Bill Text: OH SB166 | 2013-2014 | 130th General Assembly | Introduced

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Bill Title: To revise the law governing the Medicaid program, to create the Joint Medicaid Oversight Committee, to abolish the Joint Legislative Committee on Health Care Oversight and the Joint Legislative Committee on Medicaid Technology and Reform, and to make appropriations.

Spectrum: Partisan Bill (Democrat 10-0)

Status: (Introduced - Dead) 2013-07-30 - To Finance [SB166 Detail]

Download: Ohio-2013-SB166-Introduced.html

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As Introduced

130th General Assembly Regular Session 2013-2014

S. B. No. 166

Senator Cafaro 

Cosponsors: Senators Schiavoni, Turner, Skindell, Sawyer, Kearney, Smith, Brown, Tavares, Gentile 

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A BILL

To amend sections 5162.01, 5162.20, 5165.15, and

1

5167.01, to enact sections 103.41, 103.411,

2

103.412, 103.413, 5162.70, 5162.71, 5163.04,

3

5164.16, 5164.882, 5164.94, 5167.15, and 6301.15,

4

and to repeal sections 101.39 and 101.391 of the

5

Revised Code to revise the law governing the

6

Medicaid program, to create the Joint Medicaid

7

Oversight Committee, to abolish the Joint

8

Legislative Committee on Health Care Oversight and

9

the Joint Legislative Committee on Medicaid

10

Technology and Reform, and to make appropriations.

11

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

Section 1. That sections 5162.01, 5162.20, 5165.15, and	12
5167.01 be amended and sections 103.41, 103.411, 103.412, 103.413,	13
5162.70, 5162.71, 5163.04, 5164.16, 5164.882, 5164.94, 5167.15,	14
and 6301.15 of the Revised Code be enacted to read as follows:	15

Sec. 103.41.  (A) In this section:

16

"Rule" includes a new rule or the amendment or rescission of	17
an existing rule. If a state agency revises a proposed rule, the	18
revised rule is a "rule" for purposes of this section.	19

"Workforce development activity" has the same meaning as in	20
section 6301.01 of the Revised Code.	21

(B) On the same day that a state agency files a rule under	22
division (D) of section 111.15 or division (H) of section 119.03	23
of the Revised Code, the state agency also shall file a copy of	24
the rule with the joint medicaid oversight committee if the rule	25
concerns either of the following:	26

(1) The administration of, eligibility requirements for,	27
services covered by, service delivery methods of, or other aspects	28
of the medicaid program;	29

(2) A workforce development activity that could reasonably be	30
expected to impact medicaid recipients.	31

(C) The joint medicaid oversight committee, not later than	32
thirty days after it receives the original version of a proposed	33
rule or not later than fifteen days after it receives a revised	34
version of a proposed rule, shall review the rule and determine	35
whether the rule is likely to improve the administration of the	36
medicaid program or the ability of medicaid recipients to achieve	37
greater financial independence. The committee, based on its	38
determination, shall form an opinion whether it views the rule	39
favorably, unfavorably, or neutrally. The committee shall prepare	40
a memorandum that states the committee's opinion and includes a	41
concise explanation of the committee's reasoning that supports its	42
opinion. The committee promptly shall transmit a copy of the rule	43
and the memorandum to the state agency and joint committee on	44
agency rule review.	45

The committee may give notice of and conduct a public hearing	46
in the course of its review of a rule.	47

Sec. 103.411. (A) As used in this section, "medicaid waiver"	48
means the authority, granted by the United States department of	49
health and human services, for the medicaid director to implement,	50
and receive federal financial participation for, a component of	51
the medicaid program for which federal financial participation is	52
not available without the waiver. "Medicaid waiver" includes all	53
of the following:	54

(1) A waiver for the medicaid program issued under section	55
1115, 1115A, or 1915 of the "Social Security Act," 42 U.S.C. 1315,	56
1315a, or 1396n, or any other federal statute;	57

(2) An amendment to a medicaid waiver; (3) An application for	58
renewal, with or without changes, of an existing medicaid waiver.	59

(B) Before the medicaid director submits a request for a	60
medicaid waiver to the United States department of health and	61
human services, the director shall submit a copy of the requested	62
medicaid waiver to the joint medicaid oversight committee. The	63
committee may recommend that the director revise a medicaid waiver	64
request.	65

Sec. 103.412. There is a joint medicaid oversight committee.	66
The committee is comprised of ten members. The president of the	67
senate and the speaker of the house of representatives each shall	68
appoint five members to the committee from their respective	69
houses, three of whom are members of the majority party and two of	70
whom are members of the minority party. Vacancies on the committee	71
shall be filled in the same manner as the original appointment.	72

In odd-numbered years, the president shall designate the	73
chairperson of the committee from among the senate members of the	74
committee. In even-numbered years, the speaker shall designate the	75
chairperson of the committee from among the house members of the	76
committee. In odd-numbered years, the speaker shall designate one	77
of the minority members from the house as ranking minority member.	78
In even-numbered years, the president shall designate one of the	79
minority members from the senate as ranking minority member.	80

In appointing members from the minority, and in designating	81
ranking minority members, the president and speaker shall consult	82
with the minority leader of their respective houses.	83

The committee shall meet at the call of the chairperson, but	84
not less often than once each calendar month.	85

The committee shall employ professional, technical, and	86
clerical employees as are necessary for the committee to be able	87
successfully and efficiently to perform its duties. The employees	88
are in the unclassified service and serve at the pleasure of the	89
committee.	90

The committee may contract for the services of persons who	91
are qualified by education and experience to advise, consult with,	92
or otherwise assist the committee in the performance of its	93
duties.	94

The chairperson of the committee, when authorized by the	95
committee and by the president and speaker, may issue subpoenas	96
and subpoenas duces tecum in aid of the committee's performance of	97
its duties. A subpoena may require a witness in any part of the	98
state to appear before the committee at a time and place	99
designated in the subpoena to testify. A subpoena duces tecum may	100
require witnesses or other persons in any part of the state to	101
produce books, papers, records, and other tangible evidence before	102
the committee at a time and place designated in the subpoena duces	103
tecum. A subpoena or subpoena duces tecum shall be issued, served,	104
and returned, and has consequences, as specified in sections	105
101.41 to 101.45 of the Revised Code.	106

The chairperson of the committee may administer oaths to	107
witnesses appearing before the committee.	108

Sec. 103.413.  The joint medicaid oversight committee shall	109
conduct a continuing study of the medicaid program and workforce	110
development activities related to the medicaid program.	111

The committee may plan, advertise, organize, and conduct	112
forums, conferences, and other meetings at which representatives	113
of state agencies and other individuals having expertise in the	114
medicaid program and workforce development activities may	115
participate to increase knowledge and understanding of, and to	116
develop and propose improvements in, the medicaid program and	117
workforce development activities. The director of job and family	118
services shall submit to the committee relevant statistics on	119
workforce development activities to assist the committee.	120

The committee may prepare and issue reports on its continuing	121
studies. The committee may solicit written comments on, and may	122
conduct public hearings at which persons may offer verbal comments	123
on, drafts of its reports.	124

The committee may recommend improvements in rules affecting	125
the medicaid program and workforce development activities related	126
to the medicaid program, and may recommend legislation for	127
improvement of statutes regarding those issues.	128

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

129

(1) "Medicaid" and "medicaid program" mean the program of	130
medical assistance established by Title XIX of the "Social	131
Security Act," 42 U.S.C. 1396 et seq., including any medical	132
assistance provided under the medicaid state plan or a federal	133
medicaid waiver granted by the United States secretary of health	134
and human services.	135

(2) "Medicare" and "medicare program" mean the federal health	136
insurance program established by Title XVIII of the "Social	137
Security Act," 42 U.S.C. 1395 et seq.	138

(B) As used in this chapter:

139

(1) "CPI inflation rate" means the inflation rate as	140
specified in the consumer price index for all urban consumers as	141
published by the United States bureau of labor statistics.	142

(2) "Dual eligible individual" has the same meaning as in	143
section 5160.01 of the Revised Code.	144

(2)(3) "Federal financial participation" has the same meaning	145
as in section 5160.01 of the Revised Code.	146

(3)(4) "Federal poverty line" means the official poverty line	147
defined by the United States office of management and budget based	148
on the most recent data available from the United States bureau of	149
the census and revised by the United States secretary of health	150
and human services pursuant to the "Omnibus Budget Reconciliation	151
Act of 1981," section 673(2), 42 U.S.C. 9902(2).	152

(4)(5) "Healthy start component" means the component of the	153
medicaid program that covers pregnant women and children and is	154
identified in rules adopted under section 5162.02 of the Revised	155
Code as the healthy start component.	156

(5)(6) "ICF/IID" has the same meaning as in section 5124.01	157
of the Revised Code.	158

(6)(7) "Medicaid managed care organization" has the same	159
meaning as in section 5167.01 of the Revised Code.	160

(7)(8) "Medicaid provider" has the same meaning as in section	161
5164.01 of the Revised Code.	162

(8)(9) "Medicaid services" has the same meaning as in section	163
5164.01 of the Revised Code.	164

(9)(10) "Medicaid transition population" means both of the	165
following:	166

(a) Medicaid recipients whose countable family incomes are	167
within the top twenty-five percentage points of the income	168
eligibility threshold for the eligibility group under which they	169
qualify for medicaid;	170

(b) Medicaid recipients whose countable family incomes are	171
not less than the federal poverty line.	172

(11) "Nursing facility" has the same meaning as in section	173
5165.01 of the Revised Code.	174

(10)(12) "Political subdivision" means a municipal	175
corporation, township, county, school district, or other body	176
corporate and politic responsible for governmental activities only	177
in a geographical area smaller than that of the state.	178

(11)(13) "Prescribed drug" has the same meaning as in section	179
5164.01 of the Revised Code.	180

(12)(14) "Provider agreement" has the same meaning as in	181
section 5164.01 of the Revised Code.	182

(13)(15) "Qualified medicaid school provider" means the board	183
of education of a city, local, or exempted village school	184
district, the governing authority of a community school	185
established under Chapter 3314. of the Revised Code, the state	186
school for the deaf, and the state school for the blind to which	187
both of the following apply:	188

(a) It holds a valid provider agreement.

189

(b) It meets all other conditions for participation in the	190
medicaid school component of the medicaid program established in	191
rules authorized by section 5162.364 of the Revised Code.	192

(14)(16) "State agency" means every organized body, office,	193
or agency, other than the department of medicaid, established by	194
the laws of the state for the exercise of any function of state	195
government.	196

(15)(17) "Vendor offset" means a reduction of a medicaid	197
payment to a medicaid provider to correct a previous, incorrect	198
medicaid payment to that provider.	199

Sec. 5162.20.  (A) The department of medicaid shall institute	200
cost-sharing requirements for the medicaid program in a manner	201
consistent with the "Social Security Act," sections 1916 and	202
1916A, 42 U.S.C. 1396o and 1396o-1. The cost-sharingIn	203
instituting the requirements the department shall include a	204
copayment requirement for at least dental services, vision	205
services, nonemergency emergency department services, and	206
prescribed drugsdo all of the following:	207

(1) Apply the requirements to all medicaid recipients to whom	208
the requirements may be applied;	209

(2) Apply the requirements to all medicaid services to which	210
the requirements may be applied;	211

(3) Establish premiums, deductibles, copayments, coinsurance,	212
and all other types of cost-sharing charges that may be	213
established;	214

(4) Set the amounts of the premiums, deductibles, copayments,	215
coinsurance, and all other types of cost-sharing charges at the	216
maximum amounts permitted. The cost-sharing requirements also	217
shall include requirements regarding premiums, enrollment fees,	218
deductions, and similar charges.	219

(B)(1) No provider shall refuse to provide a service to a	220
medicaid recipient who is unable to pay a required copayment for	221
the service.	222

(2) Division (B)(1) of this section shall not be considered	223
to do either of the following with regard to a medicaid recipient	224
who is unable to pay a required copayment:	225

(a) Relieve the medicaid recipient from the obligation to pay	226
a copayment;	227

(b) Prohibit the provider from attempting to collect an	228
unpaid copayment.	229

(C) Except as provided in division (F) of this section, no	230
provider shall waive a medicaid recipient's obligation to pay the	231
provider a copayment.	232

(D) No provider or drug manufacturer, including the	233
manufacturer's representative, employee, independent contractor,	234
or agent, shall pay any copayment on behalf of a medicaid	235
recipient.	236

(E) If it is the routine business practice of a provider to	237
refuse service to any individual who owes an outstanding debt to	238
the provider, the provider may consider an unpaid copayment	239
imposed by the cost-sharing requirements as an outstanding debt	240
and may refuse service to a medicaid recipient who owes the	241
provider an outstanding debt. If the provider intends to refuse	242
service to a medicaid recipient who owes the provider an	243
outstanding debt, the provider shall notify the recipient of the	244
provider's intent to refuse service.	245

(F) In the case of a provider that is a hospital, the	246
cost-sharing program shall permit the hospital to take action to	247
collect a copayment by providing, at the time services are	248
rendered to a medicaid recipient, notice that a copayment may be	249
owed. If the hospital provides the notice and chooses not to take	250
any further action to pursue collection of the copayment, the	251
prohibition against waiving copayments specified in division (C)	252
of this section does not apply.	253

(G) The department of medicaid may collaborate with a state	254
agency that is administering, pursuant to a contract entered into	255
under section 5162.35 of the Revised Code, one or more components,	256
or one or more aspects of a component, of the medicaid program as	257
necessary for the state agency to apply the cost-sharing	258
requirements to the components or aspects of a component that the	259
state agency administers.	260

Sec. 5162.70. (A) The medicaid director shall implement	261
reforms to the medicaid program that do all of the following:	262

(1) Provide for the growth in the per member per month cost	263
of the medicaid program, as determined on an aggregate basis for	264
all eligibility groups, for the six-month period immediately	265
preceding the first day of each January and the six-month period	266
immediately preceding the first day of each July to be not more	267
than the average annual increase in the CPI inflation rate for	268
medical care for the most recent three-year period for which the	269
necessary data is available as of that first day of January or	270
July;	271

(2) Achieve the limit in the growth of the per member per	272
month cost of the medicaid program required by division (A)(1) of	273
this section in a manner that does all of the following:	274

(a) Improves the physical and mental health of medicaid	275
recipients;	276

(b) Provides for medicaid recipients to receive medicaid	277
services in the most cost-effective and sustainable manner;	278

(c) Removes barriers that impede medicaid recipients' ability	279
to transfer to lower cost, and more appropriate, medicaid	280
services.	281

(3) Reduce the relative number of individuals who need	282
medicaid that is achieved in a manner that utilizes both of the	283
following:	284

(a) Programs that have been demonstrated to be effective and	285
have one or more of the following features:	286

(i) Have low costs;

287

(ii) Utilize volunteers;

288

(iii) Utilize incentives;

289

(iv) Are led by peers.

290

(b) The identification and elimination of medicaid	291
eligibility requirements that are barriers to achieving greater	292
financial independence.	293

(4) Provide medicaid recipients with information about the	294
actual costs of medicaid services and the amounts the medicaid	295
program pays for the services so that recipients are able to use	296
this information when choosing medicaid providers;	297

(5) Reduce the number of times that medicaid recipients are	298
readmitted to hospitals or utilize emergency department services	299
when the readmissions or utilizations are avoidable;	300

(6) Reduce a nursing facility's medicaid payment rate if its	301
residents utilize hospital emergency department services at higher	302
than average rates;	303

(7) Reduce a nursing facility's medicaid payment rate if its	304
residents who are dual eligible individuals have higher than	305
average hospital admission rates;	306

(8) Establish standards for medicaid managed care	307
organizations to promote compliance with primary care requirements	308
applicable to medicaid recipients for whom the organizations	309
provide, or arrange for the provision of, medicaid services;	310

(9) Provide for medicaid managed care organizations to	311
receive, beginning not later than December 31, 2014, medicaid	312
payments based on reductions in medicaid costs that they help	313
achieve;	314

(10) Require managed care organizations, as a condition of	315
becoming medicaid managed care organizations, to do both of the	316
following:	317

(a) Obtain accreditation from the national committee for	318
quality assurance or another accrediting organization the director	319
determines has accreditation standards that are similar to the	320
national committee for quality assurance's accreditation	321
standards;	322

(b) Utilize the healthcare effectiveness data and information	323
set established by the national committee for quality assurance or	324
a similar performance measuring tool that the director determines	325
is similar to the healthcare effectiveness data and information	326
set.	327

(11) Gather data about the medicaid transition population's	328
utilization of workforce development activities administered by	329
the department of job and family services to determine all of the	330
following:	331

(a) The length of time they utilize the activities;

332

(b) When their employment status changes;

333

(c) The events that cause them to cease to be eligible for	334
medicaid.	335

(B) The reforms implemented under this section shall, without	336
making the medicaid program's eligibility requirements more	337
restrictive, reduce the relative number of individuals enrolled in	338
the medicaid program who have the greatest potential to obtain the	339
income and resources that would enable them to cease enrollment in	340
medicaid and instead obtain health care coverage through	341
employer-sponsored health insurance or the health insurance	342
marketplace.	343

(C) Each quarter, the medicaid director shall transmit the	344
data gathered under the reform implemented pursuant to division	345
(A)(11) of this section to the joint medicaid oversight committee.	346
The director also shall submit an annual report to the committee	347
regarding the findings made from the data.	348

Sec. 5162.71.  The medicaid director shall implement within	349
the medicaid program systems that have the goal of reducing both	350
of the following:	351

(A) Health disparities among medicaid recipients who are	352
members of minority populations;	353

(B) The incidence among medicaid recipients of alcoholism,	354
drug addiction, tobacco use, and abuse of other substances the	355
director specifies in rules adopted under section 5162.02 of the	356
Revised Code.	357

Sec. 5163.04.  The medicaid program shall not cover the group	358
described in the "Social Security Act," section	359
1902(a)(10)(A)(i)(VIII), 42 U.S.C. 1396a(a)(10)(A)(i)(VIII),	360
unless the federal medical assistance percentage for expenditures	361
for medicaid services provided to the group is at least the amount	362
specified in the "Social Security Act," section 1905(y), 42 U.S.C.	363
1396d(y), as of March 30, 2010. If the medicaid program covers the	364
group and the federal medical assistance percentage for such	365
expenditures is reduced below the amount so specified, the	366
medicaid program shall cease to cover the group. Notwithstanding	367
section 5160.31 of the Revised Code, an individual's disenrollment	368
from the medicaid program is not subject to appeal under that	369
section when the disenrollment is the result of the medicaid	370
program ceasing to cover the individual's group under this	371
section.	372

Sec. 5164.16. As used in this section, "telemedicine" means	373
the delivery of a medicaid service to a medicaid recipient through	374
the use of an interactive, electronic communication device that	375
enables the medicaid provider to communicate in an audible or	376
visual manner, or both manners, with the medicaid recipient or	377
another medicaid provider of the medicaid recipient from a site	378
other than the site at which the medicaid recipient or other	379
medicaid provider is located.	380

The medicaid program may cover telemedicine to the extent,	381
and in the manner, authorized by rules adopted under section	382
5164.02 of the Revised Code.	383

Sec. 5164.882.  The medicaid director shall implement within	384
the medicaid program a system designed to reduce the rate of	385
chronic conditions among medicaid recipients. The system	386
implemented under this section shall be in addition to the systems	387
required by sections 5164.88 and 5164.881 of the Revised Code. The	388
system shall include features that enable medicaid providers to	389
share with the medicaid program savings achieved by reducing rates	390
of chronic conditions among medicaid recipients.	391

Sec. 5164.94.  The medicaid director shall establish a system	392
within the medicaid program that encourages medicaid providers to	393
provide medicaid services to medicaid recipients in culturally and	394
linguistically appropriate manners.	395

Sec. 5165.15.  (A) Except as otherwise provided by sections	396
5162.70, 5165.151 to 5165.156, and 5165.34 of the Revised Code,	397
the total per medicaid day payment rate that the department of	398
medicaid shall pay a nursing facility provider for nursing	399
facility services the provider's nursing facility provides during	400
a fiscal year shall equal the sum of all of the following:	401

(1) The per medicaid day payment rate for ancillary and	402
support costs determined for the nursing facility under section	403
5165.16 of the Revised Code;	404

(2) The per medicaid day payment rate for capital costs	405
determined for the nursing facility under section 5165.17 of the	406
Revised Code;	407

(3) The per medicaid day payment rate for direct care costs	408
determined for the nursing facility under section 5165.19 of the	409
Revised Code;	410

(4) The per medicaid day payment rate for tax costs	411
determined for the nursing facility under section 5165.21 of the	412
Revised Code;	413

(5) If the nursing facility qualifies as a critical access	414
nursing facility, the nursing facility's critical access incentive	415
payment paid under section 5165.23 of the Revised Code;	416

(6) The quality incentive payment paid to the nursing	417
facility under section 5165.25 of the Revised Code.	418

(B) In addition to paying a nursing facility provider the	419
nursing facility's total rate determined under division (A) of	420
this section for a fiscal year, the department shall pay the	421
provider a quality bonus under section 5165.26 of the Revised Code	422
for that fiscal year if the provider's nursing facility is a	423
qualifying nursing facility, as defined in that section, for that	424
fiscal year. The quality bonus shall not be part of the total	425
rate.	426

Sec. 5167.01.  As used in this chapter:

427

(A) "Controlled substance" has the same meaning as in section	428
3719.01 of the Revised Code.	429

(B) "Dual eligible individual" has the same meaning as in	430
section 5160.01 of the Revised Code.	431

(C) "Emergency services" has the same meaning as in the	432
"Social Security Act," section 1932(b)(2), 42 U.S.C.	433
1396u-2(b)(2).	434

(D) "Home and community-based services medicaid waiver	435
component" has the same meaning as in section 5166.01 of the	436
Revised Code.	437

(E) "Medicaid managed care organization" means a managed care	438
organization under contract with the department of medicaid	439
pursuant to section 5167.10 of the Revised Code.	440

(F) "Medicaid transition population" has the same meaning as	441
in section 5162.01 of the Revised Code.	442

"Medicaid waiver component" has the same meaning as in	443
section 5166.01 of the Revised Code.	444

(G) "Nursing facility" has the same meaning as in section	445
5165.01 of the Revised Code.	446

(H) "Prescribed drug" has the same meaning as in section	447
5164.01 of the Revised Code.	448

(I) "Provider" means any person or government entity that	449
furnishes services to a medicaid recipient enrolled in a medicaid	450
managed care organization, regardless of whether the person or	451
entity has a provider agreement.	452

(J) "Provider agreement" has the same meaning as in section	453
5164.01 of the Revised Code.	454

"Workforce development activity" has the same meaning as in	455
section 6301.01 of the Revised Code.	456

Sec. 5167.15.  (A) Each contract the department of medicaid	457
enters into with a managed care organization under section 5167.10	458
of the Revised Code shall require the managed care organization to	459
provide, or arrange for the provision of, case management services	460
to all medicaid recipients who enroll in the managed care	461
organization and are part of the medicaid transition population.	462
The case management services shall include all of the following:	463

(1) A clinical assessment of the recipient to determine	464
whether the recipient has a medical or other condition to which	465
both of the following apply:	466

(a) The condition may impede the recipient's ability to gain	467
or maintain employment or improve the recipient's employment	468
situation;	469

(b) The condition may be reasonably remediated through	470
medical, mental health, or substance abuse treatment.	471

(2) A care plan for the recipient that includes services	472
designed to address the barriers to self-sufficiency that the	473
recipient has been identified as having;	474

(3) Referrals to employment-related programs that will assist	475
the recipient in gaining access to, and maintaining, optimal	476
employment, including the following programs:	477

(a) On-the-job training programs;

478

(b) Workforce investment activities;

479

(c) Programs that enable individuals seeking employment to	480
find employment opportunities listed on internet web sites;	481

(d) Other programs administered by the department of job and	482
family services or the opportunities for Ohioans with disabilities	483
agency.	484

(4) Referrals from employment-related programs that are	485
administered by the department of job and family services, the	486
opportunities for Ohioans with disabilities agency, or workforce	487
investment boards and provide services designed to treat any	488
medical or other problems the recipient has that hinder the	489
recipient's ability to gain or maintain employment or improve the	490
recipient's employment situation.	491

(B) The department of job and family services shall provide	492
workforce investment boards any technical guidance the boards need	493
for the purpose of the referrals made under division (B)(4) of	494
this section.	495

Sec. 6301.15.  The director of job and family services shall	497
implement reforms to workforce development activities that do both	498
of the following:	499

(A) Reduce the relative number of individuals who need	500
medicaid that is achieved in a manner that utilizes all of the	501
following:	502

(1) Programs that have been demonstrated to be effective and	503
have one or more of the following features:	504

(a) Have low costs;

505

(b) Utilize volunteers;

506

(c) Utilize incentives;

507

(d) Are led by peers.

508

(2) Educational and training opportunities;

509

(3) Employment opportunities;

510

(4) Other initiatives the director considers appropriate.

511

(B) Enhance the relationship between educational facilities,	512
workforce development activities, and employers.	513

Section 2.  That existing sections 5162.01, 5162.20, 5165.15,	514
and 5167.01 of the Revised Code are hereby repealed.	515

Section 3. That sections 101.39 and 101.391 of the Revised	516
Code are repealed.	517

Section 4. The Joint Medicaid Oversight Committee shall	518
prepare a report with recommendations for legislation regarding	519
Medicaid payment rates for Medicaid services. The goal of the	520
recommendations shall be to provide the Medicaid Director	521
statutory authority to implement innovative methodologies for	522
setting Medicaid payment rates that limit the growth in Medicaid	523
costs and protect, and establish guiding principles for, Medicaid	524
providers and recipients. The Medicaid Director shall assist the	525
Committee with the report. The Committee shall submit the report	526
to the General Assembly in accordance with section 101.68 of the	527
Revised Code not later than January 1, 2014.	528

Section 5. (A) As used in this section, "Medicaid transition	529
population" has the same meaning as in section 5162.01 of the	530
Revised Code.	531

(B) The Joint Medicaid Oversight Committee shall prepare a	532
report with recommendations for legislation that would create a	533
comprehensive pilot program under which peer mentors assist	534
Medicaid recipients who are part of the Medicaid transition	535
population, and the families of such recipients, to develop and	536
implement plans for overcoming barriers to both achieving greater	537
financial independence and successfully accessing employment	538
opportunities. The recommendations shall provide for the pilot	539
program to have all of the following features:	540

(1) A mechanism under which local, nonprofit community	541
organizations compete to participate in the pilot program in a	542
manner that is similar to the manner in which entities compete to	543
serve as navigators under a grant program established by an	544
Exchange under the "Patient Protection and Affordable Care Act,"	545
section 1311(i), 42 U.S.C. 18031(i);	546

(2) Requirements for the local, nonprofit community	547
organizations participating in the pilot program to do both of the	548
following:	549

(a) Provide for individuals who are to serve as peer mentors	550
under the pilot program to be trained in a uniform manner across	551
the state on at least both of the following:	552

(i) Workforce development activity eligibility requirements	553
and opportunities;	554

(ii) Methods for peer mentors to work with Medicaid	555
recipients who are part of the Medicaid transition population and	556
the families of such recipients in culturally competent ways.	557

(b) Make the trained peer mentors available to work with	558
Medicaid recipients who are part of the Medicaid transition	559
population and the families of such recipients.	560

(C) The Committee's report shall recommend that the pilot	561
program do all of the following:	562

(1) Begin operation not later than January 1, 2015;

563

(2) Continue operation for not less than six months;

564

(3) Be operated in urban, suburban, and rural counties;

565

(4) Provide for the Medicaid Director to submit to the	566
General Assembly, in accordance with section 101.68 of the Revised	567
Code, recommendations for adjustments that should be made before	568
the pilot program is expanded statewide.	569

(D) The Committee shall submit the report to the General	570
Assembly in accordance with section 101.68 of the Revised Code not	571
later than June 30, 2014.	572

Section 6. (A) The Joint Medicaid Oversight Committee shall	573
prepare a report regarding all of the following:	574

(1) The appropriate roles of the different types of health	575
care professionals in the Medicaid program and different service	576
delivery systems within the Medicaid program;	577

(2) Regulatory models for all health care professionals who	578
must obtain a license, certificate, or other form of approval from	579
the state to practice in this state;	580

(3) Other issues regarding health care professionals that the	581
Committee considers appropriate for the report.	582

(B) The Executive Director of the Governor's Office of Health	583
Transformation, Medicaid Director, Director of Mental Health and	584
Addiction Services, Director of Health, Director of Aging, and	585
Director of Developmental Disabilities shall assist the Committee	586
with the report. The Committee may request that members of the	587
public and interested parties with expertise in the issue of	588
health care professionals also assist the Committee with the	589
report. The Committee shall submit the report to the General	590
Assembly in accordance with section 101.68 of the Revised Code not	591
later than March 1, 2014.	592

Section 7.  All items in this section are hereby appropriated	593
as designated out of any moneys in the state treasury to the	594
credit of the designated fund. For all appropriations made in this	595
act, those in the first column are for fiscal year 2014 and those	596
in the second column are for fiscal year 2015. The appropriations	597
made in this act are in addition to any other appropriations made	598
for the FY 2014-FY 2015 biennium.	599

Appropriations

JMO JOINT MEDICAID OVERSIGHT COMMITTEE	600

General Revenue Fund	601

GRF	048321		Operating Expenses		$	350,000		$	500,000		602
TOTAL GRF General Revenue Fund					$	350,000		$	500,000		603
TOTAL ALL BUDGET FUND GROUPS					$	350,000		$	500,000		604

OPERATING EXPENSES

605

The foregoing appropriation item 048321, Operating Expenses,	606
shall be used to support expenses related to the Joint Medicaid	607
Oversight Committee established in section 103.412 of the Revised	608
Code.	609

Appropriations

MCD DEPARTMENT OF MEDICAID	610

General Revenue Fund	611

GRF	651525		Medicaid/Health Care Services								612
			State		$	0		$	0		613
			Federal		$	499,665,563		$	1,815,000,192		614
			Medicaid/Health Care Services Total		$	499,665,563		$	1,815,000,192		615
TOTAL GRF General Revenue Fund											616
			State		$	0		$	0		617
			Federal		$	499,665,563		$	1,815,000,192		618
			Total		$	499,665,563		$	1,815,000,192		619
TOTAL ALL BUDGET FUND GROUPS					$	499,665,563		$	1,815,000,192		620

MEDICAID/HEALTH CARE SERVICES

621

Of the foregoing appropriation item 651525, Medicaid/Health	622
Care Services, $499,665,563 in fiscal year 2014 and $1,815,000,192	623
in fiscal year 2015 shall be used to cover the eligibility	624
expansion group authorized by the Patient Protection and	625
Affordable Care Act.	626

Section 8. Within the limits set forth in this act, the	627
Director of Budget and Management shall establish accounts	628
indicating the source and amount of funds for each appropriation	629
made in this act, and shall determine the form and manner in which	630
appropriation accounts shall be maintained. Expenditures from	631
appropriations contained in this act shall be accounted for as	632
though made in the main operating appropriations act of the 130th	633
General Assembly.	634

The appropriations made in this act are subject to all	635
provisions of the main operating appropriations act of the 130th	636
General Assembly that are generally applicable to such	637
appropriations.	638