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H. B. No. 287 As IntroducedAs Introduced
129th General Assembly | Regular Session | 2011-2012 |
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Representatives Hagan, R., Foley
Cosponsors:
Representatives Antonio, Yuko, Ramos, Letson, Williams, Luckie, Mallory, Boyd
A BILL
To amend section 109.02 and to enact sections 3922.01
to 3922.15, 3922.21 to 3922.27, 3922.31, 3922.32,
and 3922.33 of the Revised Code to enact the Ohio
Health Security Act to establish and operate the
Ohio Health Care Plan to provide universal health
care coverage to all Ohio residents.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 109.02 be amended and sections
3922.01, 3922.02, 3922.03, 3922.04, 3922.05, 3922.06, 3922.07,
3922.08, 3922.09, 3922.10, 3922.11, 3922.12, 3922.13, 3922.14,
3922.15, 3922.21, 3922.22, 3922.23, 3922.24, 3922.25, 3922.26,
3922.27, 3922.31, 3922.32, and 3922.33 of the Revised Code be
enacted to read as follows:
Sec. 109.02. The attorney general is the chief law officer
for the state and all its departments and shall be provided with
adequate office space in Columbus. Except as provided in division
(E) of section 120.06 and in sections 3517.152 to 3517.157 and
3922.04 of the Revised Code, no state officer or board, or head of
a department or institution of the state shall employ, or be
represented by, other counsel or attorneys at law. The attorney
general shall appear for the state in the trial and argument of
all civil and criminal causes in the supreme court in which the
state is directly or indirectly interested. When required by the
governor or the general assembly, the attorney general shall
appear for the state in any court or tribunal in a cause in which
the state is a party, or in which the state is directly
interested. Upon the written request of the governor, the attorney
general shall prosecute any person indicted for a crime.
Sec. 3922.01. As used in this chapter:
(A) "Blind trust" means an independently managed trust in
which the beneficiary has no management rights and in which the
beneficiary is not given notice of alterations in or other
dispositions of the stock, mutual funds, or other property subject
to the trust.
(B) "Health care facility" means any facility, except a
health care practitioner's office, that provides preventive,
diagnostic, therapeutic, acute convalescent, rehabilitation,
mental health, mental retardation, intermediate care, or skilled
nursing services.
(C) "Provider" means a hospital or other health care
facility, and physicians, podiatrists, dentists, pharmacists,
chiropractors, and other health care personnel, licensed,
certified, accredited, or otherwise authorized in this state to
furnish health care services.
Sec. 3922.02. (A)(1) There is hereby created the Ohio health
care plan, which shall be administered by the Ohio health care
agency under the direction of the Ohio health care board.
(2) The Ohio health care plan shall provide universal and
affordable health care coverage for all Ohio residents, consisting
of a comprehensive benefit package that includes benefits for
prescription drugs. The Ohio health care plan shall work
simultaneously to control health care costs, control health care
spending, achieve measurable improvement in health care outcomes,
increase all parties' satisfaction with the health care system,
implement policies that strengthen and improve culturally and
linguistically sensitive care, and develop an integrated health
care database to support health care planning.
(B) There is hereby created the Ohio health care agency. The
Ohio health care agency shall administer the Ohio health care plan
and is the sole agency authorized to accept applicable
grants-in-aid from the federal and state government, using the
funds in order to secure full compliance with provisions of state
and federal law and to carry out the purposes of sections 3922.01
to 3922.33 of the Revised Code. All grants-in-aid accepted by the
Ohio health care agency shall be deposited into the Ohio health
care fund established under section 3922.09 of the Revised Code.
Sections 101.82 and 101.83 of the Revised Code do not apply
to the Ohio health care agency.
Sec. 3922.03. (A) There is hereby created the Ohio health
care board. The Ohio health care board shall consist of fifteen
voting members, consisting of the director of health and fourteen
members elected in accordance with this section.
(B) For purposes of representation on the Ohio health care
board, the state shall be divided into seven regions each composed
of designated counties as follows:
(1) Region 1: Ashtabula, Cuyahoga, Geauga, Lake, Lorain;
(2) Region 2: Allen, Auglaize, Defiance, Erie, Fulton,
Hancock, Henry, Huron, Lucas, Mercer, Ottawa, Paulding, Putnam,
Sandusky, Seneca, Van Wert, Williams, Wood;
(3) Region 3: Athens, Belmont, Coshocton, Gallia, Guernsey,
Harrison, Hocking, Jackson, Jefferson, Lawrence, Meigs, Monroe,
Morgan, Muskingum, Noble, Perry, Pike, Ross, Scioto, Vinton,
Washington;
(4) Region 4: Adams, Brown, Butler, Clermont, Clinton,
Hamilton, Highland, Warren;
(5) Region 5: Crawford, Delaware, Fairfield, Fayette,
Franklin, Hardin, Knox, Licking, Logan, Madison, Marion, Morrow,
Pickaway, Union, Wyandot;
(6) Region 6: Ashland, Carroll, Columbiana, Holmes, Mahoning,
Medina, Portage, Richland, Stark, Summit, Trumbull, Tuscarawas,
Wayne;
(7) Region 7: Champaign, Clark, Darke, Greene, Miami,
Montgomery, Preble, Shelby.
(C)(1) The health commissioner of the most populous county in
each region shall convene a meeting of all county and city health
commissioners in the region within ninety days following the
effective date of this section. If there are two or more health
districts located wholly or partially in the most populous county
of the region, the health commissioner of the health district with
the largest territorial jurisdiction in that county shall convene
the meeting of all county and city health commissioners within
ninety days following the effective date of this section.
(2) At the meeting called pursuant to division (C)(1) of this
section, the county and city health commissioners in each region
shall elect one resident from each county in the region to
represent the county on a regional health advisory committee
established for that region. The county and city health
commissioners also shall set a date, not sooner than one hundred
days and not later than one hundred ten days after the effective
date of this section, for the initial meeting of the regional
health advisory committee.
(3) Following the initial meetings of county and city health
commissioners called pursuant to division (C)(1) of this section,
the county and city health commissioners in each region shall
convene a meeting every two years to elect representatives to the
regional health advisory committee in accordance with this
division. Each biennial meeting shall be held within five days of
the same day of the same month as the initial meeting.
(4) Each representative elected under this division shall
hold office for two years, starting on the date of the
representative's election. Any individual appointed to fill a
vacancy occurring prior to the expiration of the term for which a
representative is elected shall hold office for the remainder of
the predecessor's term.
(D)(1) Each of the seven regional health advisory committees
shall elect a chairperson from among the representatives to their
committees. Each chairperson shall convene and preside over the
initial meeting of that regional health advisory committee on the
date set pursuant to division (C) of this section. At the initial
meeting of the regional health advisory committees, the
committees' representatives shall elect two residents from the
region to represent that region as members of the Ohio health care
board. One of the two residents elected from each region to serve
on the Ohio health care board shall be a resident of the region's
most populous county and the other shall be a resident of any
county in the region other than the region's most populous county.
Except for the elections to the Ohio health care board at the
initial meeting of each regional health advisory committee, each
resident elected to the board shall be elected to a two-year term
of office. At the initial meeting, the resident from the most
populous county in the region shall be elected to a term of three
years.
(2) Annually, beginning in the second year following the
initial elections to the Ohio health care board, the chairperson
of each regional health advisory committee shall convene a meeting
within five calendar days of the same date of the same month as
the initial meeting of that regional health advisory committee to
elect a resident from the region to serve as a member of the Ohio
health care board. The regional health advisory committee shall
elect a resident of a county as is necessary to meet the
representation requirements set by division (D)(1) of this
section. No individual may serve as a member of the Ohio health
care board for more than four consecutive terms.
(3) In addition to meeting for the election of Ohio health
care board members, the regional health advisory committees shall
meet as necessary to fulfill any functions and responsibilities
assigned to them under sections 3922.01 to 3922.15 of the Revised
Code. Meetings shall be held at the call of the chairperson and as
may be provided by procedures adopted by the regional health
advisory committee.
(4) In addition to the fourteen members of the Ohio health
care board elected by the seven regional health advisory
committees, the director of health shall be a voting ex officio
member of the Ohio health care board.
(E)(1) The director of health shall set the time, place, and
date for the initial meeting of the Ohio health care board and
shall preside over the Ohio health care board's initial meeting.
The initial meeting shall be set not sooner than one hundred
fifteen days and not later than one hundred twenty-five days after
the effective date of this section.
(2) The members of the Ohio health care board annually shall
elect a member of the board to serve as chairperson at meetings of
the board. Meetings shall be held upon the call of the chairperson
and as provided by procedures prescribed by the Ohio health care
board. Two-thirds of the members of the Ohio health care board
shall constitute a quorum for the conduct of business at meetings
of the board. Decisions at meetings of the Ohio health care board
shall be reached by majority vote.
(3) All meetings of the Ohio health care board are open to
the public unless questions of patient confidentiality arise. The
Ohio health care board may go into closed executive session with
regard to issues related to confidential patient information. The
fourteen members of the Ohio health care board elected by the
regional health advisory committees shall receive an annual salary
and benefits established in accordance with division (J) of
section 124.15 of the Revised Code.
(F) The seven regional health advisory committees shall act
as advisory bodies to the Ohio health care board, representing
their individual regions. The regional health advisory committees
shall oversee the management of consumer and provider complaints
originating in their respective regions and shall hold a hearing
on all such complaints. The regional health advisory committees
shall offer assistance to resolve consumer and provider disputes
and shall seek the agreement of all parties to the dispute to
submit the dispute to negotiation or binding arbitration. A
regional health advisory committee shall transfer any dispute that
is not resolved at the regional level to the director of the Ohio
health care agency's department of consumer affairs within six
months; however, the committee may vote to transfer individual
disputes at an earlier date.
(G)(1) If a vacancy occurs on the Ohio health care board for
any reason, resulting in a region being without full
representation on the board, that region's health advisory
committee shall elect a resident of that region to fill the
vacancy. Any resident elected to fill a vacancy shall serve the
remainder of the departing member's term. The health advisory
committee shall elect a resident of a county as necessary to meet
the representation requirements set by division (D)(1) of this
section.
(2) A serving member of the Ohio health care board shall
continue to serve following the expiration of their term until a
successor takes office or a period of ninety days has elapsed,
whichever occurs first.
(H)(1) The members and staff of the Ohio health care board
and employees of the Ohio health care agency, and their immediate
families, are prohibited from having any pecuniary interest in any
business with a contract, or in negotiation for a contract, with
either the Ohio health care board or Ohio health care agency, or
that is subject to the Ohio health care board's oversight. The
members and staff of the Ohio health care board and employees of
the Ohio health care agency shall not receive remuneration for
health care service of any kind during their term of service or
employment. The members and staff of the Ohio health care board
and employees of the Ohio health care agency, and their immediate
families, shall not receive consulting fees of any kind from any
source that is directly or indirectly related to the delivery of
health care services pursuant to the Ohio health care plan. The
members and staff of the Ohio health care board and employees of
the Ohio health care agency, and their immediate families, are
prohibited from owning stock in, and from investing in mutual
funds holding stock in, pharmaceutical companies, health
maintenance organizations, or other businesses that relate
directly or indirectly to the delivery of health care services,
unless the stock or mutual funds are in a blind trust.
(2) No member of the Ohio health care board other than the
director of health shall hold any other salaried public position
with the state, either elected or appointed, during the member's
tenure on the board. The director of health shall receive no
salary or benefits by virtue of the director's service on the Ohio
health care board.
(3) The chairperson of the Ohio health care board may conduct
hearings to determine if a violation of this division has
occurred. Notice of any hearing, the conduct of the hearing, and
all other matters relating to the holding of the hearing shall be
governed by Chapter 119. of the Revised Code. If a member of the
Ohio health care board, or of the member's immediate family, is
found to have violated this division, the chairperson of the Ohio
health care board of health shall remove the member from the Ohio
health care board. If a staffer of the Ohio health care board or
an employee of the Ohio health care agency, or a member of the
staffer's or employee's immediate family, is found to have
violated this division, the Ohio health care board or Ohio health
care agency shall take appropriate disciplinary action against the
staffer or employee, which action may include termination of
employment.
Sections 101.82 and 101.83 of the Revised Code do not apply
to the Ohio health care board and the regional health advisory
committees.
Sec. 3922.04. (A) The Ohio health care board is responsible
for directing the Ohio health care agency in the performance of
all duties, the exercise of all powers, and the assumption and
discharge of all functions vested in the Ohio health care agency.
The Ohio health care board shall adopt rules in accordance with
Chapter 119. of the Revised Code as needed to carry out the
purposes of, and to enforce, Chapter 3922. of the Revised Code.
(B) The duties and functions of the Ohio health care board
include, but are not limited to, the following:
(1) Implementing statutory eligibility standards for
benefits;
(2) Annually adopting a benefits package for participants of
the Ohio health care plan;
(3) Acting directly or through one or more contractors as the
single payer for all claims for health care services made under
the Ohio health care plan;
(4) Developing and implementing separate formulas for
determining budgets under sections 3922.21 to 3922.28 of the
Revised Code;
(5) Annually reviewing the formulas for determining the
appropriateness and sufficiency of rates, fees, and prices;
(6) Providing for timely payments to providers through a
structure that is well organized and that eliminates unnecessary
administrative costs;
(7) Implementing, to the extent permitted by federal law,
standardized claims and reporting methods for use by the Ohio
health care plan;
(8) Developing a system of centralized electronic claims and
payments;
(9) Establishing an enrollment system that will ensure that
all eligible Ohio residents, including those who travel
frequently, those who cannot read, and those who do not speak
English, are aware of their right to health care and are formally
enrolled in the Ohio health care plan;
(10) Reporting annually to the general assembly and the
governor, on or before the first day of October, on the
performance of the Ohio health care plan, the fiscal condition of
the Ohio health care plan, any need for rate adjustments,
recommendations for statutory changes, the receipt of payments
from the federal government, whether current year goals and
priorities were met, future goals and priorities, and major new
technology or prescription drugs that may affect the cost of the
health care services provided by the Ohio health care plan;
(11) Administering the revenues of the Ohio health care fund
pursuant to section 3922.09 of the Revised Code;
(12) Obtaining appropriate liability and other forms of
insurance to provide coverage for the Ohio health care plan, the
Ohio health care board, the Ohio health care agency, and their
employees and agents;
(13) Establishing, appointing, and funding appropriate staff
for the Ohio health care agency throughout Ohio;
(14) Procuring requisite office space and administrative
support;
(15) Administering aspects of the Ohio health care agency by
taking actions that include, but are not limited to, the
following:
(a) Establishing standards and criteria for the allocation of
operating funds;
(b) Meeting regularly with the executive director and
administrators of the Ohio health care agency to review the impact
of the agency and its policies on the regional districts
established under section 3922.03 of the Revised Code;
(c) Establishing goals for the health care system established
pursuant to the Ohio health care plan in measurable terms;
(d) Establishing statewide health care databases to support
health care services planning;
(e) Implementing policies, and developing mechanisms and
incentives, to assure culturally and linguistically sensitive
care;
(f) Establishing standards and criteria for the determination
of appropriate compensation and training for residents of Ohio who
are displaced from work due to the implementation of the Ohio
health care plan;
(g) Establishing methods for the recovery of costs for health
care services provided pursuant to the Ohio health care plan to a
participant that are covered under the terms of a policy of
insurance, a health benefit plan, or other collateral source
available to the participant under which the participant has a
right of action for compensation. Receipt of health care services
pursuant to the Ohio health care plan shall be deemed an
assignment by the participant of any right to payment for services
from any policy, plan, or other source. The other source of health
care benefits shall pay to the Ohio health care fund all amounts
it is obligated to pay to the participant for covered health care
services. The Ohio health care board may commence any action
necessary to recover the amounts due.
(16) Appointing a technical and medical advisory board. The
members of the technical and medical advisory board shall
represent a cross section of the medical and provider community
and consumers, and shall include two persons, one being a provider
and the other representing consumers, from each region designated
in section 3922.03 of the Revised Code. The members of the
technical and medical advisory board shall be reimbursed for
actual and necessary expenses incurred in the performance of their
duties. The technical and medical advisory board's duties include:
(a) Advising the Ohio health care board on the establishment
of policy on medical issues, population-based public health
issues, research priorities, scope of services, expanding access
to health care services, and evaluating the performance of the
Ohio health care plan;
(b) Investigating proposals for innovative approaches to the
promotion of health, the prevention of disease and injury, patient
education, research, and health care delivery;
(c) Advising the Ohio health care board on the establishment
of standards and criteria to evaluate requests from health care
facilities for capital improvements.
(C) The Ohio health care board shall employ and fix the
compensation of Ohio health care agency personnel, with the
approval of the department of administrative services, as needed
by the agency to properly discharge the agency's duties. The
employment of personnel by the Ohio health care board is subject
to the civil service laws of this state. The Ohio health care
board shall employ personnel including, but not limited to, the
following:
(2) Administrator of planning, research, and development;
(3) Administrator of finance;
(4) Administrator of quality assurance;
(5) Administrator of consumer affairs;
(6) Legal counsel to represent the Ohio health care agency
and Ohio health care board in any legal action brought by or
against the agency or board under or pursuant to any provision of
the Revised Code under the agency's or board's jurisdiction.
(D) No member of the Ohio health care board or individual on
the staff of the Ohio health care board or Ohio health care agency
shall use for personal benefit any information filed with or
obtained by the Ohio health care board that is not then readily
available to the public. No member of the Ohio health care board
shall use or in any way attempt to use their position as a member
to influence a decision of any other governmental body.
Sections 101.82 and 101.83 of the Revised Code do not apply
to the technical and medical advisory board established pursuant
to this section.
Sec. 3922.05. The executive director of the Ohio health care
agency appointed under section 3922.04 of the Revised Code is the
chief administrator of the Ohio health care plan and shall
administer and enforce Chapter 3922. of the Revised Code. The
executive director shall oversee the operation of the Ohio health
care agency and the agency's performance of any duties assigned by
the Ohio health care board.
Sec. 3922.06. (A) The executive director of the Ohio health
care agency shall determine the duties of the administrator of
planning, research, and development. Those duties shall include,
but not be limited to, the following:
(1) Establishing policy on medical issues, population-based
public health issues, research priorities, scope of services, the
expansion of participants' access to health care services, and
evaluating the performance of the Ohio health care plan;
(2) Investigating proposals for innovative approaches for the
promotion of health, the prevention of disease and injury, patient
education, research, and the delivery of health care services;
(3) Establishing standards and criteria for evaluating
applications from health care facilities for capital improvements.
(B)(1) The executive director shall determine the duties of
the administrator of consumer affairs. Those duties shall include,
but not be limited to, the following:
(a) Developing educational and informational guides for
consumers that describe consumer rights and responsibilities and
that inform consumers of effective ways to exercise consumer
rights to obtain health care services. The guides shall be easy to
read and understand and available in English and in other
languages. The Ohio health care agency shall make the guides
available to the public through public outreach and educational
programs and through the internet web site of the Ohio health care
agency.
(b) Establishing a toll-free telephone number to receive
questions and complaints regarding the Ohio health care agency and
the agency's services. The Ohio health care agency's internet web
site shall provide complaint forms and instructions online.
(c) Examining suggestions from the public;
(d) Making recommendations for improvements to the Ohio
health care board;
(e) Examining the extent to which individual health care
facilities in a region meet the needs of the community in which
they are located;
(f) Receiving, investigating, and responding to all
complaints about any aspect of the Ohio health care plan and
referring the results of all investigations into the provision of
health care services by health care providers or facilities to the
appropriate provider or health care facility licensing board, or
when appropriate, to a law enforcement agency;
(g) Publishing an annual report for the public and the
general assembly that contains a statewide evaluation of the Ohio
health care agency and of the delivery of health care services in
each region established under section 3922.03 of the Revised Code;
(h) Holding public hearings, at least annually, within each
region established under section 3922.03 of the Revised Code for
public suggestions and complaints.
(2) The administrator of consumer affairs shall work closely
with the seven regional health advisory committees on the
resolution of complaints. In the discharge of the administrator's
duties, the administrator shall have unlimited access to all
nonconfidential and nonprivileged documents in the custody and
control of the agency. Nothing in Chapter 3922. of the Revised
Code prohibits a consumer or class of consumers, or the
administrator of consumer affairs, from seeking relief through the
courts.
(C) The executive director, in consultation with the
technical and medical advisory board, shall determine the duties
of the administrator of quality assurance. Those duties shall
include, but not be limited to, the following:
(1) Studying and reporting on the efficacy of health care
treatments and medications for particular conditions;
(2) Identifying causes of medical errors and devising
procedures to decrease medical errors;
(3) Establishing an evidence-based formulary;
(4) Identifying treatments and medications that are unsafe or
have no proven value;
(5) Establishing a process for soliciting information on
medical standards from providers and consumers for purposes of
this division.
(D) The executive director shall determine the duties of the
administrator of finance. Those duties shall include, but not be
limited to, the following:
(1) Administering the Ohio health care fund;
(2) Making prompt payments to providers;
(3) Developing a system of centralized claims and payments;
(4) Communicating to the treasurer of state when funds are
needed for the operation of the Ohio health care plan;
(5) Developing information systems for utilization review;
(6) Investigating possible provider or consumer fraud.
Sec. 3922.07. (A) All Ohio residents and individuals
employed in Ohio, including the homeless and migrant workers, are
eligible for coverage under the Ohio health care plan. The Ohio
health care board shall establish standards and a simplified
procedure to demonstrate proof of residency. The Ohio health care
board shall establish a procedure to enroll eligible residents and
employees and to provide each individual covered under the Ohio
health care plan with identification that providers may use to
determine eligibility for health care services under the Ohio
health care plan.
(B) If waivers are not obtained under sections 3922.31 to
3922.33 of the Revised Code from the medical assistance and
medicare programs operated under Title XVIII or XIX of the "Social
Security Act," 49 Stat. 20 (1935), 42 U.S.C. 301, as amended, or
whenever a necessary waiver is not in effect, the medical
assistance and medicare programs shall act as the primary insurers
for Ohio residents and individuals employed in this state for
health coverage and the Ohio health care plan shall serve as the
secondary or supplemental plan of health coverage. When the Ohio
health care plan serves as a secondary or supplemental plan of
health coverage the Ohio health care plan shall not provide
coverage to an Ohio resident or individual employed in this state
for any covered health care service that the resident or worker is
then eligible to receive under the medical assistance or medicare
program.
(C) A plan of employee health coverage provided by an
out-of-state employer to an Ohio resident working outside of this
state shall serve as the employee's primary plan of health
coverage and the Ohio health care plan shall serve as the
employee's secondary plan of health coverage.
(D) The Ohio health care agency shall bill an out-of-state
employer or the employer's insurer for the cost of covered health
care services provided in accordance with the Ohio health care
plan to residents of this state employed by the out-of-state
employer when the health care services provided are covered under
the terms of the employer's plan of employee health coverage.
(E) The Ohio health care plan shall reimburse Ohio health
care board approved providers practicing outside of this state at
Ohio health care plan rates for health care services rendered to a
plan participant while the participant is out of state.
(F) Any employer operating in this state may purchase
coverage under the Ohio health care plan for an employee who lives
out of state but who works in this state.
(G) Any institution of higher education, as defined in
section 2741.01 of the Revised Code, located in this state may
purchase coverage under the Ohio health care plan for a student
who does not otherwise have status as a resident of this state.
(H) Any individual who arrives at a health care facility
unconscious or otherwise unable due to their mental or physical
condition to document eligibility for coverage under the Ohio
health care plan shall be presumed to be eligible.
Sec. 3922.08. (A) The Ohio health care board shall establish
a single health benefits package that shall include, but not be
limited to, all of the following:
(1) Inpatient and outpatient provider care, both primary and
secondary;
(2) Emergency services, as defined in division (A) of section
3923.65 of the Revised Code, twenty-four hours each day on a
prudent layperson standard. Residents who are temporarily out of
state may receive benefits for emergency services rendered in that
state. The Ohio health care agency shall make timely emergency
services, including hospital care and triage, available to all
Ohio residents, including all residents not enrolled in the Ohio
health care plan.
(3) Emergency and other transportation services to covered
health care services, subject to division (B) of this section;
(4) Rehabilitation services, including speech, occupational,
and physical therapy;
(5) Inpatient and outpatient mental health services and
substance abuse treatment;
(7) Prescription drugs and prescribed medical nutrition;
(8) Vision care, aids, and equipment;
(9) Hearing care, hearing aids, and equipment;
(10) Diagnostic medical tests, including laboratory tests and
imaging procedures;
(11) Medical supplies and prescribed medical equipment, both
durable and nondurable;
(12) Immunizations, preventive care, health maintenance care,
and screening;
(14) Home health care services.
(B) The Ohio health care plan shall provide necessary
transportation in each county to covered health care services.
Independent transportation providers shall be reimbursed on a
fee-for-service basis. Fee schedules for covered transportation
may take into account the recognized differences among geographic
areas regarding cost. A covered transportation benefits account is
hereby created within the Ohio health care fund.
(C) The Ohio health care plan shall not exclude or limit
coverage of its participants' pre-existing conditions.
(D) Residents enrolled in the Ohio health care plan are not
subject to copayments, point-of-service charges, or any other fee
or charge, and shall not be directly billed by providers for
covered health care services provided to the resident.
(E) The Ohio health care board, with the consent of the
technical and medical advisory board, shall remove or exclude
procedures and treatments, equipment, and prescription drugs from
the Ohio health care plan's benefit package that the board finds
unsafe, experimental, of no proven value, or that add no
therapeutic value.
(F) The Ohio health care board shall exclude coverage for any
surgical, orthodontic, or other medical procedure, or prescription
drug, that the technical and medical advisory board determines was
or will be provided primarily for cosmetic purposes, unless
required to correct a congenital defect, to restore or correct
disfigurements resulting from injury or disease, or that is
determined to be medically necessary by a qualified, licensed
provider.
(G) Participants shall have free choice of the providers
eligible to participate in the Ohio health care plan.
(H) No provider shall be compelled by the Ohio health care
agency to offer any particular service, provided that the provider
does not discriminate among patients in providing health care
services.
(I) The Ohio health care plan and the providers participating
in the plan shall not discriminate on the basis of race, color,
national origin, gender, age, religion, sexual orientation, health
status, mental or physical disability, employment status, veteran
status, or occupation.
Sec. 3922.09. (A) The Ohio health care fund is hereby
established in the state treasury. The administrator of finance of
the Ohio health care agency shall administer and monitor the Ohio
health care fund. All moneys collected and received by the Ohio
health care plan shall be transmitted to the treasurer of state
for deposit into the Ohio health care fund, to be used to finance
the Ohio health care plan and to pay the costs of compensation and
training for displaced workers pursuant to section 3922.11 of the
Revised Code.
(B) The treasurer of state may invest the interest earned by
the Ohio health care fund in any manner authorized by the Revised
Code for the investment of state moneys. Any revenue or interest
earned from the investments shall be credited to the Ohio health
care fund.
(C) All provider claims for payment for health care services
rendered under the Ohio health care plan shall be transmitted to
the Ohio health care fund by the provider or the provider's agent.
The format of, and the method of transmitting, provider claims
shall be determined by the Ohio health care board.
(D) All payments for health care services rendered under the
Ohio health care plan shall be disbursed from the Ohio health care
fund. The administrator of finance of the Ohio health care agency
shall establish a reserve account within the Ohio health care
fund. When the revenue available to the Ohio health care plan in
any biennium exceeds the total amount expended or obligated during
that biennium, the excess revenue shall be transferred to the
reserve account. The Ohio health care board may use the money in
the reserve account for expenses of the Ohio health care agency or
the Ohio health care plan.
(E) The administrator of finance of the Ohio health care
agency shall notify the Ohio health care board when the annual
expenditures or anticipated future expenditures of the Ohio health
care plan appear to be in excess of the revenues or anticipated
revenues for the same period. The Ohio health care board shall
implement appropriate cost control measures based on the
notification. The Ohio health care board shall seek a special
appropriation for the Ohio health care fund if the cost control
measures implemented do not reduce the Ohio health care plan's
expenditures to an amount that may be covered by its revenue.
Sec. 3922.10. (A) The Ohio health care board shall establish
written procedures for the receipt and resolution of disputes and
grievances. The procedures shall provide for an initial hearing
before the appropriate regional health advisory committee in
accordance with division (F) of section 3922.03 of the Revised
Code. The board shall accord to plaintiffs the right to be heard
at the hearing.
(B) Any party aggrieved by an order or decision issued
pursuant to the procedures established in division (A) of this
section may appeal the order or decision to the court of common
pleas. The appellant shall file a notice of appeal with the Ohio
health care board within fifteen days of the filing of the appeal
with the court of common pleas.
(C) Appeals of denied claims may be submitted by Ohio health
care plan beneficiaries or providers, or businesses selling
medical equipment and supplies to the Ohio health care board. The
board shall conduct appeals in compliance with its written
procedures and both laws of this state and federal laws.
Sec. 3922.11. (A) The department of job and family services
shall determine which residents of this state employed by a health
care insurer, health insuring corporation, or other health care
related business, have lost employment as a result of the
implementation and operation of the Ohio health care plan. The
department also shall determine the amount of monthly wages that
the resident lost due to the plan's implementation. The department
shall attempt to position these displaced workers in comparable
positions of employment with the Ohio health care agency.
(B) The department of job and family services shall forward
the information on the amount of monthly wages lost by Ohio
residents due to the implementation of the Ohio health care plan
to the Ohio health care agency. The Ohio health care agency shall
determine the amount of compensation and training that each
displaced worker shall receive and shall submit a claim to the
Ohio health care fund for payment. A displaced worker, however,
shall not receive compensation from the Ohio health care fund in
excess of sixty thousand dollars per year for two years.
Compensation paid to the displaced worker under this section shall
serve as a supplement to any compensation the worker receives from
the department of job and family services.
Sec. 3922.12. (A) Any employer operating in this state and
providing employees with benefits under a public or private health
care policy, plan, or agreement as of the date that benefits are
initially provided pursuant to Chapter 3922. of the Revised Code,
which benefits are less valuable than those provided by the Ohio
health care plan, may participate in the Ohio health care plan or
shall provide additional benefits so that, until the expiration of
the policy, plan, or agreement, the benefits provided by the
employer at least equal the amount and scope of the benefits
provided by the Ohio health care plan. If an employer chooses to
provide additional benefits to match or exceed the benefits
provided by the Ohio health care plan the additional benefits
shall include the employer's payment of any employee premium
contributions, copayments, and deductible payments called for by
the policy, contract, or agreement. Employers are exempt from all
health taxes imposed under Chapter 3922. of the Revised Code until
the expiration of the policy, plan, or agreement, at which point
the employer and the employer's employees become participants in
the Ohio health care plan.
(B) A person covered by a health care policy, plan, or
agreement that has its premiums paid for in any part with public
money, including money from the state, a political subdivision,
state educational institution, public school, or other entity,
shall be covered by the Ohio health care plan on the day that
benefits become available under the Ohio health care plan.
(C) Health care insurers, health insuring corporations, and
other persons selling or providing health care benefits may
deliver, issue for delivery, renew, or provide health benefit
packages that do not duplicate the health benefit package provided
by the Ohio health care plan, but shall not, except as provided by
division (A) of this section, deliver, issue for delivery, renew,
or provide health benefit packages that duplicate the health
benefit package provided by the Ohio health care plan.
Sec. 3922.13. The Ohio health care agency is subrogated to
all rights of a participant who has received benefits, or who has
a right to benefits, under any other policy or contract of health
care.
Sec. 3922.14. (A) All providers, as defined in section
3922.01 of the Revised Code, may participate in the Ohio health
care plan.
(B) The Ohio health care board and the technical and medical
advisory board shall assess the number of primary and specialty
providers needed to supply adequate health care services to all
participants in the Ohio health care plan, and shall develop a
plan to meet that need. The Ohio health care board shall develop
incentives for providers in order to increase residents' access to
health care services in unserved or underserved areas of the
state.
(C) The Ohio health care board annually shall evaluate
residents' access to trauma care, and shall establish measures to
ensure participants have equitable access to trauma care and to
specialized medical procedures and technology.
(D) The Ohio health care board, with the advice of the
technical and medical advisory board and the administrator of
quality assurance, shall define performance criteria and goals for
the Ohio health care plan and shall report to the general assembly
at least annually on the plan's performance. The Ohio health care
board shall establish a system to monitor the quality of health
care and patient and provider satisfaction with that care and a
system to devise improvements to the provision of health care
services.
(E) All providers subject to the Ohio health care plan shall
provide data upon request to the Ohio health care board, which
data the board requires to devise methods to maintain and improve
the provision of health care services.
(F) The Ohio health care board, with the advice of the
technical and medical advisory board, shall coordinate the Ohio
health care plan's provision of health care services with any
other state and local agencies that provide health care services
directly to their residents.
Sec. 3922.15. In the absence of fraud or bad faith, county
and city health commissioners, regional health advisory
committees, and the Ohio health care board and Ohio health care
agency and their members and employees, shall incur no liability
in relation to the performance of their duties and
responsibilities under sections 3922.01 to 3922.15 of the Revised
Code. The state shall incur no liability in relation to the
implementation and operation of the Ohio health care plan.
Sec. 3922.21. (A) The Ohio health care board shall prepare
and recommend to the general assembly an annual budget for health
care that specifies and establishes a limit on total annual state
expenditures for health care provided pursuant to sections 3922.01
to 3922.15 of the Revised Code. The budget shall include all of
the following components:
(1) A system budget covering all expenditures for the system,
in accordance with section 3922.22 of the Revised Code;
(2) Provider budgets for the fee-for-service and integrated
health delivery system and for individual health care facilities
and their associated clinics, in accordance with section 3922.23
of the Revised Code;
(3) A capital investment budget in accordance with section
3922.24 of the Revised Code;
(4) A purchasing budget in accordance with section 3922.25 of
the Revised Code;
(5) A research and innovation budget in accordance with
section 3922.26 of the Revised Code.
(B) In preparing the budget, the Ohio health care board shall
consider anticipated increased expenditures and savings,
including, but not limited to, projected increases in expenditures
due to improved access for underserved populations and improved
reimbursement for primary care, projected administrative savings
under the single-payer mechanism, projected savings in
prescription drug expenditures under competitive bidding and a
single buyer, and projected savings due to provision of primary
care rather than emergency room treatment.
Sec. 3922.22. (A) The system budget referred to in division
(A)(1) of section 3922.21 of the Revised Code shall comprise the
cost of the system, services and benefits provided,
administration, data gathering, planning and other activities, and
revenues deposited with the system account of the Ohio health care
fund.
The Ohio health care board shall limit administrative costs
to five per cent of the system budget and shall annually evaluate
methods to reduce administrative costs and report the results of
that evaluation to the general assembly. The board shall also
limit growth of health care costs in the system budget by
reference to changes in state gross domestic product, population,
employment rates, and other demographic indicators, as
appropriate. Moneys in the reserve account of the Ohio health care
fund shall not be considered as available revenues for purposes of
preparing the system budget.
(B) The Ohio health care board shall implement cost control
measures pursuant to division (A) of this section. However, no
cost control measure shall limit access to care that is needed on
an emergency basis or that is determined by a patient's provider
to be medically appropriate for a patient's condition.
Mandatory cost control measures include, but are not limited
to, some or all of the following:
(1) Postponement of the introduction of new benefits or
benefit improvements;
(2) Postponement of new capital investment;
(3) Adjustment of provider budgets to correct for
inappropriate provider utilization;
(4) Establishment of a limit on provider reimbursement above
a specified amount of aggregate billing;
(5) Deferred funding of the reserve account;
(6) Establishment of a limit on aggregate reimbursements to
pharmaceutical manufacturers;
(7) Imposition of an eligibility waiting period in the event
of substantial influx of individuals into the state for purposes
of obtaining health care through the Ohio health care plan.
Sec. 3922.23. (A) The provider budgets referred to in
division (A)(2) of section 3922.21 of the Revised Code shall
include allocations for fee-for-service providers and capitated
providers. These allocations shall consider the relative usage of
fee-for-service providers and capitated providers. Each annual
provider budget shall include adjustments to reflect changes in
the utilization of services and the addition or exclusion of
covered services made by the Ohio health care board upon the
recommendation of the technical and medical advisory board and its
staff.
(B) Providers shall choose whether they will be compensated
as fee-for-service providers or as part of a capitated provider
network.
(1) The budget for fee-for-service providers shall be divided
among categories of licensed health care providers in order to
establish a total annual budget for each category. Each of these
category budgets shall be sufficient to cover all included
services anticipated to be required by eligible individuals
choosing fee-for-service at the rates negotiated or set by the
Ohio health care board, except as necessary for cost containment
purposes pursuant to section 3922.22 of the Revised Code.
The board shall negotiate fee-for-service reimbursement rates
or salaries for licensed health care providers. In the event
negotiations are not concluded in a timely manner, the board shall
establish the reimbursement rates. Reimbursement rates shall
reflect the goals of the system.
(2) The budget shall detail all operating expenses for health
care facilities or clinics that are not part of a capitated
provider network. In establishing a health care facility budget,
the Ohio health care board shall develop and utilize separate
formulas that reflect the differences in cost of primary,
secondary, and tertiary care services and health care services
provided by academic medical centers. The board shall negotiate
reimbursement rates with facilities and clinics. Reimbursement
rates shall reflect the goals of the system.
(C)(1) The budget for capitated providers shall be sufficient
to cover all included services anticipated to be required by
eligible individuals choosing an integrated health care delivery
system at the rates negotiated or set by the Ohio health care
board. All health care facilities, group practices, and integrated
health care systems shall submit annual operating budget requests
to the board and may choose to be reimbursed through a global
facility budget or on a capitated basis. The board shall adjust
budgets on the basis of the health risk of enrollees; the scope of
services provided; proposed innovative programs that improve
quality, workplace safety, or consumer, provider, or employee
satisfaction; costs of providing care for nonmembers; and an
appropriate operating margin.
(2) Providers that choose to operate a health care facility
on a capitated basis shall not be paid additionally on a
fee-for-service basis unless they are providing services in a
separate private medical practice or health care facility.
Providers and health care facilities that operate on a capitated
basis shall report immediately any projected operating deficits to
the Ohio health care board. The board shall determine whether the
projected deficits reflect appropriate increases in health care
needs, in which case the board shall adjust the provider or health
care facility budget appropriately. If the board determines that
the deficit is not justifiable, no adjustment shall be made.
(3) The board may terminate the funding for health care
facilities, group practices, and integrated health care systems or
particular services provided by them if they fail to meet
standards of care and practice established by the board. The board
shall make future funding contingent on measurable improvements in
quality of care and health care outcomes.
(D) The Ohio health care board shall prohibit charges to the
Ohio health care plan or to patients for covered health care
services other than those established by regulation, negotiation,
or the appeals process. Licensed health care providers who provide
services not covered by sections 3922.01 to 3922.15 of the Revised
Code may charge patients for those services.
Sec. 3922.24. (A) The capital investment budget referred to
in division (A)(3) of section 3922.21 of the Revised Code shall be
established by the Ohio health care board, with the advice of the
technical and medical advisory board and its staff, and shall
provide for capital maintenance and development. In preparing the
budget, the Ohio health care board shall determine capital
investment priorities and evaluate whether the capital investment
program has improved access to services and has eliminated
redundant capital investments.
(B) All capital investments valued at five hundred thousand
dollars or greater, including the costs of studies, surveys,
design plans and working drawing specifications, and other
activities essential to planning and execution of capital
investment, and all capital investments that change the bed
capacity of a health care facility or add a new service or license
category incurred by any health system entity, shall require the
approval of the Ohio health care board. When a health care
facility, or individual acting on behalf of a health care
facility, or any other purchaser, obtains by lease or comparable
arrangement any health care facility or part of a health care
facility, or any equipment for a health care facility, the market
value of which would have been a capital expenditure, the lease or
arrangement shall be considered a capital expenditure for purposes
of sections 3922.01 to 3922.15 of the Revised Code.
(C) Health care facilities shall provide the Ohio health care
board with at least three-months' advance notice of any planned
capital investment of more than fifty thousand dollars but less
than five hundred thousand dollars. These capital investments
shall minimize unneeded expansion of health care facilities and
services based on the priorities and goals for capital investment
established by the board.
(D) No capital investment shall be undertaken using funds
from a health care facility operating budget.
Sec. 3922.25. The purchasing budget referred to in division
(A)(4) of section 3922.21 of the Revised Code shall provide for
the purchase of prescription drugs and durable and nondurable
medical equipment for the system. The Ohio health care board shall
purchase all prescription drugs and durable and nondurable medical
equipment for the system from this budget.
Sec. 3922.26. The research and innovation budget referred to
in division (A)(5) of section 3922.21 of the Revised Code shall
support research and innovation that has been recommended by the
Ohio health care board, the technical and medical advisory board,
and the administrator of consumer affairs. This research and
innovation includes, but is not limited to, methods for improving
the administration of the system, improving the quality of health
care, educating patients, and improving communication among health
care providers.
Sec. 3922.27. The Ohio health care board shall establish a
capital account in the Ohio health care fund as part of the Ohio
health care plan. Moneys in the account shall be used solely to
pay for the establishment and maintenance of a loan program for
health care facilities and equipment for use by health care
professionals who desire to establish practices in areas of the
state in which, according to criteria established by the board,
the level of health care services is inadequate.
Sec. 3922.31. (A) As used in sections 3922.31 to 3922.33 of
the Revised Code:
(1) "CHIP" means the children's health insurance program
parts I and II provided for by sections 5101.50 to 5101.5110 of
the Revised Code.
(2) "Federal employees health benefits program" means the
program of health insurance benefits available to employees of the
federal government that the United States office of personnel
management is authorized to contract for under 5 U.S.C. 8902.
(3) "Federal poverty guidelines" has the same meaning as in
section 5101.46 of the Revised Code.
(4) "Medicaid" means the program provided for under Title XIX
of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1396,
as amended.
(5) "Medicare" means the program provided for under Title
XVII of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C.
1395, as amended.
(B) At the request of the Ohio health care board, the Ohio
health care agency's executive director shall seek federal
financial participation in the Ohio health care plan, including
funding otherwise available under medicare, medicaid, CHIP, and
the federal employees health benefits program. The executive
director shall request that the amount of the federal financial
participation be at least equal to the medicaid federal financial
participation rate in effect for this state on the effective date
of this section. The executive director shall periodically seek
adjustments to the federal financial participation rate for the
Ohio health care plan to reflect changes in the state domestic
gross product, the state's population, including changes in age
groups, and the number of residents with income below the federal
poverty guidelines.
Sec. 3922.32. At the request of the Ohio health care board,
the Ohio health care agency's executive director shall negotiate
with the United States office of personnel management to have
included in the Ohio health care plan residents of this state who
would otherwise be covered by the federal employees health
benefits program. As part of the negotiations, the executive
director shall seek to have the federal government provide the
Ohio health care plan with amounts equal to the amount federal
employees participating in the Ohio health care plan would
otherwise pay as premiums under the federal employees health
benefits program.
Sec. 3922.33. At the request of the Ohio health care board,
the director of job and family services shall seek any federal
waivers necessary for the Ohio health care plan to receive federal
financial participation under section 3922.31 of the Revised Code
otherwise available under the medicaid and CHIP programs.
Notwithstanding sections 5101.50 to 5101.5110 of the Revised Code
and Chapter 5111. of the Revised Code, the director of job and
family services shall cease to implement the medicaid and CHIP
programs on implementation of federal waivers authorizing the use
of federal medicaid and CHIP funds for the Ohio health care plan,
if necessary due to the implementation of the waivers.
Section 2. That existing section 109.02 of the Revised Code
is hereby repealed.
Section 3. This act shall be known as the "Ohio Health
Security Act."
Section 4. In the first two years following the effective
date of sections 3922.01 to 3922.33 of the Revised Code, the Ohio
Health Care Board shall prepare for the delivery of universal,
affordable health care coverage to all eligible Ohio residents and
individuals employed in Ohio. The Ohio Health Care Board shall
appoint a Transition Advisory Group to assist with the transition
to the provision of care under the Ohio Health Care Plan. The
transition group shall include, but is not limited to, a broad
selection of experts in health care finance and administration,
providers from a variety of medical fields, representatives of
Ohio's counties, employers and employees, representatives of
hospitals and clinics, and representatives from state regulatory
bodies. Members of the Transition Advisory Group shall be
reimbursed by the Ohio Health Care Agency for necessary and actual
expenses incurred in the performance of their duties as members.
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