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Sub. S. B. No. 206 As Reported by the Senate Finance CommitteeAs Reported by the Senate Finance Committee
130th General Assembly | Regular Session | 2013-2014 |
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Cosponsors:
Senators Coley, LaRose, Tavares
A BILL
To amend sections 191.02, 5162.01, 5162.13, 5162.131,
5162.132, 5162.20, 5163.01, 5163.06, 5163.09,
5163.0910, and 5164.911; to amend, for the purpose
of adopting a new section number as indicated in
parentheses, section 5163.0910 (5162.133); to
enact sections 103.41, 103.411, 103.412, 103.413,
103.414, 103.415, 191.08, 5162.134, 5162.70,
5162.71, and 5164.94; and to repeal sections
101.39, 101.391, and 5163.099 of the Revised Code;
to amend Section 323.90 of Am. Sub. H.B. 59 of the
130th General Assembly; to require implementation
of certain Medicaid revisions, reform systems, and
program oversight; to provide for government
programs that provide public benefits to
prioritize employment goals; and to make an
appropriation.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 191.02, 5162.01, 5162.13, 5162.131,
5162.132, 5162.20, 5163.01, 5163.06, 5163.09, 5163.0910, and
5164.911 be amended; section 5163.0910 (5162.133) be amended for
the purpose of adopting a new section number as indicated in
parentheses; and sections 103.41, 103.411, 103.412, 103.413,
103.414, 103.415, 191.08, 5162.134, 5162.70, 5162.71, and 5164.94
of the Revised Code be enacted to read as follows:
Sec. 103.41. (A) As used in sections 103.41 to 103.415 of
the Revised Code:
(1) "JMOC" means the joint medicaid oversight committee
created under this section.
(2) "State and local government medicaid agency" means all of
the following:
(a) The department of medicaid;
(b) The office of health transformation;
(c) Each state agency and political subdivision with which
the department of medicaid contracts under section 5162.35 of the
Revised Code to have the state agency or political subdivision
administer one or more components of the medicaid program, or one
or more aspects of a component, under the department's
supervision;
(d) Each agency of a political subdivision that is
responsible for administering one or more components of the
medicaid program, or one or more aspects of a component, under the
supervision of the department or a state agency or political
subdivision described in division (A)(2)(c) of this section.
(B) There is hereby created the joint medicaid oversight
committee. JMOC shall consist of the following members:
(1) Five members of the senate appointed by the president of
the senate, three of whom are members of the majority party and
two of whom are members of the minority party;
(2) Five members of the house of representatives appointed by
the speaker of the house of representatives, three of whom are
members of the majority party and two of whom are members of the
minority party.
(C) The term of each JMOC member shall begin on the day of
appointment to JMOC and end on the last day that the member serves
in the house (in the case of a member appointed by the speaker) or
senate (in the case of a member appointed by the president) during
the general assembly for which the member is appointed to JMOC.
The president and speaker shall make the initial appointments not
later than fifteen days after the effective date of this section.
However, if this section takes effect before January 1, 2014, the
president and speaker shall make the initial appointments during
the period beginning January 1, 2014, and ending January 15, 2014.
The president and speaker shall make subsequent appointments not
later than fifteen days after the commencement of the first
regular session of each general assembly. JMOC members may be
reappointed. A vacancy on JMOC shall be filled in the same manner
as the original appointment.
(D) In odd-numbered years, the speaker shall designate one of
the majority members from the house as the JMOC chairperson and
the president shall designate one of the minority members from the
senate as the JMOC ranking minority member. In even-numbered
years, the president shall designate one of the majority members
from the senate as the JMOC chairperson and the speaker shall
designate one of the minority members from the house as the JMOC
ranking minority member.
(E) In appointing members from the minority, and in
designating ranking minority members, the president and speaker
shall consult with the minority leader of their respective houses.
(F) JMOC shall meet at the call of the JMOC chairperson. The
chairperson shall call JMOC to meet not less often than once each
calendar month, unless the chairperson and ranking minority member
agree that the chairperson should not call JMOC to meet for a
particular month.
(G) JMOC may employ professional, technical, and clerical
employees as are necessary for JMOC to be able successfully and
efficiently to perform its duties. All such employees are in the
unclassified service and serve at JMOC's pleasure. JMOC may
contract for the services of persons who are qualified by
education and experience to advise, consult with, or otherwise
assist JMOC in the performance of its duties.
(H) The JMOC chairperson, when authorized by JMOC and the
president and speaker, may issue subpoenas and subpoenas duces
tecum in aid of JMOC's performance of its duties. A subpoena may
require a witness in any part of the state to appear before JMOC
at a time and place designated in the subpoena to testify. A
subpoena duces tecum may require witnesses or other persons in any
part of the state to produce books, papers, records, and other
tangible evidence before JMOC at a time and place designated in
the subpoena duces tecum. A subpoena or subpoena duces tecum shall
be issued, served, and returned, and has consequences, as
specified in sections 101.41 to 101.45 of the Revised Code.
(I) The JMOC chairperson may administer oaths to witnesses
appearing before JMOC.
Sec. 103.411. The JMOC chairperson may request that the
medicaid director appear before JMOC to provide information and
answer questions about the medicaid program. If so requested, the
medicaid director shall appear before JMOC at the time and place
specified in the request.
Sec. 103.412. (A) JMOC shall oversee the medicaid program on
a continuing basis. As part of its oversight, JMOC shall do all of
the following:
(1) Review how the medicaid program relates to the public and
private provision of health care coverage in this state and the
United States;
(2) Review the reforms implemented under section 5162.70 of
the Revised Code and evaluate the reforms' successes in achieving
their objectives;
(3) Recommend policies and strategies to encourage both of
the following:
(a) Medicaid recipients being physically and mentally able to
join and stay in the workforce and ultimately becoming
self-sufficient;
(b) Less use of the medicaid program.
(4) Recommend, to the extent JMOC determines appropriate,
improvements in statutes and rules concerning the medicaid
program;
(5) Develop a plan of action for the future of the medicaid
program.
(B) JMOC may do all of the following:
(1) Plan, advertise, organize, and conduct forums,
conferences, and other meetings at which representatives of state
agencies and other individuals having expertise in the medicaid
program may participate to increase knowledge and understanding
of, and to develop and propose improvements in, the medicaid
program;
(2) Prepare and issue reports on the medicaid program;
(3) Solicit written comments on, and conduct public hearings
at which persons may offer verbal comments on, drafts of its
reports.
Sec. 103.413. (A) JMOC may investigate state and local
government medicaid agencies. Subject to division (B) of this
section, all of the following apply to an investigation:
(1) JMOC, including its employees, may inspect the offices of
a state and local government medicaid agency as necessary for the
conduct of the investigation.
(2) No person shall deny JMOC or a JMOC employee access to
such an office when access is needed for such an inspection.
(3) Neither JMOC nor a JMOC employee is required to give
advance notice of, or to make prior arrangements before, such an
inspection.
(B) Neither JMOC nor a JMOC employee shall conduct an
inspection under this section unless the JMOC chairperson grants
prior approval for the inspection. The chairperson shall not grant
such approval unless JMOC, the president of the senate, and the
speaker of the house of representatives authorize the chairperson
to grant the approval. Each inspection shall be conducted during
the normal business hours of the office being inspected, unless
the chairperson determines that the inspection must be conducted
outside of normal business hours. The chairperson may make such a
determination only due to an emergency circumstance or other
justifiable cause that furthers JMOC's mission. If the chairperson
makes such a determination, the chairperson shall specify the
reason for the determination in the grant of prior approval for
the inspection.
Sec. 103.414. Before the beginning of each fiscal biennium,
JMOC shall contract with an actuary to determine the projected
medical inflation rate for the upcoming fiscal biennium. The
contract shall require the actuary to make the determination using
the same types of classifications and sub-classifications of
medical care that the United States bureau of labor statistics
uses in determining the inflation rate for medical care in the
consumer price index. The contract also shall require the actuary
to provide JMOC a report with its determination at least one
hundred twenty days before the governor is required to submit a
state budget for the fiscal biennium to the general assembly under
section 107.03 of the Revised Code.
On receipt of the actuary's report, JMOC shall determine
whether it agrees with the actuary's projected medical inflation
rate. If JMOC disagrees with the actuary's projected medical
inflation rate, JMOC shall determine a different projected medical
inflation rate for the upcoming fiscal biennium.
The actuary and, if JMOC determines a different projected
medical inflation rate, JMOC shall determine the projected medical
inflation rate for the state unless that is not practicable in
which case the determination shall be made for the midwest region.
Regardless of whether it agrees with the actuary's projected
medical inflation rate or determines a different projected medical
inflation rate, JMOC shall complete a report regarding the
projected medical inflation rate. JMOC shall include a copy of the
actuary's report in JMOC's report. JMOC's report shall state
whether JMOC agrees with the actuary's projected medical inflation
rate and, if JMOC disagrees, the reason why JMOC disagrees and the
different medical inflation rate JMOC determined. At least ninety
days before the governor is required to submit a state budget for
the upcoming fiscal biennium to the general assembly under section
107.03 of the Revised Code, JMOC shall submit a copy of the report
to the general assembly in accordance with section 101.68 of the
Revised Code and to the governor and medicaid director.
Sec. 103.415. JMOC may review bills and resolutions
regarding the medicaid program that are introduced in the general
assembly. JMOC may submit a report of its review of a bill or
resolution to the general assembly in accordance with section
101.68 of the Revised Code. The report may include JMOC's
determination regarding the bill's or resolution's desirability as
a matter of public policy.
JMOC's decision on whether and when to review a bill or
resolution has no effect on the general assembly's authority to
act on the bill or resolution.
Sec. 191.02. The executive director of the office of health
transformation, in consultation with all of the following
individuals, shall identify each government program administered
by a state agency that is to be considered a government program
providing public benefits for purposes of section sections 191.04
and 191.08 of the Revised Code:
(A) The director of administrative services;
(B) The director of aging;
(C) The director of development services;
(D) The director of developmental disabilities;
(E) The director of health;
(F) The director of job and family services;
(G) The director of medicaid director;
(H) The director of mental health and addiction services;
(I) The director of rehabilitation and correction;
(J) The director of veterans services;
(K) The director of youth services;
(L) The executive director of the opportunities for Ohioans
with disabilities agency;
(M) The administrator of workers' compensation;
(N) The superintendent of insurance;
(O) The superintendent of public instruction;
(P) The tax commissioner.
Sec. 191.08. The executive director of the office of health
transformation shall adopt strategies that prioritize employment
as a goal for individuals participating in government programs
providing public benefits.
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.
(3)(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).
(4)(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.
(5)(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.
(6)(9) "Medicaid managed care organization" has the same
meaning as in section 5167.01 of the Revised Code.
(7)(10) "Medicaid provider" has the same meaning as in
section 5164.01 of the Revised Code.
(8)(11) "Medicaid services" has the same meaning as in
section 5164.01 of the Revised Code.
(9)(12) "Nursing facility" has and "nursing facility
services" have the same meaning meanings as in section 5165.01 of
the Revised Code.
(10)(13) "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.
(11)(14) "Prescribed drug" has the same meaning as in section
5164.01 of the Revised Code.
(12)(15) "Provider agreement" has the same meaning as in
section 5164.01 of the Revised Code.
(13)(16) "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 of the Revised Code.
(14)(17) "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.
(15)(18) "Vendor offset" means a reduction of a medicaid
payment to a medicaid provider to correct a previous, incorrect
medicaid payment to that provider.
Sec. 5162.13. On or before the first day of January of each
year, the department of medicaid shall submit to the speaker and
minority leader of the house of representatives and the president
and minority leader of the senate, and shall make available to the
public, complete a report on the effectiveness of the medicaid
program in meeting the health care needs of low-income pregnant
women, infants, and children. The report shall include: the
estimated number of pregnant women, infants, and children eligible
for the program; the actual number of eligible persons enrolled in
the program; the number of prenatal, postpartum, and child health
visits; a report on birth outcomes, including a comparison of
low-birthweight births and infant mortality rates of medicaid
recipients with the general female child-bearing and infant
population in this state; and a comparison of the prenatal,
delivery, and child health costs of the program with such costs of
similar programs in other states, where available.
The department
shall submit the report to the general assembly in accordance with
section 101.68 of the Revised Code and to the joint medicaid
oversight committee. The department also shall make the report
available to the public.
Sec. 5162.131. Semiannually, the medicaid director shall
submit to the president and minority leader of the senate, speaker
and minority leader of the house of representatives, and the
chairpersons of the standing committees of the senate and house of
representatives with primary responsibility for legislation making
biennial appropriations complete a report on the establishment and
implementation of programs designed to control the increase of the
cost of the medicaid program, increase the efficiency of the
medicaid program, and promote better health outcomes. The director
shall submit the report to the general assembly in accordance with
section 101.68 of the Revised Code and to the joint medicaid
oversight committee. In each calendar year, one report shall be
submitted not later than the last day of June and the subsequent
report shall be submitted not later than the last day of December.
Sec. 5162.132. Annually, the department of medicaid shall
prepare a report on the department's efforts to minimize fraud,
waste, and abuse in the medicaid program.
Each report shall be made available on the department's web
site. The department shall submit a copy of each report to the
governor, general assembly, and, joint medicaid oversight
committee. The copy to the general assembly shall be submitted in
accordance with section 101.68 of the Revised Code, the general
assembly. Copies of the report also shall be made available to the
public on request.
Sec. 5163.0910 5162.133. Not less than once each year, the
medicaid director shall submit a report on the medicaid buy-in for
workers with disabilities program to the governor, speaker and
minority leader of the house of representatives, president and
minority leader of the senate, and chairpersons of the house and
senate committees to which the biennial operating budget bill is
referred general assembly, and joint medicaid oversight committee.
The copy to the general assembly shall be submitted in accordance
with section 101.68 of the Revised Code. The report shall include
all of the following information:
(A) The number of individuals who participated in the
medicaid buy-in for workers with disabilities program;
(B) The cost of the program;
(C) The amount of revenue generated by premiums that
participants pay under section 5163.094 of the Revised Code;
(D) The average amount of earned income of participants'
families;
(E) The average amount of time participants have participated
in the program;
(F) The types of other health insurance participants have
been able to obtain.
Sec. 5162.134. Not later than the first day of each July,
the medicaid director shall complete a report of the evaluation
conducted under section 5164.911 of the Revised Code regarding the
integrated care delivery system. The director shall provide a copy
of the report to the general assembly and joint medicaid oversight
committee. The copy to the general assembly shall be provided in
accordance with section 101.68 of the Revised Code. The director
also shall make the report available to the public.
Sec. 5162.20. (A) The department of medicaid shall institute
cost-sharing requirements for the medicaid program. The
cost-sharing requirements shall include a copayment requirement
for at least dental services, vision services, nonemergency
emergency department services, and prescribed drugs. The
cost-sharing requirements also shall include requirements
regarding premiums, enrollment fees, deductions, and similar
charges The department shall not institute cost-sharing
requirements in a manner that disproportionately impacts the
ability of medicaid recipients with chronic illnesses to obtain
medically necessary medicaid services.
(B)(1) No provider shall refuse to provide a service to a
medicaid recipient who is unable to pay a required copayment for
the service.
(2) Division (B)(1) of this section shall not be considered
to do either of the following with regard to a medicaid recipient
who is unable to pay a required copayment:
(a) Relieve the medicaid recipient from the obligation to pay
a copayment;
(b) Prohibit the provider from attempting to collect an
unpaid copayment.
(C) Except as provided in division (F) of this section, no
provider shall waive a medicaid recipient's obligation to pay the
provider a copayment.
(D) No provider or drug manufacturer, including the
manufacturer's representative, employee, independent contractor,
or agent, shall pay any copayment on behalf of a medicaid
recipient.
(E) If it is the routine business practice of a provider to
refuse service to any individual who owes an outstanding debt to
the provider, the provider may consider an unpaid copayment
imposed by the cost-sharing requirements as an outstanding debt
and may refuse service to a medicaid recipient who owes the
provider an outstanding debt. If the provider intends to refuse
service to a medicaid recipient who owes the provider an
outstanding debt, the provider shall notify the recipient of the
provider's intent to refuse service.
(F) In the case of a provider that is a hospital, the
cost-sharing program shall permit the hospital to take action to
collect a copayment by providing, at the time services are
rendered to a medicaid recipient, notice that a copayment may be
owed. If the hospital provides the notice and chooses not to take
any further action to pursue collection of the copayment, the
prohibition against waiving copayments specified in division (C)
of this section does not apply.
(G) The department of medicaid may collaborate with a state
agency that is administering, pursuant to a contract entered into
under section 5162.35 of the Revised Code, one or more components,
or one or more aspects of a component, of the medicaid program as
necessary for the state agency to apply the cost-sharing
requirements to the components or aspects of a component that the
state agency administers.
Sec. 5162.70. (A) As used in this section:
(1) "CPI" means the consumer price index for all urban
consumers as published by the United States bureau of labor
statistics.
(2) "CPI medical inflation rate" means the inflation rate for
medical care, or the successor term for medical care, for the
midwest region as specified in the CPI.
(3) "JMOC projected medical inflation rate" means the
following:
(a) The projected medical inflation rate for a fiscal
biennium determined by the actuary with which the joint medicaid
oversight committee contracts under section 103.414 of the Revised
Code if the committee agrees with the actuary's projected medical
inflation rate for that fiscal biennium;
(b) The different projected medical inflation rate for a
fiscal biennium determined by the joint medicaid oversight
committee under section 103.414 of the Revised Code if the
committee disagrees with the projected medical inflation rate
determined for that fiscal biennium by the actuary with which the
committee contracts under that section.
(4) "Successor term" means a term that the United States
bureau of labor statistics uses in place of another term in
revisions to the CPI.
(B) The medicaid director shall implement reforms to the
medicaid program that do all of the following:
(1) Limit the growth in the per recipient per month cost of
the medicaid program, as determined on an aggregate basis for all
eligibility groups, for a fiscal biennium to not more than the
lesser of the following:
(a) The average annual increase in the CPI medical inflation
rate for the most recent three-year period for which the necessary
data is available as of the first day of the fiscal biennium,
weighted by the most recent year of the three years;
(b) The JMOC projected medical inflation rate for the fiscal
biennium.
(2) Achieve the limit in the growth of the per recipient per
month cost of the medicaid program under division (B)(1) of this
section by doing all of the following:
(a) Improving the physical and mental health of medicaid
recipients;
(b) Providing for medicaid recipients to receive medicaid
services in the most cost-effective and sustainable manner;
(c) Removing barriers that impede medicaid recipients'
ability to transfer to lower cost, and more appropriate, medicaid
services, including home and community-based services;
(d) Establishing medicaid payment rates that encourage value
over volume and result in medicaid services being provided in the
most efficient and effective manner possible;
(e) Implementing fraud and abuse prevention and cost
avoidance mechanisms to the fullest extent possible;
(f) Integrating in the care management system established
under section 5167.03 of the Revised Code the delivery of physical
health, behavioral health, nursing facility, and home and
community-based services covered by medicaid.
(3) Reduce the prevalence of comorbid health conditions
among, and the mortality rates of, medicaid recipients.
(C) The medicaid director shall implement the reforms under
this section in accordance with evidence-based strategies that
include measurable goals.
(D) The reforms implemented under this section shall, without
making the medicaid program's eligibility requirements more
restrictive, reduce the relative number of individuals enrolled in
the medicaid program who have the greatest potential to obtain the
income and resources that would enable them to cease enrollment in
medicaid and instead obtain health care coverage through
employer-sponsored health insurance or an exchange.
Sec. 5162.71. The medicaid director shall implement within
the medicaid program systems that do both of the following:
(A) Improve the health of medicaid recipients through the use
of population health measures;
(B) Reduce health disparities, including, but not limited to,
those within racial and ethnic populations.
Sec. 5163.01. As used in this chapter:
"Caretaker relative" has the same meaning as in 42 C.F.R.
435.4 as that regulation is amended effective January 1, 2014.
"Children's hospital" has the same meaning as in section
2151.86 of the Revised Code.
"Federal financial participation" has the same meaning as in
section 5160.01 of the Revised Code.
"Federally qualified health center" has the same meaning as
in the "Social Security Act," section 1905(l)(2)(B), 42 U.S.C.
1396d(l)(2)(B).
"Federally qualified health center look-alike" has the same
meaning as in section 3701.047 of the Revised Code.
"Federal poverty line" has the same meaning as in section
5162.01 of the Revised Code.
"Healthy start component" has the same meaning as in section
5162.01 of the Revised Code.
"Home and community-based services medicaid waiver component"
has the same meaning as in section 5166.01 of the Revised Code.
"Intermediate care facility for individuals with intellectual
disabilities" and "ICF/IID" have the same meanings as in section
5124.01 of the Revised Code.
"Mandatory eligibility groups" means the groups of
individuals that must be covered by the medicaid state plan as a
condition of the state receiving federal financial participation
for the medicaid program.
"Medicaid buy-in for workers with disabilities program" means
the component of the medicaid program established under sections
5163.09 to 5163.0910 5163.098 of the Revised Code.
"Medicaid services" has the same meaning as in section
5164.01 of the Revised Code.
"Medicaid waiver component" has the same meaning as in
section 5166.01 of the Revised Code.
"Nursing facility" and "nursing facility services" have the
same meanings as in section 5165.01 of the Revised Code.
"Optional eligibility groups" means the groups of individuals
who may be covered by the medicaid state plan or a federal
medicaid waiver and for whom the medicaid program receives federal
financial participation.
"Other medicaid-funded long-term care services" has the
meaning specified in rules adopted under section 5163.02 of the
Revised Code.
"Supplemental security income program" means the program
established by Title XVI of the "Social Security Act," 42 U.S.C.
1381 et seq.
Sec. 5163.06. The medicaid program shall cover all of the
following optional eligibility groups:
(A) The group consisting of children placed with adoptive
parents who are specified in the "Social Security Act," section
1902(a)(10)(A)(ii)(VIII), 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII);
(B) Subject to section 5163.061 of the Revised Code, the
group consisting of women during pregnancy and the sixty-day
period beginning on the last day of the pregnancy, infants, and
children who are specified in the "Social Security Act," section
1902(a)(10)(A)(ii)(IX), 42 U.S.C. 1396a(a)(10)(A)(ii)(IX);
(C) Subject to sections 5163.09 to 5163.0910 5163.098 of the
Revised Code, the group consisting of employed individuals with
disabilities who are specified in the "Social Security Act,"
section 1902(a)(10)(A)(ii)(XV), 42 U.S.C. 1396a(a)(10)(A)(ii)(XV);
(D) Subject to sections 5163.09 to 5163.0910 5163.098 of the
Revised Code, the group consisting of employed individuals with
medically improved disabilities who are specified in the "Social
Security Act," section 1902(a)(10)(A)(ii)(XVI), 42 U.S.C.
1396a(a)(10)(A)(ii)(XVI);
(E) The group consisting of independent foster care
adolescents who are specified in the "Social Security Act,"
section 1902(a)(10)(A)(ii)(XVII), 42 U.S.C.
1396a(a)(10)(A)(ii)(XVII);
(F) The group consisting of women in need of treatment for
breast or cervical cancer who are specified in the "Social
Security Act," section 1902(a)(10)(A)(ii)(XVIII), 42 U.S.C.
1396a(a)(10)(A)(ii)(XVIII);
(G) The group consisting of nonpregnant individuals who may
receive family planning services and supplies and are specified in
the "Social Security Act," section 1902(a)(10)(A)(ii)(XXI), 42
U.S.C. 1396a(a)(10)(A)(ii)(XXI).
Sec. 5163.09. (A) As used in sections 5163.09 to 5163.0910
5163.098 of the Revised Code:
"Applicant" means an individual who applies to participate in
the medicaid buy-in for workers with disabilities program.
"Earned income" has the meaning established by rules
authorized by section 5163.098 of the Revised Code.
"Employed individual with a medically improved disability"
has the same meaning as in the "Social Security Act," section
1905(v), 42 U.S.C. 1396d(v).
"Family" means an applicant or participant and the spouse and
dependent children of the applicant or participant. If an
applicant or participant is under eighteen years of age, "family"
also means the parents of the applicant or participant.
"Health insurance" has the meaning established by rules
authorized by section 5163.098 of the Revised Code.
"Income" means earned income and unearned income.
"Participant" means an individual who has been determined
eligible for the medicaid buy-in for workers with disabilities
program and is participating in the program.
"Resources" has the meaning established by rules authorized
by section 5163.098 of the Revised Code.
"Spouse" has the meaning established in by rules authorized
by section 5163.098 of the Revised Code.
"Unearned income" has the meaning established by rules
authorized by section 5163.098 of the Revised Code.
(B) The medicaid program's coverage of the optional
eligibility groups specified in the "Social Security Act," section
1902(a)(10)(A)(ii)(XV) and (XVI), 42 U.S.C.
1396a(a)(10)(A)(ii)(XV) and (XVI) shall be known as the medicaid
buy-in for workers with disabilities program.
Sec. 5164.911. (A) If the medicaid director implements the
integrated care delivery system and except as provided in division
(D)(C) of this section, the director shall annually evaluate all
of the following:
(1) The health outcomes of ICDS participants;
(2) How changes to the administration of the ICDS affect all
of the following:
(c) The number of reassessments requested;
(d) Prior authorization requests for services.
(3) The provider panel selection process used by medicaid
managed care organizations participating in the ICDS.
(B) When conducting an evaluation under division (A) of this
section, the director shall do all of the following:
(1) For the purpose of division (A)(1) of this section, do
both of the following:
(a) Compare the health outcomes of ICDS participants to the
health outcomes of individuals who are not ICDS participants;
(b) Use both of the following:
(i) A control group consisting of ICDS participants who
receive health care services from providers not participating in
ICDS;
(ii) A control group consisting of ICDS participants who
receive health care services from alternative providers that are
not part of a participating medicaid managed care organization's
provider panel but provide health care services in the geographic
service area in which ICDS participants receive health care
services.
(2) For the purpose of division (A)(2) of this section, do
all of the following:
(a) To the extent the data is available, use data from all of
the following:
(i) The fee-for-service component of the medicaid program;
(ii) Medicaid managed care organizations;
(iii) Managed care organizations participating in the
medicare advantage program established under Part C of Title XVIII
of the "Social Security Act," 42 U.S.C. 1395w-21 et seq.
(b) Identify all of the following:
(i) Changes in the amount of time it takes to process claims
and the number of claims denied and the reasons for the changes;
(ii) The impact that changes to the administration of the
ICDS had on the appeals process and number of reassessments
requested;
(iii) The number of prior authorization denials that were
overturned and the reasons for the overturned denials.
(3) Require medicaid managed care organizations participating
in the ICDS to submit to the director any data the director needs
for the evaluation.
(C) Not later than the first day of each July, the director
shall complete a report of the evaluation conducted under this
section. The director shall provide a copy of the report to the
general assembly in accordance with section 101.68 of the Revised
Code and make the report available to the public.
(D) The director is not required to conduct an evaluation
under this section for a year if the same evaluation is conducted
for that year by an organization under contract with the United
States department of health and human services.
Sec. 5164.94. The medicaid director shall implement within
the medicaid program a system that encourages medicaid providers
to provide medicaid services to medicaid recipients in culturally
and linguistically appropriate manners.
Section 2. That existing sections 191.02, 5162.01, 5162.13,
5162.131, 5162.132, 5162.20, 5163.01, 5163.06, 5163.09, 5163.0910,
and 5164.911 of the Revised Code are hereby repealed.
Section 3. That sections 101.39, 101.391, and 5163.099 of the
Revised Code are hereby repealed.
Section 4. That Section 323.90 of Am. Sub. H.B. 59 of the
130th General Assembly be amended to read as follows:
Sec. 323.90. JOINT LEGISLATIVE MEDICAID OVERSIGHT COMMITTEE
FOR UNIFIED LONG-TERM SERVICES AND SUPPORTS STUDY
(A) The Joint Legislative Committee for Unified Long-Term
Services and Supports created under section 309.30.73 of Am. Sub.
H.B. 153 of the 129th General Assembly, as subsequently amended,
shall continue to exist during fiscal year 2014 and fiscal year
2015. The Committee shall consist of the following members:
(1) Two members of the House of Representatives from the
majority party, appointed by the Speaker of the House of
Representatives;
(2) One member of the House of Representatives from the
minority party, appointed by the Speaker of the House of
Representatives;
(3) Two members of the Senate from the majority party,
appointed by the President of the Senate;
(4) One member of the Senate from the minority party,
appointed by the President of the Senate.
(B) The Speaker of the House of Representatives shall
designate one of the members of the Committee appointed under
division (A)(1) of this section to serve as co-chairperson of the
Committee. The President of the Senate shall designate one of the
members of the Committee appointed under division (A)(3) of this
section to serve as the other co-chairperson of the Committee. The
Committee shall meet at the call of the co-chairpersons. The
co-chairpersons may request assistance for the Committee from the
Legislative Service Commission.
(C) The Joint Medicaid Oversight Committee may examine the
following issues:
(1) The implementation of the dual eligible integrated care
demonstration project authorized by section 5164.91 of the Revised
Code;
(2) The implementation of a unified long-term services and
support Medicaid waiver component under section 5166.14 of the
Revised Code;
(3) Providing consumers choices regarding a continuum of
services that meet their health-care needs, promote autonomy and
independence, and improve quality of life;
(4) Ensuring that long-term care services and supports are
delivered in a cost-effective and quality manner;
(5) Subjecting county homes, county nursing homes, and
district homes operated pursuant to Chapter 5155. of the Revised
Code to the franchise permit fee under sections 5168.40 to 5168.56
of the Revised Code;
(6) Other issues of interest to the committee.
(D)(B) The co-chairpersons of the Committee chairperson shall
provide for the Medicaid Director to testify before the Committee
at least quarterly regarding the issues that the Committee
examines.
Section 5. That existing Section 323.90 of Am. Sub. H.B. 59
of the 130th General Assembly is hereby repealed.
Section 6. The Joint Medicaid Oversight Committee shall
prepare a report with recommendations for legislation regarding
Medicaid payment rates for Medicaid services. The goal of the
recommendations shall be to provide the Medicaid Director
statutory authority to implement innovative methodologies for
setting Medicaid payment rates that limit the growth in Medicaid
costs and protect, and establish guiding principles for, Medicaid
providers and recipients. The Medicaid Director shall assist the
Committee with the report. The Committee shall submit the report
to the General Assembly in accordance with section 101.68 of the
Revised Code not later than January 1, 2015.
Section 7. The General Assembly encourages the Department of
Medicaid to achieve greater cost savings for the Medicaid program
than required by section 5162.70 of the Revised Code. It is the
intent of the General Assembly that any amounts saved under that
section not be expended for any other purpose.
Section 8. Nothing in this act shall be construed as the
General Assembly endorsing, validating, or otherwise approving the
Medicaid program's coverage 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).
Section 9. 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.
JMO JOINT MEDICAID OVERSIGHT COMMITTEE
GRF |
048321 |
|
Operating Expenses |
|
$ |
350,000 |
|
$ |
500,000 |
|
|
TOTAL GRF General Revenue Fund
| |
$ |
350,000 |
|
$ |
500,000 |
|
|
TOTAL ALL BUDGET FUND GROUPS
| |
$ |
350,000 |
|
$ |
500,000 |
|
|
The foregoing appropriation item 048321, Operating Expenses,
shall be used to support expenses related to the Joint Medicaid
Oversight Committee created by section 103.41 of the Revised Code.
Section 10. 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.
|