Bill Text: OH HB121 | 2013-2014 | 130th General Assembly | Introduced
Bill Title: To enact the Ohio Health Security Act to establish and operate the Ohio Health Care Plan to provide universal health care coverage to all Ohio residents.
Spectrum: Partisan Bill (Democrat 6-0)
Status: (Introduced - Dead) 2013-04-10 - To Insurance [HB121 Detail]
Download: Ohio-2013-HB121-Introduced.html
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Representatives Hagan, R., Foley
Cosponsors:
Representatives Antonio, Ramos, Boyd, Patterson
To amend section 109.02 and to enact sections 3920.01 | 1 |
to 3920.15, 3920.21 to 3920.27, 3920.31, 3920.32, | 2 |
and 3920.33 of the Revised Code to enact the Ohio | 3 |
Health Security Act to establish and operate the | 4 |
Ohio Health Care Plan to provide universal health | 5 |
care coverage to all Ohio residents. | 6 |
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 109.02 be amended and sections | 7 |
3920.01, 3920.02, 3920.03, 3920.04, 3920.05, 3920.06, 3920.07, | 8 |
3920.08, 3920.09, 3920.10, 3920.11, 3920.12, 3920.13, 3920.14, | 9 |
3920.15, 3920.21, 3920.22, 3920.23, 3920.24, 3920.25, 3920.26, | 10 |
3920.27, 3920.31, 3920.32, and 3920.33 of the Revised Code be | 11 |
enacted to read as follows: | 12 |
Sec. 109.02. The attorney general is the chief law officer | 13 |
for the state and all its departments and shall be provided with | 14 |
adequate office space in Columbus. Except as provided in division | 15 |
(E) of section 120.06 and in sections 3517.152 to 3517.157 and | 16 |
3920.04 of the Revised Code, no state officer or board, or head of | 17 |
a department or institution of the state shall employ, or be | 18 |
represented by, other counsel or attorneys at law. The attorney | 19 |
general shall appear for the state in the trial and argument of | 20 |
all civil and criminal causes in the supreme court in which the | 21 |
state is directly or indirectly interested. When required by the | 22 |
governor or the general assembly, the attorney general shall | 23 |
appear for the state in any court or tribunal in a cause in which | 24 |
the state is a party, or in which the state is directly | 25 |
interested. Upon the written request of the governor, the attorney | 26 |
general shall prosecute any person indicted for a crime. | 27 |
Sec. 3920.01. As used in this chapter: | 28 |
(A) "Blind trust" means an independently managed trust in | 29 |
which the beneficiary has no management rights and in which the | 30 |
beneficiary is not given notice of alterations in or other | 31 |
dispositions of the stock, mutual funds, or other property subject | 32 |
to the trust. | 33 |
(B) "Health care facility" means any facility, except a | 34 |
health care practitioner's office, that provides preventive, | 35 |
diagnostic, therapeutic, acute convalescent, rehabilitation, | 36 |
mental health, mental retardation, intermediate care, or skilled | 37 |
nursing services. | 38 |
(C) "Provider" means a hospital or other health care | 39 |
facility, and physicians, podiatrists, dentists, pharmacists, | 40 |
chiropractors, and other health care personnel, licensed, | 41 |
certified, accredited, or otherwise authorized in this state to | 42 |
furnish health care services. | 43 |
Sec. 3920.02. (A)(1) There is hereby created the Ohio health | 44 |
care plan, which shall be administered by the Ohio health care | 45 |
agency under the direction of the Ohio health care board. | 46 |
(2) The Ohio health care plan shall provide universal and | 47 |
affordable health care coverage for all Ohio residents, consisting | 48 |
of a comprehensive benefit package that includes benefits for | 49 |
prescription drugs. The Ohio health care plan shall work | 50 |
simultaneously to control health care costs, control health care | 51 |
spending, achieve measurable improvement in health care outcomes, | 52 |
increase all parties' satisfaction with the health care system, | 53 |
implement policies that strengthen and improve culturally and | 54 |
linguistically sensitive care, and develop an integrated health | 55 |
care database to support health care planning. | 56 |
(B) There is hereby created the Ohio health care agency. The | 57 |
Ohio health care agency shall administer the Ohio health care plan | 58 |
and is the sole agency authorized to accept applicable | 59 |
grants-in-aid from the federal and state government, using the | 60 |
funds in order to secure full compliance with provisions of state | 61 |
and federal law and to carry out the purposes of sections 3920.01 | 62 |
to 3920.33 of the Revised Code. All grants-in-aid accepted by the | 63 |
Ohio health care agency shall be deposited into the Ohio health | 64 |
care fund established under section 3920.09 of the Revised Code. | 65 |
Sections 101.82 and 101.83 of the Revised Code do not apply | 66 |
to the Ohio health care agency. | 67 |
Sec. 3920.03. (A) There is hereby created the Ohio health | 68 |
care board. The Ohio health care board shall consist of fifteen | 69 |
voting members, consisting of the director of health and fourteen | 70 |
members elected in accordance with this section. | 71 |
(B) For purposes of representation on the Ohio health care | 72 |
board, the state shall be divided into seven regions each composed | 73 |
of designated counties as follows: | 74 |
(1) Region 1: Ashtabula, Cuyahoga, Geauga, Lake, Lorain; | 75 |
(2) Region 2: Allen, Auglaize, Defiance, Erie, Fulton, | 76 |
Hancock, Henry, Huron, Lucas, Mercer, Ottawa, Paulding, Putnam, | 77 |
Sandusky, Seneca, Van Wert, Williams, Wood; | 78 |
(3) Region 3: Athens, Belmont, Coshocton, Gallia, Guernsey, | 79 |
Harrison, Hocking, Jackson, Jefferson, Lawrence, Meigs, Monroe, | 80 |
Morgan, Muskingum, Noble, Perry, Pike, Ross, Scioto, Vinton, | 81 |
Washington; | 82 |
(4) Region 4: Adams, Brown, Butler, Clermont, Clinton, | 83 |
Hamilton, Highland, Warren; | 84 |
(5) Region 5: Crawford, Delaware, Fairfield, Fayette, | 85 |
Franklin, Hardin, Knox, Licking, Logan, Madison, Marion, Morrow, | 86 |
Pickaway, Union, Wyandot; | 87 |
(6) Region 6: Ashland, Carroll, Columbiana, Holmes, Mahoning, | 88 |
Medina, Portage, Richland, Stark, Summit, Trumbull, Tuscarawas, | 89 |
Wayne; | 90 |
(7) Region 7: Champaign, Clark, Darke, Greene, Miami, | 91 |
Montgomery, Preble, Shelby. | 92 |
(C)(1) The health commissioner of the most populous county in | 93 |
each region shall convene a meeting of all county and city health | 94 |
commissioners in the region within ninety days following the | 95 |
effective date of this section. If there are two or more health | 96 |
districts located wholly or partially in the most populous county | 97 |
of the region, the health commissioner of the health district with | 98 |
the largest territorial jurisdiction in that county shall convene | 99 |
the meeting of all county and city health commissioners within | 100 |
ninety days following the effective date of this section. | 101 |
(2) At the meeting called pursuant to division (C)(1) of this | 102 |
section, the county and city health commissioners in each region | 103 |
shall elect one resident from each county in the region to | 104 |
represent the county on a regional health advisory committee | 105 |
established for that region. The county and city health | 106 |
commissioners also shall set a date, not sooner than one hundred | 107 |
days and not later than one hundred ten days after the effective | 108 |
date of this section, for the initial meeting of the regional | 109 |
health advisory committee. | 110 |
(3) Following the initial meetings of county and city health | 111 |
commissioners called pursuant to division (C)(1) of this section, | 112 |
the county and city health commissioners in each region shall | 113 |
convene a meeting every two years to elect representatives to the | 114 |
regional health advisory committee in accordance with this | 115 |
division. Each biennial meeting shall be held within five days of | 116 |
the same day of the same month as the initial meeting. | 117 |
(4) Each representative elected under this division shall | 118 |
hold office for two years, starting on the date of the | 119 |
representative's election. Any individual appointed to fill a | 120 |
vacancy occurring prior to the expiration of the term for which a | 121 |
representative is elected shall hold office for the remainder of | 122 |
the predecessor's term. | 123 |
(D)(1) Each of the seven regional health advisory committees | 124 |
shall elect a chairperson from among the representatives to their | 125 |
committees. Each chairperson shall convene and preside over the | 126 |
initial meeting of that regional health advisory committee on the | 127 |
date set pursuant to division (C) of this section. At the initial | 128 |
meeting of the regional health advisory committees, the | 129 |
committees' representatives shall elect two residents from the | 130 |
region to represent that region as members of the Ohio health care | 131 |
board. One of the two residents elected from each region to serve | 132 |
on the Ohio health care board shall be a resident of the region's | 133 |
most populous county and the other shall be a resident of any | 134 |
county in the region other than the region's most populous county. | 135 |
Except for the elections to the Ohio health care board at the | 136 |
initial meeting of each regional health advisory committee, each | 137 |
resident elected to the board shall be elected to a two-year term | 138 |
of office. At the initial meeting, the resident from the most | 139 |
populous county in the region shall be elected to a term of three | 140 |
years. | 141 |
(2) Annually, beginning in the second year following the | 142 |
initial elections to the Ohio health care board, the chairperson | 143 |
of each regional health advisory committee shall convene a meeting | 144 |
within five calendar days of the same date of the same month as | 145 |
the initial meeting of that regional health advisory committee to | 146 |
elect a resident from the region to serve as a member of the Ohio | 147 |
health care board. The regional health advisory committee shall | 148 |
elect a resident of a county as is necessary to meet the | 149 |
representation requirements set by division (D)(1) of this | 150 |
section. No individual may serve as a member of the Ohio health | 151 |
care board for more than four consecutive terms. | 152 |
(3) In addition to meeting for the election of Ohio health | 153 |
care board members, the regional health advisory committees shall | 154 |
meet as necessary to fulfill any functions and responsibilities | 155 |
assigned to them under sections 3920.01 to 3920.15 of the Revised | 156 |
Code. Meetings shall be held at the call of the chairperson and as | 157 |
may be provided by procedures adopted by the regional health | 158 |
advisory committee. | 159 |
(4) In addition to the fourteen members of the Ohio health | 160 |
care board elected by the seven regional health advisory | 161 |
committees, the director of health shall be a voting ex officio | 162 |
member of the Ohio health care board. | 163 |
(E)(1) The director of health shall set the time, place, and | 164 |
date for the initial meeting of the Ohio health care board and | 165 |
shall preside over the Ohio health care board's initial meeting. | 166 |
The initial meeting shall be set not sooner than one hundred | 167 |
fifteen days and not later than one hundred twenty-five days after | 168 |
the effective date of this section. | 169 |
(2) The members of the Ohio health care board annually shall | 170 |
elect a member of the board to serve as chairperson at meetings of | 171 |
the board. Meetings shall be held upon the call of the chairperson | 172 |
and as provided by procedures prescribed by the Ohio health care | 173 |
board. Two-thirds of the members of the Ohio health care board | 174 |
shall constitute a quorum for the conduct of business at meetings | 175 |
of the board. Decisions at meetings of the Ohio health care board | 176 |
shall be reached by majority vote. | 177 |
(3) All meetings of the Ohio health care board are open to | 178 |
the public unless questions of patient confidentiality arise. The | 179 |
Ohio health care board may go into closed executive session with | 180 |
regard to issues related to confidential patient information. The | 181 |
fourteen members of the Ohio health care board elected by the | 182 |
regional health advisory committees shall receive an annual salary | 183 |
and benefits established in accordance with division (J) of | 184 |
section 124.15 of the Revised Code. | 185 |
(F) The seven regional health advisory committees shall act | 186 |
as advisory bodies to the Ohio health care board, representing | 187 |
their individual regions. The regional health advisory committees | 188 |
shall oversee the management of consumer and provider complaints | 189 |
originating in their respective regions and shall hold a hearing | 190 |
on all such complaints. The regional health advisory committees | 191 |
shall offer assistance to resolve consumer and provider disputes | 192 |
and shall seek the agreement of all parties to the dispute to | 193 |
submit the dispute to negotiation or binding arbitration. A | 194 |
regional health advisory committee shall transfer any dispute that | 195 |
is not resolved at the regional level to the director of the Ohio | 196 |
health care agency's department of consumer affairs within six | 197 |
months; however, the committee may vote to transfer individual | 198 |
disputes at an earlier date. | 199 |
(G)(1) If a vacancy occurs on the Ohio health care board for | 200 |
any reason, resulting in a region being without full | 201 |
representation on the board, that region's health advisory | 202 |
committee shall elect a resident of that region to fill the | 203 |
vacancy. Any resident elected to fill a vacancy shall serve the | 204 |
remainder of the departing member's term. The health advisory | 205 |
committee shall elect a resident of a county as necessary to meet | 206 |
the representation requirements set by division (D)(1) of this | 207 |
section. | 208 |
(2) A serving member of the Ohio health care board shall | 209 |
continue to serve following the expiration of their term until a | 210 |
successor takes office or a period of ninety days has elapsed, | 211 |
whichever occurs first. | 212 |
(H)(1) The members and staff of the Ohio health care board | 213 |
and employees of the Ohio health care agency, and their immediate | 214 |
families, are prohibited from having any pecuniary interest in any | 215 |
business with a contract, or in negotiation for a contract, with | 216 |
either the Ohio health care board or Ohio health care agency, or | 217 |
that is subject to the Ohio health care board's oversight. The | 218 |
members and staff of the Ohio health care board and employees of | 219 |
the Ohio health care agency shall not receive remuneration for | 220 |
health care service of any kind during their term of service or | 221 |
employment. The members and staff of the Ohio health care board | 222 |
and employees of the Ohio health care agency, and their immediate | 223 |
families, shall not receive consulting fees of any kind from any | 224 |
source that is directly or indirectly related to the delivery of | 225 |
health care services pursuant to the Ohio health care plan. The | 226 |
members and staff of the Ohio health care board and employees of | 227 |
the Ohio health care agency, and their immediate families, are | 228 |
prohibited from owning stock in, and from investing in mutual | 229 |
funds holding stock in, pharmaceutical companies, health | 230 |
maintenance organizations, or other businesses that relate | 231 |
directly or indirectly to the delivery of health care services, | 232 |
unless the stock or mutual funds are in a blind trust. | 233 |
(2) No member of the Ohio health care board other than the | 234 |
director of health shall hold any other salaried public position | 235 |
with the state, either elected or appointed, during the member's | 236 |
tenure on the board. The director of health shall receive no | 237 |
salary or benefits by virtue of the director's service on the Ohio | 238 |
health care board. | 239 |
(3) The chairperson of the Ohio health care board may conduct | 240 |
hearings to determine if a violation of this division has | 241 |
occurred. Notice of any hearing, the conduct of the hearing, and | 242 |
all other matters relating to the holding of the hearing shall be | 243 |
governed by Chapter 119. of the Revised Code. If a member of the | 244 |
Ohio health care board, or of the member's immediate family, is | 245 |
found to have violated this division, the chairperson of the Ohio | 246 |
health care board of health shall remove the member from the Ohio | 247 |
health care board. If a staffer of the Ohio health care board or | 248 |
an employee of the Ohio health care agency, or a member of the | 249 |
staffer's or employee's immediate family, is found to have | 250 |
violated this division, the Ohio health care board or Ohio health | 251 |
care agency shall take appropriate disciplinary action against the | 252 |
staffer or employee, which action may include termination of | 253 |
employment. | 254 |
Sections 101.82 and 101.83 of the Revised Code do not apply | 255 |
to the Ohio health care board and the regional health advisory | 256 |
committees. | 257 |
Sec. 3920.04. (A) The Ohio health care board is responsible | 258 |
for directing the Ohio health care agency in the performance of | 259 |
all duties, the exercise of all powers, and the assumption and | 260 |
discharge of all functions vested in the Ohio health care agency. | 261 |
The Ohio health care board shall adopt rules in accordance with | 262 |
Chapter 119. of the Revised Code as needed to carry out the | 263 |
purposes of, and to enforce, Chapter 3920. of the Revised Code. | 264 |
(B) The duties and functions of the Ohio health care board | 265 |
include, but are not limited to, the following: | 266 |
(1) Implementing statutory eligibility standards for | 267 |
benefits; | 268 |
(2) Annually adopting a benefits package for participants of | 269 |
the Ohio health care plan; | 270 |
(3) Acting directly or through one or more contractors as the | 271 |
single payer for all claims for health care services made under | 272 |
the Ohio health care plan; | 273 |
(4) Developing and implementing separate formulas for | 274 |
determining budgets under sections 3920.21 to 3920.28 of the | 275 |
Revised Code; | 276 |
(5) Annually reviewing the formulas for determining the | 277 |
appropriateness and sufficiency of rates, fees, and prices; | 278 |
(6) Providing for timely payments to providers through a | 279 |
structure that is well organized and that eliminates unnecessary | 280 |
administrative costs; | 281 |
(7) Implementing, to the extent permitted by federal law, | 282 |
standardized claims and reporting methods for use by the Ohio | 283 |
health care plan; | 284 |
(8) Developing a system of centralized electronic claims and | 285 |
payments; | 286 |
(9) Establishing an enrollment system that will ensure that | 287 |
all eligible Ohio residents, including those who travel | 288 |
frequently, those who cannot read, and those who do not speak | 289 |
English, are aware of their right to health care and are formally | 290 |
enrolled in the Ohio health care plan; | 291 |
(10) Reporting annually to the general assembly and the | 292 |
governor, on or before the first day of October, on the | 293 |
performance of the Ohio health care plan, the fiscal condition of | 294 |
the Ohio health care plan, any need for rate adjustments, | 295 |
recommendations for statutory changes, the receipt of payments | 296 |
from the federal government, whether current year goals and | 297 |
priorities were met, future goals and priorities, and major new | 298 |
technology or prescription drugs that may affect the cost of the | 299 |
health care services provided by the Ohio health care plan; | 300 |
(11) Administering the revenues of the Ohio health care fund | 301 |
pursuant to section 3920.09 of the Revised Code; | 302 |
(12) Obtaining appropriate liability and other forms of | 303 |
insurance to provide coverage for the Ohio health care plan, the | 304 |
Ohio health care board, the Ohio health care agency, and their | 305 |
employees and agents; | 306 |
(13) Establishing, appointing, and funding appropriate staff | 307 |
for the Ohio health care agency throughout Ohio; | 308 |
(14) Procuring requisite office space and administrative | 309 |
support; | 310 |
(15) Administering aspects of the Ohio health care agency by | 311 |
taking actions that include, but are not limited to, the | 312 |
following: | 313 |
(a) Establishing standards and criteria for the allocation of | 314 |
operating funds; | 315 |
(b) Meeting regularly with the executive director and | 316 |
administrators of the Ohio health care agency to review the impact | 317 |
of the agency and its policies on the regional districts | 318 |
established under section 3920.03 of the Revised Code; | 319 |
(c) Establishing goals for the health care system established | 320 |
pursuant to the Ohio health care plan in measurable terms; | 321 |
(d) Establishing statewide health care databases to support | 322 |
health care services planning; | 323 |
(e) Implementing policies, and developing mechanisms and | 324 |
incentives, to assure culturally and linguistically sensitive | 325 |
care; | 326 |
(f) Establishing standards and criteria for the determination | 327 |
of appropriate compensation and training for residents of Ohio who | 328 |
are displaced from work due to the implementation of the Ohio | 329 |
health care plan; | 330 |
(g) Establishing methods for the recovery of costs for health | 331 |
care services provided pursuant to the Ohio health care plan to a | 332 |
participant that are covered under the terms of a policy of | 333 |
insurance, a health benefit plan, or other collateral source | 334 |
available to the participant under which the participant has a | 335 |
right of action for compensation. Receipt of health care services | 336 |
pursuant to the Ohio health care plan shall be deemed an | 337 |
assignment by the participant of any right to payment for services | 338 |
from any policy, plan, or other source. The other source of health | 339 |
care benefits shall pay to the Ohio health care fund all amounts | 340 |
it is obligated to pay to the participant for covered health care | 341 |
services. The Ohio health care board may commence any action | 342 |
necessary to recover the amounts due. | 343 |
(16) Appointing a technical and medical advisory board. The | 344 |
members of the technical and medical advisory board shall | 345 |
represent a cross section of the medical and provider community | 346 |
and consumers, and shall include two persons, one being a provider | 347 |
and the other representing consumers, from each region designated | 348 |
in section 3920.03 of the Revised Code. The members of the | 349 |
technical and medical advisory board shall be reimbursed for | 350 |
actual and necessary expenses incurred in the performance of their | 351 |
duties. The technical and medical advisory board's duties include: | 352 |
(a) Advising the Ohio health care board on the establishment | 353 |
of policy on medical issues, population-based public health | 354 |
issues, research priorities, scope of services, expanding access | 355 |
to health care services, and evaluating the performance of the | 356 |
Ohio health care plan; | 357 |
(b) Investigating proposals for innovative approaches to the | 358 |
promotion of health, the prevention of disease and injury, patient | 359 |
education, research, and health care delivery; | 360 |
(c) Advising the Ohio health care board on the establishment | 361 |
of standards and criteria to evaluate requests from health care | 362 |
facilities for capital improvements. | 363 |
(C) The Ohio health care board shall employ and fix the | 364 |
compensation of Ohio health care agency personnel, with the | 365 |
approval of the department of administrative services, as needed | 366 |
by the agency to properly discharge the agency's duties. The | 367 |
employment of personnel by the Ohio health care board is subject | 368 |
to the civil service laws of this state. The Ohio health care | 369 |
board shall employ personnel including, but not limited to, the | 370 |
following: | 371 |
(1) Executive director; | 372 |
(2) Administrator of planning, research, and development; | 373 |
(3) Administrator of finance; | 374 |
(4) Administrator of quality assurance; | 375 |
(5) Administrator of consumer affairs; | 376 |
(6) Legal counsel to represent the Ohio health care agency | 377 |
and Ohio health care board in any legal action brought by or | 378 |
against the agency or board under or pursuant to any provision of | 379 |
the Revised Code under the agency's or board's jurisdiction. | 380 |
(D) No member of the Ohio health care board or individual on | 381 |
the staff of the Ohio health care board or Ohio health care agency | 382 |
shall use for personal benefit any information filed with or | 383 |
obtained by the Ohio health care board that is not then readily | 384 |
available to the public. No member of the Ohio health care board | 385 |
shall use or in any way attempt to use their position as a member | 386 |
to influence a decision of any other governmental body. | 387 |
Sections 101.82 and 101.83 of the Revised Code do not apply | 388 |
to the technical and medical advisory board established pursuant | 389 |
to this section. | 390 |
Sec. 3920.05. The executive director of the Ohio health care | 391 |
agency appointed under section 3920.04 of the Revised Code is the | 392 |
chief administrator of the Ohio health care plan and shall | 393 |
administer and enforce Chapter 3920. of the Revised Code. The | 394 |
executive director shall oversee the operation of the Ohio health | 395 |
care agency and the agency's performance of any duties assigned by | 396 |
the Ohio health care board. | 397 |
Sec. 3920.06. (A) The executive director of the Ohio health | 398 |
care agency shall determine the duties of the administrator of | 399 |
planning, research, and development. Those duties shall include, | 400 |
but not be limited to, the following: | 401 |
(1) Establishing policy on medical issues, population-based | 402 |
public health issues, research priorities, scope of services, the | 403 |
expansion of participants' access to health care services, and | 404 |
evaluating the performance of the Ohio health care plan; | 405 |
(2) Investigating proposals for innovative approaches for the | 406 |
promotion of health, the prevention of disease and injury, patient | 407 |
education, research, and the delivery of health care services; | 408 |
(3) Establishing standards and criteria for evaluating | 409 |
applications from health care facilities for capital improvements. | 410 |
(B)(1) The executive director shall determine the duties of | 411 |
the administrator of consumer affairs. Those duties shall include, | 412 |
but not be limited to, the following: | 413 |
(a) Developing educational and informational guides for | 414 |
consumers that describe consumer rights and responsibilities and | 415 |
that inform consumers of effective ways to exercise consumer | 416 |
rights to obtain health care services. The guides shall be easy to | 417 |
read and understand and available in English and in other | 418 |
languages. The Ohio health care agency shall make the guides | 419 |
available to the public through public outreach and educational | 420 |
programs and through the internet web site of the Ohio health care | 421 |
agency. | 422 |
(b) Establishing a toll-free telephone number to receive | 423 |
questions and complaints regarding the Ohio health care agency and | 424 |
the agency's services. The Ohio health care agency's internet web | 425 |
site shall provide complaint forms and instructions online. | 426 |
(c) Examining suggestions from the public; | 427 |
(d) Making recommendations for improvements to the Ohio | 428 |
health care board; | 429 |
(e) Examining the extent to which individual health care | 430 |
facilities in a region meet the needs of the community in which | 431 |
they are located; | 432 |
(f) Receiving, investigating, and responding to all | 433 |
complaints about any aspect of the Ohio health care plan and | 434 |
referring the results of all investigations into the provision of | 435 |
health care services by health care providers or facilities to the | 436 |
appropriate provider or health care facility licensing board, or | 437 |
when appropriate, to a law enforcement agency; | 438 |
(g) Publishing an annual report for the public and the | 439 |
general assembly that contains a statewide evaluation of the Ohio | 440 |
health care agency and of the delivery of health care services in | 441 |
each region established under section 3920.03 of the Revised Code; | 442 |
(h) Holding public hearings, at least annually, within each | 443 |
region established under section 3920.03 of the Revised Code for | 444 |
public suggestions and complaints. | 445 |
(2) The administrator of consumer affairs shall work closely | 446 |
with the seven regional health advisory committees on the | 447 |
resolution of complaints. In the discharge of the administrator's | 448 |
duties, the administrator shall have unlimited access to all | 449 |
nonconfidential and nonprivileged documents in the custody and | 450 |
control of the agency. Nothing in Chapter 3920. of the Revised | 451 |
Code prohibits a consumer or class of consumers, or the | 452 |
administrator of consumer affairs, from seeking relief through the | 453 |
courts. | 454 |
(C) The executive director, in consultation with the | 455 |
technical and medical advisory board, shall determine the duties | 456 |
of the administrator of quality assurance. Those duties shall | 457 |
include, but not be limited to, the following: | 458 |
(1) Studying and reporting on the efficacy of health care | 459 |
treatments and medications for particular conditions; | 460 |
(2) Identifying causes of medical errors and devising | 461 |
procedures to decrease medical errors; | 462 |
(3) Establishing an evidence-based formulary; | 463 |
(4) Identifying treatments and medications that are unsafe or | 464 |
have no proven value; | 465 |
(5) Establishing a process for soliciting information on | 466 |
medical standards from providers and consumers for purposes of | 467 |
this division. | 468 |
(D) The executive director shall determine the duties of the | 469 |
administrator of finance. Those duties shall include, but not be | 470 |
limited to, the following: | 471 |
(1) Administering the Ohio health care fund; | 472 |
(2) Making prompt payments to providers; | 473 |
(3) Developing a system of centralized claims and payments; | 474 |
(4) Communicating to the treasurer of state when funds are | 475 |
needed for the operation of the Ohio health care plan; | 476 |
(5) Developing information systems for utilization review; | 477 |
(6) Investigating possible provider or consumer fraud. | 478 |
Sec. 3920.07. (A) All Ohio residents and individuals | 479 |
employed in Ohio, including the homeless and migrant workers, are | 480 |
eligible for coverage under the Ohio health care plan. The Ohio | 481 |
health care board shall establish standards and a simplified | 482 |
procedure to demonstrate proof of residency. The Ohio health care | 483 |
board shall establish a procedure to enroll eligible residents and | 484 |
employees and to provide each individual covered under the Ohio | 485 |
health care plan with identification that providers may use to | 486 |
determine eligibility for health care services under the Ohio | 487 |
health care plan. | 488 |
(B) If waivers are not obtained under sections 3920.31 to | 489 |
3920.33 of the Revised Code from the medical assistance and | 490 |
medicare programs operated under Title XVIII or XIX of the "Social | 491 |
Security Act," 49 Stat. 20 (1935), 42 U.S.C. 301, as amended, or | 492 |
whenever a necessary waiver is not in effect, the medical | 493 |
assistance and medicare programs shall act as the primary insurers | 494 |
for Ohio residents and individuals employed in this state for | 495 |
health coverage and the Ohio health care plan shall serve as the | 496 |
secondary or supplemental plan of health coverage. When the Ohio | 497 |
health care plan serves as a secondary or supplemental plan of | 498 |
health coverage the Ohio health care plan shall not provide | 499 |
coverage to an Ohio resident or individual employed in this state | 500 |
for any covered health care service that the resident or worker is | 501 |
then eligible to receive under the medical assistance or medicare | 502 |
program. | 503 |
(C) A plan of employee health coverage provided by an | 504 |
out-of-state employer to an Ohio resident working outside of this | 505 |
state shall serve as the employee's primary plan of health | 506 |
coverage and the Ohio health care plan shall serve as the | 507 |
employee's secondary plan of health coverage. | 508 |
(D) The Ohio health care agency shall bill an out-of-state | 509 |
employer or the employer's insurer for the cost of covered health | 510 |
care services provided in accordance with the Ohio health care | 511 |
plan to residents of this state employed by the out-of-state | 512 |
employer when the health care services provided are covered under | 513 |
the terms of the employer's plan of employee health coverage. | 514 |
(E) The Ohio health care plan shall reimburse Ohio health | 515 |
care board approved providers practicing outside of this state at | 516 |
Ohio health care plan rates for health care services rendered to a | 517 |
plan participant while the participant is out of state. | 518 |
(F) Any employer operating in this state may purchase | 519 |
coverage under the Ohio health care plan for an employee who lives | 520 |
out of state but who works in this state. | 521 |
(G) Any institution of higher education, as defined in | 522 |
section 2741.01 of the Revised Code, located in this state may | 523 |
purchase coverage under the Ohio health care plan for a student | 524 |
who does not otherwise have status as a resident of this state. | 525 |
(H) Any individual who arrives at a health care facility | 526 |
unconscious or otherwise unable due to their mental or physical | 527 |
condition to document eligibility for coverage under the Ohio | 528 |
health care plan shall be presumed to be eligible. | 529 |
Sec. 3920.08. (A) The Ohio health care board shall establish | 530 |
a single health benefits package that shall include, but not be | 531 |
limited to, all of the following: | 532 |
(1) Inpatient and outpatient provider care, both primary and | 533 |
secondary; | 534 |
(2) Emergency services, as defined in division (A) of section | 535 |
3923.65 of the Revised Code, twenty-four hours each day on a | 536 |
prudent layperson standard. Residents who are temporarily out of | 537 |
state may receive benefits for emergency services rendered in that | 538 |
state. The Ohio health care agency shall make timely emergency | 539 |
services, including hospital care and triage, available to all | 540 |
Ohio residents, including all residents not enrolled in the Ohio | 541 |
health care plan. | 542 |
(3) Emergency and other transportation services to covered | 543 |
health care services, subject to division (B) of this section; | 544 |
(4) Rehabilitation services, including speech, occupational, | 545 |
and physical therapy; | 546 |
(5) Inpatient and outpatient mental health services and | 547 |
substance abuse treatment; | 548 |
(6) Hospice care; | 549 |
(7) Prescription drugs and prescribed medical nutrition; | 550 |
(8) Vision care, aids, and equipment; | 551 |
(9) Hearing care, hearing aids, and equipment; | 552 |
(10) Diagnostic medical tests, including laboratory tests and | 553 |
imaging procedures; | 554 |
(11) Medical supplies and prescribed medical equipment, both | 555 |
durable and nondurable; | 556 |
(12) Immunizations, preventive care, health maintenance care, | 557 |
and screening; | 558 |
(13) Dental care; | 559 |
(14) Home health care services. | 560 |
(B) The Ohio health care plan shall provide necessary | 561 |
transportation in each county to covered health care services. | 562 |
Independent transportation providers shall be reimbursed on a | 563 |
fee-for-service basis. Fee schedules for covered transportation | 564 |
may take into account the recognized differences among geographic | 565 |
areas regarding cost. A covered transportation benefits account is | 566 |
hereby created within the Ohio health care fund. | 567 |
(C) The Ohio health care plan shall not exclude or limit | 568 |
coverage of its participants' pre-existing conditions. | 569 |
(D) Residents enrolled in the Ohio health care plan are not | 570 |
subject to copayments, point-of-service charges, or any other fee | 571 |
or charge, and shall not be directly billed by providers for | 572 |
covered health care services provided to the resident. | 573 |
(E) The Ohio health care board, with the consent of the | 574 |
technical and medical advisory board, shall remove or exclude | 575 |
procedures and treatments, equipment, and prescription drugs from | 576 |
the Ohio health care plan's benefit package that the board finds | 577 |
unsafe, experimental, of no proven value, or that add no | 578 |
therapeutic value. | 579 |
(F) The Ohio health care board shall exclude coverage for any | 580 |
surgical, orthodontic, or other medical procedure, or prescription | 581 |
drug, that the technical and medical advisory board determines was | 582 |
or will be provided primarily for cosmetic purposes, unless | 583 |
required to correct a congenital defect, to restore or correct | 584 |
disfigurements resulting from injury or disease, or that is | 585 |
determined to be medically necessary by a qualified, licensed | 586 |
provider. | 587 |
(G) Participants shall have free choice of the providers | 588 |
eligible to participate in the Ohio health care plan. | 589 |
(H) No provider shall be compelled by the Ohio health care | 590 |
agency to offer any particular service, provided that the provider | 591 |
does not discriminate among patients in providing health care | 592 |
services. | 593 |
(I) The Ohio health care plan and the providers participating | 594 |
in the plan shall not discriminate on the basis of race, color, | 595 |
religion, gender, age, national origin, sexual orientation, health | 596 |
status, mental or physical disability, employment status, veteran | 597 |
status, or occupation. | 598 |
Sec. 3920.09. (A) The Ohio health care fund is hereby | 599 |
established in the state treasury. The administrator of finance of | 600 |
the Ohio health care agency shall administer and monitor the Ohio | 601 |
health care fund. All moneys collected and received by the Ohio | 602 |
health care plan shall be transmitted to the treasurer of state | 603 |
for deposit into the Ohio health care fund, to be used to finance | 604 |
the Ohio health care plan and to pay the costs of compensation and | 605 |
training for displaced workers pursuant to section 3920.11 of the | 606 |
Revised Code. | 607 |
(B) The treasurer of state may invest the interest earned by | 608 |
the Ohio health care fund in any manner authorized by the Revised | 609 |
Code for the investment of state moneys. Any revenue or interest | 610 |
earned from the investments shall be credited to the Ohio health | 611 |
care fund. | 612 |
(C) All provider claims for payment for health care services | 613 |
rendered under the Ohio health care plan shall be transmitted to | 614 |
the Ohio health care fund by the provider or the provider's agent. | 615 |
The format of, and the method of transmitting, provider claims | 616 |
shall be determined by the Ohio health care board. | 617 |
(D) All payments for health care services rendered under the | 618 |
Ohio health care plan shall be disbursed from the Ohio health care | 619 |
fund. The administrator of finance of the Ohio health care agency | 620 |
shall establish a reserve account within the Ohio health care | 621 |
fund. When the revenue available to the Ohio health care plan in | 622 |
any biennium exceeds the total amount expended or obligated during | 623 |
that biennium, the excess revenue shall be transferred to the | 624 |
reserve account. The Ohio health care board may use the money in | 625 |
the reserve account for expenses of the Ohio health care agency or | 626 |
the Ohio health care plan. | 627 |
(E) The administrator of finance of the Ohio health care | 628 |
agency shall notify the Ohio health care board when the annual | 629 |
expenditures or anticipated future expenditures of the Ohio health | 630 |
care plan appear to be in excess of the revenues or anticipated | 631 |
revenues for the same period. The Ohio health care board shall | 632 |
implement appropriate cost control measures based on the | 633 |
notification. The Ohio health care board shall seek a special | 634 |
appropriation for the Ohio health care fund if the cost control | 635 |
measures implemented do not reduce the Ohio health care plan's | 636 |
expenditures to an amount that may be covered by its revenue. | 637 |
Sec. 3920.10. (A) The Ohio health care board shall establish | 638 |
written procedures for the receipt and resolution of disputes and | 639 |
grievances. The procedures shall provide for an initial hearing | 640 |
before the appropriate regional health advisory committee in | 641 |
accordance with division (F) of section 3920.03 of the Revised | 642 |
Code. The board shall accord to plaintiffs the right to be heard | 643 |
at the hearing. | 644 |
(B) Any party aggrieved by an order or decision issued | 645 |
pursuant to the procedures established in division (A) of this | 646 |
section may appeal the order or decision to the court of common | 647 |
pleas. The appellant shall file a notice of appeal with the Ohio | 648 |
health care board within fifteen days of the filing of the appeal | 649 |
with the court of common pleas. | 650 |
(C) Appeals of denied claims may be submitted by Ohio health | 651 |
care plan beneficiaries or providers, or businesses selling | 652 |
medical equipment and supplies to the Ohio health care board. The | 653 |
board shall conduct appeals in compliance with its written | 654 |
procedures and both laws of this state and federal laws. | 655 |
Sec. 3920.11. (A) The department of job and family services | 656 |
shall determine which residents of this state employed by a health | 657 |
care insurer, health insuring corporation, or other health care | 658 |
related business, have lost employment as a result of the | 659 |
implementation and operation of the Ohio health care plan. The | 660 |
department also shall determine the amount of monthly wages that | 661 |
the resident lost due to the plan's implementation. The department | 662 |
shall attempt to position these displaced workers in comparable | 663 |
positions of employment with the Ohio health care agency. | 664 |
(B) The department of job and family services shall forward | 665 |
the information on the amount of monthly wages lost by Ohio | 666 |
residents due to the implementation of the Ohio health care plan | 667 |
to the Ohio health care agency. The Ohio health care agency shall | 668 |
determine the amount of compensation and training that each | 669 |
displaced worker shall receive and shall submit a claim to the | 670 |
Ohio health care fund for payment. A displaced worker, however, | 671 |
shall not receive compensation from the Ohio health care fund in | 672 |
excess of sixty thousand dollars per year for two years. | 673 |
Compensation paid to the displaced worker under this section shall | 674 |
serve as a supplement to any compensation the worker receives from | 675 |
the department of job and family services. | 676 |
Sec. 3920.12. (A) Any employer operating in this state and | 677 |
providing employees with benefits under a public or private health | 678 |
care policy, plan, or agreement as of the date that benefits are | 679 |
initially provided pursuant to Chapter 3920. of the Revised Code, | 680 |
which benefits are less valuable than those provided by the Ohio | 681 |
health care plan, may participate in the Ohio health care plan or | 682 |
shall provide additional benefits so that, until the expiration of | 683 |
the policy, plan, or agreement, the benefits provided by the | 684 |
employer at least equal the amount and scope of the benefits | 685 |
provided by the Ohio health care plan. If an employer chooses to | 686 |
provide additional benefits to match or exceed the benefits | 687 |
provided by the Ohio health care plan the additional benefits | 688 |
shall include the employer's payment of any employee premium | 689 |
contributions, copayments, and deductible payments called for by | 690 |
the policy, contract, or agreement. Employers are exempt from all | 691 |
health taxes imposed under Chapter 3920. of the Revised Code until | 692 |
the expiration of the policy, plan, or agreement, at which point | 693 |
the employer and the employer's employees become participants in | 694 |
the Ohio health care plan. | 695 |
(B) A person covered by a health care policy, plan, or | 696 |
agreement that has its premiums paid for in any part with public | 697 |
money, including money from the state, a political subdivision, | 698 |
state educational institution, public school, or other entity, | 699 |
shall be covered by the Ohio health care plan on the day that | 700 |
benefits become available under the Ohio health care plan. | 701 |
(C) Health care insurers, health insuring corporations, and | 702 |
other persons selling or providing health care benefits may | 703 |
deliver, issue for delivery, renew, or provide health benefit | 704 |
packages that do not duplicate the health benefit package provided | 705 |
by the Ohio health care plan, but shall not, except as provided by | 706 |
division (A) of this section, deliver, issue for delivery, renew, | 707 |
or provide health benefit packages that duplicate the health | 708 |
benefit package provided by the Ohio health care plan. | 709 |
Sec. 3920.13. The Ohio health care agency is subrogated to | 710 |
all rights of a participant who has received benefits, or who has | 711 |
a right to benefits, under any other policy or contract of health | 712 |
care. | 713 |
Sec. 3920.14. (A) All providers, as defined in section | 714 |
3920.01 of the Revised Code, may participate in the Ohio health | 715 |
care plan. | 716 |
(B) The Ohio health care board and the technical and medical | 717 |
advisory board shall assess the number of primary and specialty | 718 |
providers needed to supply adequate health care services to all | 719 |
participants in the Ohio health care plan, and shall develop a | 720 |
plan to meet that need. The Ohio health care board shall develop | 721 |
incentives for providers in order to increase residents' access to | 722 |
health care services in unserved or underserved areas of the | 723 |
state. | 724 |
(C) The Ohio health care board annually shall evaluate | 725 |
residents' access to trauma care, and shall establish measures to | 726 |
ensure participants have equitable access to trauma care and to | 727 |
specialized medical procedures and technology. | 728 |
(D) The Ohio health care board, with the advice of the | 729 |
technical and medical advisory board and the administrator of | 730 |
quality assurance, shall define performance criteria and goals for | 731 |
the Ohio health care plan and shall report to the general assembly | 732 |
at least annually on the plan's performance. The Ohio health care | 733 |
board shall establish a system to monitor the quality of health | 734 |
care and patient and provider satisfaction with that care and a | 735 |
system to devise improvements to the provision of health care | 736 |
services. | 737 |
(E) All providers subject to the Ohio health care plan shall | 738 |
provide data upon request to the Ohio health care board, which | 739 |
data the board requires to devise methods to maintain and improve | 740 |
the provision of health care services. | 741 |
(F) The Ohio health care board, with the advice of the | 742 |
technical and medical advisory board, shall coordinate the Ohio | 743 |
health care plan's provision of health care services with any | 744 |
other state and local agencies that provide health care services | 745 |
directly to their residents. | 746 |
Sec. 3920.15. In the absence of fraud or bad faith, county | 747 |
and city health commissioners, regional health advisory | 748 |
committees, and the Ohio health care board and Ohio health care | 749 |
agency and their members and employees, shall incur no liability | 750 |
in relation to the performance of their duties and | 751 |
responsibilities under sections 3920.01 to 3920.15 of the Revised | 752 |
Code. The state shall incur no liability in relation to the | 753 |
implementation and operation of the Ohio health care plan. | 754 |
Sec. 3920.21. (A) The Ohio health care board shall prepare | 755 |
and recommend to the general assembly an annual budget for health | 756 |
care that specifies and establishes a limit on total annual state | 757 |
expenditures for health care provided pursuant to sections 3920.01 | 758 |
to 3920.15 of the Revised Code. The budget shall include all of | 759 |
the following components: | 760 |
(1) A system budget covering all expenditures for the system, | 761 |
in accordance with section 3920.22 of the Revised Code; | 762 |
(2) Provider budgets for the fee-for-service and integrated | 763 |
health delivery system and for individual health care facilities | 764 |
and their associated clinics, in accordance with section 3920.23 | 765 |
of the Revised Code; | 766 |
(3) A capital investment budget in accordance with section | 767 |
3920.24 of the Revised Code; | 768 |
(4) A purchasing budget in accordance with section 3920.25 of | 769 |
the Revised Code; | 770 |
(5) A research and innovation budget in accordance with | 771 |
section 3920.26 of the Revised Code. | 772 |
(B) In preparing the budget, the Ohio health care board shall | 773 |
consider anticipated increased expenditures and savings, | 774 |
including, but not limited to, projected increases in expenditures | 775 |
due to improved access for underserved populations and improved | 776 |
reimbursement for primary care, projected administrative savings | 777 |
under the single-payer mechanism, projected savings in | 778 |
prescription drug expenditures under competitive bidding and a | 779 |
single buyer, and projected savings due to provision of primary | 780 |
care rather than emergency room treatment. | 781 |
Sec. 3920.22. (A) The system budget referred to in division | 782 |
(A)(1) of section 3920.21 of the Revised Code shall comprise the | 783 |
cost of the system, services and benefits provided, | 784 |
administration, data gathering, planning and other activities, and | 785 |
revenues deposited with the system account of the Ohio health care | 786 |
fund. | 787 |
The Ohio health care board shall limit administrative costs | 788 |
to five per cent of the system budget and shall annually evaluate | 789 |
methods to reduce administrative costs and report the results of | 790 |
that evaluation to the general assembly. The board shall also | 791 |
limit growth of health care costs in the system budget by | 792 |
reference to changes in state gross domestic product, population, | 793 |
employment rates, and other demographic indicators, as | 794 |
appropriate. Moneys in the reserve account of the Ohio health care | 795 |
fund shall not be considered as available revenues for purposes of | 796 |
preparing the system budget. | 797 |
(B) The Ohio health care board shall implement cost control | 798 |
measures pursuant to division (A) of this section. However, no | 799 |
cost control measure shall limit access to care that is needed on | 800 |
an emergency basis or that is determined by a patient's provider | 801 |
to be medically appropriate for a patient's condition. | 802 |
Mandatory cost control measures include, but are not limited | 803 |
to, some or all of the following: | 804 |
(1) Postponement of the introduction of new benefits or | 805 |
benefit improvements; | 806 |
(2) Postponement of new capital investment; | 807 |
(3) Adjustment of provider budgets to correct for | 808 |
inappropriate provider utilization; | 809 |
(4) Establishment of a limit on provider reimbursement above | 810 |
a specified amount of aggregate billing; | 811 |
(5) Deferred funding of the reserve account; | 812 |
(6) Establishment of a limit on aggregate reimbursements to | 813 |
pharmaceutical manufacturers; | 814 |
(7) Imposition of an eligibility waiting period in the event | 815 |
of substantial influx of individuals into the state for purposes | 816 |
of obtaining health care through the Ohio health care plan. | 817 |
Sec. 3920.23. (A) The provider budgets referred to in | 818 |
division (A)(2) of section 3920.21 of the Revised Code shall | 819 |
include allocations for fee-for-service providers and capitated | 820 |
providers. These allocations shall consider the relative usage of | 821 |
fee-for-service providers and capitated providers. Each annual | 822 |
provider budget shall include adjustments to reflect changes in | 823 |
the utilization of services and the addition or exclusion of | 824 |
covered services made by the Ohio health care board upon the | 825 |
recommendation of the technical and medical advisory board and its | 826 |
staff. | 827 |
(B) Providers shall choose whether they will be compensated | 828 |
as fee-for-service providers or as part of a capitated provider | 829 |
network. | 830 |
(1) The budget for fee-for-service providers shall be divided | 831 |
among categories of licensed health care providers in order to | 832 |
establish a total annual budget for each category. Each of these | 833 |
category budgets shall be sufficient to cover all included | 834 |
services anticipated to be required by eligible individuals | 835 |
choosing fee-for-service at the rates negotiated or set by the | 836 |
Ohio health care board, except as necessary for cost containment | 837 |
purposes pursuant to section 3920.22 of the Revised Code. | 838 |
The board shall negotiate fee-for-service reimbursement rates | 839 |
or salaries for licensed health care providers. In the event | 840 |
negotiations are not concluded in a timely manner, the board shall | 841 |
establish the reimbursement rates. Reimbursement rates shall | 842 |
reflect the goals of the system. | 843 |
(2) The budget shall detail all operating expenses for health | 844 |
care facilities or clinics that are not part of a capitated | 845 |
provider network. In establishing a health care facility budget, | 846 |
the Ohio health care board shall develop and utilize separate | 847 |
formulas that reflect the differences in cost of primary, | 848 |
secondary, and tertiary care services and health care services | 849 |
provided by academic medical centers. The board shall negotiate | 850 |
reimbursement rates with facilities and clinics. Reimbursement | 851 |
rates shall reflect the goals of the system. | 852 |
(C)(1) The budget for capitated providers shall be sufficient | 853 |
to cover all included services anticipated to be required by | 854 |
eligible individuals choosing an integrated health care delivery | 855 |
system at the rates negotiated or set by the Ohio health care | 856 |
board. All health care facilities, group practices, and integrated | 857 |
health care systems shall submit annual operating budget requests | 858 |
to the board and may choose to be reimbursed through a global | 859 |
facility budget or on a capitated basis. The board shall adjust | 860 |
budgets on the basis of the health risk of enrollees; the scope of | 861 |
services provided; proposed innovative programs that improve | 862 |
quality, workplace safety, or consumer, provider, or employee | 863 |
satisfaction; costs of providing care for nonmembers; and an | 864 |
appropriate operating margin. | 865 |
(2) Providers that choose to operate a health care facility | 866 |
on a capitated basis shall not be paid additionally on a | 867 |
fee-for-service basis unless they are providing services in a | 868 |
separate private medical practice or health care facility. | 869 |
Providers and health care facilities that operate on a capitated | 870 |
basis shall report immediately any projected operating deficits to | 871 |
the Ohio health care board. The board shall determine whether the | 872 |
projected deficits reflect appropriate increases in health care | 873 |
needs, in which case the board shall adjust the provider or health | 874 |
care facility budget appropriately. If the board determines that | 875 |
the deficit is not justifiable, no adjustment shall be made. | 876 |
(3) The board may terminate the funding for health care | 877 |
facilities, group practices, and integrated health care systems or | 878 |
particular services provided by them if they fail to meet | 879 |
standards of care and practice established by the board. The board | 880 |
shall make future funding contingent on measurable improvements in | 881 |
quality of care and health care outcomes. | 882 |
(D) The Ohio health care board shall prohibit charges to the | 883 |
Ohio health care plan or to patients for covered health care | 884 |
services other than those established by regulation, negotiation, | 885 |
or the appeals process. Licensed health care providers who provide | 886 |
services not covered by sections 3920.01 to 3920.15 of the Revised | 887 |
Code may charge patients for those services. | 888 |
Sec. 3920.24. (A) The capital investment budget referred to | 889 |
in division (A)(3) of section 3920.21 of the Revised Code shall be | 890 |
established by the Ohio health care board, with the advice of the | 891 |
technical and medical advisory board and its staff, and shall | 892 |
provide for capital maintenance and development. In preparing the | 893 |
budget, the Ohio health care board shall determine capital | 894 |
investment priorities and evaluate whether the capital investment | 895 |
program has improved access to services and has eliminated | 896 |
redundant capital investments. | 897 |
(B) All capital investments valued at five hundred thousand | 898 |
dollars or greater, including the costs of studies, surveys, | 899 |
design plans and working drawing specifications, and other | 900 |
activities essential to planning and execution of capital | 901 |
investment, and all capital investments that change the bed | 902 |
capacity of a health care facility or add a new service or license | 903 |
category incurred by any health system entity, shall require the | 904 |
approval of the Ohio health care board. When a health care | 905 |
facility, or individual acting on behalf of a health care | 906 |
facility, or any other purchaser, obtains by lease or comparable | 907 |
arrangement any health care facility or part of a health care | 908 |
facility, or any equipment for a health care facility, the market | 909 |
value of which would have been a capital expenditure, the lease or | 910 |
arrangement shall be considered a capital expenditure for purposes | 911 |
of sections 3920.01 to 3920.15 of the Revised Code. | 912 |
(C) Health care facilities shall provide the Ohio health care | 913 |
board with at least three-months' advance notice of any planned | 914 |
capital investment of more than fifty thousand dollars but less | 915 |
than five hundred thousand dollars. These capital investments | 916 |
shall minimize unneeded expansion of health care facilities and | 917 |
services based on the priorities and goals for capital investment | 918 |
established by the board. | 919 |
(D) No capital investment shall be undertaken using funds | 920 |
from a health care facility operating budget. | 921 |
Sec. 3920.25. The purchasing budget referred to in division | 922 |
(A)(4) of section 3920.21 of the Revised Code shall provide for | 923 |
the purchase of prescription drugs and durable and nondurable | 924 |
medical equipment for the system. The Ohio health care board shall | 925 |
purchase all prescription drugs and durable and nondurable medical | 926 |
equipment for the system from this budget. | 927 |
Sec. 3920.26. The research and innovation budget referred to | 928 |
in division (A)(5) of section 3920.21 of the Revised Code shall | 929 |
support research and innovation that has been recommended by the | 930 |
Ohio health care board, the technical and medical advisory board, | 931 |
and the administrator of consumer affairs. This research and | 932 |
innovation includes, but is not limited to, methods for improving | 933 |
the administration of the system, improving the quality of health | 934 |
care, educating patients, and improving communication among health | 935 |
care providers. | 936 |
Sec. 3920.27. The Ohio health care board shall establish a | 937 |
capital account in the Ohio health care fund as part of the Ohio | 938 |
health care plan. Moneys in the account shall be used solely to | 939 |
pay for the establishment and maintenance of a loan program for | 940 |
health care facilities and equipment for use by health care | 941 |
professionals who desire to establish practices in areas of the | 942 |
state in which, according to criteria established by the board, | 943 |
the level of health care services is inadequate. | 944 |
Sec. 3920.31. (A) As used in sections 3920.31 to 3920.33 of | 945 |
the Revised Code: | 946 |
(1) "CHIP" means the children's health insurance program | 947 |
parts I and II provided for by sections 5101.50 to 5101.5110 of | 948 |
the Revised Code. | 949 |
(2) "Federal employees health benefits program" means the | 950 |
program of health insurance benefits available to employees of the | 951 |
federal government that the United States office of personnel | 952 |
management is authorized to contract for under 5 U.S.C. 8902. | 953 |
(3) "Federal poverty guidelines" has the same meaning as in | 954 |
section 5101.46 of the Revised Code. | 955 |
(4) "Medicaid" means the program provided for under Title XIX | 956 |
of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1396, | 957 |
as amended. | 958 |
(5) "Medicare" means the program provided for under Title | 959 |
XVII of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. | 960 |
1395, as amended. | 961 |
(B) At the request of the Ohio health care board, the Ohio | 962 |
health care agency's executive director shall seek federal | 963 |
financial participation in the Ohio health care plan, including | 964 |
funding otherwise available under medicare, medicaid, CHIP, and | 965 |
the federal employees health benefits program. The executive | 966 |
director shall request that the amount of the federal financial | 967 |
participation be at least equal to the medicaid federal financial | 968 |
participation rate in effect for this state on the effective date | 969 |
of this section. The executive director shall periodically seek | 970 |
adjustments to the federal financial participation rate for the | 971 |
Ohio health care plan to reflect changes in the state domestic | 972 |
gross product, the state's population, including changes in age | 973 |
groups, and the number of residents with income below the federal | 974 |
poverty guidelines. | 975 |
Sec. 3920.32. At the request of the Ohio health care board, | 976 |
the Ohio health care agency's executive director shall negotiate | 977 |
with the United States office of personnel management to have | 978 |
included in the Ohio health care plan residents of this state who | 979 |
would otherwise be covered by the federal employees health | 980 |
benefits program. As part of the negotiations, the executive | 981 |
director shall seek to have the federal government provide the | 982 |
Ohio health care plan with amounts equal to the amount federal | 983 |
employees participating in the Ohio health care plan would | 984 |
otherwise pay as premiums under the federal employees health | 985 |
benefits program. | 986 |
Sec. 3920.33. At the request of the Ohio health care board, | 987 |
the director of job and family services shall seek any federal | 988 |
waivers necessary for the Ohio health care plan to receive federal | 989 |
financial participation under section 3920.31 of the Revised Code | 990 |
otherwise available under the medicaid and CHIP programs. | 991 |
Notwithstanding sections 5101.50 to 5101.5110 of the Revised Code | 992 |
and Chapter 5111. of the Revised Code, the director of job and | 993 |
family services shall cease to implement the medicaid and CHIP | 994 |
programs on implementation of federal waivers authorizing the use | 995 |
of federal medicaid and CHIP funds for the Ohio health care plan, | 996 |
if necessary due to the implementation of the waivers. | 997 |
Section 2. That existing section 109.02 of the Revised Code | 998 |
is hereby repealed. | 999 |
Section 3. This act shall be known as the "Ohio Health | 1000 |
Security Act." | 1001 |
Section 4. In the first two years following the effective | 1002 |
date of sections 3920.01 to 3920.33 of the Revised Code, the Ohio | 1003 |
Health Care Board shall prepare for the delivery of universal, | 1004 |
affordable health care coverage to all eligible Ohio residents and | 1005 |
individuals employed in Ohio. The Ohio Health Care Board shall | 1006 |
appoint a Transition Advisory Group to assist with the transition | 1007 |
to the provision of care under the Ohio Health Care Plan. The | 1008 |
transition group shall include, but is not limitedto, a broad | 1009 |
selection of experts in health care finance and administration, | 1010 |
providers from a variety of medical fields, representatives of | 1011 |
Ohio's counties, employers and employees, representatives of | 1012 |
hospitals and clinics, and representatives from state regulatory | 1013 |
bodies. Members of the Transition Advisory Group shall be | 1014 |
reimbursed by the Ohio Health Care Agency for necessary and actual | 1015 |
expenses incurred in the performance of their duties as members. | 1016 |