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To amend sections 191.02, 5162.01, 5162.13, 5162.131, | 1 |
5162.132, 5162.20, 5163.01, 5163.06, 5163.09, | 2 |
5163.0910, and 5164.911; to amend, for the purpose | 3 |
of adopting a new section number as indicated in | 4 |
parentheses, section 5163.0910 (5162.133); to | 5 |
enact sections 103.41, 103.411, 103.412, 103.413, | 6 |
103.414, 103.415, 191.08, 355.01, 355.02, 355.03, | 7 |
355.04, 5162.134, 5162.70, 5162.71, and 5164.94; | 8 |
and to repeal sections 101.39, 101.391, and | 9 |
5163.099 of the Revised Code; to amend Section | 10 |
323.90 of Am. Sub. H.B. 59 of the 130th General | 11 |
Assembly; to require implementation of certain | 12 |
Medicaid revisions, reform systems, and program | 13 |
oversight; to provide for government programs that | 14 |
provide public benefits to prioritize employment | 15 |
goals; to permit a board of county commissioners | 16 |
to establish a county Healthier Buckeye council; | 17 |
and to make an appropriation. | 18 |
Section 1. That sections 191.02, 5162.01, 5162.13, 5162.131, | 19 |
5162.132, 5162.20, 5163.01, 5163.06, 5163.09, 5163.0910, and | 20 |
5164.911 be amended; section 5163.0910 (5162.133) be amended for | 21 |
the purpose of adopting a new section number as indicated in | 22 |
parentheses; and sections 103.41, 103.411, 103.412, 103.413, | 23 |
103.414, 103.415, 191.08, 355.01, 355.02, 355.03, 355.04, | 24 |
5162.134, 5162.70, 5162.71, and 5164.94 of the Revised Code be | 25 |
enacted to read as follows: | 26 |
Sec. 103.41. (A) As used in sections 103.41 to 103.415 of | 27 |
the Revised Code: | 28 |
(1) "JMOC" means the joint medicaid oversight committee | 29 |
created under this section. | 30 |
(2) "State and local government medicaid agency" means all of | 31 |
the following: | 32 |
(a) The department of medicaid; | 33 |
(b) The office of health transformation; | 34 |
(c) Each state agency and political subdivision with which | 35 |
the department of medicaid contracts under section 5162.35 of the | 36 |
Revised Code to have the state agency or political subdivision | 37 |
administer one or more components of the medicaid program, or one | 38 |
or more aspects of a component, under the department's | 39 |
supervision; | 40 |
(d) Each agency of a political subdivision that is | 41 |
responsible for administering one or more components of the | 42 |
medicaid program, or one or more aspects of a component, under the | 43 |
supervision of the department or a state agency or political | 44 |
subdivision described in division (A)(2)(c) of this section. | 45 |
(B) There is hereby created the joint medicaid oversight | 46 |
committee. JMOC shall consist of the following members: | 47 |
(1) Five members of the senate appointed by the president of | 48 |
the senate, three of whom are members of the majority party and | 49 |
two of whom are members of the minority party; | 50 |
(2) Five members of the house of representatives appointed by | 51 |
the speaker of the house of representatives, three of whom are | 52 |
members of the majority party and two of whom are members of the | 53 |
minority party. | 54 |
(C) The term of each JMOC member shall begin on the day of | 55 |
appointment to JMOC and end on the last day that the member serves | 56 |
in the house (in the case of a member appointed by the speaker) or | 57 |
senate (in the case of a member appointed by the president) during | 58 |
the general assembly for which the member is appointed to JMOC. | 59 |
The president and speaker shall make the initial appointments not | 60 |
later than fifteen days after the effective date of this section. | 61 |
However, if this section takes effect before January 1, 2014, the | 62 |
president and speaker shall make the initial appointments during | 63 |
the period beginning January 1, 2014, and ending January 15, 2014. | 64 |
The president and speaker shall make subsequent appointments not | 65 |
later than fifteen days after the commencement of the first | 66 |
regular session of each general assembly. JMOC members may be | 67 |
reappointed. A vacancy on JMOC shall be filled in the same manner | 68 |
as the original appointment. | 69 |
(D) In odd-numbered years, the speaker shall designate one of | 70 |
the majority members from the house as the JMOC chairperson and | 71 |
the president shall designate one of the minority members from the | 72 |
senate as the JMOC ranking minority member. In even-numbered | 73 |
years, the president shall designate one of the majority members | 74 |
from the senate as the JMOC chairperson and the speaker shall | 75 |
designate one of the minority members from the house as the JMOC | 76 |
ranking minority member. | 77 |
(E) In appointing members from the minority, and in | 78 |
designating ranking minority members, the president and speaker | 79 |
shall consult with the minority leader of their respective houses. | 80 |
(F) JMOC shall meet at the call of the JMOC chairperson. The | 81 |
chairperson shall call JMOC to meet not less often than once each | 82 |
calendar month, unless the chairperson and ranking minority member | 83 |
agree that the chairperson should not call JMOC to meet for a | 84 |
particular month. | 85 |
(G) JMOC may employ professional, technical, and clerical | 86 |
employees as are necessary for JMOC to be able successfully and | 87 |
efficiently to perform its duties. All such employees are in the | 88 |
unclassified service and serve at JMOC's pleasure. JMOC may | 89 |
contract for the services of persons who are qualified by | 90 |
education and experience to advise, consult with, or otherwise | 91 |
assist JMOC in the performance of its duties. | 92 |
(H) The JMOC chairperson, when authorized by JMOC and the | 93 |
president and speaker, may issue subpoenas and subpoenas duces | 94 |
tecum in aid of JMOC's performance of its duties. A subpoena may | 95 |
require a witness in any part of the state to appear before JMOC | 96 |
at a time and place designated in the subpoena to testify. A | 97 |
subpoena duces tecum may require witnesses or other persons in any | 98 |
part of the state to produce books, papers, records, and other | 99 |
tangible evidence before JMOC at a time and place designated in | 100 |
the subpoena duces tecum. A subpoena or subpoena duces tecum shall | 101 |
be issued, served, and returned, and has consequences, as | 102 |
specified in sections 101.41 to 101.45 of the Revised Code. | 103 |
(I) The JMOC chairperson may administer oaths to witnesses | 104 |
appearing before JMOC. | 105 |
Sec. 103.411. The JMOC chairperson may request that the | 106 |
medicaid director appear before JMOC to provide information and | 107 |
answer questions about the medicaid program. If so requested, the | 108 |
medicaid director shall appear before JMOC at the time and place | 109 |
specified in the request. | 110 |
Sec. 103.412. (A) JMOC shall oversee the medicaid program on | 111 |
a continuing basis. As part of its oversight, JMOC shall do all of | 112 |
the following: | 113 |
(1) Review how the medicaid program relates to the public and | 114 |
private provision of health care coverage in this state and the | 115 |
United States; | 116 |
(2) Review the reforms implemented under section 5162.70 of | 117 |
the Revised Code and evaluate the reforms' successes in achieving | 118 |
their objectives; | 119 |
(3) Recommend policies and strategies to encourage both of | 120 |
the following: | 121 |
(a) Medicaid recipients being physically and mentally able to | 122 |
join and stay in the workforce and ultimately becoming | 123 |
self-sufficient; | 124 |
(b) Less use of the medicaid program. | 125 |
(4) Recommend, to the extent JMOC determines appropriate, | 126 |
improvements in statutes and rules concerning the medicaid | 127 |
program; | 128 |
(5) Develop a plan of action for the future of the medicaid | 129 |
program; | 130 |
(6) Receive and consider reports submitted by county | 131 |
healthier buckeye councils under section 355.04 of the Revised | 132 |
Code. | 133 |
(B) JMOC may do all of the following: | 134 |
(1) Plan, advertise, organize, and conduct forums, | 135 |
conferences, and other meetings at which representatives of state | 136 |
agencies and other individuals having expertise in the medicaid | 137 |
program may participate to increase knowledge and understanding | 138 |
of, and to develop and propose improvements in, the medicaid | 139 |
program; | 140 |
(2) Prepare and issue reports on the medicaid program; | 141 |
(3) Solicit written comments on, and conduct public hearings | 142 |
at which persons may offer verbal comments on, drafts of its | 143 |
reports. | 144 |
Sec. 103.413. (A) JMOC may investigate state and local | 145 |
government medicaid agencies. Subject to division (B) of this | 146 |
section, all of the following apply to an investigation: | 147 |
(1) JMOC, including its employees, may inspect the offices of | 148 |
a state and local government medicaid agency as necessary for the | 149 |
conduct of the investigation. | 150 |
(2) No person shall deny JMOC or a JMOC employee access to | 151 |
such an office when access is needed for such an inspection. | 152 |
(3) Neither JMOC nor a JMOC employee is required to give | 153 |
advance notice of, or to make prior arrangements before, such an | 154 |
inspection. | 155 |
(B) Neither JMOC nor a JMOC employee shall conduct an | 156 |
inspection under this section unless the JMOC chairperson grants | 157 |
prior approval for the inspection. The chairperson shall not grant | 158 |
such approval unless JMOC, the president of the senate, and the | 159 |
speaker of the house of representatives authorize the chairperson | 160 |
to grant the approval. Each inspection shall be conducted during | 161 |
the normal business hours of the office being inspected, unless | 162 |
the chairperson determines that the inspection must be conducted | 163 |
outside of normal business hours. The chairperson may make such a | 164 |
determination only due to an emergency circumstance or other | 165 |
justifiable cause that furthers JMOC's mission. If the chairperson | 166 |
makes such a determination, the chairperson shall specify the | 167 |
reason for the determination in the grant of prior approval for | 168 |
the inspection. | 169 |
Sec. 103.414. Before the beginning of each fiscal biennium, | 170 |
JMOC shall contract with an actuary to determine the projected | 171 |
medical inflation rate for the upcoming fiscal biennium. The | 172 |
contract shall require the actuary to make the determination using | 173 |
the same types of classifications and sub-classifications of | 174 |
medical care that the United States bureau of labor statistics | 175 |
uses in determining the inflation rate for medical care in the | 176 |
consumer price index. The contract also shall require the actuary | 177 |
to provide JMOC a report with its determination at least one | 178 |
hundred twenty days before the governor is required to submit a | 179 |
state budget for the fiscal biennium to the general assembly under | 180 |
section 107.03 of the Revised Code. | 181 |
On receipt of the actuary's report, JMOC shall determine | 182 |
whether it agrees with the actuary's projected medical inflation | 183 |
rate. If JMOC disagrees with the actuary's projected medical | 184 |
inflation rate, JMOC shall determine a different projected medical | 185 |
inflation rate for the upcoming fiscal biennium. | 186 |
The actuary and, if JMOC determines a different projected | 187 |
medical inflation rate, JMOC shall determine the projected medical | 188 |
inflation rate for the state unless that is not practicable in | 189 |
which case the determination shall be made for the midwest region. | 190 |
Regardless of whether it agrees with the actuary's projected | 191 |
medical inflation rate or determines a different projected medical | 192 |
inflation rate, JMOC shall complete a report regarding the | 193 |
projected medical inflation rate. JMOC shall include a copy of the | 194 |
actuary's report in JMOC's report. JMOC's report shall state | 195 |
whether JMOC agrees with the actuary's projected medical inflation | 196 |
rate and, if JMOC disagrees, the reason why JMOC disagrees and the | 197 |
different medical inflation rate JMOC determined. At least ninety | 198 |
days before the governor is required to submit a state budget for | 199 |
the upcoming fiscal biennium to the general assembly under section | 200 |
107.03 of the Revised Code, JMOC shall submit a copy of the report | 201 |
to the general assembly in accordance with section 101.68 of the | 202 |
Revised Code and to the governor and medicaid director. | 203 |
Sec. 103.415. JMOC may review bills and resolutions | 204 |
regarding the medicaid program that are introduced in the general | 205 |
assembly. JMOC may submit a report of its review of a bill or | 206 |
resolution to the general assembly in accordance with section | 207 |
101.68 of the Revised Code. The report may include JMOC's | 208 |
determination regarding the bill's or resolution's desirability as | 209 |
a matter of public policy. | 210 |
JMOC's decision on whether and when to review a bill or | 211 |
resolution has no effect on the general assembly's authority to | 212 |
act on the bill or resolution. | 213 |
Sec. 191.02. The executive director of the office of health | 214 |
transformation, in consultation with all of the following | 215 |
individuals, shall identify each government program administered | 216 |
by a state agency that is to be considered a government program | 217 |
providing public benefits for purposes of | 218 |
and 191.08 of the Revised Code: | 219 |
(A) The director of administrative services; | 220 |
(B) The director of aging; | 221 |
(C) The director of development services; | 222 |
(D) The director of developmental disabilities; | 223 |
(E) The director of health; | 224 |
(F) The director of job and family services; | 225 |
(G) The | 226 |
(H) The director of mental health and addiction services; | 227 |
(I) The director of rehabilitation and correction; | 228 |
(J) The director of veterans services; | 229 |
(K) The director of youth services; | 230 |
(L) The executive director of the opportunities for Ohioans | 231 |
with disabilities agency; | 232 |
(M) The administrator of workers' compensation; | 233 |
(N) The superintendent of insurance; | 234 |
(O) The superintendent of public instruction; | 235 |
(P) The tax commissioner. | 236 |
Sec. 191.08. The executive director of the office of health | 237 |
transformation shall adopt strategies that prioritize employment | 238 |
as a goal for individuals participating in government programs | 239 |
providing public benefits. | 240 |
Sec. 355.01. As used in this chapter: | 241 |
"Care coordination" means assisting an individual to access | 242 |
available physical health, behavioral health, social, employment, | 243 |
education, and housing services the individual needs. | 244 |
"Political subdivision" has the same meaning as in section | 245 |
2744.01 of the Revised Code. | 246 |
"Publicly funded assistance programs" include physical | 247 |
health, behavioral health, social, employment, education, and | 248 |
housing programs funded or provided by the state or a political | 249 |
subdivision of the state. | 250 |
Sec. 355.02. Each board of county commissioners may adopt a | 251 |
resolution to establish a county healthier buckeye council. The | 252 |
board may invite any person or entity to become a member of the | 253 |
council, including a public or private agency or group that funds, | 254 |
advocates, or provides care coordination services, provides or | 255 |
promotes private employment or educational services, or otherwise | 256 |
contributes to the well-being of individuals and families. | 257 |
Sec. 355.03. A county healthier buckeye council may do all of | 258 |
the following: | 259 |
(A) Promote means by which council members or the entities | 260 |
the members represent may reduce the reliance of individuals and | 261 |
families on publicly funded assistance programs using both of the | 262 |
following: | 263 |
(1) Programs that have been demonstrated to be effective and | 264 |
have one or more of the following features: | 265 |
(a) Low costs; | 266 |
(b) Use volunteer workers; | 267 |
(c) Use incentives to encourage designated behaviors; | 268 |
(d) Are led by peers. | 269 |
(2) Practices that identify and seek to eliminate barriers to | 270 |
achieving greater financial independence for individuals and | 271 |
families who receive services from or participate in programs | 272 |
operated by council members or the entities the members represent. | 273 |
(B) Promote care coordination among physical health, | 274 |
behavioral health, social, employment, education, and housing | 275 |
service providers within the county; | 276 |
(C) Collect and analyze data regarding individuals or | 277 |
families who receive services from or participate in programs | 278 |
operated by council members or the entities the members represent. | 279 |
Sec. 355.04. A county healthier buckeye council may report | 280 |
the following information to the joint medicaid oversight | 281 |
committee created in section 103.41 of the Revised Code: | 282 |
(A) Notification that the county council has been established | 283 |
and information regarding the council's activities; | 284 |
(B) Information regarding enrollment or outcome data | 285 |
collected under division (C) of section 355.03 of the Revised | 286 |
Code; | 287 |
(C) Recommendations regarding the best practices for the | 288 |
administration and delivery of publicly funded assistance programs | 289 |
or other services or programs provided by council members or the | 290 |
entities the members represent; | 291 |
(D) Recommendations regarding the best practices in care | 292 |
coordination. | 293 |
Sec. 5162.01. (A) As used in the Revised Code: | 294 |
(1) "Medicaid" and "medicaid program" mean the program of | 295 |
medical assistance established by Title XIX of the "Social | 296 |
Security Act," 42 U.S.C. 1396 et seq., including any medical | 297 |
assistance provided under the medicaid state plan or a federal | 298 |
medicaid waiver granted by the United States secretary of health | 299 |
and human services. | 300 |
(2) "Medicare" and "medicare program" mean the federal health | 301 |
insurance program established by Title XVIII of the "Social | 302 |
Security Act," 42 U.S.C. 1395 et seq. | 303 |
(B) As used in this chapter: | 304 |
(1) "Dual eligible individual" has the same meaning as in | 305 |
section 5160.01 of the Revised Code. | 306 |
(2) "Exchange" has the same meaning as in 45 C.F.R. 155.20. | 307 |
(3) "Federal financial participation" has the same meaning as | 308 |
in section 5160.01 of the Revised Code. | 309 |
| 310 |
defined by the United States office of management and budget based | 311 |
on the most recent data available from the United States bureau of | 312 |
the census and revised by the United States secretary of health | 313 |
and human services pursuant to the "Omnibus Budget Reconciliation | 314 |
Act of 1981," section 673(2), 42 U.S.C. 9902(2). | 315 |
| 316 |
medicaid program that covers pregnant women and children and is | 317 |
identified in rules adopted under section 5162.02 of the Revised | 318 |
Code as the healthy start component. | 319 |
| 320 |
provided under a home and community-based services medicaid waiver | 321 |
component. | 322 |
(7) "Home and community-based services medicaid waiver | 323 |
component" has the same meaning as in section 5166.01 of the | 324 |
Revised Code. | 325 |
(8) "ICF/IID" has the same meaning as in section 5124.01 of | 326 |
the Revised Code. | 327 |
| 328 |
meaning as in section 5167.01 of the Revised Code. | 329 |
| 330 |
section 5164.01 of the Revised Code. | 331 |
| 332 |
section 5164.01 of the Revised Code. | 333 |
| 334 |
services" have the same | 335 |
the Revised Code. | 336 |
| 337 |
corporation, township, county, school district, or other body | 338 |
corporate and politic responsible for governmental activities only | 339 |
in a geographical area smaller than that of the state. | 340 |
| 341 |
5164.01 of the Revised Code. | 342 |
| 343 |
section 5164.01 of the Revised Code. | 344 |
| 345 |
of education of a city, local, or exempted village school | 346 |
district, the governing authority of a community school | 347 |
established under Chapter 3314. of the Revised Code, the state | 348 |
school for the deaf, and the state school for the blind to which | 349 |
both of the following apply: | 350 |
(a) It holds a valid provider agreement. | 351 |
(b) It meets all other conditions for participation in the | 352 |
medicaid school component of the medicaid program established in | 353 |
rules authorized by section 5162.364 of the Revised Code. | 354 |
| 355 |
or agency, other than the department of medicaid, established by | 356 |
the laws of the state for the exercise of any function of state | 357 |
government. | 358 |
| 359 |
payment to a medicaid provider to correct a previous, incorrect | 360 |
medicaid payment to that provider. | 361 |
Sec. 5162.13. On or before the first day of January of each | 362 |
year, the department of medicaid shall | 363 |
364 | |
365 | |
366 | |
program in meeting the health care needs of low-income pregnant | 367 |
women, infants, and children. The report shall include: the | 368 |
estimated number of pregnant women, infants, and children eligible | 369 |
for the program; the actual number of eligible persons enrolled in | 370 |
the program; the number of prenatal, postpartum, and child health | 371 |
visits; a report on birth outcomes, including a comparison of | 372 |
low-birthweight births and infant mortality rates of medicaid | 373 |
recipients with the general female child-bearing and infant | 374 |
population in this state; and a comparison of the prenatal, | 375 |
delivery, and child health costs of the program with such costs of | 376 |
similar programs in other states, where available. The department | 377 |
shall submit the report to the general assembly in accordance with | 378 |
section 101.68 of the Revised Code and to the joint medicaid | 379 |
oversight committee. The department also shall make the report | 380 |
available to the public. | 381 |
Sec. 5162.131. Semiannually, the medicaid director shall | 382 |
383 | |
384 | |
385 | |
386 | |
387 | |
implementation of programs designed to control the increase of the | 388 |
cost of the medicaid program, increase the efficiency of the | 389 |
medicaid program, and promote better health outcomes. The director | 390 |
shall submit the report to the general assembly in accordance with | 391 |
section 101.68 of the Revised Code and to the joint medicaid | 392 |
oversight committee. In each calendar year, one report shall be | 393 |
submitted not later than the last day of June and the subsequent | 394 |
report shall be submitted not later than the last day of December. | 395 |
Sec. 5162.132. Annually, the department of medicaid shall | 396 |
prepare a report on the department's efforts to minimize fraud, | 397 |
waste, and abuse in the medicaid program. | 398 |
Each report shall be made available on the department's web | 399 |
site. The department shall submit a copy of each report to the | 400 |
governor, general assembly, and | 401 |
committee. The copy to the general assembly shall be submitted in | 402 |
accordance with section 101.68 of the Revised Code | 403 |
404 | |
public on request. | 405 |
| 406 |
medicaid director shall submit a report on the medicaid buy-in for | 407 |
workers with disabilities program to the governor, | 408 |
409 | |
410 | |
411 | |
412 | |
The copy to the general assembly shall be submitted in accordance | 413 |
with section 101.68 of the Revised Code. The report shall include | 414 |
all of the following information: | 415 |
(A) The number of individuals who participated in the | 416 |
medicaid buy-in for workers with disabilities program; | 417 |
(B) The cost of the program; | 418 |
(C) The amount of revenue generated by premiums that | 419 |
participants pay under section 5163.094 of the Revised Code; | 420 |
(D) The average amount of earned income of participants' | 421 |
families; | 422 |
(E) The average amount of time participants have participated | 423 |
in the program; | 424 |
(F) The types of other health insurance participants have | 425 |
been able to obtain. | 426 |
Sec. 5162.134. Not later than the first day of each July, | 427 |
the medicaid director shall complete a report of the evaluation | 428 |
conducted under section 5164.911 of the Revised Code regarding the | 429 |
integrated care delivery system. The director shall provide a copy | 430 |
of the report to the general assembly and joint medicaid oversight | 431 |
committee. The copy to the general assembly shall be provided in | 432 |
accordance with section 101.68 of the Revised Code. The director | 433 |
also shall make the report available to the public. | 434 |
Sec. 5162.20. (A) The department of medicaid shall institute | 435 |
cost-sharing requirements for the medicaid program. | 436 |
437 | |
438 | |
439 | |
440 | |
441 | |
442 | |
requirements in a manner that disproportionately impacts the | 443 |
ability of medicaid recipients with chronic illnesses to obtain | 444 |
medically necessary medicaid services. | 445 |
(B)(1) No provider shall refuse to provide a service to a | 446 |
medicaid recipient who is unable to pay a required copayment for | 447 |
the service. | 448 |
(2) Division (B)(1) of this section shall not be considered | 449 |
to do either of the following with regard to a medicaid recipient | 450 |
who is unable to pay a required copayment: | 451 |
(a) Relieve the medicaid recipient from the obligation to pay | 452 |
a copayment; | 453 |
(b) Prohibit the provider from attempting to collect an | 454 |
unpaid copayment. | 455 |
(C) Except as provided in division (F) of this section, no | 456 |
provider shall waive a medicaid recipient's obligation to pay the | 457 |
provider a copayment. | 458 |
(D) No provider or drug manufacturer, including the | 459 |
manufacturer's representative, employee, independent contractor, | 460 |
or agent, shall pay any copayment on behalf of a medicaid | 461 |
recipient. | 462 |
(E) If it is the routine business practice of a provider to | 463 |
refuse service to any individual who owes an outstanding debt to | 464 |
the provider, the provider may consider an unpaid copayment | 465 |
imposed by the cost-sharing requirements as an outstanding debt | 466 |
and may refuse service to a medicaid recipient who owes the | 467 |
provider an outstanding debt. If the provider intends to refuse | 468 |
service to a medicaid recipient who owes the provider an | 469 |
outstanding debt, the provider shall notify the recipient of the | 470 |
provider's intent to refuse service. | 471 |
(F) In the case of a provider that is a hospital, the | 472 |
cost-sharing program shall permit the hospital to take action to | 473 |
collect a copayment by providing, at the time services are | 474 |
rendered to a medicaid recipient, notice that a copayment may be | 475 |
owed. If the hospital provides the notice and chooses not to take | 476 |
any further action to pursue collection of the copayment, the | 477 |
prohibition against waiving copayments specified in division (C) | 478 |
of this section does not apply. | 479 |
(G) The department of medicaid may collaborate with a state | 480 |
agency that is administering, pursuant to a contract entered into | 481 |
under section 5162.35 of the Revised Code, one or more components, | 482 |
or one or more aspects of a component, of the medicaid program as | 483 |
necessary for the state agency to apply the cost-sharing | 484 |
requirements to the components or aspects of a component that the | 485 |
state agency administers. | 486 |
Sec. 5162.70. (A) As used in this section: | 487 |
(1) "CPI" means the consumer price index for all urban | 488 |
consumers as published by the United States bureau of labor | 489 |
statistics. | 490 |
(2) "CPI medical inflation rate" means the inflation rate for | 491 |
medical care, or the successor term for medical care, for the | 492 |
midwest region as specified in the CPI. | 493 |
(3) "JMOC projected medical inflation rate" means the | 494 |
following: | 495 |
(a) The projected medical inflation rate for a fiscal | 496 |
biennium determined by the actuary with which the joint medicaid | 497 |
oversight committee contracts under section 103.414 of the Revised | 498 |
Code if the committee agrees with the actuary's projected medical | 499 |
inflation rate for that fiscal biennium; | 500 |
(b) The different projected medical inflation rate for a | 501 |
fiscal biennium determined by the joint medicaid oversight | 502 |
committee under section 103.414 of the Revised Code if the | 503 |
committee disagrees with the projected medical inflation rate | 504 |
determined for that fiscal biennium by the actuary with which the | 505 |
committee contracts under that section. | 506 |
(4) "Successor term" means a term that the United States | 507 |
bureau of labor statistics uses in place of another term in | 508 |
revisions to the CPI. | 509 |
(B) The medicaid director shall implement reforms to the | 510 |
medicaid program that do all of the following: | 511 |
(1) Limit the growth in the per recipient per month cost of | 512 |
the medicaid program, as determined on an aggregate basis for all | 513 |
eligibility groups, for a fiscal biennium to not more than the | 514 |
lesser of the following: | 515 |
(a) The average annual increase in the CPI medical inflation | 516 |
rate for the most recent three-year period for which the necessary | 517 |
data is available as of the first day of the fiscal biennium, | 518 |
weighted by the most recent year of the three years; | 519 |
(b) The JMOC projected medical inflation rate for the fiscal | 520 |
biennium. | 521 |
(2) Achieve the limit in the growth of the per recipient per | 522 |
month cost of the medicaid program under division (B)(1) of this | 523 |
section by doing all of the following: | 524 |
(a) Improving the physical and mental health of medicaid | 525 |
recipients; | 526 |
(b) Providing for medicaid recipients to receive medicaid | 527 |
services in the most cost-effective and sustainable manner; | 528 |
(c) Removing barriers that impede medicaid recipients' | 529 |
ability to transfer to lower cost, and more appropriate, medicaid | 530 |
services, including home and community-based services; | 531 |
(d) Establishing medicaid payment rates that encourage value | 532 |
over volume and result in medicaid services being provided in the | 533 |
most efficient and effective manner possible; | 534 |
(e) Implementing fraud and abuse prevention and cost | 535 |
avoidance mechanisms to the fullest extent possible; | 536 |
(f) Integrating in the care management system established | 537 |
under section 5167.03 of the Revised Code the delivery of physical | 538 |
health, behavioral health, nursing facility, and home and | 539 |
community-based services covered by medicaid. | 540 |
(3) Reduce the prevalence of comorbid health conditions | 541 |
among, and the mortality rates of, medicaid recipients; | 542 |
(4) Reduce infant mortality rates among medicaid recipients. | 543 |
(C) The medicaid director shall implement the reforms under | 544 |
this section in accordance with evidence-based strategies that | 545 |
include measurable goals. | 546 |
(D) The reforms implemented under this section shall, without | 547 |
making the medicaid program's eligibility requirements more | 548 |
restrictive, reduce the relative number of individuals enrolled in | 549 |
the medicaid program who have the greatest potential to obtain the | 550 |
income and resources that would enable them to cease enrollment in | 551 |
medicaid and instead obtain health care coverage through | 552 |
employer-sponsored health insurance or an exchange. | 553 |
Sec. 5162.71. The medicaid director shall implement within | 554 |
the medicaid program systems that do both of the following: | 555 |
(A) Improve the health of medicaid recipients through the use | 556 |
of population health measures; | 557 |
(B) Reduce health disparities, including, but not limited to, | 558 |
those within racial and ethnic populations. | 559 |
Sec. 5163.01. As used in this chapter: | 560 |
"Caretaker relative" has the same meaning as in 42 C.F.R. | 561 |
435.4 as that regulation is amended effective January 1, 2014. | 562 |
"Children's hospital" has the same meaning as in section | 563 |
2151.86 of the Revised Code. | 564 |
"Federal financial participation" has the same meaning as in | 565 |
section 5160.01 of the Revised Code. | 566 |
"Federally qualified health center" has the same meaning as | 567 |
in the "Social Security Act," section 1905(l)(2)(B), 42 U.S.C. | 568 |
1396d(l)(2)(B). | 569 |
"Federally qualified health center look-alike" has the same | 570 |
meaning as in section 3701.047 of the Revised Code. | 571 |
"Federal poverty line" has the same meaning as in section | 572 |
5162.01 of the Revised Code. | 573 |
"Healthy start component" has the same meaning as in section | 574 |
5162.01 of the Revised Code. | 575 |
"Home and community-based services medicaid waiver component" | 576 |
has the same meaning as in section 5166.01 of the Revised Code. | 577 |
"Intermediate care facility for individuals with intellectual | 578 |
disabilities" and "ICF/IID" have the same meanings as in section | 579 |
5124.01 of the Revised Code. | 580 |
"Mandatory eligibility groups" means the groups of | 581 |
individuals that must be covered by the medicaid state plan as a | 582 |
condition of the state receiving federal financial participation | 583 |
for the medicaid program. | 584 |
"Medicaid buy-in for workers with disabilities program" means | 585 |
the component of the medicaid program established under sections | 586 |
5163.09 to | 587 |
"Medicaid services" has the same meaning as in section | 588 |
5164.01 of the Revised Code. | 589 |
"Medicaid waiver component" has the same meaning as in | 590 |
section 5166.01 of the Revised Code. | 591 |
"Nursing facility" and "nursing facility services" have the | 592 |
same meanings as in section 5165.01 of the Revised Code. | 593 |
"Optional eligibility groups" means the groups of individuals | 594 |
who may be covered by the medicaid state plan or a federal | 595 |
medicaid waiver and for whom the medicaid program receives federal | 596 |
financial participation. | 597 |
"Other medicaid-funded long-term care services" has the | 598 |
meaning specified in rules adopted under section 5163.02 of the | 599 |
Revised Code. | 600 |
"Supplemental security income program" means the program | 601 |
established by Title XVI of the "Social Security Act," 42 U.S.C. | 602 |
1381 et seq. | 603 |
Sec. 5163.06. The medicaid program shall cover all of the | 604 |
following optional eligibility groups: | 605 |
(A) The group consisting of children placed with adoptive | 606 |
parents who are specified in the "Social Security Act," section | 607 |
1902(a)(10)(A)(ii)(VIII), 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII); | 608 |
(B) Subject to section 5163.061 of the Revised Code, the | 609 |
group consisting of women during pregnancy and the sixty-day | 610 |
period beginning on the last day of the pregnancy, infants, and | 611 |
children who are specified in the "Social Security Act," section | 612 |
1902(a)(10)(A)(ii)(IX), 42 U.S.C. 1396a(a)(10)(A)(ii)(IX); | 613 |
(C) Subject to sections 5163.09 to | 614 |
Revised Code, the group consisting of employed individuals with | 615 |
disabilities who are specified in the "Social Security Act," | 616 |
section 1902(a)(10)(A)(ii)(XV), 42 U.S.C. 1396a(a)(10)(A)(ii)(XV); | 617 |
(D) Subject to sections 5163.09 to | 618 |
Revised Code, the group consisting of employed individuals with | 619 |
medically improved disabilities who are specified in the "Social | 620 |
Security Act," section 1902(a)(10)(A)(ii)(XVI), 42 U.S.C. | 621 |
1396a(a)(10)(A)(ii)(XVI); | 622 |
(E) The group consisting of independent foster care | 623 |
adolescents who are specified in the "Social Security Act," | 624 |
section 1902(a)(10)(A)(ii)(XVII), 42 U.S.C. | 625 |
1396a(a)(10)(A)(ii)(XVII); | 626 |
(F) The group consisting of women in need of treatment for | 627 |
breast or cervical cancer who are specified in the "Social | 628 |
Security Act," section 1902(a)(10)(A)(ii)(XVIII), 42 U.S.C. | 629 |
1396a(a)(10)(A)(ii)(XVIII); | 630 |
(G) The group consisting of nonpregnant individuals who may | 631 |
receive family planning services and supplies and are specified in | 632 |
the "Social Security Act," section 1902(a)(10)(A)(ii)(XXI), 42 | 633 |
U.S.C. 1396a(a)(10)(A)(ii)(XXI). | 634 |
Sec. 5163.09. (A) As used in sections 5163.09 to | 635 |
5163.098 of the Revised Code: | 636 |
"Applicant" means an individual who applies to participate in | 637 |
the medicaid buy-in for workers with disabilities program. | 638 |
"Earned income" has the meaning established by rules | 639 |
authorized by section 5163.098 of the Revised Code. | 640 |
"Employed individual with a medically improved disability" | 641 |
has the same meaning as in the "Social Security Act," section | 642 |
1905(v), 42 U.S.C. 1396d(v). | 643 |
"Family" means an applicant or participant and the spouse and | 644 |
dependent children of the applicant or participant. If an | 645 |
applicant or participant is under eighteen years of age, "family" | 646 |
also means the parents of the applicant or participant. | 647 |
"Health insurance" has the meaning established by rules | 648 |
authorized by section 5163.098 of the Revised Code. | 649 |
"Income" means earned income and unearned income. | 650 |
"Participant" means an individual who has been determined | 651 |
eligible for the medicaid buy-in for workers with disabilities | 652 |
program and is participating in the program. | 653 |
"Resources" has the meaning established by rules authorized | 654 |
by section 5163.098 of the Revised Code. | 655 |
"Spouse" has the meaning established | 656 |
by section 5163.098 of the Revised Code. | 657 |
"Unearned income" has the meaning established by rules | 658 |
authorized by section 5163.098 of the Revised Code. | 659 |
(B) The medicaid program's coverage of the optional | 660 |
eligibility groups specified in the "Social Security Act," section | 661 |
1902(a)(10)(A)(ii)(XV) and (XVI), 42 U.S.C. | 662 |
1396a(a)(10)(A)(ii)(XV) and (XVI) shall be known as the medicaid | 663 |
buy-in for workers with disabilities program. | 664 |
Sec. 5164.911. (A) If the medicaid director implements the | 665 |
integrated care delivery system and except as provided in division | 666 |
667 | |
of the following: | 668 |
(1) The health outcomes of ICDS participants; | 669 |
(2) How changes to the administration of the ICDS affect all | 670 |
of the following: | 671 |
(a) Claims processing; | 672 |
(b) The appeals process; | 673 |
(c) The number of reassessments requested; | 674 |
(d) Prior authorization requests for services. | 675 |
(3) The provider panel selection process used by medicaid | 676 |
managed care organizations participating in the ICDS. | 677 |
(B) When conducting an evaluation under division (A) of this | 678 |
section, the director shall do all of the following: | 679 |
(1) For the purpose of division (A)(1) of this section, do | 680 |
both of the following: | 681 |
(a) Compare the health outcomes of ICDS participants to the | 682 |
health outcomes of individuals who are not ICDS participants; | 683 |
(b) Use both of the following: | 684 |
(i) A control group consisting of ICDS participants who | 685 |
receive health care services from providers not participating in | 686 |
ICDS; | 687 |
(ii) A control group consisting of ICDS participants who | 688 |
receive health care services from alternative providers that are | 689 |
not part of a participating medicaid managed care organization's | 690 |
provider panel but provide health care services in the geographic | 691 |
service area in which ICDS participants receive health care | 692 |
services. | 693 |
(2) For the purpose of division (A)(2) of this section, do | 694 |
all of the following: | 695 |
(a) To the extent the data is available, use data from all of | 696 |
the following: | 697 |
(i) The fee-for-service component of the medicaid program; | 698 |
(ii) Medicaid managed care organizations; | 699 |
(iii) Managed care organizations participating in the | 700 |
medicare advantage program established under Part C of Title XVIII | 701 |
of the "Social Security Act," 42 U.S.C. 1395w-21 et seq. | 702 |
(b) Identify all of the following: | 703 |
(i) Changes in the amount of time it takes to process claims | 704 |
and the number of claims denied and the reasons for the changes; | 705 |
(ii) The impact that changes to the administration of the | 706 |
ICDS had on the appeals process and number of reassessments | 707 |
requested; | 708 |
(iii) The number of prior authorization denials that were | 709 |
overturned and the reasons for the overturned denials. | 710 |
(3) Require medicaid managed care organizations participating | 711 |
in the ICDS to submit to the director any data the director needs | 712 |
for the evaluation. | 713 |
(C) | 714 |
715 | |
716 | |
717 | |
718 |
| 719 |
under this section for a year if the same evaluation is conducted | 720 |
for that year by an organization under contract with the United | 721 |
States department of health and human services. | 722 |
Sec. 5164.94. The medicaid director shall implement within | 723 |
the medicaid program a system that encourages medicaid providers | 724 |
to provide medicaid services to medicaid recipients in culturally | 725 |
and linguistically appropriate manners. | 726 |
Section 2. That existing sections 191.02, 5162.01, 5162.13, | 727 |
5162.131, 5162.132, 5162.20, 5163.01, 5163.06, 5163.09, 5163.0910, | 728 |
and 5164.911 of the Revised Code are hereby repealed. | 729 |
Section 3. That sections 101.39, 101.391, and 5163.099 of the | 730 |
Revised Code are hereby repealed. | 731 |
Section 4. That Section 323.90 of Am. Sub. H.B. 59 of the | 732 |
130th General Assembly be amended to read as follows: | 733 |
Sec. 323.90. JOINT | 734 |
735 |
(A) | 736 |
737 | |
738 | |
739 | |
740 |
| 741 |
742 | |
743 |
| 744 |
745 | |
746 |
| 747 |
748 |
| 749 |
750 |
| 751 |
752 | |
753 | |
754 | |
755 | |
756 | |
757 | |
758 | |
759 |
| 760 |
following issues: | 761 |
(1) The implementation of the dual eligible integrated care | 762 |
demonstration project authorized by section 5164.91 of the Revised | 763 |
Code; | 764 |
(2) The implementation of a unified long-term services and | 765 |
support Medicaid waiver component under section 5166.14 of the | 766 |
Revised Code; | 767 |
(3) Providing consumers choices regarding a continuum of | 768 |
services that meet their health-care needs, promote autonomy and | 769 |
independence, and improve quality of life; | 770 |
(4) Ensuring that long-term care services and supports are | 771 |
delivered in a cost-effective and quality manner; | 772 |
(5) Subjecting county homes, county nursing homes, and | 773 |
district homes operated pursuant to Chapter 5155. of the Revised | 774 |
Code to the franchise permit fee under sections 5168.40 to 5168.56 | 775 |
of the Revised Code; | 776 |
(6) Other issues of interest to the committee. | 777 |
| 778 |
provide for the Medicaid Director to testify before the Committee | 779 |
at least quarterly regarding the issues that the Committee | 780 |
examines. | 781 |
Section 5. That existing Section 323.90 of Am. Sub. H.B. 59 | 782 |
of the 130th General Assembly is hereby repealed. | 783 |
Section 6. The Joint Medicaid Oversight Committee shall | 784 |
prepare a report with recommendations for legislation regarding | 785 |
Medicaid payment rates for Medicaid services. The goal of the | 786 |
recommendations shall be to provide the Medicaid Director | 787 |
statutory authority to implement innovative methodologies for | 788 |
setting Medicaid payment rates that limit the growth in Medicaid | 789 |
costs and protect, and establish guiding principles for, Medicaid | 790 |
providers and recipients. The Medicaid Director shall assist the | 791 |
Committee with the report. The Committee shall submit the report | 792 |
to the General Assembly in accordance with section 101.68 of the | 793 |
Revised Code not later than January 1, 2015. | 794 |
Section 7. The General Assembly encourages the Department of | 795 |
Medicaid to achieve greater cost savings for the Medicaid program | 796 |
than required by section 5162.70 of the Revised Code. It is the | 797 |
intent of the General Assembly that any amounts saved under that | 798 |
section not be expended for any other purpose. | 799 |
Section 8. Nothing in this act shall be construed as the | 800 |
General Assembly endorsing, validating, or otherwise approving the | 801 |
Medicaid program's coverage of the group described in the "Social | 802 |
Security Act," section 1902(a)(10)(A)(i)(VIII), 42 U.S.C. | 803 |
1396a(a)(10)(A)(i)(VIII). | 804 |
Section 9. All items in this section are hereby appropriated | 805 |
as designated out of any moneys in the state treasury to the | 806 |
credit of the designated fund. For all appropriations made in this | 807 |
act, those in the first column are for fiscal year 2014 and those | 808 |
in the second column are for fiscal year 2015. The appropriations | 809 |
made in this act are in addition to any other appropriations made | 810 |
for the FY 2014-FY 2015 biennium. | 811 |
Appropriations |
812 | |
General Revenue Fund | 813 |
GRF | 048321 | Operating Expenses | $ | 350,000 | $ | 500,000 | 814 | ||||
TOTAL GRF General Revenue Fund | $ | 350,000 | $ | 500,000 | 815 | ||||||
TOTAL ALL BUDGET FUND GROUPS | $ | 350,000 | $ | 500,000 | 816 |
OPERATING EXPENSES | 817 |
The foregoing appropriation item 048321, Operating Expenses, | 818 |
shall be used to support expenses related to the Joint Medicaid | 819 |
Oversight Committee created by section 103.41 of the Revised Code. | 820 |
Section 10. Within the limits set forth in this act, the | 821 |
Director of Budget and Management shall establish accounts | 822 |
indicating the source and amount of funds for each appropriation | 823 |
made in this act, and shall determine the form and manner in which | 824 |
appropriation accounts shall be maintained. Expenditures from | 825 |
appropriations contained in this act shall be accounted for as | 826 |
though made in the main operating appropriations act of the 130th | 827 |
General Assembly. | 828 |
The appropriations made in this act are subject to all | 829 |
provisions of the main operating appropriations act of the 130th | 830 |
General Assembly that are generally applicable to such | 831 |
appropriations. | 832 |