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H. B. No. 176 As Reported by the House Finance and Appropriations CommitteeAs Reported by the House Finance and Appropriations Committee
130th General Assembly | Regular Session | 2013-2014 |
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A BILL
To amend section 101.391 and to enact sections
5111.0126, 5111.80, 5111.801, 5111.802, and
5111.947 of the Revised Code to require the
Medical Assistance Director to implement Medicaid
reforms, to permit the Medicaid program to cover
an additional group under certain circumstances,
to revise the duties of the Joint Legislative
Committee on Medicaid Technology and Reform, and
to make an appropriation.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 101.391 be amended and sections
5111.0126, 5111.80, 5111.801, 5111.802, and 5111.947 of the
Revised Code be enacted to read as follows:
Sec. 101.391. (A) There is hereby created the joint
legislative committee on medicaid technology and reform. The
committee may review or study any matter that it considers
relevant to the operation of the medicaid program established
under Chapter 5111. of the Revised Code, with priority given to
the study or review of mechanisms both of the following:
(1) The reforms to be implemented under section 5111.80 of
the Revised Code;
(2) Mechanisms to enhance the program's effectiveness through
improved technology systems and program reform.
(B)(1) The committee shall consist of five the following
members:
(a) Three members of the house of representatives from the
majority party appointed by the speaker of the house of
representatives and five;
(b) Two members of the house of representatives from the
minority party appointed by the speaker of the house of
representatives;
(c) Three members of the senate from the majority party
appointed by the president of the senate;
(d) Two members of the senate from the minority party
appointed by the president of the senate. Not more than three
members appointed by the speaker of the house of representatives
and not more than three members appointed by the president of the
senate may be of the same political party.
(2) Each member of the committee shall hold office during the
general assembly in which the member is appointed and until a
successor has been appointed, notwithstanding the adjournment sine
die of the general assembly in which the member was appointed or
the expiration of the member's term as a member of the general
assembly. Any vacancies occurring among the members of the
committee shall be filled in the manner of the original
appointment.
(C) The speaker of the house of representatives shall
designate one of the members of the committee appointed under
division (B)(1)(a) of this section to serve as a co-chairperson of
the committee. The president of the senate shall designate one of
the members of the committee appointed under division (B)(1)(c) of
this section to serve as the other co-chairperson. The
co-chairpersons shall call the committee to meet at least once
each quarter and shall arrange for the medical assistance director
to testify before the committee regarding the reforms to be
implemented under section 5111.80 of the Revised Code periodically
but not more than once each quarter. The co-chairpersons may
request assistance and staff support for the committee from the
legislative service commission.
(D) The committee has the same powers as other standing or
select committees of the general assembly. The committee may
employ an executive director.
Sec. 5111.0126. (A) Subject to division (B) of this section,
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
both of the following apply:
(1) 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;
(2) The medicaid program is able to cover the group or
subgroup in a manner that causes per recipient medicaid
expenditures to be reduced.
(B) The medicaid program shall cease to cover the group, and
any subgroup of the group, specified in division (A) of this
section 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. An individual's disenrollment from the medicaid
program is not subject to appeal under section 5101.35 of the
Revised Code when the disenrollment is the result of the medicaid
program ceasing to cover the individual's group or subgroup under
this division.
Sec. 5111.80. (A) As used in this section:
"Exchange" has the same meaning as in 45 C.F.R. 155.20.
"Medicaid waiver component" has the same meaning as in
section 5111.85 of the Revised Code.
(B) Subject to section 5111.801 of the Revised Code, the
medical assistance director shall implement reforms to the
medicaid program that do all of the following:
(1) Improve the health of medicaid recipients while reducing
both of the following:
(a) The cost of health care;
(b) Uncompensated health care costs.
(2) Control medicaid expenditures and reduce the rate of
increase in expenditures;
(3) Enroll at least eighty per cent of medicaid recipients in
any of the following:
(a) The care management system established under section
5111.16 of the Revised Code;
(b) Group health plans pursuant to section 5111.13 of the
Revised Code;
(c) A medicaid component established in accordance with the
"Social Security Act," section 1906A, 42 U.S.C. 1396e-1, that
provides premium assistance subsidies for qualified
employer-sponsored coverage to medicaid recipients under nineteen
years of age and the parents of such recipients;
(d) A medicaid component established in a manner consistent
with the definition of "medical assistance" in the "Social
Security Act," section 1905(a), 42 U.S.C. 1396d(a), that provides
payments for insurance premiums for medical or other type of
remedial care for medicaid recipients, other than the following:
(i) Recipients who are at least sixty-five years of age;
(ii) Recipients who are disabled and entitled to health
insurance benefits under the medicare program but not enrolled
under part B of the medicare program.
(e) A medicaid waiver component that provides premium
assistance for medicaid recipients to purchase qualified health
plans through an exchange.
(4) Require medicaid recipients to assume greater personal
responsibility under both of the following:
(a) The cost-sharing program instituted under section
5111.0112 of the Revised Code;
(b) A medicaid component that incorporates the objectives of
health savings accounts through value-based insurance designs.
(5) Ensure that medicaid recipients who abuse narcotics
receive proper treatment and are unable to access the narcotics
they abuse through the health care system;
(6) Promote employment-related services and job training
available under medicaid and other programs to lower medicaid
caseloads by assisting able-bodied, adult medicaid recipients into
the workforce;
(7) Make the administration of the medicaid program more
efficient and establish the state as a national leader in
preventing medicaid fraud and abuse;
(8) Support health care payment innovations in the private
sector by assisting other purchasers of health care services and
health care providers by leveraging the medicaid program's
purchasing power.
Sec. 5111.801. (A) The medical assistance director shall
implement the reforms under section 5111.80 of the Revised Code in
accordance with all of the following:
(1) The medicaid state plan approved by the United States
secretary of health and human services, including amendments to
the plan approved by the United States secretary;
(2) Federal medicaid waivers granted by the United States
secretary, including amendments to waivers approved by the United
States secretary;
(3) Other types of federal approval, including demonstration
grants, that establish requirements for the reforms;
(4) Except as otherwise authorized by a federal medicaid
waiver granted by the United States secretary, all applicable
federal statutes, regulations, and policy guidances;
(5) All applicable state statutes.
(B) The medical assistance director shall seek federal
approval for all of the reforms to be implemented under section
5111.80 of the Revised Code that require federal approval. None of
the reforms that require federal approval shall be implemented
without receipt of the federal approval. However, a reform that
requires federal approval may begin to be implemented before
receipt of the federal approval if federal law permits
implementation to begin before receipt of the federal approval.
Implementation shall cease if federal approval is ultimately
denied.
Sec. 5111.802. Not later than December 31, 2014, and the
last day of each calendar year thereafter, the medical assistance
director shall submit to the general assembly, in accordance with
section 101.68 of the Revised Code, a full report on the progress
being made in implementing the reforms under section 5111.80 of
the Revised Code. The report may include recommendations for
legislation that would support the reforms.
Sec. 5111.947. There is established in the state treasury
the Ohio medicaid reform fund. All federal funds the state
receives for the federal share of medicaid expenditures for the
eligibility group or subgroups authorized by section 5111.0126 of
the Revised Code shall be deposited into the fund. All money in
the fund shall be used as the federal share of medicaid
expenditures for that eligibility group or those subgroups.
Section 2. That existing section 101.391 of the Revised Code
is hereby repealed.
Section 3. The Director of Budget and Management may create
any necessary accounts or line items for the Ohio Medicaid Reform
Fund established under section 5111.947 of the Revised Code. All
money deposited into the Fund under that section during fiscal
year 2014 and fiscal year 2015 is hereby appropriated for those
fiscal years.
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