130th Ohio General Assembly
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S. B. No. 103  As Introduced
As Introduced

126th General Assembly
Regular Session
2005-2006
S. B. No. 103


Senators Hagan, Dann, Fedor 



A BILL
To amend sections 5111.013 and 5112.17 and to enact sections 5101.56 and 5101.561 of the Revised Code to require applicants for CHIP, Disability Medical Assistance, and Medicaid to provide information about their employers, to require hospitals to gather employer information from patients who receive treatment under the Hospital Care Assurance Program, and to require an annual report identifying the employers.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1.  That sections 5111.013 and 5112.17 be amended and sections 5101.56 and 5101.561 of the Revised Code be enacted to read as follows:
Sec. 5101.56. (A) As used in this section and section 5101.561 of the Revised Code:
(1) "CHIP" means the children's health insurance program parts I and II provided for by sections 5101.50 to 5101.5110 of the Revised Code.
(2) "Disability medical assistance" means the program established under section 5115.10 of the Revised Code.
(3) "Employer" has the same meaning as in section 3911.091 of the Revised Code.
(4) "Medicaid" means the program provided for under Title XIX of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1396, as amended.
(B) Application forms for the CHIP, disability medical assistance, and medicaid programs shall provide for the applicant to specify the name and address of each of the applicant's employers and the name and address of each of the employers of all individuals whose income is counted in determining the applicant's eligibility for CHIP, disability medical assistance, or medicaid.
Sec. 5101.561.  (A) Not later than the first day of each February, the director of job and family services shall complete a report that provides all of the following:
(1) The name and address of each employer that employed twenty-five or more employees who were any of the following while employed by the employer in this state during the previous calendar year:
(a) A recipient of CHIP, disability medical assistance, or medicaid;
(b) An individual whose income was counted in determining eligibility for CHIP, disability medical assistance, or medicaid;
(c) An individual who received hospital-level services provided without charge to the individual under section 5112.17 of the Revised Code.
(2) The total number of individuals specified in division (A)(1) of this section who were employed in the previous calendar year by the employers named in the report, broken down by employer;
(3) The total cost to the state for the previous calendar year of providing benefits under CHIP, disability medical assistance, and medicaid to employees of the employers named in the report, broken down by employer;
(4) The total cost to hospitals for the previous calendar year of providing hospital-level services without charge under section 5112.17 of the Revised Code to the employees of the employers named in the report, broken down by employer.
(B) The report shall not include any identifying information about any of the employees specified in division (A)(1) of this section.
The director shall provide a copy of the report to each member of the general assembly.
The report is a public record under section 149.43 of the Revised Code.
Sec. 5111.013.  (A) The provision of medical assistance to pregnant women and young children who are eligible for medical assistance under division (A)(3) of section 5111.01 of the Revised Code, but who are not otherwise eligible for medical assistance under that section, shall be known as the healthy start program.
(B) The department of job and family services shall do all of the following with regard to the application procedures for the healthy start program:
(1) Establish a short application form for the program that requires the applicant to provide no more information than is necessary for making determinations of eligibility for the healthy start program, except that the form may require applicants to provide their social security numbers and shall comply with section 5101.56 of the Revised Code. The form shall include a statement, which must be signed by the applicant, indicating that she does not choose at the time of making application for the program to apply for assistance provided under any other program administered by the department and that she understands that she is permitted at any other time to apply at the county department of job and family services of the county in which she resides for any other assistance administered by the department.
(2) To the extent permitted by federal law, do one or both of the following:
(a) Distribute the application form for the program to each public or private entity that serves as a women, infants, and children clinic or as a child and family health clinic and to each administrative body for such clinics and train employees of each such agency or entity to provide applicants assistance in completing the form;
(b) In cooperation with the department of health, develop arrangements under which employees of county departments of job and family services are stationed at public or private agencies or entities selected by the department of job and family services that serve as women, infants, and children clinics; child and family health clinics; or administrative bodies for such clinics for the purpose both of assisting applicants for the program in completing the application form and of making determinations at that location of eligibility for the program.
(3) Establish performance standards by which a county department of job and family services' level of enrollment of persons potentially eligible for the program can be measured, and establish acceptable levels of enrollment for each county department.
(4) Direct any county department of job and family services whose rate of enrollment of potentially eligible enrollees in the program is below acceptable levels established under division (B)(3) of this section to implement corrective action. Corrective action may include but is not limited to any one or more of the following to the extent permitted by federal law:
(a) Establishing formal referral and outreach methods with local health departments and local entities receiving funding through the bureau of maternal and child health;
(b) Designating a specialized intake unit within the county department for healthy start applicants;
(c) Establishing abbreviated timeliness requirements to shorten the time between receipt of an application and the scheduling of an initial application interview;
(d) Establishing a system for telephone scheduling of intake interviews for applicants;
(e) Establishing procedures to minimize the time an applicant must spend in completing the application and eligibility determination process, including permitting applicants to complete the process at times other than the regular business hours of the county department and at locations other than the offices of the county department.
(C) To the extent permitted by federal law, local funds, whether from public or private sources, expended by a county department for administration of the healthy start program shall be considered to have been expended by the state for the purpose of determining the extent to which the state has complied with any federal requirement that the state provide funds to match federal funds for medical assistance, except that this division shall not affect the amount of funds the county is entitled to receive under section 5101.16, 5101.161, or 5111.012 of the Revised Code.
(D) The director of job and family services shall do one or both of the following:
(1) To the extent that federal funds are provided for such assistance, adopt a plan for granting presumptive eligibility for pregnant women applying for healthy start;
(2) To the extent permitted by federal medicaid regulations, adopt a plan for making same-day determinations of eligibility for pregnant women applying for healthy start.
(E) A county department of job and family services that maintains offices at more than one location shall accept applications for the healthy start program at all of those locations.
(F) The director of job and family services shall adopt rules in accordance with section 111.15 of the Revised Code as necessary to implement this section.
Sec. 5112.17.  (A) As used in this section:
(1) "Federal poverty guideline" means the official poverty guideline as revised annually by the United States secretary of health and human services in accordance with section 673 of the "Community Service Block Grant Act," 95 Stat. 511 (1981), 42 U.S.C.A. 9902, as amended, for a family size equal to the size of the family of the person whose income is being determined.
(2) "Third-party payer" means any private or public entity or program that may be liable by law or contract to make payment to or on behalf of an individual for health care services. "Third-party payer" does not include a hospital.
(B) Each hospital that receives funds distributed under sections 5112.01 to 5112.21 of the Revised Code shall provide, without charge to the individual, basic, medically necessary hospital-level services to individuals who are residents of this state, are not recipients of the medical assistance program, and whose income is at or below the federal poverty guideline. Recipients of disability financial assistance and recipients of disability medical assistance provided under Chapter 5115. of the Revised Code qualify for services under this section. The director of job and family services shall adopt rules under section 5112.03 of the Revised Code specifying the hospital services to be provided under this section.
(C) Nothing in this section shall be construed to prevent a hospital from requiring an individual to apply for eligibility under the medical assistance program before the hospital processes an application under this section. Hospitals may bill any third-party payer for services rendered under this section. Hospitals may bill the medical assistance program, in accordance with Chapter 5111. of the Revised Code and the rules adopted under that chapter, for services rendered under this section if the individual becomes a recipient of the program. Hospitals may bill individuals for services under this section if all of the following apply:
(1) The hospital has an established post-billing procedure for determining the individual's income and canceling the charges if the individual is found to qualify for services under this section.
(2) The initial bill, and at least the first follow-up bill, is accompanied by a written statement that does all of the following:
(a) Explains that individuals with income at or below the federal poverty guideline are eligible for services without charge;
(b) Specifies the federal poverty guideline for individuals and families of various sizes at the time the bill is sent;
(c) Describes the procedure required by division (C)(1) of this section.
(3) The hospital complies with any additional rules the department adopts under section 5112.03 of the Revised Code.
Notwithstanding division (B) of this section, a hospital providing care to an individual under this section is subrogated to the rights of any individual to receive compensation or benefits from any person or governmental entity for the hospital goods and services rendered.
(D) Each hospital shall collect and report to the department, in the form and manner prescribed by the department, information on the both of the following:
(1) The number and identity of patients served pursuant to this section;
(2) Any other information the department needs to complete the report required by section 5101.561 of the Revised Code.
(E) This section applies beginning May 22, 1992, regardless of whether the department has adopted rules specifying the services to be provided. Nothing in this section alters the scope or limits the obligation of any governmental entity or program, including the program awarding reparations to victims of crime under sections 2743.51 to 2743.72 of the Revised Code and the program for medically handicapped children established under section 3701.023 of the Revised Code, to pay for hospital services in accordance with state or local law.
Section 2.  That existing sections 5111.013 and 5112.17 of the Revised Code are hereby repealed.
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