Bill Text: OH SB141 | 2009-2010 | 128th General Assembly | Introduced

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Bill Title: To provide that a terminally ill individual with an anticipated life expectancy of five years or less who is on a waiting list for the PACE program or a Medicaid waiver program providing home and community-based services is to have priority over other individuals on such a waiting list.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2009-06-16 - To Health, Human Services, & Aging [SB141 Detail]

Download: Ohio-2009-SB141-Introduced.html

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As Introduced

128th General Assembly Regular Session 2009-2010

S. B. No. 141

Senator Miller, R. 

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A BILL

To amend section 5111.851 and to enact section

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173.501 of the Revised Code to provide that a

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terminally ill individual with an anticipated life

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expectancy of five years or less who is on a

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waiting list for the PACE program or a Medicaid

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waiver program providing home and community-based

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services is to have priority over other

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individuals on such a waiting list.

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

Section 1. That section 5111.851 be amended and section	9
173.501 of the Revised Code be enacted to read as follows:	10

Sec. 173.501.  An individual diagnosed as terminally ill with	11
an anticipated life expectancy of five years or less who is on a	12
waiting list for the PACE program shall have priority for	13
enrollment in the program over other individuals on the waiting	14
list.	15

Sec. 5111.851.  (A) As used in sections 5111.851 to 5111.855	16
of the Revised Code:	17

"Administrative agency" means, with respect to a home and	18
community-based services medicaid waiver component, the department	19
of job and family services or, if a state agency or political	20
subdivision contracts with the department under section 5111.91 of	21
the Revised Code to administer the component, that state agency or	22
political subdivision.	23

"Home and community-based services medicaid waiver component"	24
means a medicaid waiver component under which home and	25
community-based services are provided as an alternative to	26
hospital, nursing facility, or intermediate care facility for the	27
mentally retarded services.	28

"Hospital" has the same meaning as in section 3727.01 of the	29
Revised Code.	30

"Intermediate care facility for the mentally retarded" has	31
the same meaning as in section 5111.20 of the Revised Code.	32

"Level of care determination" means a determination of	33
whether an individual needs the level of care provided by a	34
hospital, nursing facility, or intermediate care facility for the	35
mentally retarded and whether the individual, if determined to	36
need that level of care, would receive hospital, nursing facility,	37
or intermediate care facility for the mentally retarded services	38
if not for a home and community-based services medicaid waiver	39
component.	40

"Medicaid buy-in for workers with disabilities program" means	41
the component of the medicaid program established under sections	42
5111.70 to 5111.7011 of the Revised Code.	43

"Nursing facility" has the same meaning as in section 5111.20	44
of the Revised Code.	45

"Skilled nursing facility" means a facility certified as a	46
skilled nursing facility under Title XVIII of the "Social Security	47
Act," 79 Stat. 286 (1965), 42 U.S.C. 1395, as amended.	48

(B) The following requirements apply to each home and	49
community-based services medicaid waiver component:	50

(1) Only an individual who qualifies for a component shall	51
receive that component's services.	52

(2) A level of care determination shall be made as part of	53
the process of determining whether an individual qualifies for a	54
component and shall be made each year after the initial	55
determination if, during such a subsequent year, the	56
administrative agency determines there is a reasonable indication	57
that the individual's needs have changed.	58

(3) A written plan of care or individual service plan based	59
on an individual assessment of the services that an individual	60
needs to avoid needing admission to a hospital, nursing facility,	61
or intermediate care facility for the mentally retarded shall be	62
created for each individual determined eligible for a component.	63

(4) Each individual determined eligible for a component shall	64
receive that component's services in accordance with the	65
individual's level of care determination and written plan of care	66
or individual service plan.	67

(5) No individual may receive services under a component	68
while the individual is a hospital inpatient or resident of a	69
skilled nursing facility, nursing facility, or intermediate care	70
facility for the mentally retarded.	71

(6) No individual may receive prevocational, educational, or	72
supported employment services under a component if the individual	73
is eligible for such services that are funded with federal funds	74
provided under 29 U.S.C. 730 or the "Individuals with Disabilities	75
Education Act," 111 Stat. 37 (1997), 20 U.S.C. 1400, as amended.	76

(7) Safeguards shall be taken to protect the health and	77
welfare of individuals receiving services under a component,	78
including safeguards established in rules adopted under section	79
5111.85 of the Revised Code and safeguards established by	80
licensing and certification requirements that are applicable to	81
the providers of that component's services.	82

(8) No services may be provided under a component by a	83
provider that is subject to standards that 42 U.S.C. 1382e(e)(1)	84
requires be established if the provider fails to comply with the	85
standards applicable to the provider.	86

(9) Individuals determined to be eligible for a component, or	87
such individuals' representatives, shall be informed of that	88
component's services, including any choices that the individual or	89
representative may make regarding the component's services, and	90
given the choice of either receiving services under that component	91
or, as appropriate, hospital, nursing facility, or intermediate	92
care facility for the mentally retarded services.	93

(10) No individual shall lose eligibility for services under	94
a component, or have the services reduced or otherwise disrupted,	95
on the basis that the individual also receives services under the	96
medicaid buy-in for workers with disabilities program.	97

(11) No individual shall lose eligibility for services under	98
a component, or have the services reduced or otherwise disrupted,	99
on the basis that the individual's income or resources increase to	100
an amount above the eligibility limit for the component if the	101
individual is participating in the medicaid buy-in for workers	102
with disabilities program and the amount of the individual's	103
income or resources does not exceed the eligibility limit for the	104
medicaid buy-in for workers with disabilities program.	105

(12) No individual receiving services under a component shall	106
be required to pay any cost sharing expenses for the services for	107
any period during which the individual also participates in the	108
medicaid buy-in for workers with disabilities program.	109

(13) An individual diagnosed as terminally ill with an	110
anticipated life expectancy of five years or less who is on a	111
waiting list for a home and community-based services medicaid	112
waiver component shall have priority for enrollment in the	113
component over other individuals on the waiting list.	114

Section 2. That existing section 5111.851 of the Revised Code	115
is hereby repealed.	116