The online versions of legislation provided on this website are not official. Enrolled bills are the final version passed by the Ohio General Assembly and presented to the Governor for signature. The official version of acts signed by the Governor are available from the Secretary of State's Office in the Continental Plaza, 180 East Broad St., Columbus.
|
H. B. No. 562 As IntroducedAs Introduced
130th General Assembly | Regular Session | 2013-2014 |
| |
A BILL
To amend section 5165.01 of the Revised Code to
remove behavioral and mental health services from
nursing facilities' bundled services for purposes
of Medicaid payments.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 5165.01 of the Revised Code be
amended to read as follows:
Sec. 5165.01. As used in this chapter:
(A) "Affiliated operator" means an operator affiliated with
either of the following:
(1) The exiting operator for whom the affiliated operator is
to assume liability for the entire amount of the exiting
operator's debt under the medicaid program or the portion of the
debt that represents the franchise permit fee the exiting operator
owes;
(2) The entering operator involved in the change of operator
with the exiting operator specified in division (A)(1) of this
section.
(B) "Allowable costs" are a nursing facility's costs that the
department of medicaid determines are reasonable. Fines paid under
sections 5165.60 to 5165.89 and section 5165.99 of the Revised
Code are not allowable costs.
(C) "Ancillary and support costs" means all reasonable costs
incurred by a nursing facility other than direct care costs, tax
costs, or capital costs. "Ancillary and support costs" includes,
but is not limited to, costs of activities, social services,
pharmacy consultants, habilitation supervisors, qualified mental
retardation professionals, program directors, medical and
habilitation records, program supplies, incontinence supplies,
food, enterals, dietary supplies and personnel, laundry,
housekeeping, security, administration, medical equipment,
utilities, liability insurance, bookkeeping, purchasing
department, human resources, communications, travel, dues, license
fees, subscriptions, home office costs not otherwise allocated,
legal services, accounting services, minor equipment, maintenance
and repairs, help-wanted advertising, informational advertising,
start-up costs, organizational expenses, other interest, property
insurance, employee training and staff development, employee
benefits, payroll taxes, and workers' compensation premiums or
costs for self-insurance claims and related costs as specified in
rules adopted under section 5165.02 of the Revised Code, for
personnel listed in this division. "Ancillary and support costs"
also means the cost of equipment, including vehicles, acquired by
operating lease executed before December 1, 1992, if the costs are
reported as administrative and general costs on the nursing
facility's cost report for the cost reporting period ending
December 31, 1992.
(D)(1) "Capital costs" means the actual expense incurred by a
nursing facility for all of the following:
(a) Depreciation and interest on any capital assets that cost
five hundred dollars or more per item, including the following:
(ii) Building improvements;
(iii) Except as provided in division (C) of this section,
equipment;
(iv) Transportation equipment.
(b) Amortization and interest on land improvements and
leasehold improvements;
(c) Amortization of financing costs;
(d) Lease and rent of land, buildings, and equipment.
(2) The costs of capital assets of less than five hundred
dollars per item may be considered capital costs in accordance
with a provider's practice.
(E) "Capital lease" and "operating lease" shall be construed
in accordance with generally accepted accounting principles.
(F) "Case-mix score" means a measure determined under section
5165.192 of the Revised Code of the relative direct-care resources
needed to provide care and habilitation to a nursing facility
resident.
(G) "Change of operator" means an entering operator becoming
the operator of a nursing facility in the place of the exiting
operator.
(1) Actions that constitute a change of operator include the
following:
(a) A change in an exiting operator's form of legal
organization, including the formation of a partnership or
corporation from a sole proprietorship;
(b) A transfer of all the exiting operator's ownership
interest in the operation of the nursing facility to the entering
operator, regardless of whether ownership of any or all of the
real property or personal property associated with the nursing
facility is also transferred;
(c) A lease of the nursing facility to the entering operator
or the exiting operator's termination of the exiting operator's
lease;
(d) If the exiting operator is a partnership, dissolution of
the partnership;
(e) If the exiting operator is a partnership, a change in
composition of the partnership unless both of the following apply:
(i) The change in composition does not cause the
partnership's dissolution under state law.
(ii) The partners agree that the change in composition does
not constitute a change in operator.
(f) If the operator is a corporation, dissolution of the
corporation, a merger of the corporation into another corporation
that is the survivor of the merger, or a consolidation of one or
more other corporations to form a new corporation.
(2) The following, alone, do not constitute a change of
operator:
(a) A contract for an entity to manage a nursing facility as
the operator's agent, subject to the operator's approval of daily
operating and management decisions;
(b) A change of ownership, lease, or termination of a lease
of real property or personal property associated with a nursing
facility if an entering operator does not become the operator in
place of an exiting operator;
(c) If the operator is a corporation, a change of one or more
members of the corporation's governing body or transfer of
ownership of one or more shares of the corporation's stock, if the
same corporation continues to be the operator.
(H) "Cost center" means the following:
(1) Ancillary and support costs;
(I) "Custom wheelchair" means a wheelchair to which both of
the following apply:
(1) It has been measured, fitted, or adapted in consideration
of either of the following:
(a) The body size or disability of the individual who is to
use the wheelchair;
(b) The individual's period of need for, or intended use of,
the wheelchair.
(2) It has customized features, modifications, or components,
such as adaptive seating and positioning systems, that the
supplier who assembled the wheelchair, or the manufacturer from
which the wheelchair was ordered, added or made in accordance with
the instructions of the physician of the individual who is to use
the wheelchair.
(J)(1) "Date of licensure" means the following:
(a) In the case of a nursing facility that was required by
law to be licensed as a nursing home under Chapter 3721. of the
Revised Code when it originally began to be operated as a nursing
home, the date the nursing facility was originally so licensed;
(b) In the case of a nursing facility that was not required
by law to be licensed as a nursing home when it originally began
to be operated as a nursing home, the date it first began to be
operated as a nursing home, regardless of the date the nursing
facility was first licensed as a nursing home.
(2) If, after a nursing facility's original date of
licensure, more nursing home beds are added to the nursing
facility, the nursing facility has a different date of licensure
for the additional beds. This does not apply, however, to
additional beds when both of the following apply:
(a) The additional beds are located in a part of the nursing
facility that was constructed at the same time as the continuing
beds already located in that part of the nursing facility;
(b) The part of the nursing facility in which the additional
beds are located was constructed as part of the nursing facility
at a time when the nursing facility was not required by law to be
licensed as a nursing home.
(3) The definition of "date of licensure" in this section
applies in determinations of nursing facilities' medicaid payment
rates but does not apply in determinations of nursing facilities'
franchise permit fees.
(K) "Desk-reviewed" means that a nursing facility's costs as
reported on a cost report submitted under section 5165.10 of the
Revised Code have been subjected to a desk review under section
5165.108 of the Revised Code and preliminarily determined to be
allowable costs.
(L) "Direct care costs" means all of the following costs
incurred by a nursing facility:
(1) Costs for registered nurses, licensed practical nurses,
and nurse aides employed by the nursing facility;
(2) Costs for direct care staff, administrative nursing
staff, medical directors, respiratory therapists, and except as
provided in division (L)(8) of this section, other persons holding
degrees qualifying them to provide therapy;
(3) Costs of purchased nursing services;
(4) Costs of quality assurance;
(5) Costs of training and staff development, employee
benefits, payroll taxes, and workers' compensation premiums or
costs for self-insurance claims and related costs as specified in
rules adopted under section 5165.02 of the Revised Code, for
personnel listed in divisions (L)(1), (2), (4), and (8) of this
section;
(6) Costs of consulting and management fees related to direct
care;
(7) Allocated direct care home office costs;
(8) Costs of habilitation staff (other than habilitation
supervisors), medical supplies, emergency oxygen, over-the-counter
pharmacy products, behavioral and mental health services, physical
therapists, physical therapy assistants, occupational therapists,
occupational therapy assistants, speech therapists, audiologists,
habilitation supplies, and universal precautions supplies;
(9) Until January 1, 2014, costs of oxygen, wheelchairs, and
resident transportation;
(10) Beginning January 1, 2014, costs of both of the
following:
(b) Wheelchairs other than the following:
(ii) Repairs to and replacements of custom wheelchairs and
parts that are made in accordance with the instructions of the
physician of the individual who uses the custom wheelchair.
(11) Until July 1, 2014, costs of behavioral and mental
health services;
(12) Costs of other direct-care resources that are specified
as direct care costs in rules adopted under section 5165.02 of the
Revised Code.
(M) "Dual eligible individual" has the same meaning as in
section 5160.01 of the Revised Code.
(N) "Effective date of a change of operator" means the day
the entering operator becomes the operator of the nursing
facility.
(O) "Effective date of a facility closure" means the last day
that the last of the residents of the nursing facility resides in
the nursing facility.
(P) "Effective date of an involuntary termination" means the
date the department of medicaid terminates the operator's provider
agreement for the nursing facility.
(Q) "Effective date of a voluntary withdrawal of
participation" means the day the nursing facility ceases to accept
new medicaid residents other than the individuals who reside in
the nursing facility on the day before the effective date of the
voluntary withdrawal of participation.
(R) "Entering operator" means the person or government entity
that will become the operator of a nursing facility when a change
of operator occurs or following an involuntary termination.
(S) "Exiting operator" means any of the following:
(1) An operator that will cease to be the operator of a
nursing facility on the effective date of a change of operator;
(2) An operator that will cease to be the operator of a
nursing facility on the effective date of a facility closure;
(3) An operator of a nursing facility that is undergoing or
has undergone a voluntary withdrawal of participation;
(4) An operator of a nursing facility that is undergoing or
has undergone an involuntary termination.
(T)(1) Subject to divisions (T)(2) and (3) of this section,
"facility closure" means either of the following:
(a) Discontinuance of the use of the building, or part of the
building, that houses the facility as a nursing facility that
results in the relocation of all of the nursing facility's
residents;
(b) Conversion of the building, or part of the building, that
houses a nursing facility to a different use with any necessary
license or other approval needed for that use being obtained and
one or more of the nursing facility's residents remaining in the
building, or part of the building, to receive services under the
new use.
(2) A facility closure occurs regardless of any of the
following:
(a) The operator completely or partially replacing the
nursing facility by constructing a new nursing facility or
transferring the nursing facility's license to another nursing
facility;
(b) The nursing facility's residents relocating to another of
the operator's nursing facilities;
(c) Any action the department of health takes regarding the
nursing facility's medicaid certification that may result in the
transfer of part of the nursing facility's survey findings to
another of the operator's nursing facilities;
(d) Any action the department of health takes regarding the
nursing facility's license under Chapter 3721. of the Revised
Code.
(3) A facility closure does not occur if all of the nursing
facility's residents are relocated due to an emergency evacuation
and one or more of the residents return to a medicaid-certified
bed in the nursing facility not later than thirty days after the
evacuation occurs.
(U) "Fiscal year" means the fiscal year of this state, as
specified in section 9.34 of the Revised Code.
(V) "Franchise permit fee" means the fee imposed by sections
5168.40 to 5168.56 of the Revised Code.
(W) "Inpatient days" means both of the following:
(1) All days during which a resident, regardless of payment
source, occupies a bed in a nursing facility that is included in
the nursing facility's medicaid-certified capacity;
(2) Fifty per cent of the days for which payment is made
under section 5165.34 of the Revised Code.
(X) "Involuntary termination" means the department of
medicaid's termination of the operator's provider agreement for
the nursing facility when the termination is not taken at the
operator's request.
(Y) "Low resource utilization resident" means a medicaid
recipient residing in a nursing facility who, for purposes of
calculating the nursing facility's medicaid payment rate for
direct care costs, is placed in either of the two lowest resource
utilization groups, excluding any resource utilization group that
is a default group used for residents with incomplete assessment
data.
(Z) "Maintenance and repair expenses" means a nursing
facility's expenditures that are necessary and proper to maintain
an asset in a normally efficient working condition and that do not
extend the useful life of the asset two years or more.
"Maintenance and repair expenses" includes but is not limited to
the costs of ordinary repairs such as painting and wallpapering.
(AA) "Medicaid-certified capacity" means the number of a
nursing facility's beds that are certified for participation in
medicaid as nursing facility beds.
(BB) "Medicaid days" means both of the following:
(1) All days during which a resident who is a medicaid
recipient eligible for nursing facility services occupies a bed in
a nursing facility that is included in the nursing facility's
medicaid-certified capacity;
(2) Fifty per cent of the days for which payment is made
under section 5165.34 of the Revised Code.
(CC)(1) "New nursing facility" means a nursing facility for
which the provider obtains an initial provider agreement following
medicaid certification of the nursing facility by the director of
health, including such a nursing facility that replaces one or
more nursing facilities for which a provider previously held a
provider agreement.
(2) "New nursing facility" does not mean a nursing facility
for which the entering operator seeks a provider agreement
pursuant to section 5165.511 or 5165.512 or (pursuant to section
5165.515) section 5165.07 of the Revised Code.
(DD) "Nursing facility" has the same meaning as in the
"Social Security Act," section 1919(a), 42 U.S.C. 1396r(a).
(EE) "Nursing facility services" has the same meaning as in
the "Social Security Act," section 1905(f), 42 U.S.C. 1396d(f).
(FF) "Nursing home" has the same meaning as in section
3721.01 of the Revised Code.
(GG) "Operator" means the person or government entity
responsible for the daily operating and management decisions for a
nursing facility.
(HH)(1) "Owner" means any person or government entity that
has at least five per cent ownership or interest, either directly,
indirectly, or in any combination, in any of the following
regarding a nursing facility:
(a) The land on which the nursing facility is located;
(b) The structure in which the nursing facility is located;
(c) Any mortgage, contract for deed, or other obligation
secured in whole or in part by the land or structure on or in
which the nursing facility is located;
(d) Any lease or sublease of the land or structure on or in
which the nursing facility is located.
(2) "Owner" does not mean a holder of a debenture or bond
related to the nursing facility and purchased at public issue or a
regulated lender that has made a loan related to the nursing
facility unless the holder or lender operates the nursing facility
directly or through a subsidiary.
(II) "Per diem" means a nursing facility's actual, allowable
costs in a given cost center in a cost reporting period, divided
by the nursing facility's inpatient days for that cost reporting
period.
(JJ) "Provider" means an operator with a provider agreement.
(KK) "Provider agreement" means a provider agreement, as
defined in section 5164.01 of the Revised Code, that is between
the department of medicaid and the operator of a nursing facility
for the provision of nursing facility services under the medicaid
program.
(LL) "Purchased nursing services" means services that are
provided in a nursing facility by registered nurses, licensed
practical nurses, or nurse aides who are not employees of the
nursing facility.
(MM) "Reasonable" means that a cost is an actual cost that is
appropriate and helpful to develop and maintain the operation of
patient care facilities and activities, including normal standby
costs, and that does not exceed what a prudent buyer pays for a
given item or services. Reasonable costs may vary from provider to
provider and from time to time for the same provider.
(NN) "Related party" means an individual or organization
that, to a significant extent, has common ownership with, is
associated or affiliated with, has control of, or is controlled
by, the provider.
(1) An individual who is a relative of an owner is a related
party.
(2) Common ownership exists when an individual or individuals
possess significant ownership or equity in both the provider and
the other organization. Significant ownership or equity exists
when an individual or individuals possess five per cent ownership
or equity in both the provider and a supplier. Significant
ownership or equity is presumed to exist when an individual or
individuals possess ten per cent ownership or equity in both the
provider and another organization from which the provider
purchases or leases real property.
(3) Control exists when an individual or organization has the
power, directly or indirectly, to significantly influence or
direct the actions or policies of an organization.
(4) An individual or organization that supplies goods or
services to a provider shall not be considered a related party if
all of the following conditions are met:
(a) The supplier is a separate bona fide organization.
(b) A substantial part of the supplier's business activity of
the type carried on with the provider is transacted with others
than the provider and there is an open, competitive market for the
types of goods or services the supplier furnishes.
(c) The types of goods or services are commonly obtained by
other nursing facilities from outside organizations and are not a
basic element of patient care ordinarily furnished directly to
patients by nursing facilities.
(d) The charge to the provider is in line with the charge for
the goods or services in the open market and no more than the
charge made under comparable circumstances to others by the
supplier.
(OO) "Relative of owner" means an individual who is related
to an owner of a nursing facility by one of the following
relationships:
(2) Natural parent, child, or sibling;
(3) Adopted parent, child, or sibling;
(4) Stepparent, stepchild, stepbrother, or stepsister;
(5) Father-in-law, mother-in-law, son-in-law,
daughter-in-law, brother-in-law, or sister-in-law;
(6) Grandparent or grandchild;
(7) Foster caregiver, foster child, foster brother, or foster
sister.
(PP) "Residents' rights advocate" has the same meaning as in
section 3721.10 of the Revised Code.
(QQ) "Skilled nursing facility" has the same meaning as in
the "Social Security Act," section 1819(a), 42 U.S.C. 1395i-3(a).
(RR) "Sponsor" has the same meaning as in section 3721.10 of
the Revised Code.
(SS) "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.
(TT) "Title XIX" means Title XIX of the "Social Security
Act," 42 U.S.C. 1396 et seq.
(UU) "Title XVIII" means Title XVIII of the "Social Security
Act," 42 U.S.C. 1395 et seq.
(VV) "Voluntary withdrawal of participation" means an
operator's voluntary election to terminate the participation of a
nursing facility in the medicaid program but to continue to
provide service of the type provided by a nursing facility.
Section 2. That existing section 5165.01 of the Revised Code
is hereby repealed.
|
|