Bill Text: OH HB255 | 2013-2014 | 130th General Assembly | Introduced

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Bill Title: To revise the law governing eligibility for the Medicaid program and to abolish the Medicaid Buy-In for Workers with Disabilities Program.

Spectrum: Partisan Bill (Republican 2-0)

Status: (Introduced - Dead) 2013-08-27 - To Health and Aging [HB255 Detail]

Download: Ohio-2013-HB255-Introduced.html

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As Introduced

130th General Assembly Regular Session 2013-2014

H. B. No. 255

Representative Becker 

Cosponsor: Representative Lynch 

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A BILL

To amend sections 5163.01, 5163.06, 5163.061,

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5163.07, 5166.01, and 5166.04, to enact new

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section 5163.09, and to repeal sections 5163.09,

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5163.091, 5163.092, 5163.093, 5163.094, 5163.095,

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5163.096, 5163.097, 5163.098, 5163.099, and

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5163.0910 of the Revised Code to revise the law

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governing eligibility for the Medicaid program and

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to abolish the Medicaid Buy-In for Workers with

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Disabilities Program.

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

Section 1. That sections 5163.01, 5163.06, 5163.061, 5163.07,	10
5166.01, and 5166.04 be amended and new section 5163.09 of the	11
Revised Code be enacted to read as follows:	12

Sec. 5163.01. As used in this chapter:

13

"Caretaker relative" has the same meaning as in 42 C.F.R.	14
435.4 as that regulation is amended effective January 1, 2014.	15

"Children's hospital" has the same meaning as in section	16
2151.86 of the Revised Code.	17

"Federal financial participation" has the same meaning as in	18
section 5160.01 of the Revised Code.	19

"Federally qualified health center" has the same meaning as	20
in the "Social Security Act," section 1905(l)(2)(B), 42 U.S.C.	21
1396d(l)(2)(B).	22

"Federally qualified health center look-alike" has the same	23
meaning as in section 3701.047 of the Revised Code.	24

"Federal poverty line" has the same meaning as in section	25
5162.01 of the Revised Code.	26

"Healthy start component" has the same meaning as in section	27
5162.01 of the Revised Code.	28

"Home and community-based services medicaid waiver component"	29
has the same meaning as in section 5166.01 of the Revised Code.	30

"Intermediate care facility for individuals with intellectual	31
disabilities" and "ICF/IID" have the same meanings as in section	32
5124.01 of the Revised Code.	33

"Mandatory eligibility groups" means the groups of	34
individuals that must be covered by the medicaid state plan as a	35
condition of the state receiving federal financial participation	36
for the medicaid program.	37

"Medicaid buy-in for workers with disabilities program" means	38
the component of the medicaid program established under sections	39
5163.09 to 5163.0910 of the Revised Code.	40

"Medicaid services" has the same meaning as in section	41
5164.01 of the Revised Code.	42

"Medicaid waiver component" has the same meaning as in	43
section 5166.01 of the Revised Code.	44

"Nursing facility" and "nursing facility services" have the	45
same meanings as in section 5165.01 of the Revised Code.	46

"Optional eligibility groups" means the groups of individuals	47
who may be covered by the medicaid state plan or a federal	48
medicaid waiver and for whom the medicaid program receives federal	49
financial participation.	50

"Other medicaid-funded long-term care services" has the	51
meaning specified in rules adopted under section 5163.02 of the	52
Revised Code.	53

"Supplemental security income program" means the program	54
established by Title XVI of the "Social Security Act," 42 U.S.C.	55
1381 et seq.	56

Sec. 5163.06. The medicaid program shall cover all of the	57
following optional eligibility groups:	58

(A) The group consisting of children placed with adoptive	59
parents who are specified in the "Social Security Act," section	60
1902(a)(10)(A)(ii)(VIII), 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII);	61

(B) Subject to section 5163.061 of the Revised Code, the	62
group consisting of women during pregnancy and the sixty-day	63
period beginning on the last day of the pregnancy, infants, and	64
children who are specified in the "Social Security Act," section	65
1902(a)(10)(A)(ii)(IX), 42 U.S.C. 1396a(a)(10)(A)(ii)(IX);	66

(C) Subject to sections 5163.09 to 5163.0910 of the Revised	67
Code, the group consisting of employed individuals with	68
disabilities who are specified in the "Social Security Act,"	69
section 1902(a)(10)(A)(ii)(XV), 42 U.S.C. 1396a(a)(10)(A)(ii)(XV);	70

(D) Subject to sections 5163.09 to 5163.0910 of the Revised	71
Code, the group consisting of employed individuals with medically	72
improved disabilities who are specified in the "Social Security	73
Act," section 1902(a)(10)(A)(ii)(XVI), 42 U.S.C.	74
1396a(a)(10)(A)(ii)(XVI);	75

(E) The group consisting of independent foster care	76
adolescents who are specified in the "Social Security Act,"	77
section 1902(a)(10)(A)(ii)(XVII), 42 U.S.C.	78
1396a(a)(10)(A)(ii)(XVII);	79

(F)(D) The group consisting of women in need of treatment for	80
breast or cervical cancer who are specified in the "Social	81
Security Act," section 1902(a)(10)(A)(ii)(XVIII), 42 U.S.C.	82
1396a(a)(10)(A)(ii)(XVIII);	83

(G)(E) The group consisting of nonpregnant individuals who	84
may receive family planning services and supplies and are	85
specified in the "Social Security Act," section	86
1902(a)(10)(A)(ii)(XXI), 42 U.S.C. 1396a(a)(10)(A)(ii)(XXI).	87

Sec. 5163.061. The income eligibility threshold is twoone	88
hundred thirty-three per cent of the federal poverty line for	89
women during pregnancy and the sixty-day period beginning on the	90
last day of the pregnancy who are covered by the medicaid program	91
under division (B) of section 5163.06 of the Revised Code.	92

Sec. 5163.07.  The medicaid director shall implement the	93
option authorized by the "Social Security Act," section	94
1931(b)(2)(C), 42 U.S.C. 1396u-1(b)(2)(C), to set the income	95
eligibility threshold at ninetyis thirty-four per cent of the	96
federal poverty line for parents and caretaker relatives who are	97
covered by the medicaid program under that section of the "Social	98
Security Act.," section 1931, 42 U.S.C. 1396u-1.	99

Sec. 5163.09.  The medicaid program shall not cover the	100
following optional eligibility groups:	101

(A) The group consisting of employed individuals with	102
disabilities who are specified in the "Social Security Act,"	103
section 1902(a)(10)(A)(ii)(XV), 42 U.S.C. 1396a(a)(10)(A)(ii)(XV);	104

(B) The group consisting of employed individuals with	105
medically improved disabilities who are specified in the "Social	106
Security Act," section 1902(a)(10)(A)(ii)(XVI), 42 U.S.C.	107
1396a(a)(10)(A)(ii)(XVI).	108

Sec. 5166.01.  As used in this chapter:

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"Administrative agency" means, with respect to a home and	110
community-based services medicaid waiver component, the department	111
of medicaid or, if a state agency or political subdivision	112
contracts with the department under section 5162.35 of the Revised	113
Code to administer the component, that state agency or political	114
subdivision.	115

"Dual eligible individual" has the same meaning as in section	116
5160.01 of the Revised Code.	117

"Home and community-based services medicaid waiver component"	118
means a medicaid waiver component under which home and	119
community-based services are provided as an alternative to	120
hospital services, nursing facility services, or ICF/IID services.	121

"Hospital" has the same meaning as in section 3727.01 of the	122
Revised Code.	123

"Hospital long-term care unit" has the same meaning as in	124
section 5168.40 of the Revised Code.	125

"ICDS participant" has the same meaning as in section 5164.01	126
of the Revised Code.	127

"ICF/IID" and "ICF/IID services" have the same meanings as in	128
section 5124.01 of the Revised Code.	129

"Integrated care delivery system" and "ICDS" have the same	130
meanings as in section 5164.01 of the Revised Code.	131

"Level of care determination" means a determination of	132
whether an individual needs the level of care provided by a	133
hospital, nursing facility, or ICF/IID and whether the individual,	134
if determined to need that level of care, would receive hospital	135
services, nursing facility services, or ICF/IID services if not	136
for a home and community-based services medicaid waiver component.	137

"Medicaid buy-in for workers with disabilities program" has	138
the same meaning as in section 5163.01 of the Revised Code.	139

"Medicaid services" has the same meaning as in section	140
5164.01 of the Revised Code.	141

"Medicaid waiver component" means a component of the medicaid	142
program authorized by a waiver granted by the United States	143
department of health and human services under the "Social Security	144
Act," section 1115 or 1915, 42 U.S.C. 1315 or 1396n. "Medicaid	145
waiver component" does not include a care management system	146
established under section 5167.03 of the Revised Code.	147

"Nursing facility" and "nursing facility services" have the	148
same meanings as in section 5165.01 of the Revised Code.	149

"Ohio home care waiver program" means the home and	150
community-based services medicaid waiver component that is known	151
as Ohio home care and was created pursuant to section 5166.11 of	152
the Revised Code.	153

"Ohio transitions II aging carve-out program" means the home	154
and community-based services medicaid waiver component that is	155
known as Ohio transitions II aging carve-out and was created	156
pursuant to section 5166.11 of the Revised Code.	157

"Provider agreement" has the same meaning as in section	158
5164.01 of the Revised Code.	159

"Residential treatment facility" means a residential facility	160
licensed by the department of mental health and addiction services	161
under section 5119.34 of the Revised Code, or an institution	162
certified by the department of job and family services under	163
section 5103.03 of the Revised Code, that serves children and	164
either has more than sixteen beds or is part of a campus of	165
multiple facilities or institutions that, combined, have a total	166
of more than sixteen beds.	167

"Skilled nursing facility" has the same meaning as in section	168
5165.01 of the Revised Code.	169

"Unified long-term services and support medicaid waiver	170
component" means the medicaid waiver component authorized by	171
section 5166.14 of the Revised Code.	172

Sec. 5166.04.  The following requirements apply to each home	173
and community-based services medicaid waiver component:	174

(A) Only an individual who qualifies for a component shall	175
receive that component's medicaid services.	176

(B) A level of care determination shall be made as part of	177
the process of determining whether an individual qualifies for a	178
component and shall be made each year after the initial	179
determination if, during such a subsequent year, the	180
administrative agency determines there is a reasonable indication	181
that the individual's needs have changed.	182

(C) A written plan of care or individual service plan based	183
on an individual assessment of the medicaid services that an	184
individual needs to avoid needing admission to a hospital, nursing	185
facility, or ICF/IID shall be created for each individual	186
determined eligible for a component.	187

(D) Each individual determined eligible for a component shall	188
receive that component's medicaid services in accordance with the	189
individual's level of care determination and written plan of care	190
or individual service plan.	191

(E) No individual may receive medicaid services under a	192
component while the individual is a hospital inpatient or resident	193
of a skilled nursing facility, nursing facility, or ICF/IID.	194

(F) No individual may receive prevocational, educational, or	195
supported employment services under a component if the individual	196
is eligible for such services that are funded with federal funds	197
provided under 29 U.S.C. 730 or the "Individuals with Disabilities	198
Education Act," 111 Stat. 37 (1997), 20 U.S.C. 1400, as amended.	199

(G) Safeguards shall be taken to protect the health and	200
welfare of individuals receiving medicaid services under a	201
component, including safeguards established in rules adopted under	202
section 5166.02 of the Revised Code and safeguards established by	203
licensing and certification requirements that are applicable to	204
the providers of that component's medicaid services.	205

(H) No medicaid services may be provided under a component by	206
a provider that is subject to standards that the "Social Security	207
Act," section 1616(e)(1), 42 U.S.C. 1382e(e)(1), requires be	208
established if the provider fails to comply with the standards	209
applicable to the provider.	210

(I) Individuals determined to be eligible for a component, or	211
such individuals' representatives, shall be informed of that	212
component's medicaid services, including any choices that the	213
individual or representative may make regarding the component's	214
medicaid services, and given the choice of either receiving	215
medicaid services under that component or, as appropriate,	216
hospital services, nursing facility services, or ICF/IID services.	217

(J) No individual shall lose eligibility for services under a	218
component, or have the services reduced or otherwise disrupted, on	219
the basis that the individual also receives services under the	220
medicaid buy-in for workers with disabilities program.	221

(K) No individual shall lose eligibility for services under a	222
component, or have the services reduced or otherwise disrupted, on	223
the basis that the individual's income or resources increase to an	224
amount above the eligibility limit for the component if the	225
individual is participating in the medicaid buy-in for workers	226
with disabilities program and the amount of the individual's	227
income or resources does not exceed the eligibility limit for the	228
medicaid buy-in for workers with disabilities program.	229

(L) No individual receiving services under a component shall	230
be required to pay any cost sharing expenses for the services for	231
any period during which the individual also participates in the	232
medicaid buy-in for workers with disabilities program.	233

Section 2.  That existing sections 5163.01, 5163.06,	234
5163.061, 5163.07, 5166.01, and 5166.04 and sections 5163.09,	235
5163.091, 5163.092, 5163.093, 5163.094, 5163.095, 5163.096,	236
5163.097, 5163.098, 5163.099, and 5163.0910 of the Revised Code	237
are hereby repealed.	238

Section 3. Sections 1 and 2 of this act take effect on the	239
later of the following:	240

(A) January 1, 2014;

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(B) The earliest time permitted by law.

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