director of developmental disabilities;223

       (E) The director of health;224

       (F) The director of job and family services;225

       (G) The director of medicaid director;226

       (H) The director of mental health and addiction services;227

       (I) The director of rehabilitation and correction;228

       (J) The director of veterans services;229

       (K) The director of youth services;230

       (L) The executive director of the opportunities for Ohioans 231
with disabilities agency;232

       (M) The administrator of workers' compensation;233

       (N) The superintendent of insurance;234

       (O) The superintendent of public instruction;235

       (P) The tax commissioner.236

       Sec. 191.08.  The executive director of the office of health 237
transformation shall adopt strategies that prioritize employment 238
as a goal for individuals participating in government programs 239
providing public benefits.240

       Sec. 355.01. As used in this chapter:241

       "Care coordination" means assisting an individual to access 242
available physical health, behavioral health, social, employment, 243
education, and housing services the individual needs.244

       "Political subdivision" has the same meaning as in section 245
2744.01 of the Revised Code.246

       "Publicly funded assistance programs" include physical 247
health, behavioral health, social, employment, education, and 248
housing programs funded or provided by the state or a political 249
subdivision of the state. 250

       Sec. 355.02. Each board of county commissioners may adopt a 251
resolution to establish a county healthier buckeye council. The 252
board may invite any person or entity to become a member of the 253
council, including a public or private agency or group that funds, 254
advocates, or provides care coordination services, provides or 255
promotes private employment or educational services, or otherwise 256
contributes to the well-being of individuals and families. 257

       Sec. 355.03. A county healthier buckeye council may do all of 258
the following:259

       (A) Promote means by which council members or the entities 260
the members represent may reduce the reliance of individuals and 261
families on publicly funded assistance programs using both of the 262
following:263

       (1) Programs that have been demonstrated to be effective and 264
have one or more of the following features:265

       (a) Low costs;266

       (b) Use volunteer workers;267

       (c) Use incentives to encourage designated behaviors;268

       (d) Are led by peers.269

       (2) Practices that identify and seek to eliminate barriers to 270
achieving greater financial independence for individuals and 271
families who receive services from or participate in programs 272
operated by council members or the entities the members represent.273

       (B) Promote care coordination among physical health, 274
behavioral health, social, employment, education, and housing 275
service providers within the county;276

       (C) Collect and analyze data regarding individuals or 277
families who receive services from or participate in programs 278
operated by council members or the entities the members represent.279

       Sec. 355.04. A county healthier buckeye council may report 280
the following information to the joint medicaid oversight 281
committee created in section 103.41 of the Revised Code:282

       (A) Notification that the county council has been established 283
and information regarding the council's activities; 284

       (B) Information regarding enrollment or outcome data 285
collected under division (C) of section 355.03 of the Revised 286
Code;287

       (C) Recommendations regarding the best practices for the 288
administration and delivery of publicly funded assistance programs 289
or other services or programs provided by council members or the 290
entities the members represent;291

       (D) Recommendations regarding the best practices in care 292
coordination.293

       Sec. 5162.01.  (A) As used in the Revised Code:294

       (1) "Medicaid" and "medicaid program" mean the program of 295
medical assistance established by Title XIX of the "Social 296
Security Act," 42 U.S.C. 1396 et seq., including any medical 297
assistance provided under the medicaid state plan or a federal 298
medicaid waiver granted by the United States secretary of health 299
and human services.300

       (2) "Medicare" and "medicare program" mean the federal health 301
insurance program established by Title XVIII of the "Social 302
Security Act," 42 U.S.C. 1395 et seq.303

       (B) As used in this chapter:304

       (1) "Dual eligible individual" has the same meaning as in 305
section 5160.01 of the Revised Code.306

       (2) "Exchange" has the same meaning as in 45 C.F.R. 155.20.307

       (3) "Federal financial participation" has the same meaning as 308
in section 5160.01 of the Revised Code.309

       (3)(4) "Federal poverty line" means the official poverty line 310
defined by the United States office of management and budget based 311
on the most recent data available from the United States bureau of 312
the census and revised by the United States secretary of health 313
and human services pursuant to the "Omnibus Budget Reconciliation 314
Act of 1981," section 673(2), 42 U.S.C. 9902(2).315

       (4)(5) "Healthy start component" means the component of the 316
medicaid program that covers pregnant women and children and is 317
identified in rules adopted under section 5162.02 of the Revised 318
Code as the healthy start component.319

       (5)(6) "Home and community-based services" means services 320
provided under a home and community-based services medicaid waiver 321
component.322

       (7) "Home and community-based services medicaid waiver 323
component" has the same meaning as in section 5166.01 of the 324
Revised Code.325

       (8) "ICF/IID" has the same meaning as in section 5124.01 of 326
the Revised Code.327

       (6)(9) "Medicaid managed care organization" has the same 328
meaning as in section 5167.01 of the Revised Code.329

       (7)(10) "Medicaid provider" has the same meaning as in 330
section 5164.01 of the Revised Code.331

       (8)(11) "Medicaid services" has the same meaning as in 332
section 5164.01 of the Revised Code.333

       (9)(12) "Nursing facility" hasand "nursing facility 334
services" have the same meaningmeanings as in section 5165.01 of 335
the Revised Code.336

       (10)(13) "Political subdivision" means a municipal 337
corporation, township, county, school district, or other body 338
corporate and politic responsible for governmental activities only 339
in a geographical area smaller than that of the state.340

       (11)(14) "Prescribed drug" has the same meaning as in section 341
5164.01 of the Revised Code.342

       (12)(15) "Provider agreement" has the same meaning as in 343
section 5164.01 of the Revised Code.344

       (13)(16) "Qualified medicaid school provider" means the board 345
of education of a city, local, or exempted village school 346
district, the governing authority of a community school 347
established under Chapter 3314. of the Revised Code, the state 348
school for the deaf, and the state school for the blind to which 349
both of the following apply:350

       (a) It holds a valid provider agreement.351

       (b) It meets all other conditions for participation in the 352
medicaid school component of the medicaid program established in 353
rules authorized by section 5162.364 of the Revised Code.354

       (14)(17) "State agency" means every organized body, office, 355
or agency, other than the department of medicaid, established by 356
the laws of the state for the exercise of any function of state 357
government.358

       (15)(18) "Vendor offset" means a reduction of a medicaid 359
payment to a medicaid provider to correct a previous, incorrect 360
medicaid payment to that provider.361

       Sec. 5162.13.  On or before the first day of January of each 362
year, the department of medicaid shall submit to the speaker and 363
minority leader of the house of representatives and the president 364
and minority leader of the senate, and shall make available to the 365
public,complete a report on the effectiveness of the medicaid 366
program in meeting the health care needs of low-income pregnant 367
women, infants, and children. The report shall include: the 368
estimated number of pregnant women, infants, and children eligible 369
for the program; the actual number of eligible persons enrolled in 370
the program; the number of prenatal, postpartum, and child health 371
visits; a report on birth outcomes, including a comparison of 372
low-birthweight births and infant mortality rates of medicaid 373
recipients with the general female child-bearing and infant 374
population in this state; and a comparison of the prenatal, 375
delivery, and child health costs of the program with such costs of 376
similar programs in other states, where available. The department 377
shall submit the report to the general assembly in accordance with 378
section 101.68 of the Revised Code and to the joint medicaid 379
oversight committee. The department also shall make the report 380
available to the public.381

       Sec. 5162.131.  Semiannually, the medicaid director shall 382
submit to the president and minority leader of the senate, speaker 383
and minority leader of the house of representatives, and the 384
chairpersons of the standing committees of the senate and house of 385
representatives with primary responsibility for legislation making 386
biennial appropriationscomplete a report on the establishment and 387
implementation of programs designed to control the increase of the 388
cost of the medicaid program, increase the efficiency of the 389
medicaid program, and promote better health outcomes. The director 390
shall submit the report to the general assembly in accordance with 391
section 101.68 of the Revised Code and to the joint medicaid 392
oversight committee. In each calendar year, one report shall be 393
submitted not later than the last day of June and the subsequent 394
report shall be submitted not later than the last day of December.395

       Sec. 5162.132.  Annually, the department of medicaid shall 396
prepare a report on the department's efforts to minimize fraud, 397
waste, and abuse in the medicaid program.398

        Each report shall be made available on the department's web 399
site. The department shall submit a copy of each report to the 400
governor, general assembly, and,joint medicaid oversight 401
committee. The copy to the general assembly shall be submitted in 402
accordance with section 101.68 of the Revised Code, the general 403
assembly. Copies of the report also shall be made available to the 404
public on request.405

       Sec. 5163.0910.        Sec. 5162.133.  Not less than once each year, the 406
medicaid director shall submit a report on the medicaid buy-in for 407
workers with disabilities program to the governor, speaker and 408
minority leader of the house of representatives, president and 409
minority leader of the senate, and chairpersons of the house and 410
senate committees to which the biennial operating budget bill is 411
referredgeneral assembly, and joint medicaid oversight committee. 412
The copy to the general assembly shall be submitted in accordance 413
with section 101.68 of the Revised Code. The report shall include 414
all of the following information:415

       (A) The number of individuals who participated in the 416
medicaid buy-in for workers with disabilities program;417

       (B) The cost of the program;418

       (C) The amount of revenue generated by premiums that 419
participants pay under section 5163.094 of the Revised Code;420

       (D) The average amount of earned income of participants' 421
families;422

       (E) The average amount of time participants have participated 423
in the program;424

       (F) The types of other health insurance participants have 425
been able to obtain.426

       Sec. 5162.134.  Not later than the first day of each July, 427
the medicaid director shall complete a report of the evaluation 428
conducted under section 5164.911 of the Revised Code regarding the 429
integrated care delivery system. The director shall provide a copy 430
of the report to the general assembly and joint medicaid oversight 431
committee. The copy to the general assembly shall be provided in 432
accordance with section 101.68 of the Revised Code. The director 433
also shall make the report available to the public.434

       Sec. 5162.20.  (A) The department of medicaid shall institute 435
cost-sharing requirements for the medicaid program. The 436
cost-sharing requirements shall include a copayment requirement 437
for at least dental services, vision services, nonemergency 438
emergency department services, and prescribed drugs. The 439
cost-sharing requirements also shall include requirements 440
regarding premiums, enrollment fees, deductions, and similar 441
chargesThe department shall not institute cost-sharing 442
requirements in a manner that disproportionately impacts the 443
ability of medicaid recipients with chronic illnesses to obtain 444
medically necessary medicaid services. 445

       (B)(1) No provider shall refuse to provide a service to a 446
medicaid recipient who is unable to pay a required copayment for 447
the service.448

        (2) Division (B)(1) of this section shall not be considered 449
to do either of the following with regard to a medicaid recipient 450
who is unable to pay a required copayment:451

       (a) Relieve the medicaid recipient from the obligation to pay 452
a copayment;453

        (b) Prohibit the provider from attempting to collect an 454
unpaid copayment.455

        (C) Except as provided in division (F) of this section, no 456
provider shall waive a medicaid recipient's obligation to pay the 457
provider a copayment.458

        (D) No provider or drug manufacturer, including the 459
manufacturer's representative, employee, independent contractor, 460
or agent, shall pay any copayment on behalf of a medicaid 461
recipient.462

        (E) If it is the routine business practice of a provider to 463
refuse service to any individual who owes an outstanding debt to 464
the provider, the provider may consider an unpaid copayment 465
imposed by the cost-sharing requirements as an outstanding debt 466
and may refuse service to a medicaid recipient who owes the 467
provider an outstanding debt. If the provider intends to refuse 468
service to a medicaid recipient who owes the provider an 469
outstanding debt, the provider shall notify the recipient of the 470
provider's intent to refuse service.471

       (F) In the case of a provider that is a hospital, the 472
cost-sharing program shall permit the hospital to take action to 473
collect a copayment by providing, at the time services are 474
rendered to a medicaid recipient, notice that a copayment may be 475
owed. If the hospital provides the notice and chooses not to take 476
any further action to pursue collection of the copayment, the 477
prohibition against waiving copayments specified in division (C) 478
of this section does not apply.479

       (G) The department of medicaid may collaborate with a state 480
agency that is administering, pursuant to a contract entered into 481
under section 5162.35 of the Revised Code, one or more components, 482
or one or more aspects of a component, of the medicaid program as 483
necessary for the state agency to apply the cost-sharing 484
requirements to the components or aspects of a component that the 485
state agency administers.486

       Sec. 5162.70. (A) As used in this section:487

       (1) "CPI" means the consumer price index for all urban 488
consumers as published by the United States bureau of labor 489
statistics. 490

       (2) "CPI medical inflation rate" means the inflation rate for 491
medical care, or the successor term for medical care, for the 492
midwest region as specified in the CPI.493

       (3) "JMOC projected medical inflation rate" means the 494
following:495

        (a) The projected medical inflation rate for a fiscal 496
biennium determined by the actuary with which the joint medicaid 497
oversight committee contracts under section 103.414 of the Revised 498
Code if the committee agrees with the actuary's projected medical 499
inflation rate for that fiscal biennium;500

        (b) The different projected medical inflation rate for a 501
fiscal biennium determined by the joint medicaid oversight 502
committee under section 103.414 of the Revised Code if the 503
committee disagrees with the projected medical inflation rate 504
determined for that fiscal biennium by the actuary with which the 505
committee contracts under that section.506

        (4) "Successor term" means a term that the United States 507
bureau of labor statistics uses in place of another term in 508
revisions to the CPI.509

       (B) The medicaid director shall implement reforms to the 510
medicaid program that do all of the following:511

       (1) Limit the growth in the per recipient per month cost of 512
the medicaid program, as determined on an aggregate basis for all 513
eligibility groups, for a fiscal biennium to not more than the 514
lesser of the following:515

       (a) The average annual increase in the CPI medical inflation 516
rate for the most recent three-year period for which the necessary 517
data is available as of the first day of the fiscal biennium, 518
weighted by the most recent year of the three years;519

       (b) The JMOC projected medical inflation rate for the fiscal 520
biennium.521

       (2) Achieve the limit in the growth of the per recipient per 522
month cost of the medicaid program under division (B)(1) of this 523
section by doing all of the following:524

       (a) Improving the physical and mental health of medicaid 525
recipients;526

       (b) Providing for medicaid recipients to receive medicaid 527
services in the most cost-effective and sustainable manner;528

       (c) Removing barriers that impede medicaid recipients' 529
ability to transfer to lower cost, and more appropriate, medicaid 530
services, including home and community-based services;531

       (d) Establishing medicaid payment rates that encourage value 532
over volume and result in medicaid services being provided in the 533
most efficient and effective manner possible;534

       (e) Implementing fraud and abuse prevention and cost 535
avoidance mechanisms to the fullest extent possible;536

       (f) Integrating in the care management system established 537
under section 5167.03 of the Revised Code the delivery of physical 538
health, behavioral health, nursing facility, and home and 539
community-based services covered by medicaid.540

       (3) Reduce the prevalence of comorbid health conditions 541
among, and the mortality rates of, medicaid recipients;542

       (4) Reduce infant mortality rates among medicaid recipients.543

       (C) The medicaid director shall implement the reforms under 544
this section in accordance with evidence-based strategies that 545
include measurable goals.546

       (D) The reforms implemented under this section shall, without 547
making the medicaid program's eligibility requirements more 548
restrictive, reduce the relative number of individuals enrolled in 549
the medicaid program who have the greatest potential to obtain the 550
income and resources that would enable them to cease enrollment in 551
medicaid and instead obtain health care coverage through 552
employer-sponsored health insurance or an exchange.553

       Sec. 5162.71.  The medicaid director shall implement within 554
the medicaid program systems that do both of the following:555

       (A) Improve the health of medicaid recipients through the use 556
of population health measures;557

       (B) Reduce health disparities, including, but not limited to, 558
those within racial and ethnic populations.559

       Sec. 5163.01. As used in this chapter:560

       "Caretaker relative" has the same meaning as in 42 C.F.R. 561
435.4 as that regulation is amended effective January 1, 2014.562

       "Children's hospital" has the same meaning as in section 563
2151.86 of the Revised Code.564

       "Federal financial participation" has the same meaning as in 565
section 5160.01 of the Revised Code.566

       "Federally qualified health center" has the same meaning as 567
in the "Social Security Act," section 1905(l)(2)(B), 42 U.S.C. 568
1396d(l)(2)(B).569

       "Federally qualified health center look-alike" has the same 570
meaning as in section 3701.047 of the Revised Code.571

       "Federal poverty line" has the same meaning as in section 572
5162.01 of the Revised Code.573

       "Healthy start component" has the same meaning as in section 574
5162.01 of the Revised Code.575

       "Home and community-based services medicaid waiver component" 576
has the same meaning as in section 5166.01 of the Revised Code.577

       "Intermediate care facility for individuals with intellectual 578
disabilities" and "ICF/IID" have the same meanings as in section 579
5124.01 of the Revised Code.580

       "Mandatory eligibility groups" means the groups of 581
individuals that must be covered by the medicaid state plan as a 582
condition of the state receiving federal financial participation 583
for the medicaid program.584

       "Medicaid buy-in for workers with disabilities program" means 585
the component of the medicaid program established under sections 586
5163.09 to 5163.09105163.098 of the Revised Code.587

       "Medicaid services" has the same meaning as in section 588
5164.01 of the Revised Code.589

       "Medicaid waiver component" has the same meaning as in 590
section 5166.01 of the Revised Code.591

       "Nursing facility" and "nursing facility services" have the 592
same meanings as in section 5165.01 of the Revised Code.593

       "Optional eligibility groups" means the groups of individuals 594
who may be covered by the medicaid state plan or a federal 595
medicaid waiver and for whom the medicaid program receives federal 596
financial participation.597

       "Other medicaid-funded long-term care services" has the 598
meaning specified in rules adopted under section 5163.02 of the 599
Revised Code.600

       "Supplemental security income program" means the program 601
established by Title XVI of the "Social Security Act," 42 U.S.C. 602
1381 et seq.603

       Sec. 5163.06. The medicaid program shall cover all of the 604
following optional eligibility groups:605

       (A) The group consisting of children placed with adoptive 606
parents who are specified in the "Social Security Act," section 607
1902(a)(10)(A)(ii)(VIII), 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII);608

       (B) Subject to section 5163.061 of the Revised Code, the 609
group consisting of women during pregnancy and the sixty-day 610
period beginning on the last day of the pregnancy, infants, and 611
children who are specified in the "Social Security Act," section 612
1902(a)(10)(A)(ii)(IX), 42 U.S.C. 1396a(a)(10)(A)(ii)(IX);613

       (C) Subject to sections 5163.09 to 5163.09105163.098 of the 614
Revised Code, the group consisting of employed individuals with 615
disabilities who are specified in the "Social Security Act," 616
section 1902(a)(10)(A)(ii)(XV), 42 U.S.C. 1396a(a)(10)(A)(ii)(XV);617

       (D) Subject to sections 5163.09 to 5163.09105163.098 of the 618
Revised Code, the group consisting of employed individuals with 619
medically improved disabilities who are specified in the "Social 620
Security Act," section 1902(a)(10)(A)(ii)(XVI), 42 U.S.C. 621
1396a(a)(10)(A)(ii)(XVI);622

       (E) The group consisting of independent foster care 623
adolescents who are specified in the "Social Security Act," 624
section 1902(a)(10)(A)(ii)(XVII), 42 U.S.C. 625
1396a(a)(10)(A)(ii)(XVII);626

       (F) The group consisting of women in need of treatment for 627
breast or cervical cancer who are specified in the "Social 628
Security Act," section 1902(a)(10)(A)(ii)(XVIII), 42 U.S.C. 629
1396a(a)(10)(A)(ii)(XVIII);630

       (G) The group consisting of nonpregnant individuals who may 631
receive family planning services and supplies and are specified in 632
the "Social Security Act," section 1902(a)(10)(A)(ii)(XXI), 42 633
U.S.C. 1396a(a)(10)(A)(ii)(XXI).634

       Sec. 5163.09.  (A) As used in sections 5163.09 to 5163.0910635
5163.098 of the Revised Code:636

       "Applicant" means an individual who applies to participate in 637
the medicaid buy-in for workers with disabilities program.638

       "Earned income" has the meaning established by rules 639
authorized by section 5163.098 of the Revised Code.640

       "Employed individual with a medically improved disability" 641
has the same meaning as in the "Social Security Act," section 642
1905(v), 42 U.S.C. 1396d(v).643

       "Family" means an applicant or participant and the spouse and 644
dependent children of the applicant or participant. If an 645
applicant or participant is under eighteen years of age, "family" 646
also means the parents of the applicant or participant.647

       "Health insurance" has the meaning established by rules 648
authorized by section 5163.098 of the Revised Code.649

       "Income" means earned income and unearned income.650

       "Participant" means an individual who has been determined 651
eligible for the medicaid buy-in for workers with disabilities 652
program and is participating in the program.653

       "Resources" has the meaning established by rules authorized 654
by section 5163.098 of the Revised Code.655

       "Spouse" has the meaning established inby rules authorized 656
by section 5163.098 of the Revised Code.657

       "Unearned income" has the meaning established by rules 658
authorized by section 5163.098 of the Revised Code.659

       (B) The medicaid program's coverage of the optional 660
eligibility groups specified in the "Social Security Act," section 661
1902(a)(10)(A)(ii)(XV) and (XVI), 42 U.S.C. 662
1396a(a)(10)(A)(ii)(XV) and (XVI) shall be known as the medicaid 663
buy-in for workers with disabilities program.664

       Sec. 5164.911. (A) If the medicaid director implements the 665
integrated care delivery system and except as provided in division 666
(D)(C) of this section, the director shall annually evaluate all 667
of the following:668

        (1) The health outcomes of ICDS participants;669

        (2) How changes to the administration of the ICDS affect all 670
of the following:671

        (a) Claims processing;672

        (b) The appeals process;673

        (c) The number of reassessments requested; 674

       (d) Prior authorization requests for services. 675

       (3) The provider panel selection process used by medicaid 676
managed care organizations participating in the ICDS. 677

       (B) When conducting an evaluation under division (A) of this 678
section, the director shall do all of the following: 679

       (1) For the purpose of division (A)(1) of this section, do 680
both of the following:681

        (a) Compare the health outcomes of ICDS participants to the 682
health outcomes of individuals who are not ICDS participants;683

        (b) Use both of the following:684

       (i) A control group consisting of ICDS participants who 685
receive health care services from providers not participating in 686
ICDS;687

        (ii) A control group consisting of ICDS participants who 688
receive health care services from alternative providers that are 689
not part of a participating medicaid managed care organization's 690
provider panel but provide health care services in the geographic 691
service area in which ICDS participants receive health care 692
services.693

        (2) For the purpose of division (A)(2) of this section, do 694
all of the following:695

        (a) To the extent the data is available, use data from all of 696
the following: 697

       (i) The fee-for-service component of the medicaid program;698

        (ii) Medicaid managed care organizations;699

        (iii) Managed care organizations participating in the 700
medicare advantage program established under Part C of Title XVIII 701
of the "Social Security Act," 42 U.S.C. 1395w-21 et seq.702

        (b) Identify all of the following: 703

       (i) Changes in the amount of time it takes to process claims 704
and the number of claims denied and the reasons for the changes;705

        (ii) The impact that changes to the administration of the 706
ICDS had on the appeals process and number of reassessments 707
requested; 708

       (iii) The number of prior authorization denials that were 709
overturned and the reasons for the overturned denials. 710

       (3) Require medicaid managed care organizations participating 711
in the ICDS to submit to the director any data the director needs 712
for the evaluation.713

        (C) Not later than the first day of each July, the director 714
shall complete a report of the evaluation conducted under this 715
section. The director shall provide a copy of the report to the 716
general assembly in accordance with section 101.68 of the Revised 717
Code and make the report available to the public.718

       (D) The director is not required to conduct an evaluation 719
under this section for a year if the same evaluation is conducted 720
for that year by an organization under contract with the United 721
States department of health and human services.722

       Sec. 5164.94.  The medicaid director shall implement within 723
the medicaid program a system that encourages medicaid providers 724
to provide medicaid services to medicaid recipients in culturally 725
and linguistically appropriate manners.726

       Section 2.  That existing sections 191.02, 5162.01, 5162.13, 727
5162.131, 5162.132, 5162.20, 5163.01, 5163.06, 5163.09, 5163.0910, 728
and 5164.911 of the Revised Code are hereby repealed.729

       Section 3. That sections 101.39, 101.391, and 5163.099 of the 730
Revised Code are hereby repealed.731

       Section 4.  That Section 323.90 of Am. Sub. H.B. 59 of the 732
130th General Assembly be amended to read as follows:733

       Sec. 323.90.  JOINT LEGISLATIVEMEDICAID OVERSIGHT COMMITTEE 734
FOR UNIFIED LONG-TERM SERVICES AND SUPPORTSSTUDY735

       (A) The Joint Legislative Committee for Unified Long-Term 736
Services and Supports created under section 309.30.73 of Am. Sub. 737
H.B. 153 of the 129th General Assembly, as subsequently amended, 738
shall continue to exist during fiscal year 2014 and fiscal year 739
2015. The Committee shall consist of the following members:740

       (1) Two members of the House of Representatives from the 741
majority party, appointed by the Speaker of the House of 742
Representatives;743

       (2) One member of the House of Representatives from the 744
minority party, appointed by the Speaker of the House of 745
Representatives;746

       (3) Two members of the Senate from the majority party, 747
appointed by the President of the Senate;748

       (4) One member of the Senate from the minority party, 749
appointed by the President of the Senate.750

       (B) The Speaker of the House of Representatives shall 751
designate one of the members of the Committee appointed under 752
division (A)(1) of this section to serve as co-chairperson of the 753
Committee. The President of the Senate shall designate one of the 754
members of the Committee appointed under division (A)(3) of this 755
section to serve as the other co-chairperson of the Committee. The 756
Committee shall meet at the call of the co-chairpersons. The 757
co-chairpersons may request assistance for the Committee from the 758
Legislative Service Commission.759

       (C) The Joint Medicaid Oversight Committee may examine the 760
following issues:761

       (1) The implementation of the dual eligible integrated care 762
demonstration project authorized by section 5164.91 of the Revised 763
Code;764

       (2) The implementation of a unified long-term services and 765
support Medicaid waiver component under section 5166.14 of the 766
Revised Code;767

       (3) Providing consumers choices regarding a continuum of 768
services that meet their health-care needs, promote autonomy and 769
independence, and improve quality of life;770

       (4) Ensuring that long-term care services and supports are 771
delivered in a cost-effective and quality manner;772

       (5) Subjecting county homes, county nursing homes, and 773
district homes operated pursuant to Chapter 5155. of the Revised 774
Code to the franchise permit fee under sections 5168.40 to 5168.56 775
of the Revised Code;776

       (6) Other issues of interest to the committee.777

       (D)(B) The co-chairpersons of the Committee chairperson shall 778
provide for the Medicaid Director to testify before the Committee 779
at least quarterly regarding the issues that the Committee 780
examines.781

       Section 5.  That existing Section 323.90 of Am. Sub. H.B. 59 782
of the 130th General Assembly is hereby repealed.783

       Section 6. The Joint Medicaid Oversight Committee shall 784
prepare a report with recommendations for legislation regarding 785
Medicaid payment rates for Medicaid services. The goal of the 786
recommendations shall be to provide the Medicaid Director 787
statutory authority to implement innovative methodologies for 788
setting Medicaid payment rates that limit the growth in Medicaid 789
costs and protect, and establish guiding principles for, Medicaid 790
providers and recipients. The Medicaid Director shall assist the 791
Committee with the report. The Committee shall submit the report 792
to the General Assembly in accordance with section 101.68 of the 793
Revised Code not later than January 1, 2015.794

       Section 7. The General Assembly encourages the Department of 795
Medicaid to achieve greater cost savings for the Medicaid program 796
than required by section 5162.70 of the Revised Code. It is the 797
intent of the General Assembly that any amounts saved under that 798
section not be expended for any other purpose.799

       Section 8. Nothing in this act shall be construed as the 800
General Assembly endorsing, validating, or otherwise approving the 801
Medicaid program's coverage of the group described in the "Social 802
Security Act," section 1902(a)(10)(A)(i)(VIII), 42 U.S.C. 803
1396a(a)(10)(A)(i)(VIII).804

       Section 9.  All items in this section are hereby appropriated 805
as designated out of any moneys in the state treasury to the 806
credit of the designated fund. For all appropriations made in this 807
act, those in the first column are for fiscal year 2014 and those 808
in the second column are for fiscal year 2015. The appropriations 809
made in this act are in addition to any other appropriations made 810
for the FY 2014-FY 2015 biennium.811

Appropriations

JMO JOINT MEDICAID OVERSIGHT COMMITTEE
812

General Revenue Fund813

GRF 048321 Operating Expenses $ 350,000 $ 500,000 814
TOTAL GRF General Revenue Fund $ 350,000 $ 500,000 815
TOTAL ALL BUDGET FUND GROUPS $ 350,000 $ 500,000 816

       OPERATING EXPENSES817

       The foregoing appropriation item 048321, Operating Expenses, 818
shall be used to support expenses related to the Joint Medicaid 819
Oversight Committee created by section 103.41 of the Revised Code.820

       Section 10. Within the limits set forth in this act, the 821
Director of Budget and Management shall establish accounts 822
indicating the source and amount of funds for each appropriation 823
made in this act, and shall determine the form and manner in which 824
appropriation accounts shall be maintained. Expenditures from 825
appropriations contained in this act shall be accounted for as 826
though made in the main operating appropriations act of the 130th 827
General Assembly.828

       The appropriations made in this act are subject to all 829
provisions of the main operating appropriations act of the 130th 830
General Assembly that are generally applicable to such 831
appropriations.832