As Passed by the Senate

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 

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, 5162.134, 5162.70, 7
5162.71, and 5164.94; and to repeal sections 8
101.39, 101.391, and 5163.099 of the Revised Code; 9
to amend Section 323.90 of Am. Sub. H.B. 59 of the 10
130th General Assembly; to require implementation 11
of certain Medicaid revisions, reform systems, and 12
program oversight; to provide for government 13
programs that provide public benefits to 14
prioritize employment goals; and to make an 15
appropriation.16


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

       Section 1. That sections 191.02, 5162.01, 5162.13, 5162.131, 17
5162.132, 5162.20, 5163.01, 5163.06, 5163.09, 5163.0910, and 18
5164.911 be amended; section 5163.0910 (5162.133) be amended for 19
the purpose of adopting a new section number as indicated in 20
parentheses; and sections 103.41, 103.411, 103.412, 103.413, 21
103.414, 103.415, 191.08, 5162.134, 5162.70, 5162.71, and 5164.94 22
of the Revised Code be enacted to read as follows:23

       Sec. 103.41.  (A) As used in sections 103.41 to 103.415 of 24
the Revised Code:25

       (1) "JMOC" means the joint medicaid oversight committee 26
created under this section.27

       (2) "State and local government medicaid agency" means all of 28
the following:29

        (a) The department of medicaid;30

        (b) The office of health transformation;31

        (c) Each state agency and political subdivision with which 32
the department of medicaid contracts under section 5162.35 of the 33
Revised Code to have the state agency or political subdivision 34
administer one or more components of the medicaid program, or one 35
or more aspects of a component, under the department's 36
supervision;37

        (d) Each agency of a political subdivision that is 38
responsible for administering one or more components of the 39
medicaid program, or one or more aspects of a component, under the 40
supervision of the department or a state agency or political 41
subdivision described in division (A)(2)(c) of this section.42

       (B) There is hereby created the joint medicaid oversight 43
committee. JMOC shall consist of the following members:44

       (1) Five members of the senate appointed by the president of 45
the senate, three of whom are members of the majority party and 46
two of whom are members of the minority party;47

       (2) Five members of the house of representatives appointed by 48
the speaker of the house of representatives, three of whom are 49
members of the majority party and two of whom are members of the 50
minority party.51

       (C) The term of each JMOC member shall begin on the day of 52
appointment to JMOC and end on the last day that the member serves 53
in the house (in the case of a member appointed by the speaker) or 54
senate (in the case of a member appointed by the president) during 55
the general assembly for which the member is appointed to JMOC. 56
The president and speaker shall make the initial appointments not 57
later than fifteen days after the effective date of this section. 58
However, if this section takes effect before January 1, 2014, the 59
president and speaker shall make the initial appointments during 60
the period beginning January 1, 2014, and ending January 15, 2014. 61
The president and speaker shall make subsequent appointments not 62
later than fifteen days after the commencement of the first 63
regular session of each general assembly. JMOC members may be 64
reappointed. A vacancy on JMOC shall be filled in the same manner 65
as the original appointment.66

       (D) In odd-numbered years, the speaker shall designate one of 67
the majority members from the house as the JMOC chairperson and 68
the president shall designate one of the minority members from the 69
senate as the JMOC ranking minority member. In even-numbered 70
years, the president shall designate one of the majority members 71
from the senate as the JMOC chairperson and the speaker shall 72
designate one of the minority members from the house as the JMOC 73
ranking minority member.74

       (E) In appointing members from the minority, and in 75
designating ranking minority members, the president and speaker 76
shall consult with the minority leader of their respective houses.77

       (F) JMOC shall meet at the call of the JMOC chairperson. The 78
chairperson shall call JMOC to meet not less often than once each 79
calendar month, unless the chairperson and ranking minority member 80
agree that the chairperson should not call JMOC to meet for a 81
particular month.82

       (G) JMOC may employ professional, technical, and clerical 83
employees as are necessary for JMOC to be able successfully and 84
efficiently to perform its duties. All such employees are in the 85
unclassified service and serve at JMOC's pleasure. JMOC may 86
contract for the services of persons who are qualified by 87
education and experience to advise, consult with, or otherwise 88
assist JMOC in the performance of its duties.89

       (H) The JMOC chairperson, when authorized by JMOC and the 90
president and speaker, may issue subpoenas and subpoenas duces 91
tecum in aid of JMOC's performance of its duties. A subpoena may 92
require a witness in any part of the state to appear before JMOC 93
at a time and place designated in the subpoena to testify. A 94
subpoena duces tecum may require witnesses or other persons in any 95
part of the state to produce books, papers, records, and other 96
tangible evidence before JMOC at a time and place designated in 97
the subpoena duces tecum. A subpoena or subpoena duces tecum shall 98
be issued, served, and returned, and has consequences, as 99
specified in sections 101.41 to 101.45 of the Revised Code.100

       (I) The JMOC chairperson may administer oaths to witnesses 101
appearing before JMOC.102

       Sec. 103.411.  The JMOC chairperson may request that the 103
medicaid director appear before JMOC to provide information and 104
answer questions about the medicaid program. If so requested, the 105
medicaid director shall appear before JMOC at the time and place 106
specified in the request.107

       Sec. 103.412.  (A) JMOC shall oversee the medicaid program on 108
a continuing basis. As part of its oversight, JMOC shall do all of 109
the following:110

       (1) Review how the medicaid program relates to the public and 111
private provision of health care coverage in this state and the 112
United States;113

       (2) Review the reforms implemented under section 5162.70 of 114
the Revised Code and evaluate the reforms' successes in achieving 115
their objectives;116

       (3) Recommend policies and strategies to encourage both of 117
the following:118

       (a) Medicaid recipients being physically and mentally able to 119
join and stay in the workforce and ultimately becoming 120
self-sufficient;121

       (b) Less use of the medicaid program.122

       (4) Recommend, to the extent JMOC determines appropriate, 123
improvements in statutes and rules concerning the medicaid 124
program;125

       (5) Develop a plan of action for the future of the medicaid 126
program.127

       (B) JMOC may do all of the following:128

       (1) Plan, advertise, organize, and conduct forums, 129
conferences, and other meetings at which representatives of state 130
agencies and other individuals having expertise in the medicaid 131
program may participate to increase knowledge and understanding 132
of, and to develop and propose improvements in, the medicaid 133
program;134

       (2) Prepare and issue reports on the medicaid program;135

       (3) Solicit written comments on, and conduct public hearings 136
at which persons may offer verbal comments on, drafts of its 137
reports.138

       Sec. 103.413.  (A) JMOC may investigate state and local 139
government medicaid agencies. Subject to division (B) of this 140
section, all of the following apply to an investigation:141

       (1) JMOC, including its employees, may inspect the offices of 142
a state and local government medicaid agency as necessary for the 143
conduct of the investigation.144

       (2) No person shall deny JMOC or a JMOC employee access to 145
such an office when access is needed for such an inspection.146

       (3) Neither JMOC nor a JMOC employee is required to give 147
advance notice of, or to make prior arrangements before, such an 148
inspection.149

       (B) Neither JMOC nor a JMOC employee shall conduct an 150
inspection under this section unless the JMOC chairperson grants 151
prior approval for the inspection. The chairperson shall not grant 152
such approval unless JMOC, the president of the senate, and the 153
speaker of the house of representatives authorize the chairperson 154
to grant the approval. Each inspection shall be conducted during 155
the normal business hours of the office being inspected, unless 156
the chairperson determines that the inspection must be conducted 157
outside of normal business hours. The chairperson may make such a 158
determination only due to an emergency circumstance or other 159
justifiable cause that furthers JMOC's mission. If the chairperson 160
makes such a determination, the chairperson shall specify the 161
reason for the determination in the grant of prior approval for 162
the inspection.163

       Sec. 103.414.  Before the beginning of each fiscal biennium, 164
JMOC shall contract with an actuary to determine the projected 165
medical inflation rate for the upcoming fiscal biennium. The 166
contract shall require the actuary to make the determination using 167
the same types of classifications and sub-classifications of 168
medical care that the United States bureau of labor statistics 169
uses in determining the inflation rate for medical care in the 170
consumer price index. The contract also shall require the actuary 171
to provide JMOC a report with its determination at least one 172
hundred twenty days before the governor is required to submit a 173
state budget for the fiscal biennium to the general assembly under 174
section 107.03 of the Revised Code.175

       On receipt of the actuary's report, JMOC shall determine 176
whether it agrees with the actuary's projected medical inflation 177
rate. If JMOC disagrees with the actuary's projected medical 178
inflation rate, JMOC shall determine a different projected medical 179
inflation rate for the upcoming fiscal biennium.180

       The actuary and, if JMOC determines a different projected 181
medical inflation rate, JMOC shall determine the projected medical 182
inflation rate for the state unless that is not practicable in 183
which case the determination shall be made for the midwest region.184

        Regardless of whether it agrees with the actuary's projected 185
medical inflation rate or determines a different projected medical 186
inflation rate, JMOC shall complete a report regarding the 187
projected medical inflation rate. JMOC shall include a copy of the 188
actuary's report in JMOC's report. JMOC's report shall state 189
whether JMOC agrees with the actuary's projected medical inflation 190
rate and, if JMOC disagrees, the reason why JMOC disagrees and the 191
different medical inflation rate JMOC determined. At least ninety 192
days before the governor is required to submit a state budget for 193
the upcoming fiscal biennium to the general assembly under section 194
107.03 of the Revised Code, JMOC shall submit a copy of the report 195
to the general assembly in accordance with section 101.68 of the 196
Revised Code and to the governor and medicaid director.197

       Sec. 103.415.  JMOC may review bills and resolutions 198
regarding the medicaid program that are introduced in the general 199
assembly. JMOC may submit a report of its review of a bill or 200
resolution to the general assembly in accordance with section 201
101.68 of the Revised Code. The report may include JMOC's 202
determination regarding the bill's or resolution's desirability as 203
a matter of public policy.204

        JMOC's decision on whether and when to review a bill or 205
resolution has no effect on the general assembly's authority to 206
act on the bill or resolution. 207

       Sec. 191.02.  The executive director of the office of health 208
transformation, in consultation with all of the following 209
individuals, shall identify each government program administered 210
by a state agency that is to be considered a government program 211
providing public benefits for purposes of sectionsections 191.04 212
and 191.08 of the Revised Code:213

       (A) The director of administrative services;214

       (B) The director of aging;215

       (C) The director of development services;216

       (D) The director of developmental disabilities;217

       (E) The director of health;218

       (F) The director of job and family services;219

       (G) The director of medicaid director;220

       (H) The director of mental health and addiction services;221

       (I) The director of rehabilitation and correction;222

       (J) The director of veterans services;223

       (K) The director of youth services;224

       (L) The executive director of the opportunities for Ohioans 225
with disabilities agency;226

       (M) The administrator of workers' compensation;227

       (N) The superintendent of insurance;228

       (O) The superintendent of public instruction;229

       (P) The tax commissioner.230

       Sec. 191.08.  The executive director of the office of health 231
transformation shall adopt strategies that prioritize employment 232
as a goal for individuals participating in government programs 233
providing public benefits.234

       Sec. 5162.01.  (A) As used in the Revised Code:235

       (1) "Medicaid" and "medicaid program" mean the program of 236
medical assistance established by Title XIX of the "Social 237
Security Act," 42 U.S.C. 1396 et seq., including any medical 238
assistance provided under the medicaid state plan or a federal 239
medicaid waiver granted by the United States secretary of health 240
and human services.241

       (2) "Medicare" and "medicare program" mean the federal health 242
insurance program established by Title XVIII of the "Social 243
Security Act," 42 U.S.C. 1395 et seq.244

       (B) As used in this chapter:245

       (1) "Dual eligible individual" has the same meaning as in 246
section 5160.01 of the Revised Code.247

       (2) "Exchange" has the same meaning as in 45 C.F.R. 155.20.248

       (3) "Federal financial participation" has the same meaning as 249
in section 5160.01 of the Revised Code.250

       (3)(4) "Federal poverty line" means the official poverty line 251
defined by the United States office of management and budget based 252
on the most recent data available from the United States bureau of 253
the census and revised by the United States secretary of health 254
and human services pursuant to the "Omnibus Budget Reconciliation 255
Act of 1981," section 673(2), 42 U.S.C. 9902(2).256

       (4)(5) "Healthy start component" means the component of the 257
medicaid program that covers pregnant women and children and is 258
identified in rules adopted under section 5162.02 of the Revised 259
Code as the healthy start component.260

       (5)(6) "Home and community-based services" means services 261
provided under a home and community-based services medicaid waiver 262
component.263

       (7) "Home and community-based services medicaid waiver 264
component" has the same meaning as in section 5166.01 of the 265
Revised Code.266

       (8) "ICF/IID" has the same meaning as in section 5124.01 of 267
the Revised Code.268

       (6)(9) "Medicaid managed care organization" has the same 269
meaning as in section 5167.01 of the Revised Code.270

       (7)(10) "Medicaid provider" has the same meaning as in 271
section 5164.01 of the Revised Code.272

       (8)(11) "Medicaid services" has the same meaning as in 273
section 5164.01 of the Revised Code.274

       (9)(12) "Nursing facility" hasand "nursing facility 275
services" have the same meaningmeanings as in section 5165.01 of 276
the Revised Code.277

       (10)(13) "Political subdivision" means a municipal 278
corporation, township, county, school district, or other body 279
corporate and politic responsible for governmental activities only 280
in a geographical area smaller than that of the state.281

       (11)(14) "Prescribed drug" has the same meaning as in section 282
5164.01 of the Revised Code.283

       (12)(15) "Provider agreement" has the same meaning as in 284
section 5164.01 of the Revised Code.285

       (13)(16) "Qualified medicaid school provider" means the board 286
of education of a city, local, or exempted village school 287
district, the governing authority of a community school 288
established under Chapter 3314. of the Revised Code, the state 289
school for the deaf, and the state school for the blind to which 290
both of the following apply:291

       (a) It holds a valid provider agreement.292

       (b) It meets all other conditions for participation in the 293
medicaid school component of the medicaid program established in 294
rules authorized by section 5162.364 of the Revised Code.295

       (14)(17) "State agency" means every organized body, office, 296
or agency, other than the department of medicaid, established by 297
the laws of the state for the exercise of any function of state 298
government.299

       (15)(18) "Vendor offset" means a reduction of a medicaid 300
payment to a medicaid provider to correct a previous, incorrect 301
medicaid payment to that provider.302

       Sec. 5162.13.  On or before the first day of January of each 303
year, the department of medicaid shall submit to the speaker and 304
minority leader of the house of representatives and the president 305
and minority leader of the senate, and shall make available to the 306
public,complete a report on the effectiveness of the medicaid 307
program in meeting the health care needs of low-income pregnant 308
women, infants, and children. The report shall include: the 309
estimated number of pregnant women, infants, and children eligible 310
for the program; the actual number of eligible persons enrolled in 311
the program; the number of prenatal, postpartum, and child health 312
visits; a report on birth outcomes, including a comparison of 313
low-birthweight births and infant mortality rates of medicaid 314
recipients with the general female child-bearing and infant 315
population in this state; and a comparison of the prenatal, 316
delivery, and child health costs of the program with such costs of 317
similar programs in other states, where available. The department 318
shall submit the report to the general assembly in accordance with 319
section 101.68 of the Revised Code and to the joint medicaid 320
oversight committee. The department also shall make the report 321
available to the public.322

       Sec. 5162.131.  Semiannually, the medicaid director shall 323
submit to the president and minority leader of the senate, speaker 324
and minority leader of the house of representatives, and the 325
chairpersons of the standing committees of the senate and house of 326
representatives with primary responsibility for legislation making 327
biennial appropriationscomplete a report on the establishment and 328
implementation of programs designed to control the increase of the 329
cost of the medicaid program, increase the efficiency of the 330
medicaid program, and promote better health outcomes. The director 331
shall submit the report to the general assembly in accordance with 332
section 101.68 of the Revised Code and to the joint medicaid 333
oversight committee. In each calendar year, one report shall be 334
submitted not later than the last day of June and the subsequent 335
report shall be submitted not later than the last day of December.336

       Sec. 5162.132.  Annually, the department of medicaid shall 337
prepare a report on the department's efforts to minimize fraud, 338
waste, and abuse in the medicaid program.339

        Each report shall be made available on the department's web 340
site. The department shall submit a copy of each report to the 341
governor, general assembly, and,joint medicaid oversight 342
committee. The copy to the general assembly shall be submitted in 343
accordance with section 101.68 of the Revised Code, the general 344
assembly. Copies of the report also shall be made available to the 345
public on request.346

       Sec. 5163.0910.        Sec. 5162.133.  Not less than once each year, the 347
medicaid director shall submit a report on the medicaid buy-in for 348
workers with disabilities program to the governor, speaker and 349
minority leader of the house of representatives, president and 350
minority leader of the senate, and chairpersons of the house and 351
senate committees to which the biennial operating budget bill is 352
referredgeneral assembly, and joint medicaid oversight committee. 353
The copy to the general assembly shall be submitted in accordance 354
with section 101.68 of the Revised Code. The report shall include 355
all of the following information:356

       (A) The number of individuals who participated in the 357
medicaid buy-in for workers with disabilities program;358

       (B) The cost of the program;359

       (C) The amount of revenue generated by premiums that 360
participants pay under section 5163.094 of the Revised Code;361

       (D) The average amount of earned income of participants' 362
families;363

       (E) The average amount of time participants have participated 364
in the program;365

       (F) The types of other health insurance participants have 366
been able to obtain.367

       Sec. 5162.134.  Not later than the first day of each July, 368
the medicaid director shall complete a report of the evaluation 369
conducted under section 5164.911 of the Revised Code regarding the 370
integrated care delivery system. The director shall provide a copy 371
of the report to the general assembly and joint medicaid oversight 372
committee. The copy to the general assembly shall be provided in 373
accordance with section 101.68 of the Revised Code. The director 374
also shall make the report available to the public.375

       Sec. 5162.20.  (A) The department of medicaid shall institute 376
cost-sharing requirements for the medicaid program. The 377
cost-sharing requirements shall include a copayment requirement 378
for at least dental services, vision services, nonemergency 379
emergency department services, and prescribed drugs. The 380
cost-sharing requirements also shall include requirements 381
regarding premiums, enrollment fees, deductions, and similar 382
chargesThe department shall not institute cost-sharing 383
requirements in a manner that disproportionately impacts the 384
ability of medicaid recipients with chronic illnesses to obtain 385
medically necessary medicaid services. 386

       (B)(1) No provider shall refuse to provide a service to a 387
medicaid recipient who is unable to pay a required copayment for 388
the service.389

        (2) Division (B)(1) of this section shall not be considered 390
to do either of the following with regard to a medicaid recipient 391
who is unable to pay a required copayment:392

       (a) Relieve the medicaid recipient from the obligation to pay 393
a copayment;394

        (b) Prohibit the provider from attempting to collect an 395
unpaid copayment.396

        (C) Except as provided in division (F) of this section, no 397
provider shall waive a medicaid recipient's obligation to pay the 398
provider a copayment.399

        (D) No provider or drug manufacturer, including the 400
manufacturer's representative, employee, independent contractor, 401
or agent, shall pay any copayment on behalf of a medicaid 402
recipient.403

        (E) If it is the routine business practice of a provider to 404
refuse service to any individual who owes an outstanding debt to 405
the provider, the provider may consider an unpaid copayment 406
imposed by the cost-sharing requirements as an outstanding debt 407
and may refuse service to a medicaid recipient who owes the 408
provider an outstanding debt. If the provider intends to refuse 409
service to a medicaid recipient who owes the provider an 410
outstanding debt, the provider shall notify the recipient of the 411
provider's intent to refuse service.412

       (F) In the case of a provider that is a hospital, the 413
cost-sharing program shall permit the hospital to take action to 414
collect a copayment by providing, at the time services are 415
rendered to a medicaid recipient, notice that a copayment may be 416
owed. If the hospital provides the notice and chooses not to take 417
any further action to pursue collection of the copayment, the 418
prohibition against waiving copayments specified in division (C) 419
of this section does not apply.420

       (G) The department of medicaid may collaborate with a state 421
agency that is administering, pursuant to a contract entered into 422
under section 5162.35 of the Revised Code, one or more components, 423
or one or more aspects of a component, of the medicaid program as 424
necessary for the state agency to apply the cost-sharing 425
requirements to the components or aspects of a component that the 426
state agency administers.427

       Sec. 5162.70. (A) As used in this section:428

       (1) "CPI" means the consumer price index for all urban 429
consumers as published by the United States bureau of labor 430
statistics. 431

       (2) "CPI medical inflation rate" means the inflation rate for 432
medical care, or the successor term for medical care, for the 433
midwest region as specified in the CPI.434

       (3) "JMOC projected medical inflation rate" means the 435
following:436

        (a) The projected medical inflation rate for a fiscal 437
biennium determined by the actuary with which the joint medicaid 438
oversight committee contracts under section 103.414 of the Revised 439
Code if the committee agrees with the actuary's projected medical 440
inflation rate for that fiscal biennium;441

        (b) The different projected medical inflation rate for a 442
fiscal biennium determined by the joint medicaid oversight 443
committee under section 103.414 of the Revised Code if the 444
committee disagrees with the projected medical inflation rate 445
determined for that fiscal biennium by the actuary with which the 446
committee contracts under that section.447

        (4) "Successor term" means a term that the United States 448
bureau of labor statistics uses in place of another term in 449
revisions to the CPI.450

       (B) The medicaid director shall implement reforms to the 451
medicaid program that do all of the following:452

       (1) Limit the growth in the per recipient per month cost of 453
the medicaid program, as determined on an aggregate basis for all 454
eligibility groups, for a fiscal biennium to not more than the 455
lesser of the following:456

       (a) The average annual increase in the CPI medical inflation 457
rate for the most recent three-year period for which the necessary 458
data is available as of the first day of the fiscal biennium, 459
weighted by the most recent year of the three years;460

       (b) The JMOC projected medical inflation rate for the fiscal 461
biennium.462

       (2) Achieve the limit in the growth of the per recipient per 463
month cost of the medicaid program under division (B)(1) of this 464
section by doing all of the following:465

       (a) Improving the physical and mental health of medicaid 466
recipients;467

       (b) Providing for medicaid recipients to receive medicaid 468
services in the most cost-effective and sustainable manner;469

       (c) Removing barriers that impede medicaid recipients' 470
ability to transfer to lower cost, and more appropriate, medicaid 471
services, including home and community-based services;472

       (d) Establishing medicaid payment rates that encourage value 473
over volume and result in medicaid services being provided in the 474
most efficient and effective manner possible;475

       (e) Implementing fraud and abuse prevention and cost 476
avoidance mechanisms to the fullest extent possible;477

       (f) Integrating in the care management system established 478
under section 5167.03 of the Revised Code the delivery of physical 479
health, behavioral health, nursing facility, and home and 480
community-based services covered by medicaid.481

       (3) Reduce the prevalence of comorbid health conditions 482
among, and the mortality rates of, medicaid recipients;483

       (4) Reduce infant mortality rates among medicaid recipients.484

       (C) The medicaid director shall implement the reforms under 485
this section in accordance with evidence-based strategies that 486
include measurable goals.487

       (D) The reforms implemented under this section shall, without 488
making the medicaid program's eligibility requirements more 489
restrictive, reduce the relative number of individuals enrolled in 490
the medicaid program who have the greatest potential to obtain the 491
income and resources that would enable them to cease enrollment in 492
medicaid and instead obtain health care coverage through 493
employer-sponsored health insurance or an exchange.494

       Sec. 5162.71.  The medicaid director shall implement within 495
the medicaid program systems that do both of the following:496

       (A) Improve the health of medicaid recipients through the use 497
of population health measures;498

       (B) Reduce health disparities, including, but not limited to, 499
those within racial and ethnic populations.500

       Sec. 5163.01. As used in this chapter:501

       "Caretaker relative" has the same meaning as in 42 C.F.R. 502
435.4 as that regulation is amended effective January 1, 2014.503

       "Children's hospital" has the same meaning as in section 504
2151.86 of the Revised Code.505

       "Federal financial participation" has the same meaning as in 506
section 5160.01 of the Revised Code.507

       "Federally qualified health center" has the same meaning as 508
in the "Social Security Act," section 1905(l)(2)(B), 42 U.S.C. 509
1396d(l)(2)(B).510

       "Federally qualified health center look-alike" has the same 511
meaning as in section 3701.047 of the Revised Code.512

       "Federal poverty line" has the same meaning as in section 513
5162.01 of the Revised Code.514

       "Healthy start component" has the same meaning as in section 515
5162.01 of the Revised Code.516

       "Home and community-based services medicaid waiver component" 517
has the same meaning as in section 5166.01 of the Revised Code.518

       "Intermediate care facility for individuals with intellectual 519
disabilities" and "ICF/IID" have the same meanings as in section 520
5124.01 of the Revised Code.521

       "Mandatory eligibility groups" means the groups of 522
individuals that must be covered by the medicaid state plan as a 523
condition of the state receiving federal financial participation 524
for the medicaid program.525

       "Medicaid buy-in for workers with disabilities program" means 526
the component of the medicaid program established under sections 527
5163.09 to 5163.09105163.098 of the Revised Code.528

       "Medicaid services" has the same meaning as in section 529
5164.01 of the Revised Code.530

       "Medicaid waiver component" has the same meaning as in 531
section 5166.01 of the Revised Code.532

       "Nursing facility" and "nursing facility services" have the 533
same meanings as in section 5165.01 of the Revised Code.534

       "Optional eligibility groups" means the groups of individuals 535
who may be covered by the medicaid state plan or a federal 536
medicaid waiver and for whom the medicaid program receives federal 537
financial participation.538

       "Other medicaid-funded long-term care services" has the 539
meaning specified in rules adopted under section 5163.02 of the 540
Revised Code.541

       "Supplemental security income program" means the program 542
established by Title XVI of the "Social Security Act," 42 U.S.C. 543
1381 et seq.544

       Sec. 5163.06. The medicaid program shall cover all of the 545
following optional eligibility groups:546

       (A) The group consisting of children placed with adoptive 547
parents who are specified in the "Social Security Act," section 548
1902(a)(10)(A)(ii)(VIII), 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII);549

       (B) Subject to section 5163.061 of the Revised Code, the 550
group consisting of women during pregnancy and the sixty-day 551
period beginning on the last day of the pregnancy, infants, and 552
children who are specified in the "Social Security Act," section 553
1902(a)(10)(A)(ii)(IX), 42 U.S.C. 1396a(a)(10)(A)(ii)(IX);554

       (C) Subject to sections 5163.09 to 5163.09105163.098 of the 555
Revised Code, the group consisting of employed individuals with 556
disabilities who are specified in the "Social Security Act," 557
section 1902(a)(10)(A)(ii)(XV), 42 U.S.C. 1396a(a)(10)(A)(ii)(XV);558

       (D) Subject to sections 5163.09 to 5163.09105163.098 of the 559
Revised Code, the group consisting of employed individuals with 560
medically improved disabilities who are specified in the "Social 561
Security Act," section 1902(a)(10)(A)(ii)(XVI), 42 U.S.C. 562
1396a(a)(10)(A)(ii)(XVI);563

       (E) The group consisting of independent foster care 564
adolescents who are specified in the "Social Security Act," 565
section 1902(a)(10)(A)(ii)(XVII), 42 U.S.C. 566
1396a(a)(10)(A)(ii)(XVII);567

       (F) The group consisting of women in need of treatment for 568
breast or cervical cancer who are specified in the "Social 569
Security Act," section 1902(a)(10)(A)(ii)(XVIII), 42 U.S.C. 570
1396a(a)(10)(A)(ii)(XVIII);571

       (G) The group consisting of nonpregnant individuals who may 572
receive family planning services and supplies and are specified in 573
the "Social Security Act," section 1902(a)(10)(A)(ii)(XXI), 42 574
U.S.C. 1396a(a)(10)(A)(ii)(XXI).575

       Sec. 5163.09.  (A) As used in sections 5163.09 to 5163.0910576
5163.098 of the Revised Code:577

       "Applicant" means an individual who applies to participate in 578
the medicaid buy-in for workers with disabilities program.579

       "Earned income" has the meaning established by rules 580
authorized by section 5163.098 of the Revised Code.581

       "Employed individual with a medically improved disability" 582
has the same meaning as in the "Social Security Act," section 583
1905(v), 42 U.S.C. 1396d(v).584

       "Family" means an applicant or participant and the spouse and 585
dependent children of the applicant or participant. If an 586
applicant or participant is under eighteen years of age, "family" 587
also means the parents of the applicant or participant.588

       "Health insurance" has the meaning established by rules 589
authorized by section 5163.098 of the Revised Code.590

       "Income" means earned income and unearned income.591

       "Participant" means an individual who has been determined 592
eligible for the medicaid buy-in for workers with disabilities 593
program and is participating in the program.594

       "Resources" has the meaning established by rules authorized 595
by section 5163.098 of the Revised Code.596

       "Spouse" has the meaning established inby rules authorized 597
by section 5163.098 of the Revised Code.598

       "Unearned income" has the meaning established by rules 599
authorized by section 5163.098 of the Revised Code.600

       (B) The medicaid program's coverage of the optional 601
eligibility groups specified in the "Social Security Act," section 602
1902(a)(10)(A)(ii)(XV) and (XVI), 42 U.S.C. 603
1396a(a)(10)(A)(ii)(XV) and (XVI) shall be known as the medicaid 604
buy-in for workers with disabilities program.605

       Sec. 5164.911. (A) If the medicaid director implements the 606
integrated care delivery system and except as provided in division 607
(D)(C) of this section, the director shall annually evaluate all 608
of the following:609

        (1) The health outcomes of ICDS participants;610

        (2) How changes to the administration of the ICDS affect all 611
of the following:612

        (a) Claims processing;613

        (b) The appeals process;614

        (c) The number of reassessments requested; 615

       (d) Prior authorization requests for services. 616

       (3) The provider panel selection process used by medicaid 617
managed care organizations participating in the ICDS. 618

       (B) When conducting an evaluation under division (A) of this 619
section, the director shall do all of the following: 620

       (1) For the purpose of division (A)(1) of this section, do 621
both of the following:622

        (a) Compare the health outcomes of ICDS participants to the 623
health outcomes of individuals who are not ICDS participants;624

        (b) Use both of the following:625

       (i) A control group consisting of ICDS participants who 626
receive health care services from providers not participating in 627
ICDS;628

        (ii) A control group consisting of ICDS participants who 629
receive health care services from alternative providers that are 630
not part of a participating medicaid managed care organization's 631
provider panel but provide health care services in the geographic 632
service area in which ICDS participants receive health care 633
services.634

        (2) For the purpose of division (A)(2) of this section, do 635
all of the following:636

        (a) To the extent the data is available, use data from all of 637
the following: 638

       (i) The fee-for-service component of the medicaid program;639

        (ii) Medicaid managed care organizations;640

        (iii) Managed care organizations participating in the 641
medicare advantage program established under Part C of Title XVIII 642
of the "Social Security Act," 42 U.S.C. 1395w-21 et seq.643

        (b) Identify all of the following: 644

       (i) Changes in the amount of time it takes to process claims 645
and the number of claims denied and the reasons for the changes;646

        (ii) The impact that changes to the administration of the 647
ICDS had on the appeals process and number of reassessments 648
requested; 649

       (iii) The number of prior authorization denials that were 650
overturned and the reasons for the overturned denials. 651

       (3) Require medicaid managed care organizations participating 652
in the ICDS to submit to the director any data the director needs 653
for the evaluation.654

        (C) Not later than the first day of each July, the director 655
shall complete a report of the evaluation conducted under this 656
section. The director shall provide a copy of the report to the 657
general assembly in accordance with section 101.68 of the Revised 658
Code and make the report available to the public.659

       (D) The director is not required to conduct an evaluation 660
under this section for a year if the same evaluation is conducted 661
for that year by an organization under contract with the United 662
States department of health and human services.663

       Sec. 5164.94.  The medicaid director shall implement within 664
the medicaid program a system that encourages medicaid providers 665
to provide medicaid services to medicaid recipients in culturally 666
and linguistically appropriate manners.667

       Section 2.  That existing sections 191.02, 5162.01, 5162.13, 668
5162.131, 5162.132, 5162.20, 5163.01, 5163.06, 5163.09, 5163.0910, 669
and 5164.911 of the Revised Code are hereby repealed.670

       Section 3. That sections 101.39, 101.391, and 5163.099 of the 671
Revised Code are hereby repealed.672

       Section 4.  That Section 323.90 of Am. Sub. H.B. 59 of the 673
130th General Assembly be amended to read as follows:674

       Sec. 323.90.  JOINT LEGISLATIVEMEDICAID OVERSIGHT COMMITTEE 675
FOR UNIFIED LONG-TERM SERVICES AND SUPPORTSSTUDY676

       (A) The Joint Legislative Committee for Unified Long-Term 677
Services and Supports created under section 309.30.73 of Am. Sub. 678
H.B. 153 of the 129th General Assembly, as subsequently amended, 679
shall continue to exist during fiscal year 2014 and fiscal year 680
2015. The Committee shall consist of the following members:681

       (1) Two members of the House of Representatives from the 682
majority party, appointed by the Speaker of the House of 683
Representatives;684

       (2) One member of the House of Representatives from the 685
minority party, appointed by the Speaker of the House of 686
Representatives;687

       (3) Two members of the Senate from the majority party, 688
appointed by the President of the Senate;689

       (4) One member of the Senate from the minority party, 690
appointed by the President of the Senate.691

       (B) The Speaker of the House of Representatives shall 692
designate one of the members of the Committee appointed under 693
division (A)(1) of this section to serve as co-chairperson of the 694
Committee. The President of the Senate shall designate one of the 695
members of the Committee appointed under division (A)(3) of this 696
section to serve as the other co-chairperson of the Committee. The 697
Committee shall meet at the call of the co-chairpersons. The 698
co-chairpersons may request assistance for the Committee from the 699
Legislative Service Commission.700

       (C) The Joint Medicaid Oversight Committee may examine the 701
following issues:702

       (1) The implementation of the dual eligible integrated care 703
demonstration project authorized by section 5164.91 of the Revised 704
Code;705

       (2) The implementation of a unified long-term services and 706
support Medicaid waiver component under section 5166.14 of the 707
Revised Code;708

       (3) Providing consumers choices regarding a continuum of 709
services that meet their health-care needs, promote autonomy and 710
independence, and improve quality of life;711

       (4) Ensuring that long-term care services and supports are 712
delivered in a cost-effective and quality manner;713

       (5) Subjecting county homes, county nursing homes, and 714
district homes operated pursuant to Chapter 5155. of the Revised 715
Code to the franchise permit fee under sections 5168.40 to 5168.56 716
of the Revised Code;717

       (6) Other issues of interest to the committee.718

       (D)(B) The co-chairpersons of the Committee chairperson shall 719
provide for the Medicaid Director to testify before the Committee 720
at least quarterly regarding the issues that the Committee 721
examines.722

       Section 5.  That existing Section 323.90 of Am. Sub. H.B. 59 723
of the 130th General Assembly is hereby repealed.724

       Section 6. The Joint Medicaid Oversight Committee shall 725
prepare a report with recommendations for legislation regarding 726
Medicaid payment rates for Medicaid services. The goal of the 727
recommendations shall be to provide the Medicaid Director 728
statutory authority to implement innovative methodologies for 729
setting Medicaid payment rates that limit the growth in Medicaid 730
costs and protect, and establish guiding principles for, Medicaid 731
providers and recipients. The Medicaid Director shall assist the 732
Committee with the report. The Committee shall submit the report 733
to the General Assembly in accordance with section 101.68 of the 734
Revised Code not later than January 1, 2015.735

       Section 7. The General Assembly encourages the Department of 736
Medicaid to achieve greater cost savings for the Medicaid program 737
than required by section 5162.70 of the Revised Code. It is the 738
intent of the General Assembly that any amounts saved under that 739
section not be expended for any other purpose.740

       Section 8. Nothing in this act shall be construed as the 741
General Assembly endorsing, validating, or otherwise approving the 742
Medicaid program's coverage of the group described in the "Social 743
Security Act," section 1902(a)(10)(A)(i)(VIII), 42 U.S.C. 744
1396a(a)(10)(A)(i)(VIII).745

       Section 9.  All items in this section are hereby appropriated 746
as designated out of any moneys in the state treasury to the 747
credit of the designated fund. For all appropriations made in this 748
act, those in the first column are for fiscal year 2014 and those 749
in the second column are for fiscal year 2015. The appropriations 750
made in this act are in addition to any other appropriations made 751
for the FY 2014-FY 2015 biennium.752

Appropriations

JMO JOINT MEDICAID OVERSIGHT COMMITTEE
753

General Revenue Fund754

GRF 048321 Operating Expenses $ 350,000 $ 500,000 755
TOTAL GRF General Revenue Fund $ 350,000 $ 500,000 756
TOTAL ALL BUDGET FUND GROUPS $ 350,000 $ 500,000 757

       OPERATING EXPENSES758

       The foregoing appropriation item 048321, Operating Expenses, 759
shall be used to support expenses related to the Joint Medicaid 760
Oversight Committee created by section 103.41 of the Revised Code.761

       Section 10. Within the limits set forth in this act, the 762
Director of Budget and Management shall establish accounts 763
indicating the source and amount of funds for each appropriation 764
made in this act, and shall determine the form and manner in which 765
appropriation accounts shall be maintained. Expenditures from 766
appropriations contained in this act shall be accounted for as 767
though made in the main operating appropriations act of the 130th 768
General Assembly.769

       The appropriations made in this act are subject to all 770
provisions of the main operating appropriations act of the 130th 771
General Assembly that are generally applicable to such 772
appropriations.773