Bill Text: OH HB316 | 2013-2014 | 130th General Assembly | Introduced

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Bill Title: Regarding Medicaid-covered community behavioral health services.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2013-10-24 - To Health and Aging [HB316 Detail]

Download: Ohio-2013-HB316-Introduced.html

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As Introduced

130th General Assembly Regular Session 2013-2014

H. B. No. 316

Representative Wachtmann 

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A BILL

To amend sections 5164.01, 5167.01, and 5167.03 and

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to enact sections 5164.151, 5167.15, and 5167.151

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of the Revised Code regarding Medicaid-covered

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community behavioral health services.

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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 5164.01, 5167.01, and 5167.03 be	5
amended and sections 5164.151, 5167.15, and 5167.151 of the	6
Revised Code be enacted to read as follows:	7

Sec. 5164.01.  As used in this chapter:

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(A) "Community behavioral health services" means the	9
following:	10

(1) Community alcohol and drug addiction services provided by	11
community addiction services providers certified by the department	12
of mental health and addiction services under section 5119.36 of	13
the Revised Code;	14

(2) Community mental health services provided by community	15
mental health services providers certified by the department of	16
mental health and addiction services under section 5119.36 of the	17
Revised Code.	18

(B) "Early and periodic screening, diagnostic, and treatment	19
services" has the same meaning as in the "Social Security Act,"	20
section 1905(r), 42 U.S.C. 1396d(r).	21

(B)(C) "Federal financial participation" has the same meaning	22
as in section 5160.01 of the Revised Code.	23

(C)(D) "Healthcheck" means the component of the medicaid	24
program that provides early and periodic screening, diagnostic,	25
and treatment services.	26

(D)(E) "Home and community-based services medicaid waiver	27
component" has the same meaning as in section 5166.01 of the	28
Revised Code.	29

(E)(F) "Hospital" has the same meaning as in section 3727.01	30
of the Revised Code.	31

(F)(G) "ICDS participant" means a dual eligible individual	32
who participates in the integrated care delivery system.	33

(G)(H) "ICF/IID" has the same meaning as in section 5124.01	34
of the Revised Code.	35

(H)(I) "Integrated care delivery system" and "ICDS" mean the	36
demonstration project authorized by section 5164.91 of the Revised	37
Code.	38

(I)(J) "Mandatory services" means the health care services	39
and items that must be covered by the medicaid state plan as a	40
condition of the state receiving federal financial participation	41
for the medicaid program.	42

(J)(K) "Medicaid managed care organization" has the same	43
meaning as in section 5167.01 of the Revised Code.	44

(K)(L) "Medicaid provider" means a person or government	45
entity with a valid provider agreement to provide medicaid	46
services to medicaid recipients. To the extent appropriate in the	47
context, "medicaid provider" includes a person or government	48
entity applying for a provider agreement, a former medicaid	49
provider, or both.	50

(L)(M) "Medicaid services" means either or both of the	51
following:	52

(1) Mandatory services;

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(2) Optional services that the medicaid program covers.

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(M)(N) "Nursing facility" has the same meaning as in section	55
5165.01 of the Revised Code.	56

(N)(O) "Optional services" means the health care services and	57
items that may be covered by the medicaid state plan or a federal	58
medicaid waiver and for which the medicaid program receives	59
federal financial participation.	60

(O)(P) "Prescribed drug" has the same meaning as in 42 C.F.R.	61
440.120.	62

(P)(Q) "Provider agreement" means an agreement to which all	63
of the following apply:	64

(1) It is between a medicaid provider and the department of	65
medicaid;	66

(2) It provides for the medicaid provider to provide medicaid	67
services to medicaid recipients;	68

(3) It complies with 42 C.F.R. 431.107(b).

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(Q)(R) "Terminal distributor of dangerous drugs" has the same	70
meaning as in section 4729.01 of the Revised Code.	71

Sec. 5164.151.  The medicaid program shall not limit the	72
number of hours that, or visits at which, medicaid recipients who	73
are eligible for community behavioral heath services covered by	74
the medicaid program may receive the services.	75

Sec. 5167.01.  As used in this chapter:

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(A) "Controlled"Community behavioral health services" has	77
the same meaning as in section 5164.01 of the Revised Code.	78

"Controlled substance" has the same meaning as in section	79
3719.01 of the Revised Code.	80

(B) "Dual eligible individual" has the same meaning as in	81
section 5160.01 of the Revised Code.	82

(C) "Emergency services" has the same meaning as in the	83
"Social Security Act," section 1932(b)(2), 42 U.S.C.	84
1396u-2(b)(2).	85

(D) "Home and community-based services medicaid waiver	86
component" has the same meaning as in section 5166.01 of the	87
Revised Code.	88

(E) "Medicaid managed care organization" means a managed care	89
organization under contract with the department of medicaid	90
pursuant to section 5167.10 of the Revised Code.	91

(F) "Medicaid waiver component" has the same meaning as in	92
section 5166.01 of the Revised Code.	93

(G) "Nursing facility" has the same meaning as in section	94
5165.01 of the Revised Code.	95

(H) "Prescribed drug" has the same meaning as in section	96
5164.01 of the Revised Code.	97

(I) "Provider" means any person or government entity that	98
furnishes services to a medicaid recipient enrolled in a medicaid	99
managed care organization, regardless of whether the person or	100
entity has a provider agreement.	101

(J) "Provider agreement" has the same meaning as in section	102
5164.01 of the Revised Code.	103

Sec. 5167.03. (A) As part of the medicaid program, the	104
department of medicaid shall establish a care management system.	105

(B) The department shall implement the care management system	106
in some or all counties and shall designate the medicaid	107
recipients who are required or permitted to participate in the	108
system. In the department's implementation of the system and	109
designation of participants, allboth of the following apply:	110

(1) In the case of individuals who receive medicaid on the	111
basis of being included in the category identified by the	112
department as covered families and children, the department shall	113
implement the care management system in all counties. All	114
individuals included in the category shall be designated for	115
participation, except for individuals included in one or more of	116
the medicaid recipient groups specified in 42 C.F.R. 438.50(d).	117
The department shall ensure that all participants are enrolled in	118
medicaid managed care organizations that are health insuring	119
corporations.	120

(2) In the case of individuals who receive medicaid on the	121
basis of being aged, blind, or disabled, the department shall	122
implement the care management system in all counties. Except as	123
provided in division (C) of this section, all individuals included	124
in the category shall be designated for participation. The	125
department shall ensure that all participants are enrolled in	126
medicaid managed care organizations that are health insuring	127
corporations.	128

(3) Alcohol, drug addiction, and mental health services	129
covered by medicaid shall not be included in any component of the	130
care management system when the nonfederal share of the cost of	131
those services is provided by a board of alcohol, drug addiction,	132
and mental health services or a state agency other than the	133
department of medicaid, but the recipients of those services may	134
otherwise be designated for participation in the system.	135

(C)(1) In designating participants who receive medicaid on	136
the basis of being aged, blind, or disabled, the department shall	137
not include any of the following, except as provided under	138
division (C)(2) of this section:	139

(a) Individuals who are under twenty-one years of age;

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(b) Individuals who are institutionalized;

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(c) Individuals who become eligible for medicaid by spending	142
down their income or resources to a level that meets the medicaid	143
program's financial eligibility requirements;	144

(d) Dual eligible individuals;

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(e) Individuals to the extent that they are receiving	146
medicaid services through a medicaid waiver component.	147

(2) The department may designate any of the following	148
individuals who receive medicaid on the basis of being aged,	149
blind, or disabled as individuals who are permitted or required to	150
participate in the care management system:	151

(a) Individuals who are under twenty-one years of age;

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(b) Individuals who reside in a nursing facility;

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(c) Individuals who, as an alternative to receiving nursing	154
facility services, are participating in a home and community-based	155
services medicaid waiver component;	156

(d) Dual eligible individuals.

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(D) Subject to division (B) of this section, the department	158
may do both of the following under the care management system:	159

(1) Require or permit participants in the system to obtain	160
health care services from providers designated by the department;	161

(2) Require or permit participants in the system to obtain	162
health care services through medicaid managed care organizations.	163

Sec. 5167.15.  When contracting under section 5167.10 of the	164
Revised Code with a managed care organization that is a health	165
insuring corporation, the department of medicaid may authorize the	166
health insuring corporation to provide coverage of the following	167
community behavioral health services for medicaid recipients	168
enrolled in the health insuring corporation:	169

(A) Ambulatory detoxification;

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(B) Community psychiatric supportive treatment;

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(C) Diagnostic assessment;

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(D) Health home comprehensive care coordination;

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(E) Individual and group counseling;

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(F) Inpatient psychiatric care in freestanding psychiatric	175
hospitals;	176

(G) Intensive outpatient treatment for alcohol and drug	177
addiction;	178

(H) Methadone administration;

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(I) Partial hospitalization;

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(J) Pharmacological management.

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Sec. 5167.151.  A medicaid managed care organization that	182
provides coverage of community behavioral health services under	183
section 5167.15 of the Revised Code shall not establish any limits	184
on the number of hours that, or visits at which, medicaid	185
recipients who are eligible for the services may receive the	186
services.	187

Section 2.  That existing sections 5164.01, 5167.01, and	188
5167.03 of the Revised Code are hereby repealed.	189