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(128th General Assembly)
(Substitute House Bill Number 198)
AN ACT
To amend sections 3923.91 and 5111.242 and to enact
sections 185.01 to 185.12, 3333.611, and 3333.612
of the Revised Code, to amend Section 309.30.25 of
Am. Sub. H.B. 1 of the 128th General Assembly, and
to amend Section 5 of Sub. H.B. 125 of the 127th
General Assembly, as subsequently amended, to
establish the Patient Centered Medical Home
Education Pilot Project, to authorize
implementation of a primary care component of the
Choose Ohio First Scholarship Program, to extend
the moratorium concerning most favored nation
clauses in hospital contracts, to revise the law
governing the Medicaid reimbursement for nursing
facilities' tax costs, and to declare an
emergency.
Be it enacted by the General Assembly of the State of Ohio:
SECTION 1. That sections 3923.91 and 5111.242 be amended and
sections 185.01, 185.02, 185.03, 185.04, 185.05, 185.06, 185.07,
185.08, 185.09, 185.10, 185.11, 185.12, 3333.611, and 3333.612 of
the Revised Code be enacted to read as follows:
Sec. 185.01. As used in this chapter:
(A) "Advanced practice nurse" has the same meaning as in
section 4723.01 of the Revised Code.
(B) "Collaboration" has the same meaning as in section
4723.01 of the Revised Code.
(C) "Health care coverage and quality council" means the
entity established under section 3923.90 of the Revised Code.
(D) "Patient centered medical home education advisory group"
means the entity established under section 185.03 of the Revised
Code to implement and administer the patient centered medical home
education pilot project.
(E) "Patient centered medical home education pilot project"
means the pilot project established under section 185.02 of the
Revised Code.
Sec. 185.02. (A) There is hereby established the patient
centered medical home education pilot project. The pilot project
shall be implemented and administered by the patient centered
medical home education advisory group.
(B) The pilot project shall be operated to advance medical
education in the patient centered medical home model of care. The
patient centered medical home model of care is an enhanced model
of primary care in which care teams attend to the multifaceted
needs of patients, providing whole person comprehensive and
coordinated patient centered care.
(C) The pilot project shall not be operated in a manner that
requires a patient, unless otherwise required by the Revised Code,
to receive a referral from a physician in a practice selected for
inclusion in the pilot project under section 185.05 of the Revised
Code as a condition of being authorized to receive specialized
health care services from an individual licensed or certified
under Title XLVII of the Revised Code to provide those services.
Sec. 185.03. (A) The patient centered medical home education
advisory group is hereby created for the purpose of implementing
and administering the patient centered medical home pilot project.
The advisory group shall develop a set of expected outcomes for
the pilot project.
(B) The advisory group shall consist of the following voting
members:
(1) One individual with expertise in the training and
education of primary care physicians who is appointed by the dean
of the university of Toledo college of medicine;
(2) One individual with expertise in the training and
education of primary care physicians who is appointed by the dean
of the Boonshoft school of medicine at Wright state university;
(3) One individual with expertise in the training and
education of primary care physicians who is appointed by the
president and dean of the northeastern Ohio universities colleges
of medicine and pharmacy;
(4) One individual with expertise in the training and
education of primary care physicians who is appointed by the dean
of the Ohio university college of osteopathic medicine;
(5) Two individuals appointed by the governing board of the
Ohio academy of family physicians;
(6) One individual appointed by the governing board of the
Ohio chapter of the American college of physicians;
(7) One individual appointed by the governing board of the
American academy of pediatrics;
(8) One individual appointed by the governing board of the
Ohio osteopathic association;
(9) One individual with expertise in the training and
education of advanced practice nurses who is appointed by the
governing board of the Ohio council of deans and directors of
baccalaureate and higher degree programs in nursing;
(10) One individual appointed by the governing board of the
Ohio nurses association;
(11) One individual appointed by the governing board of the
Ohio association of advanced practice nurses;
(12) A member of the health care coverage and quality
council, other than the advisory group member specified in
division (C)(2) of this section, appointed by the superintendent
of insurance.
(C) The advisory group shall consist of the following
nonvoting, ex officio members:
(1) The executive director of the state medical board, or the
director's designee;
(2) The executive director of the board of nursing or the
director's designee;
(3) The chancellor of the Ohio board of regents, or the
chancellor's designee;
(4) The individual within the department of job and family
services who serves as the director of medicaid, or the director's
designee;
(5) The director of health or the director's designee.
(D) Advisory group members who are appointed shall serve at
the pleasure of their appointing authorities. Terms of office of
appointed members shall be three years, except that a member's
term ends if the pilot project ceases operation during the
member's term.
Vacancies shall be filled in the manner provided for original
appointments.
Members shall serve without compensation, except to the
extent that serving on the advisory group is considered part of
their regular employment duties.
(E) The advisory group shall select from among its members a
chairperson and vice-chairperson. The advisory group may select
any other officers it considers necessary to conduct its business.
A majority of the members of the advisory group constitutes a
quorum for the transaction of official business. A majority of a
quorum is necessary for the advisory group to take any action,
except that when one or more members of a quorum are required to
abstain from voting as provided in division (C)(1)(d) or (C)(2)(c)
of section 185.05 of the Revised Code, the number of members
necessary for a majority of a quorum shall be reduced accordingly.
The advisory group shall meet as necessary to fulfill its
duties. The times and places for the meetings shall be selected by
the chairperson.
(F) Sections 101.82 to 101.87 of the Revised Code do not
apply to the advisory group.
Sec. 185.04. The patient centered medical home education
advisory group may appoint an executive director and employ other
staff as it considers necessary to fulfill its duties. Until the
advisory group identifies an alternative, the Boonshoft school of
medicine at Wright state university shall provide administrative
support to the advisory group.
Sec. 185.05. (A) The patient centered medical home education
advisory group shall accept applications for inclusion in the
patient centered medical home education pilot project from primary
care practices with educational affiliations, as determined by the
advisory group, with one or more of the following:
(1) The Boonshoft school of medicine at Wright state
university;
(2) The university of Toledo college of medicine;
(3) The northeastern Ohio universities colleges of medicine
and pharmacy;
(4) The Ohio university college of osteopathic medicine;
(5) The college of nursing at the university of Toledo;
(6) The Wright state university college of nursing and
health;
(7) The college of nursing at Kent state university;
(8) The university of Akron college of nursing;
(9) The school of nursing at Ohio university.
(B)(1) Subject to division (C)(1) of this section, the
advisory group shall select for inclusion in the pilot project not
more than the following number of physician practices:
(a) Ten practices affiliated with the Boonshoft school of
medicine at Wright state university;
(b) Ten practices affiliated with the university of Toledo
college of medicine;
(c) Ten practices affiliated with the northeastern Ohio
universities colleges of medicine and pharmacy;
(d) Ten practices affiliated with the centers for osteopathic
research and education of the Ohio university college of
osteopathic medicine.
(2) Subject to division (C)(2) of this section, the advisory
group shall select for inclusion in the pilot project not less
than the following number of advanced practice nurse primary care
practices:
(a) One practice affiliated with the college of nursing at
the university of Toledo;
(b) One practice affiliated with the Wright state university
college of nursing and health;
(c) One practice affiliated with the college of nursing at
Kent state university or the university of Akron college of
nursing;
(d) One practice affiliated with the school of nursing at
Ohio university.
(C)(1) All of the following apply with respect to the
selection of physician practices under division (B) of this
section:
(a) The advisory group shall strive to select physician
practices in such a manner that the pilot project includes a
diverse range of primary care specialties, including practices
specializing in pediatrics, geriatrics, general internal medicine,
or family medicine.
(b) When evaluating an application, the advisory group shall
consider the percentage of patients in the physician practice who
are part of a medically underserved population, including medicaid
recipients and individuals without health insurance.
(c) The advisory group shall select not fewer than six
practices that serve rural areas of this state, as those areas are
determined by the advisory group.
(d) A member of the advisory group shall abstain from
participating in any vote taken regarding the selection of a
physician practice if the member would receive any financial
benefit from having the practice included in the pilot project.
(2) All of the following apply with respect to the selection
of advanced practice nurse primary care practices under division
(B) of this section:
(a) When evaluating an application, the advisory group shall
consider the percentage of patients in the advanced practice nurse
primary care practice who are part of a medically underserved
population, including medicaid recipients and individuals without
health insurance.
(b) If the advisory group determines that it has not received
an application from a sufficiently qualified advanced practice
nurse primary care practice affiliated with a particular
institution specified in division (B)(2) of this section, the
advisory group shall make the selections required under that
division in such a manner that the greatest possible number of
those institutions are represented in the pilot project. To be
selected in this manner, a practice remains subject to the
eligibility requirements specified in division (B) of section
185.06 of the Revised Code. As specified in division (B)(2) of
this section, the number of practices selected for inclusion in
the pilot project shall be at least four.
(c) A member of the advisory group shall abstain from
participating in any vote taken regarding the selection of an
advanced practice nurse primary care practice if the member would
receive any financial benefit from having the practice included in
the pilot project.
Sec. 185.06. (A) To be eligible for inclusion in the patient
centered medical home education pilot project, a physician
practice shall meet all of the following requirements:
(1) Consist of physicians who are board-certified in family
medicine, general pediatrics, or internal medicine, as those
designations are issued by a medical specialty certifying board
recognized by the American board of medical specialties or
American osteopathic association;
(2) Be capable of adapting the practice during the period in
which the practice receives funding from the patient centered
medical home education advisory group in such a manner that the
practice is fully compliant with the minimum standards for
operation of a patient centered medical home, as those standards
are established by the advisory group;
(3) Comply with any reporting requirements recommended by the
health care coverage and quality council under division (A)(12) of
section 3923.91 of the Revised Code;
(4) Meet any other criteria established by the advisory group
as part of the selection process.
(B) To be eligible for inclusion in the pilot project, an
advanced practice nurse primary care practice shall meet all of
the following requirements:
(1) Consist of advanced practice nurses who meet all of the
following requirements:
(a) Hold a certificate to prescribe issued under section
4723.48 of the Revised Code;
(b) Are board-certified as a family nurse practitioner or
adult nurse practitioner by the American academy of nurse
practitioners or American nurses credentialing center,
board-certified as a geriatric nurse practitioner or women's
health nurse practitioner by the American nurses credentialing
center, or is board-certified as a pediatric nurse practitioner by
the American nurses credentialing center or pediatric nursing
certification board;
(c) Has a collaboration agreement with a physician with board
certification as specified in division (A)(1) of this section and
who is an active participant on the health care team.
(2) Be capable of adapting the primary care practice during
the period in which the practice receives funding from the
advisory group in such a manner that the practice is fully
compliant with the minimum standards for operation of a patient
centered medical home, as those standards are established by the
advisory group;
(3) Comply with any reporting requirements recommended by the
health care coverage and quality council under division (A)(12) of
section 3923.91 of the Revised Code;
(4) Meet any other criteria established by the advisory group
as part of the selection process.
Sec. 185.07. The patient centered medical home education
advisory group shall enter into a contract with each primary care
practice selected for inclusion in the patient centered medical
home education pilot project. The contract shall specify the terms
and conditions for inclusion in the pilot project, including a
requirement that the practice provide primary care services to
patients and serve as the patients' medical home. The contract
shall also require the practice to participate in the training of
medical students, advanced practice nursing students, or primary
care residents.
Sec. 185.08. The patient centered medical home education
pilot project shall include the following services and supports
for each primary care practice included in the pilot project:
(A) Upon securing adequate funding, the patient centered
medical home education advisory group shall provide to each
participating primary care practice reimbursement for not more
than seventy-five per cent of the cost incurred in purchasing any
health information technology required to convert to the patient
centered medical home model of care, including the cost incurred
for appropriate training and technical support.
(B) The physicians, advanced practice nurses, and staff of
the practice shall receive comprehensive training on the operation
of a patient centered medical home, including assistance with
leadership training, scheduling changes, staff support, and care
management for chronic health conditions.
Sec. 185.09. (A) The patient centered medical home education
advisory group shall jointly work with all medical and nursing
schools in this state to develop appropriate curricula designed to
prepare primary care physicians and advanced practice nurses to
practice within the patient centered medical home model of care.
In developing the curricula, the advisory group, medical schools,
and nursing schools shall include all of the following:
(1) Components for use at the medical student, advanced
practice nursing student, and primary care resident training
levels;
(2) Components that reflect, as appropriate, the special
needs of patients who are part of a medically underserved
population, including medicaid recipients, individuals without
health insurance, individuals with disabilities, individuals with
chronic health conditions, and individuals within racial or ethnic
minority groups;
(3) Components that include training in interdisciplinary
cooperation between physicians and advanced practice nurses in the
patient centered medical home model of care, including curricula
ensuring that a common conception of a patient centered medical
home model of care is provided to medical students, advanced
practice nurses, and primary care residents.
(B) The advisory group shall work in association with the
medical and nursing schools to identify funding sources to ensure
that the curricula developed under division (A) of this section
are accessible to medical students, advanced practice nursing
students, and primary care residents. The advisory group shall
consider scholarship options or incentives provided to students in
addition to those provided under the choose Ohio first scholarship
program operated under section 3333.61 of the Revised Code.
Sec. 185.10. The patient centered medical home education
advisory group shall seek funding sources for the patient centered
medical home education pilot project. In doing so, the advisory
group may apply for grants, seek federal funds, seek private
donations, or seek any other type of funding that may be available
for the pilot project. To ensure that appropriate sources of and
opportunities for funding are identified and pursued, the advisory
group may ask for assistance from the health care coverage and
quality council.
Sec. 185.11. (A) All funds received on behalf of the patient
centered medical home education advisory group shall be deposited
into an account maintained in a financial institution for the
benefit of the patient centered medical home education pilot
project. The account shall be in the custody of the treasurer of
state, but shall not be part of the state treasury. All
disbursements from the account shall be released by the treasurer
of state only upon a request bearing the signature of the advisory
group's chairperson, another person designated by the advisory
group, or, if an executive director has been appointed, the
advisory group's executive director.
(B) The advisory group may use the funds deposited into the
account as it considers necessary to fulfill its duties in
implementing and administering the pilot project.
Sec. 185.12. (A) The patient centered medical home education
advisory group shall prepare reports of its findings and
recommendations from the patient centered medical home education
pilot project. Each report shall include an evaluation of the
learning opportunities generated by the pilot project, the
physicians and advanced practice nurses trained in the pilot
project, the costs of the pilot project, and the extent to which
the pilot project has met the set of expected outcomes developed
under division (A) of section 185.03 of the Revised Code.
(B) The reports shall be completed in accordance with the
following schedule:
(1) An interim report not later than six months after the
date on which the first funding is released pursuant to section
185.11 of the Revised Code;
(2) An update of the interim report not later than one year
after the date on which the first funding is released;
(3) A final report not later than two years after the date on
which the first funding is released.
(C) The advisory group shall submit each of the reports to
the governor and, in accordance with section 101.68 of the Revised
Code, to the general assembly.
Sec. 3333.611. (A) All of the following individuals shall
jointly develop a proposal for the creation of a primary care
medical student component of the choose Ohio first scholarship
program operated under section 3333.61 of the Revised Code under
which scholarships are annually made available and awarded to
medical students who meet the requirements specified in division
(D) of this section:
(1) The dean of the Ohio state university school of medicine;
(2) The dean of the Case western reserve university school of
medicine;
(3) The dean of the university of Toledo college of medicine;
(4) The president and dean of the northeastern Ohio
universities colleges of medicine and pharmacy;
(5) The dean of the university of Cincinnati college of
medicine;
(6) The dean of the Boonshoft school of medicine at Wright
state university;
(7) The dean of the Ohio university college of osteopathic
medicine.
(B) The individuals specified in division (A) of this section
shall consider including the following provisions in the proposal:
(1) Establishing a scholarship of sufficient size to permit
annually not more than fifty medical students to receive
scholarships;
(2) Specifying that a scholarship, once granted, may be
provided to a medical student for not more than four years.
(C) The individuals specified in division (A) of this section
shall submit the proposal for the component to the chancellor of
the Ohio board of regents not later than six months after the
effective date of this section. The chancellor shall review the
proposal and determine whether to implement the component as part
of the program.
(D) To be eligible for a scholarship made available under the
component, a medical student shall meet all of the following
requirements:
(1) Participate in identified patient centered medical home
model training opportunities during medical school;
(2) Commit to a post-residency primary care practice in this
state for not less than three years;
(3) Accept medicaid recipients as patients, without
restriction and, as compared to other patients, in a proportion
that is specified in the scholarship.
Sec. 3333.612. (A) All of the following individuals shall
jointly develop a proposal for the creation of a primary care
nursing student component of the choose Ohio first scholarship
program operated under section 3333.61 of the Revised Code under
which scholarships are annually made available and awarded to
advanced practice nursing students who meet the requirements
specified in division (D) of this section:
(1) The dean of the college of nursing at the university of
Toledo;
(2) The dean of the Wright state university college of
nursing and health;
(3) The dean of the college of nursing at Kent state
university;
(4) The dean of the university of Akron college of nursing;
(5) The director of the school of nursing at Ohio university.
(B) The individuals specified in division (A) of this section
shall consider including the following provisions in the proposal:
(1) Establishing a scholarship of sufficient size to permit
annually not more than thirty advanced practice nursing students
to receive scholarships;
(2) Specifying that a scholarship, once granted, may be
provided to an advanced practice nursing student for not more than
three years.
(C) The individuals specified in division (A) of this section
shall submit the proposal for the component to the chancellor of
the Ohio board of regents not later than six months after the
effective date of this section. The chancellor shall review the
proposal and determine whether to implement the component as part
of the program.
(D) To be eligible for a scholarship made available under the
component, an advanced practice nursing student shall meet all of
the following requirements:
(1) Participate in identified patient centered medical home
model training opportunities during nursing school;
(2) Commit to an advanced practice nursing primary care
practice in this state after completing nursing school for not
less than three years;
(3) Accept medicaid recipients as patients, without
restriction and, as compared to other patients, in a proportion
that is specified in the scholarship.
Sec. 3923.91. (A) The health care coverage and quality
council shall do all of the following:
(1) Advise the governor and general assembly on strategies to
improve health care programs and health insurance policies and
benefit plans;
(2) Monitor and evaluate implementation of strategies for
improving access to health insurance coverage and improving the
quality of the state's health care system, identify barriers to
implementing those strategies, and identify methods for overcoming
the barriers;
(3) Catalog existing health care data reporting efforts and
make recommendations to improve data reporting in a manner that
increases transparency and consistency in the health care and
insurance coverage systems;
(4) Study health care financing alternatives that will
increase access to health insurance coverage, promote disease
prevention and injury prevention, contain costs, and improve
quality;
(5) Evaluate the systems that individuals use to obtain or
otherwise become connected with health insurance and recommend
improvements to those systems or the use of alternative systems;
(6) Recommend minimum coverage standards for basic and
standard health insurance plans offered by insurance carriers;
(7) Recommend strategies, such as subsidies, to assist
individuals in being able to afford health insurance coverage;
(8) Recommend strategies to implement health information
technology to support improved access and quality and reduced
costs in the state's health care system;
(9) Study alternative care management options for medicaid
recipients who are not required to participate in the care
management system established under section 5111.16 of the Revised
Code;
(10)
Review the medical home model of care concept, propose
the characteristics of a patient centered medical home model of
care, pursue appropriate funding opportunities for the development
of a patient centered medical home model of care, and propose
payment reforms that encourage implementation of a patient
centered medical home model of care;
(11) Collaborate with the chancellor of the Ohio board of
regents or any other entity the council considers appropriate to
review issues that may cause limitations on the use of a patient
centered medical home model of care;
(12) Recommend reporting requirements for any physician
practice or advanced practice nurse primary care practice using a
patient centered medical home model of care;
(13) Perform any other duties specified in rules adopted by
the superintendent of insurance.
(B) The council shall prepare and issue an annual report,
which may include recommendations, on or before the thirty-first
day of December of each year. The council may prepare and issue
other reports and recommendations at other times that the council
finds appropriate.
(C) The superintendent may adopt rules as necessary for the
council to carry out its duties. The rules shall be adopted under
Chapter 119. of the Revised Code. In adopting the rules, the
superintendent may consider any recommendations made by the
council.
Sec. 5111.242. (A) As used in this section:
(1) "Applicable calendar year" means the following:
(a) For the purpose of the department of job and family
services' initial determination under this section of nursing
facilities' rate for tax costs, calendar year 2003;
(b) For the purpose of the department's subsequent
determinations under division (D)(C) of this section of nursing
facilities' rate for tax costs, the calendar year the department
selects.
(2) "Tax costs" means the costs of taxes imposed under
Chapter 5751. of the Revised Code, real estate taxes, personal
property taxes, and corporate franchise taxes.
(B) The department of job and family services shall pay a
provider for each of the provider's eligible nursing facilities a
per resident per day rate for tax costs determined under division
(C) of this section.
(C) At least once every ten years, the department shall
determine the rate for tax costs for each nursing facility. The
rate for tax costs determined under this division for a nursing
facility shall be used for subsequent years until the department
redetermines it. To determine a nursing facility's rate for tax
costs and except as provided in division (D) of this section, the
department shall divide the nursing facility's desk-reviewed,
actual, allowable tax costs paid for the applicable calendar year
by the number of inpatient days the nursing facility would have
had if its occupancy rate had been one hundred per cent during the
applicable calendar year.
(D) If a nursing facility had a credit regarding its real
estate taxes reflected on its cost report for calendar year 2003,
the department shall determine its rate for tax costs for the
period beginning on July 1, 2010, and ending on the first day of
the fiscal year for which the department first redetermines all
nursing facilities' rate for tax costs under division (C) of this
section by dividing the nursing facility's desk-reviewed, actual,
allowable tax costs paid for calendar year 2004 by the number of
inpatient days the nursing facility would have had if its
occupancy rate had been one hundred per cent during calendar year
2004.
SECTION 2. That existing sections 3923.91 and 5111.242 of the
Revised Code are hereby repealed.
SECTION 3. That Section 309.30.25 of Am. Sub. H.B. 1 of the
128th General Assembly be amended to read as follows:
Sec. 309.30.25. FISCAL YEAR 2011 MEDICAID REIMBURSEMENT
SYSTEM FOR NURSING FACILITIES
(A) As used in this section:
"Fiscal year 2010 partial rate" means the total rate a
provider of a nursing facility is paid for nursing facility
services the nursing facility provides on June 30, 2010, less the
portion of that total rate that equals the sum of the workforce
development incentive payment and consolidated services rate
included in the total rate pursuant to divisions (D) and (E) of
Section 309.30.20 of this act Am. Sub. H.B. 1 of the 128th General
Assembly.
"Franchise permit fee," "inpatient days," "Medicaid days,"
"nursing facility," and "provider" have the same meanings as in
section 5111.20 of the Revised Code.
"Nursing facility services" means nursing facility services
covered by the Medicaid program that a nursing facility provides
to a resident of the nursing facility who is a Medicaid recipient
eligible for Medicaid-covered nursing facility services.
(B) Except as otherwise provided by this section, the
provider of a nursing facility that has a valid Medicaid provider
agreement on June 30, 2010, and a valid Medicaid provider
agreement during fiscal year 2011 shall be paid, for nursing
facility services the nursing facility provides during fiscal year
2011, the rate calculated for the nursing facility under sections
5111.20 to 5111.33 of the Revised Code with the following
adjustments:
(1) The cost per case mix-unit calculated under section
5111.231 of the Revised Code, the rate for ancillary and support
costs calculated under section 5111.24 of the Revised Code, the
rate for tax costs calculated under section 5111.242 of the
Revised Code, and the rate for capital costs calculated under
section 5111.25 of the Revised Code shall each be adjusted as
follows:
(a) Increase the cost and rates so calculated by two per
cent;
(b) Increase the cost and rates determined under division
(B)(1)(a) of this section by two per cent;
(c) Increase the cost and rates determined under division
(B)(1)(b) of this section by one per cent.
(2) The mean payment used in the calculation of the quality
incentive payment made under section 5111.244 of the Revised Code
shall be, weighted by Medicaid days, three dollars and three cents
per Medicaid day.
(3) The rate, after the adjustments under divisions (B)(1)
and (2) of this section are made, shall be further adjusted by a
percentage that the Department of Job and Family Services shall
determine in consultation with the Ohio Health Care Association;
Ohio Academy of Nursing Homes; and the Association of Ohio
Philanthropic Homes, Housing, and Services for the Aging. The
percentage shall be based on expending an amount equal to the
amount determined as follows:
(a) Determine how much of the revenue to be generated under
section 3721.51 of the Revised Code for fiscal year 2011 reflects
the calculations made under divisions (A)(1) to (4) of section
3721.50 of the Revised Code;
(b) From the amount determined under division (B)(3)(a) of
this section, subtract the portion of the amount to be expended
under division (E)(F) of this section that reflects the part of
the calculation made under division (E)(F)(2) of this section.
(C) Except as provided in division (F)(G) of this section, if
the rate determined for a nursing facility under division (B) of
this section for nursing facility services provided during fiscal
year 2011 is more than one hundred two and twenty-five hundredths
per cent of the nursing facility's fiscal year 2010 partial rate,
the Department of Job and Family Services shall reduce the nursing
facility's rate determined under division (B) of this section for
fiscal year 2011 so that the rate is not more than one hundred two
and twenty-five hundredths per cent of the nursing facility's
fiscal year 2010 partial rate. Except as provided in division
(F)(G) of this section, if the rate determined for a nursing
facility under division (B) of this section for nursing facility
services provided during fiscal year 2011 is less than ninety-nine
per cent of the nursing facility's fiscal year 2010 partial rate,
the Department shall increase the nursing facility's rate
determined under division (B) of this section for fiscal year 2011
so that the rate is not less than ninety-nine per cent of the
nursing facility's fiscal year 2010 partial rate.
(D) After the adjustments under divisions (B) and (C) of this
section are made to a nursing facility's fiscal year 2011 rate,
the Department of Job and Family Services shall increase the
nursing facility's fiscal year 2011 rate by the amount of real
estate taxes reported on the nursing facility's cost report for
calendar year 2004 divided by the number of inpatient days
reported on that cost report if the nursing facility had a credit
regarding its real estate taxes reflected on its cost report for
calendar year 2003.
(E) After the adjustments under divisions (B) and, (C), and
(D) of this section are made to a nursing facility's fiscal year
2011 rate, the Department of Job and Family Services shall
increase the nursing facility's fiscal year 2011 rate by five
dollars and seventy cents per Medicaid day. This increase shall be
known as the workforce development incentive payment. The total
amount of workforce development incentive payments paid to
providers of nursing facilities shall be used to improve nursing
facilities' employee retention and direct care staffing levels,
including by increasing wages paid to nursing facilities' direct
care staff. Not later than September 30, 2012, the Department
shall submit a report to the Governor and, in accordance with
section 101.68 of the Revised Code, the General Assembly detailing
the impact that the workforce development incentive payments have
on nursing facilities' employee retention, direct care staffing
levels, and direct care staff wages.
(E)(F) After the adjustment under division (D)(E) of this
section is made to a nursing facility's fiscal year 2011 rate, the
Department of Job and Family Services shall increase the nursing
facility's fiscal year 2011 rate by the consolidated services rate
per Medicaid day. The consolidated services rate shall equal the
sum of the following:
(1) Three dollars and ninety-one cents;
(2) The amount calculated under divisions (A)(1) to (4) of
section 3721.50 of the Revised Code for fiscal year 2011.
(F)(G) If the fiscal year 2010 rate for a nursing facility as
initially determined under division (B) of section Section
309.30.20 of
this act Am. Sub. H.B. 1 of the 128th General
Assembly is not subject to an adjustment under division (C) of
that section, the nursing facility's fiscal year 2011 rate as
initially determined under division (B) of this section shall not
be subject to an adjustment under division (C) of this section
regardless of whether the nursing facility's fiscal year 2011 rate
as initially determined under division (B) of this section would,
if not for this division, be subject to the adjustment.
If the fiscal year 2011 rate for a nursing facility as
initially determined under division (B) of this section is not
subject to an adjustment under division (C) of this section, the
nursing facility's rate shall not be subject to an adjustment
under that division for the remainder of fiscal year 2011
regardless of any other adjustment made to the nursing facility's
fiscal year 2011 rate under sections 5111.20 to 5111.33 of the
Revised Code.
(G)(H) Not later than October 1, 2010, the Department of Job
and Family Services shall determine the rates to be paid providers
of nursing facilities under this section. Until the rates are
determined, the Department shall continue to pay a provider the
rate the provider is paid for nursing facility services the
provider's nursing facility provides on June 30, 2010. When the
Department determines the rates to be paid under this section, the
Department shall pay the rates retroactive to July 1, 2010.
(H)(I) If the United States Centers for Medicare and Medicaid
Services requires that the franchise permit fee be reduced or
eliminated, the Department of Job and Family Services shall reduce
the amount it pays providers of nursing facility services under
this section as necessary to reflect the loss to the state of the
revenue and federal financial participation generated from the
franchise permit fee.
(I)(J) The Department of Job and Family Services shall follow
this section in determining the rate to be paid to the provider of
a nursing facility that has a valid Medicaid provider agreement on
June 30, 2010, and a valid Medicaid provider agreement during
fiscal year 2011 notwithstanding anything to the contrary in
sections 5111.20 to 5111.33 of the Revised Code.
SECTION 4. That existing Section 309.30.25 of Am. Sub. H.B. 1
of the 128th General Assembly is hereby repealed.
SECTION 5. That Section 5 of Sub. H.B. 125 of the 127th
General Assembly, as amended by Sub. H.B. 493 of the 127th General
Assembly, be amended to read as follows:
Sec. 5. (A) As used in this section and Section 6 of Sub.
H.B. 125 of the 127th General Assembly:
(1) "Most favored nation clause" means a provision in a
health care contract that does any of the following:
(a) Prohibits, or grants a contracting entity an option to
prohibit, the participating provider from contracting with another
contracting entity to provide health care services at a lower
price than the payment specified in the contract;
(b) Requires, or grants a contracting entity an option to
require, the participating provider to accept a lower payment in
the event the participating provider agrees to provide health care
services to any other contracting entity at a lower price;
(c) Requires, or grants a contracting entity an option to
require, termination or renegotiation of the existing health care
contract in the event the participating provider agrees to provide
health care services to any other contracting entity at a lower
price;
(d) Requires the participating provider to disclose the
participating provider's contractual reimbursement rates with
other contracting entities.
(2) "Contracting entity," "health care contract," "health
care services," "participating provider," and "provider" have the
same meanings as in section 3963.01 of the Revised Code, as
enacted by Sub. H.B. 125 of the 127th General Assembly.
(B) With respect to a contracting entity and a provider other
than a hospital, no health care contract that includes a most
favored nation clause shall be entered into, and no health care
contract at the instance of a contracting entity shall be amended
or renewed to include a most favored nation clause, for a period
of three years after the effective date of Sub. H.B. 125 of the
127th General Assembly.
(C) With respect to a contracting entity and a hospital, no
health care contract that includes a most favored nation clause
shall be entered into, and no health care contract at the instance
of a contracting entity shall be amended or renewed to include a
most favored nation clause, for a period of two three years after
the effective date of Sub. H.B. 125 of the 127th General Assembly,
subject to extension as provided in Section 6 of Sub. H.B. 125 of
the 127th General Assembly.
(D) This section does not apply to and does not prohibit the
continued use of a most favored nation clause in a health care
contract that is between a contracting entity and a hospital and
that is in existence on the effective date of Sub. H.B. 125 of the
127th General Assembly even if the health care contract is
materially amended with respect to any provision of the health
care contract other than the most favored nation clause during the
two-year period specified in this section or during any extended
period of time as provided in Section 6 of Sub. H.B. 125 of the
127th General Assembly.
SECTION 6. That existing Section 5 of Sub. H.B. 125 of the
127th General Assembly, as amended by Sub. H.B. 493 of the 127th
General Assembly, is hereby repealed.
SECTION 7. Sections 1 and 2 of this act, except for the
amendments to section 5111.242 of the Revised Code, shall take
effect on the ninetieth day after the effective date of this act.
SECTION 8. This act is hereby declared to be an emergency
measure necessary for the immediate preservation of the public
peace, health, and safety. The reason for such necessity is that
it establishes continuity for existing most favored nation clauses
in health care contracts and avoids the administrative expense of
recalculating a nursing facility's Medicaid reimbursement rate for
tax costs after fiscal year 2011 begins. Therefore, this act shall
go into immediate effect.
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