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H. B. No. 125 As IntroducedAs Introduced
130th General Assembly | Regular Session | 2013-2014 |
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Representatives Carney, Antonio
Cosponsors:
Representatives Lundy, Ramos, Driehaus, Foley, Clyde, Hagan, R., Ashford, Sykes, Phillips, Celebrezze, Boyce, Williams, Reece, Budish, Redfern, Stinziano, Curtin, Fedor, Heard, Rogers, Letson, Mallory, Patterson, Barborak, Bishoff, Boyd, Cera, Gerberry, Milkovich, O'Brien, Pillich, Slesnick, Strahorn, Szollosi
A BILL
To enact sections 5111.0126, 5111.0127, and 5111.0128
of the Revised Code to permit the Medicaid program
to cover the eligibility expansion group
authorized by the Patient Protection and
Affordable Care Act and to make an appropriation.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 5111.0126, 5111.0127, and 5111.0128
of the Revised Code be enacted to read as follows:
Sec. 5111.0126. Subject to section 5111.0127 of the Revised
Code, the medicaid program may cover the group, or one or more
subgroups of the group, described in the "Social Security Act,"
section 1902(a)(10)(A)(i)(VIII), 42 U.S.C.
1396a(a)(10)(A)(i)(VIII), if the federal medical assistance
percentage for expenditures for medicaid services provided to the
group or subgroup is at least the amount specified in the "Social
Security Act," section 1905(y), 42 U.S.C. 1396d(y), as of March
30, 2010.
Sec. 5111.0127. (A) The medicaid program shall cease to
cover the group, and any subgroup of the group, specified in
section 5111.0126 of the Revised Code if the federal medical
assistance percentage for expenditures for medicaid services
provided to the group or subgroup is lowered to an amount below
the amount specified in the "Social Security Act," section
1905(y), 42 U.S.C. 1396d(y), as of March 30, 2010. If the medicaid
program ceases to cover the group, or any subgroup of the group
pursuant to this division, each individual enrolled in medicaid as
part of the group or subgroup shall be disenrolled from medicaid
on the first day of the month following the effective date of the
federal medical assistance percentage's reduction unless the
individual meets the eligibility requirements for another
eligibility group or subgroup.
(B)(1) If federal law or the United States department of
health and human services requires the state to reduce or
eliminate any tax, the medical assistance director may do either
of the following regarding the eligibility group, and any subgroup
of the group, specified in section 5111.0126 of the Revised Code:
(a) Terminate the medicaid program's coverage of the
eligibility group or subgroup;
(b) Alter the eligibility requirements for the group or
subgroup in a manner that causes fewer individuals to meet the
eligibility requirements.
(2) If the medical assistance director terminates the
medicaid program's coverage of the group or subgroup pursuant to
division (B)(1)(a) of this section, each individual enrolled in
medicaid as part of the group or subgroup shall be disenrolled
from medicaid on a date the director specifies unless the
individual meets the eligibility requirements for another
eligibility group or subgroup.
(3) If the medical assistance director alters the group's or
subgroup's eligibility requirements pursuant to division (B)(1)(b)
of this section, each individual enrolled in medicaid as part of
the group or subgroup shall be disenrolled from medicaid on a date
the director specifies unless the individual meets the altered
eligibility requirements or meets the eligibility requirements for
another eligibility group or subgroup.
(C) Notwithstanding section 5101.35 of the Revised Code, an
individual's disenrollment from medicaid pursuant to this section
is not subject to appeal under that section.
Sec. 5111.0128. (A) If the medicaid program covers the
group, or any subgroup of the group, specified in section
5111.0126 of the Revised Code, the cost-sharing requirements
instituted under section 5111.0112 of the Revised Code do not
apply to any member of the group or subgroup who has countable
income exceeding one hundred per cent of the federal poverty line.
Instead, the office of medical assistance shall institute
cost-sharing requirements for such members of the group or
subgroup in accordance with this section.
(B) In instituting cost-sharing requirements under this
section, all of the following apply:
(1) The requirements shall not apply to any individual exempt
from the requirements pursuant to the "Social Security Act,"
sections 1916 and 1916A, 42 U.S.C. 1396o and 1396o-1.
(2) The copayment amounts for drugs shall be not less than
the copayment amounts for drugs established under the cost-sharing
requirements instituted under section 5111.0112 of the Revised
Code.
(3) The copayment amount for nonemergency emergency
department services shall be higher than the copayment amount for
nonemergency emergency department services established under the
cost-sharing requirements instituted under section 5111.0112 of
the Revised Code.
(4) Copayments shall be established for at least all other
types of medicaid services that are subject to copayments included
in the cost-sharing requirements instituted under section
5111.0112 of the Revised Code, and the copayment amounts for those
services may be higher than the copayment amounts for those
services under the cost-sharing requirements established under
that section.
(C) All of the following apply to the cost-sharing
requirements instituted under this section:
(1) Subject to division (C)(2) of this section, a medicaid
provider may refuse to provide a medicaid service to a medicaid
recipient who fails to pay the copayment for the service if the
recipient is subject to the copayment requirement.
(2) Before refusing to provide a medicaid service under
division (C)(1) of this section, a medicaid provider shall inform
the medicaid recipient whether an alternative medicaid service for
which there is no copayment is available.
(3) A medicaid provider may attempt to collect unpaid
copayments.
(4) A medicaid provider shall not waive a medicaid
recipient's obligation to pay a copayment.
(5) In the case of a medicaid provider that is a hospital,
the provider may take action to collect a copayment by providing,
at the time the provider provides hospital services to a medicaid
recipient subject to the copayment requirement, notice that a
copayment may be owed.
Section 2. All items in this section are hereby appropriated
as designated out of any moneys in the state treasury to the
credit of the designated fund. For all appropriations made in this
act, those in the first column are for fiscal year 2014 and those
in the second column are for fiscal year 2015. The appropriations
made in this act are in addition to any other appropriations made
for the FY 2014-FY 2015 biennium.
MCD DEPARTMENT OF MEDICAID
GRF |
651525 |
|
Medicaid/Health Care Services |
|
|
|
|
|
|
|
|
|
|
|
State |
|
$ |
0 |
|
$ |
0 |
|
|
|
|
|
Federal |
|
$ |
499,665,563 |
|
$ |
1,815,000,192 |
|
|
|
|
|
Medicaid/Health Care Services Total |
|
$ |
499,665,563 |
|
$ |
1,815,000,192 |
|
|
TOTAL GRF General Revenue Fund
| |
|
|
|
|
|
|
|
|
|
|
State |
|
$ |
0 |
|
$ |
0 |
|
|
|
|
|
Federal |
|
$ |
499,665,563 |
|
$ |
1,815,000,192 |
|
|
|
|
|
GRF Total |
|
$ |
499,665,563 |
|
$ |
1,815,000,192 |
|
|
TOTAL ALL BUDGET FUND GROUPS
| |
$ |
499,665,563 |
|
$ |
1,815,000,192 |
|
|
Section 3. Within the limits set forth in this act, the
Director of Budget and Management shall establish accounts
indicating the source and amount of funds for each appropriation
made in this act, and shall determine the form and manner in which
appropriation accounts shall be maintained. Expenditures from
appropriations contained in this act shall be accounted for as
though made in the main operating appropriations act of the 130th
General Assembly.
The appropriations made in this act are subject to all
provisions of the main operating appropriations act of the 130th
General Assembly that are generally applicable to such
appropriations.
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