130th Ohio General Assembly
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H. B. No. 176  As Reported by the House Finance and Appropriations Committee
As Reported by the House Finance and Appropriations Committee

130th General Assembly
Regular Session
2013-2014
H. B. No. 176


Representative Sears 



A BILL
To amend section 101.391 and to enact sections 5111.0126, 5111.80, 5111.801, 5111.802, and 5111.947 of the Revised Code to require the Medical Assistance Director to implement Medicaid reforms, to permit the Medicaid program to cover an additional group under certain circumstances, to revise the duties of the Joint Legislative Committee on Medicaid Technology and Reform, and to make an appropriation.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1.  That section 101.391 be amended and sections 5111.0126, 5111.80, 5111.801, 5111.802, and 5111.947 of the Revised Code be enacted to read as follows:
Sec. 101.391.  (A) There is hereby created the joint legislative committee on medicaid technology and reform. The committee may review or study any matter that it considers relevant to the operation of the medicaid program established under Chapter 5111. of the Revised Code, with priority given to the study or review of mechanisms both of the following:
(1) The reforms to be implemented under section 5111.80 of the Revised Code;
(2) Mechanisms to enhance the program's effectiveness through improved technology systems and program reform.
(B)(1) The committee shall consist of five the following members:
(a) Three members of the house of representatives from the majority party appointed by the speaker of the house of representatives and five;
(b) Two members of the house of representatives from the minority party appointed by the speaker of the house of representatives;
(c) Three members of the senate from the majority party appointed by the president of the senate;
(d) Two members of the senate from the minority party appointed by the president of the senate. Not more than three members appointed by the speaker of the house of representatives and not more than three members appointed by the president of the senate may be of the same political party.
(2) Each member of the committee shall hold office during the general assembly in which the member is appointed and until a successor has been appointed, notwithstanding the adjournment sine die of the general assembly in which the member was appointed or the expiration of the member's term as a member of the general assembly. Any vacancies occurring among the members of the committee shall be filled in the manner of the original appointment.
(C) The speaker of the house of representatives shall designate one of the members of the committee appointed under division (B)(1)(a) of this section to serve as a co-chairperson of the committee. The president of the senate shall designate one of the members of the committee appointed under division (B)(1)(c) of this section to serve as the other co-chairperson. The co-chairpersons shall call the committee to meet at least once each quarter and shall arrange for the medical assistance director to testify before the committee regarding the reforms to be implemented under section 5111.80 of the Revised Code periodically but not more than once each quarter. The co-chairpersons may request assistance and staff support for the committee from the legislative service commission.
(D) The committee has the same powers as other standing or select committees of the general assembly. The committee may employ an executive director.
Sec. 5111.0126.  (A) Subject to division (B) of this section, the medicaid program may cover the group, or one or more subgroups of the group, described in the "Social Security Act," section 1902(a)(10)(A)(i)(VIII), 42 U.S.C. 1396a(a)(10)(A)(i)(VIII), if both of the following apply:
(1) The federal medical assistance percentage for expenditures for medicaid services provided to the group or subgroup is at least the amount specified in the "Social Security Act," section 1905(y), 42 U.S.C. 1396d(y), as of March 30, 2010;
(2) The medicaid program is able to cover the group or subgroup in a manner that causes per recipient medicaid expenditures to be reduced.
(B) The medicaid program shall cease to cover the group, and any subgroup of the group, specified in division (A) of this section if the federal medical assistance percentage for expenditures for medicaid services provided to the group or subgroup is lowered to an amount below the amount specified in the "Social Security Act," section 1905(y), 42 U.S.C. 1396d(y), as of March 30, 2010. An individual's disenrollment from the medicaid program is not subject to appeal under section 5101.35 of the Revised Code when the disenrollment is the result of the medicaid program ceasing to cover the individual's group or subgroup under this division.
Sec. 5111.80.  (A) As used in this section:
"Exchange" has the same meaning as in 45 C.F.R. 155.20.
"Medicaid waiver component" has the same meaning as in section 5111.85 of the Revised Code.
(B) Subject to section 5111.801 of the Revised Code, the medical assistance director shall implement reforms to the medicaid program that do all of the following:
(1) Improve the health of medicaid recipients while reducing both of the following:
(a) The cost of health care;
(b) Uncompensated health care costs.
(2) Control medicaid expenditures and reduce the rate of increase in expenditures;
(3) Enroll at least eighty per cent of medicaid recipients in any of the following:
(a) The care management system established under section 5111.16 of the Revised Code;
(b) Group health plans pursuant to section 5111.13 of the Revised Code;
(c) A medicaid component established in accordance with the "Social Security Act," section 1906A, 42 U.S.C. 1396e-1, that provides premium assistance subsidies for qualified employer-sponsored coverage to medicaid recipients under nineteen years of age and the parents of such recipients;
(d) A medicaid component established in a manner consistent with the definition of "medical assistance" in the "Social Security Act," section 1905(a), 42 U.S.C. 1396d(a), that provides payments for insurance premiums for medical or other type of remedial care for medicaid recipients, other than the following:
(i) Recipients who are at least sixty-five years of age;
(ii) Recipients who are disabled and entitled to health insurance benefits under the medicare program but not enrolled under part B of the medicare program.
(e) A medicaid waiver component that provides premium assistance for medicaid recipients to purchase qualified health plans through an exchange.
(4) Require medicaid recipients to assume greater personal responsibility under both of the following:
(a) The cost-sharing program instituted under section 5111.0112 of the Revised Code;
(b) A medicaid component that incorporates the objectives of health savings accounts through value-based insurance designs.
(5) Ensure that medicaid recipients who abuse narcotics receive proper treatment and are unable to access the narcotics they abuse through the health care system;
(6) Promote employment-related services and job training available under medicaid and other programs to lower medicaid caseloads by assisting able-bodied, adult medicaid recipients into the workforce;
(7) Make the administration of the medicaid program more efficient and establish the state as a national leader in preventing medicaid fraud and abuse;
(8) Support health care payment innovations in the private sector by assisting other purchasers of health care services and health care providers by leveraging the medicaid program's purchasing power.
Sec. 5111.801.  (A) The medical assistance director shall implement the reforms under section 5111.80 of the Revised Code in accordance with all of the following:
(1) The medicaid state plan approved by the United States secretary of health and human services, including amendments to the plan approved by the United States secretary;
(2) Federal medicaid waivers granted by the United States secretary, including amendments to waivers approved by the United States secretary;
(3) Other types of federal approval, including demonstration grants, that establish requirements for the reforms;
(4) Except as otherwise authorized by a federal medicaid waiver granted by the United States secretary, all applicable federal statutes, regulations, and policy guidances;
(5) All applicable state statutes.
(B) The medical assistance director shall seek federal approval for all of the reforms to be implemented under section 5111.80 of the Revised Code that require federal approval. None of the reforms that require federal approval shall be implemented without receipt of the federal approval. However, a reform that requires federal approval may begin to be implemented before receipt of the federal approval if federal law permits implementation to begin before receipt of the federal approval. Implementation shall cease if federal approval is ultimately denied.
Sec. 5111.802.  Not later than December 31, 2014, and the last day of each calendar year thereafter, the medical assistance director shall submit to the general assembly, in accordance with section 101.68 of the Revised Code, a full report on the progress being made in implementing the reforms under section 5111.80 of the Revised Code. The report may include recommendations for legislation that would support the reforms.
Sec. 5111.947.  There is established in the state treasury the Ohio medicaid reform fund. All federal funds the state receives for the federal share of medicaid expenditures for the eligibility group or subgroups authorized by section 5111.0126 of the Revised Code shall be deposited into the fund. All money in the fund shall be used as the federal share of medicaid expenditures for that eligibility group or those subgroups.
Section 2.  That existing section 101.391 of the Revised Code is hereby repealed.
Section 3. The Director of Budget and Management may create any necessary accounts or line items for the Ohio Medicaid Reform Fund established under section 5111.947 of the Revised Code. All money deposited into the Fund under that section during fiscal year 2014 and fiscal year 2015 is hereby appropriated for those fiscal years.
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