To amend sections 5162.01, 5162.36, 5162.361, 5162.363, 5162.364, 5162.54, and 5162.64; to amend, for the purpose of adopting new section numbers as indicated in parentheses, sections 5162.362 (5162.363), 5162.363 (5162.364), and 5162.364 (5162.369); and to enact new section 5162.362 and sections 5162.365, 5162.366, 5162.367, and 5162.368 of the Revised Code regarding the Medicaid School Program.

Section 1. That sections 5162.01, 5162.36, 5162.361, 5162.363, 5162.364, 5162.54, and 5162.64 be amended; sections 5162.362 (5162.363), 5162.363 (5162.364), and 5162.364 (5162.369) be amended for the purpose of adopting new section numbers as indicated in parentheses; and new section 5162.362 and sections 5162.365, 5162.366, 5162.367, and 5162.368 of the Revised Code be enacted to read as follows:

Sec. 5162.01.  (A) As used in the Revised Code:

(1) "Medicaid" and "medicaid program" mean the program of medical assistance established by Title XIX of the "Social Security Act," 42 U.S.C. 1396 et seq., including any medical assistance provided under the medicaid state plan or a federal medicaid waiver granted by the United States secretary of health and human services.

(2) "Medicare" and "medicare program" mean the federal health insurance program established by Title XVIII of the "Social Security Act," 42 U.S.C. 1395 et seq.

(B) As used in this chapter:

(1) "Dual eligible individual" has the same meaning as in section 5160.01 of the Revised Code.

(2) "Exchange" has the same meaning as in 45 C.F.R. 155.20.

(3) "Federal financial participation" has the same meaning as in section 5160.01 of the Revised Code.

(4) "Federal poverty line" means the official poverty line defined by the United States office of management and budget based on the most recent data available from the United States bureau of the census and revised by the United States secretary of health and human services pursuant to the "Omnibus Budget Reconciliation Act of 1981," section 673(2), 42 U.S.C. 9902(2).

(5) "Healthy start component" means the component of the medicaid program that covers pregnant women and children and is identified in rules adopted under section 5162.02 of the Revised Code as the healthy start component.

(6) "Home and community-based services" means services provided under a home and community-based services medicaid waiver component.

(7) "Home and community-based services medicaid waiver component" has the same meaning as in section 5166.01 of the Revised Code.

(8) "ICF/IID" has the same meaning as in section 5124.01 of the Revised Code.

(9) "Individualized education program" has the same meaning as in section 3323.011 of the Revised Code.

(10) "Medicaid managed care organization" has the same meaning as in section 5167.01 of the Revised Code.

(10)(11) "Medicaid provider" has the same meaning as in section 5164.01 of the Revised Code.

(11)(12) "Medicaid services" has the same meaning as in section 5164.01 of the Revised Code.

(12)(13) "Nursing facility" and "nursing facility services" have the same meanings as in section 5165.01 of the Revised Code.

(13)(14) "Personal care services" has the same meaning as in 42 C.F.R. 440.167.

(15) "Political subdivision" means a municipal corporation, township, county, school district, or other body corporate and politic responsible for governmental activities only in a geographical area smaller than that of the state.

(14)(16) "Prescribed drug" has the same meaning as in section 5164.01 of the Revised Code.

(15)(17) "Provider agreement" has the same meaning as in section 5164.01 of the Revised Code.

(16)(18) "Qualified medicaid school provider" means the board of education of a city, local, or exempted village school district, the governing authority of a community school established under Chapter 3314. of the Revised Code, the state school for the deaf, and the state school for the blind to which both of the following apply:

(a) It holds a valid provider agreement.

(b) It meets all other conditions for participation in the medicaid school component of the medicaid program established in rules authorized by section 5162.364 5162.369 of the Revised Code.

(17)(19) "State agency" means every organized body, office, or agency, other than the department of medicaid, established by the laws of the state for the exercise of any function of state government.

(18)(20) "Vendor offset" means a reduction of a medicaid payment to a medicaid provider to correct a previous, incorrect medicaid payment to that provider.

Sec. 5162.36. (A) (B) The medicaid director shall create, in accordance with sections 5162.36 to 5162.364 5162.369 of the Revised Code, the medicaid school component of the medicaid program.

Sec. 5162.361.  A qualified medicaid school provider participating in the medicaid school component of the medicaid program may submit a claim to the department of medicaid for federal financial participation for providing, in schools, services covered by the medicaid school component to medicaid recipients who are eligible for the services. No qualified medicaid school provider may submit such a claim before the provider incurs the cost of providing the service.

The claim shall include certification of the qualified medicaid school provider's expenditures for the service. The certification shall show that the money the qualified medicaid school provider used for the expenditures was nonfederal money the provider may legally use for providing the service and that the amount of the expenditures was sufficient to pay the full cost of the service.

Except as otherwise provided in sections 5162.36 to 5162.364 5162.369 of the Revised Code and rules authorized by sections 5162.363 5162.364 and 5162.364 5162.369 of the Revised Code, a qualified medicaid school provider is subject to all conditions of participation in the medicaid program that generally apply to providers of goods and services under the medicaid program, including conditions regarding audits and recovery of overpayments. A qualified medicaid school provider also must annually submit to the department of education a report showing the number of the provider's students who received special education and related services provided pursuant to Chapter 3323. of the Revised Code in the most recent previous October.

Sec. 5162.362.  (A) A qualified medicaid school provider's claim for a service covered by the medicaid school component of the medicaid program shall be rejected if any of the following applies:

(1) Unless the service is an initial assessment or evaluation performed in the development of a medicaid recipient's individualized education program, the service is not included in the individualized education program developed for the recipient to whom the service is provided.

(2) Except as provided in division (B) of this section, the medicaid recipient who receives the service fails to show progress in meeting the goals included in the recipient's individualized education program over two consecutive three-month periods.

(3) Another reason for rejection specified in rules authorized by section 5162.369 of the Revised Code applies to the claim.

(B) A qualified medicaid school provider's claim for a service covered by the medicaid school component may be paid even though the circumstance described in division (A)(2) of this section applies if either of the following is the case:

(1) There is documentation that a method or technique of the service has been modified to help the medicaid recipient meet a goal included in the recipient's individualized education program.

(2) It is not the purpose of the service to help the medicaid recipient show progress in meeting the goals included in the recipient's individualized education program.

Sec. 5162.362 5162.363.  The department of medicaid shall seek federal financial participation for each claim a qualified medicaid school provider properly submits to the department under section 5162.361 of the Revised Code. The department shall disburse the federal financial participation the department receives from the federal government for such a claim to the qualified medicaid school provider that submitted the claim. The department may not pay the qualified medicaid school provider the nonfederal share of the cost of the services for which the claim was submitted.

Sec. 5162.363 5162.364.  The department of medicaid shall enter into an interagency agreement with the department of education under section 5162.35 of the Revised Code that provides for the department of education to administer the medicaid school component of the medicaid program other than the aspects of the component that sections 5162.36 to 5162.364 5162.369 of the Revised Code require the department of medicaid to administer. The interagency agreement may include a provision that provides for the department of education to pay to the department of medicaid the nonfederal share of a portion of the administrative expenses the department of medicaid incurs in administering the aspects of the medicaid school component that the department of medicaid administers. The interagency agreement shall include a provision that provides for the department of education to receive at least three and one-half per cent of the federal financial participation the state receives for the medicaid school component.

To the extent authorized by rules authorized by section 5162.021 of the Revised Code, the department of education shall establish, in rules adopted under section 5162.02 of the Revised Code, a process by which qualified medicaid school providers participating in the medicaid school component pay to the department of education the nonfederal share of the department's expenses incurred in administering the component. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.

Sec. 5162.365.  The department of medicaid and department of education jointly shall prepare and annually update procedural guidelines for, and other informational materials about, the medicaid school component of the medicaid program that give qualified medicaid school providers clear instructions for participation in the component.

Sec. 5162.366.  The medicaid school component of the medicaid program shall cover nursing services provided by any of the following:

(A) A registered nurse;

(B) A licensed practical nurse;

(C) An individual (including a school health aide), regardless of whether the individual is licensed, certified, or otherwise authorized by a board or other agency of the state to provide a health care service, to whom all of the following apply:

(1) The individual is at least eighteen years of age.

(2) A registered nurse or licensed practical nurse has delegated the nursing services to the individual in accordance with rules adopted under section 4723.07 of the Revised Code.

(3) The individual and the registered nurse or licensed practice nurse who delegated the nursing services to the individual are employed by or under contract with the qualified medicaid school provider that submits the claim to the department of medicaid for the nursing services.

Sec. 5162.367.  (A) Subject to divisions (B) and (C) of this section, the medicaid school component of the medicaid program shall cover personal care services.

(B) A medicaid recipient who is eligible for the medicaid school component may receive personal care services covered by the component if both of the following apply:

(1) The recipient needs the services because the recipient either cannot perform one or more activities of daily living or instrumental activities of daily living or has a limitation in performing one or more such activities due to a functional, cognitive, or behavioral impairment.

(2) The personal care services help the recipient benefit from special education and related services provided pursuant to Chapter 3323. of the Revised Code.

(C) Personal care services covered by the medicaid school component may be provided by an individual who meets all of the following requirements:

(1) The individual must be at least eighteen years of age.

(2) The individual must be trained to provide the personal care services to the medicaid recipient who receives the services.

(3) The individual must provide the personal care services under the direct supervision of a health care professional to whom both of the following apply:

(a) The health care professional is licensed, certified, or otherwise authorized by a board or other agency of the state to provide a health care service.

(b) The health care professional is employed by or under contract with the qualified medicaid school provider that submits the claim to the department of medicaid for the personal care services.

Sec. 5162.368.  (A) Subject to divisions (B) to (E) of this section, the medicaid school component of the medicaid program shall cover specialized medical transportation services.

(B) A medicaid recipient eligible for the medicaid school component may receive specialized medical transportation services covered by the component if both of the following requirements are met:

(1) Either of the following must apply to the recipient:

(a) School bus transportation to the school in which the medicaid recipient is enrolled must not be provided to the school's students who reside in the same area as the recipient.

(b) If school bus transportation to the school in which the medicaid recipient is enrolled is provided to the school's students who reside in the same area as the recipient, the school bus used for the transportation must not have the adaptations that the recipient needs to be able to be transported in the school bus.

(2) On the same day that the medicaid recipient receives the specialized medical transportation services, the recipient must also receive at least one other service covered by the medicaid school component. The other service may be personal care services provided to the recipient while receiving the specialized medical transportation services.

(C) Specialized medical transportation services covered by the medicaid school component must be provided in a specially adapted vehicle that has been physically modified in a manner that enables the medicaid recipient receiving the services to be transported in the vehicle. Modifications may include the addition of a wheelchair lift, seatbelts, harnesses, child protective seats, air conditioning, and similar modifications. The use of a school bus monitor or other personnel who accompany students on a school bus is not a modification.

(D) A medicaid recipient eligible to receive specialized medical transportation services covered by the medicaid school component may receive the services for any of the following one-way trips:

(1) From the recipient's residence to the recipient's school;

(2) From the recipient's school to the recipient's residence;

(3) From the recipient's residence or school to a location to receive a service covered by the medicaid school component from a health care provider under contract with the qualified medicaid school provider;

(4) From the location where a service specified in division (D)(3) of this section is received to the recipient's residence or school;

(5) From the recipient's school to another school operated by a qualified medicaid school provider;

(6) From another school operated by a qualified medicaid school provider to the recipient's school.

(E) A claim for specialized medical transportation services provided to a medicaid recipient under the medicaid school component shall show a separate charge for each one-way trip that the recipient receives.

Sec. 5162.364 5162.369.  The medicaid director shall adopt rules under section 5162.02 of the Revised Code as necessary to implement the medicaid school component of the medicaid program, including rules that establish or specify all of the following:

(A) Conditions a board of education of a city, local, or exempted school district, governing authority of a community school established under Chapter 3314. of the Revised Code, the state school for the deaf, and the state school for the blind must meet to participate in the component;

(B) Services In addition to the services specified in sections 5162.366, 5162.367, and 5162.368 of the Revised Code, services the component covers;

(C) Payment rates for the services the component covers.

The rules shall be adopted in accordance with Chapter 119. of the Revised Code.

Sec. 5162.54.  (A) There is hereby created in the state treasury the health care services administration fund. Except as provided in division (C) of this section, all the following shall be deposited into the fund:

(1) Amounts deposited into the fund pursuant to sections 5162.12, 5162.40, and 5162.41 of the Revised Code;

(2) The amount of the state share of all money the department of medicaid recovers each fiscal year pursuant to a tort action under the department's right of recovery under section 5160.37 of the Revised Code that exceeds the state share of all money the department, in fiscal year 2002, recovers pursuant to a tort action under that right of recovery;

(3) Subject to division (B) of this section, the amount of the state share of all money the department of medicaid, in fiscal year 2003 and each fiscal year thereafter, recovers through audits of medicaid providers that exceeds the state share of all money the department, in fiscal year 2002, recovers through such audits;

(4) Amounts from assessments on hospitals under section 5168.06 of the Revised Code and intergovernmental transfers by governmental hospitals under section 5168.07 of the Revised Code that are deposited into the fund in accordance with the law;

(5) Amounts that the department of education pays to the department of medicaid, if any, pursuant to an interagency agreement authorized by section 5162.363 5162.364 of the Revised Code;

(6) The application fees charged to providers under section 5164.31 of the Revised Code;

(7) The fines collected under section 5165.1010 of the Revised Code;

(8) Money the department receives in a fiscal year for performing eligibility verification services necessary for compliance with the independent, certified audit requirement of 42 C.F.R. 455.304, other than the amounts of such money that are to be credited to the health care/medicaid support and recoveries fund under section 5162.52 of the Revised Code.

(B) In determining under division (A)(3) of this section the amount of money the department, in a fiscal year, recovers through audits of medicaid providers, the amount recovered in the form of vendor offset shall be excluded.

(C) The department of medicaid shall use funds available in the health care services administration fund to pay for costs associated with the administration of the medicaid program.

Sec. 5162.64.  (A) There is hereby created in the state treasury the medicaid school program administrative fund.

(B) Both of the following shall be deposited into the medicaid school program administrative fund:

(1) The federal funds the department of education receives for the expenses the department incurs in administering the medicaid school component of the medicaid program created under section 5162.36 of the Revised Code;

(2) The money the department collects from qualified medicaid school providers in the process established in rules authorized by section 5162.363 5162.364 of the Revised Code.

(C) The department of education shall use money in the medicaid school program administrative fund for both of the following purposes:

(1) Paying for the expenses the department incurs in administering the medicaid school component of the medicaid program;

(2) Paying a qualified medicaid school provider a refund for any overpayment the provider makes to the department under the process established in rules authorized by section 5162.363 5162.364 of the Revised Code if the process results in an overpayment.

Section 2.  That existing sections 5162.01, 5162.36, 5162.361, 5162.362, 5162.363, 5162.364, 5162.54, and 5162.64 of the Revised Code are hereby repealed.