SUB. H.B. 49 AS PASSED BY THE HOUSE SELECTED HOSPITAL-RELATED PROVISIONS

Transcription

1 SUB. H.B. 49 AS PASSED BY THE HOUSE SELECTED HOSPITAL-RELATED PROVISIONS HOSPITAL ISSUES: CONTENTS Medicaid payment rates for hospital services... 2 Medicaid eligibility requirements for expansion group... 2 Controlling Board authorization regarding Medicaid expenditures... 3 Legislative oversight of rules increasing Medicaid rates... 4 Health services cost estimates... 6 Managed care payment rates for non-contracting hospitals... 6 Behavioral health redesign... 7 Health insuring corporation franchise fee... 7 Hospital Franchise Fee Program Coverage of telemedicine services Patient-centered medical home program Biennial review and submission of hospital nurse staffing plan Hospital data collection and disclosure Hospital Care Assurance match Medicaid rates for neonatal and newborn services Transfer of certain ODH program enrollees to medicaid and new non-medicaid program Medicaid waiver to provide services at insitutions for mental diseases RESOURCES: Comparison document: hp.pdf Substitute Bill:

2 Page 2 MEDICAID PAYMENT RATES FOR HOSPITAL SERVICES (P. 514) MCDCD55 Sets the Medicaid payment rate for a hospital service provided from July 1, 2017, through June 30, 2019, to an amount that is equal to the amount that was paid for the same service on January 1, 2017, except for any change resulting from the rebasing or recalibration of hospital rates on July 1, Requires ODM to reduce payment rates for hospital services if it projects after January 1, 2018, that the total amount to be paid for hospital services could exceed $6.9 billion in either fiscal year. Fiscal effect: Decreases expenditures in GRF appropriation item , Medicaid/Health Care Services, by $197 million ($57.7 million state share) in FY 2018 and by $100 million ($29.3 million state share) in FY Section PAYMENT RATES FOR HOSPITAL SERVICES (A) The Medicaid payment rate for a hospital service provided during the period beginning July 1, 2017, and ending June 30, 2019, shall equal the rate that was in effect for the same type of hospital service on January 1, 2017, except as provided in division (B) of this section and for any change in that rate that occurs as a result of any rebasing or recalibration of hospital payment rates by the Department of Medicaid on July 1, (B) If the Department of Medicaid determines at any time after January 1, 2018, that the total amount projected for making Medicaid payments for hospital services in accordance with division (A) of this section could exceed $6,900,000,000 in fiscal year 2018 or $6,900,000,000 in fiscal year 2019, the Department shall reduce the Medicaid payment rates for hospital services as necessary to remain within those limitations for each fiscal year. [p.4374] MEDICAID ELIGIBILITY REQUIREMENTS FOR EXPANSION GROUP (P. 498) MCDCD59 Requires the ODM Director to establish a waiver program under which an individual included in the Medicaid expansion group (Group VIII) must satisfy at least one of a list of requirements to be eligible for Medicaid. Fiscal effect: This provision will likely reduce the number of Medicaid enrollees in the expansion group, thus reducing costs. Sec The medicaid director shall establish a medicaid waiver component under which an individual included in the eligibility group described in section 1902(a)(10)(A)(i)(VIII) of the "Social 2

3 Page 3 Security Act," 42 U.S.C. 1396a(a)(10)(A)(i)(VIII), must satisfy at least one of the following requirements to be able to enroll in medicaid as part of the eligibility group: (A) Be at least fifty-five years of age; (B) Be employed; (C) Be enrolled in school or an occupational training program; (D) Be participating in an alcohol and drug addiction treatment program; (E) Have intensive health care needs. [p ] CONTROLLING BOARD AUTHORIZATION REGARDING MEDICAID EXPENDITURES (P. 504) MCDCD73 Provides for the Health and Human Services Fund to continue to exist during the fiscal biennium. Requires the OBM Director to transfer $57,885,768 in FY 2018 and $68,661,704 in FY 2019 from the GRF to the Health and Human Services Fund. Permits the ODM Director, not more than once every six months during the fiscal biennium, to request that the Controlling Board authorize expenditure from the Health and Human Services Fund in an amount necessary to pay for the costs of the Medicaid program. Specifies conditions that must be met in order for the Controlling Board to be permitted to authorize the expenditure. Permits the OBM Director, if the Controlling Board authorizes the expenditures, to transfer up to $26,309,868 in FY 2018 and $34,667,668 in FY 2019 from Fund 5DL0 and up to $196,226,296 in FY 2018 and $226,841,369 in FY 2019 from Fund 5TN0 to the Health and Human Services Fund. Section CASH TRANSFERS TO THE HEALTH AND HUMAN SERVICES FUND On July 1, 2017, or as soon as possible thereafter, the Director of Budget and Management shall transfer $57,885,768 cash from the General Revenue Fund to the Health and Human Services Fund. Upon Controlling Board authorization of expenditures under division (B) of the section of this act titled "HEALTH AND HUMAN SERVICES FUND CONTINUED" during fiscal year 2018, the Director of Budget and Management may transfer up to $26,309,868 cash from the Support and Recoveries Fund (Fund 5DL0), and up to $196,226,296 cash from the HIC Class Franchise Fee Fund (Fund 5TN0) to the Health and Human Services Fund. On July 1, 2018, or as soon as possible thereafter, the Director of Budget and Management shall transfer $68,661,704 cash from the General Revenue Fund to the Health and Human Services Fund. 3

4 Page 4 Upon Controlling Board authorization of expenditures under division (B) of the section of this act titled "HEALTH AND HUMAN SERVICES FUND CONTINUED" during fiscal year 2019, the Director of Budget and Management may transfer up to $34,667,668 cash from the Support and Recoveries Fund (Fund 5DL0), and up to $226,841,369 cash from the HIC Class Franchise Fee Fund (Fund 5TN0) to the Health and Human Services Fund. Section HEALTH AND HUMAN SERVICES FUND CONTINUED (A) The Health and Human Services Fund created under Section of Am. Sub. H.B. 64 of the 131st General Assembly shall continue to exist during the fiscal biennium. (B) Not more than once every six months during the fiscal biennium, the Medicaid Director may request the Controlling Board to authorize expenditure from the Health and Human Services Fund in an amount necessary to pay for the costs of the Medicaid program. The amount per request may not exceed the amount of such costs for six months. The Controlling Board may authorize the expenditure if both of the following requirements are met: (1) The United States Congress has not amended on or after the effective date of this section the federal law governing the federal medical assistance percentage in a manner that reduces the percentage. (2) The Controlling Board is satisfied with both of the following: (a) Any changes, other than a change described in division (B)(1) of this section, made on or after the effective date of this section by the United States Congress to federal law governing health and human services issues; (b) The progress made by the executive branch of the government of this state in all of the following: (i) Obtaining an innovative waiver regarding health insurance coverage in this state as required by section of the Revised Code and subsequently implementing the waiver; (ii) Obtaining a federal Medicaid waiver for the Healthy Ohio Program established under section of the Revised Code and subsequently implementing the Program; (iii) Enforcing state law that requires health care providers to give cost estimates to patients before rendering health care services to the patients. [p ] LEGISLATIVE OVERSIGHT OF RULES INCREASING MEDICAID RATES (P. 489) MCDC68 Prohibits the implementation of a proposal to increase a Medicaid payment rate if any of the following occurs: 4

5 Page 5 (1) The Department of Medicaid or other responsible state agency fails to submit the proposal to JMOC. (2) JMOC votes, not later than 30 days after receiving the proposal, to prohibit the proposal's implementation. (3) The General Assembly, not later than ninety days after JMOC's deadline, adopts a concurrent resolution prohibiting the proposal's implementation. Fiscal effect: Increase in the administrative costs involved in increasing a Medicaid payment rate. Sec (A) Neither the department of medicaid, nor another state agency with which the department has entered into a contract under section of the Revised Code to administer one or more components of the medicaid program or one or more aspects of a component, may increase the medicaid payment rate for a medicaid service, by rule or otherwise, if any of the following applies: (1) The department or other state agency fails to submit the proposal to the joint medicaid oversight committee in accordance with section of the Revised Code. (2) The joint medicaid oversight committee votes, not later than the deadline established by section of the Revised Code, to prohibit the implementation of the proposal. (3) The general assembly, not later than ninety days after that deadline, adopts a concurrent resolution prohibiting the implementation of the proposal. (B) The general assembly's authority to adopt a concurrent resolution prohibiting the implementation of a proposal to increase the medicaid payment rate for a medicaid service applies regardless of whether the joint medicaid oversight committee votes to permit the implementation of the proposal or fails to vote on the proposal before the deadline. (C) This section applies to a proposal to increase the medicaid payment rate for a medicaid service regardless of whether the proposal involves a change to the method by which the rate is to be determined or specifies the actual amount of the rate increase. Sec (A) During the period beginning July 1, 2015, and ending June 30, 2018, the joint medicaid oversight committee JMOC on a quarterly basis shall monitor the actions of the department of medicaid under section of the Revised Code in preparing to implement and implementing inclusion of alcohol, drug addiction, and mental health services covered by medicaid in the care management system established under section of the Revised Code. (B)(1) The committee shall review any proposal by the department to include all or part of the services in all or part of the system before January 1, In conducting its review, the committee shall consider all of the following for each service to be included: 5

6 Page 6 (a) The proposed timeline for including the service; (b) Any issues related to medicaid recipients' access to the service; (c) The adequacy of the network of providers of the service (d) Payment levels for the service. (2) The committee shall vote on whether to approve or disapprove the proposal. If a majority of the committee members approve the proposal, the committee shall notify the department and the proposal may be implemented. (C) Beginning July 1, 2018, the committee Code. When the inclusion of the services in the system begins to be implemented, JMOC on a periodic basis shall monitor the department's inclusion of the services in the system. [p ] Sec The medicaid director shall adopt rules under sections , , , , , , and of the Revised Code as necessary to authorize the directors of other state agencies to adopt rules regarding medicaid components, or aspects of medicaid components, the other state agencies administer pursuant to contracts entered into under section of the Revised Code. When the director of another state agency adopts a rule that would increase the medicaid payment rate for a medicaid service provided under a medicaid component or aspect of a medicaid component that the other state agency administers, the director of the other state agency shall comply with section of the Revised Code as if that director were the medicaid director. [p ] HEALTH SERVICES COST ESTIMATES (P. 517) MCDCD35 NO PROVISION (MAINTAINS CURRENT LAW) Also, repeals the law establishing the Health Services Price Disclosure Study Committee. Section That Section 7 of Am. Sub. H.B. 52 of the 131st General Assembly is hereby repealed. [p.4615] MANAGED CARE PAYMENT RATES FOR NON-CONTRACTING HOSPITALS (P. 501) MCDCD37 NO PROVISION (MAINTAINS CURRENT LAW) 6

7 Page 7 BEHAVIORAL HEALTH REDESIGN (P. 500) MCDCD56 Prohibits alcohol, drug addiction, and mental health services from being included in Medicaid managed care before July 1, Prohibits other elements of the behavioral health redesign from being implemented before January 1, Fiscal effect: Decreases expenditures in GRF appropriation item , Medicaid/Health Care Services, by $122.6 million ($34.1 million state share) in FY Increases expenditures in GRF appropriation item , Medicaid/Health Care Services by $129.6 million ($36.2 million state share) in FY Sec (A) Subject to division (B) of this section, the The department of medicaid shall include alcohol, drug addiction, and mental health services covered by medicaid in the care management system established under section of the Revised Code. (B) All of the following apply to the manner in which division (A) of this section is implemented: (1) The department shall begin to include the services in the system not later than January Code. The services shall not be included in the system before July 1, (2) Before January 1, 2018, any proposal by the department to include all or part of the services in all or part of the system is subject to review by the joint medicaid oversight committee under division (B) of section of the Revised Code. The department may implement the proposal only if the committee approves the proposal. (3) On and after January 1, 2018, any proposal by the department to include all or part of the services in all or part of the system is subject to monitoring by the committee under division (A) or (C) of section of the Revised Code, but approval by the committee is no longer required before the proposal may be implemented. [p ] Other sections: R.C , , and Section HEALTH INSURING CORPORATION FRANCHISE FEE (P.502) MCDCD39 SAME AS EXECUTIVE Levies a monthly franchise fee on health insuring corporations beginning July Sets the rate for each Ohio Medicaid member month, that is a month in which an Ohio Medicaid recipient is enrolled in the health insuring corporation, equal to: (1) $56 for the first 250,000 Medicaid member months; (2) $45 for the second 250,000 Medicaid member months; (3) $26 for each Medicaid member month above 500,000. 7

8 Page 8 Sets the rate for each other Ohio member month, that is a month in which an Ohio resident who is not a Medicaid recipient is enrolled in the health insuring corporation, equal to: (1) $2 for the first 150,000 other member months; (2) $1 for all other member months above 150,000. Fiscal effect: ODM estimates that the fee will be charged on approximately 30.8 million Medicaid member months and 2.7 million other member months per year, raising an annual $854 million and $4 million, respectively. Medicaid MCOs will be reimbursed $854 million for their payments, of which approximately $243 million will be state share and $611 million will be federal share. On net, therefore, the state will realize a gain of $615 million in annual revenue. This new franchise fee is intended to replace the current sales and use tax on the Medicaid managed care organization payments which the Centers for Medicare & Medicaid Services (CMS) deemed an impermissible health care tax. CMS gave Ohio until June 30, 2017 to comply. Sec (A) For the purposes specified in section of the Revised Code and subject to sections , , and of the Revised Code, a franchise fee is hereby imposed each month beginning with July 2017 on each health insuring corporation. follows: (B) The amount of a health insuring corporation's franchise fee for a month shall be determined as (1) Multiply the number of Ohio medicaid member months that the health insuring corporation had for the month by the applicable rate or rates as determined in accordance with division (C) of this section; (2) Multiply the number of other Ohio member months that the health insuring corporation had for the month by the applicable rate or rates as determined in accordance with division (D) of this section; (3) Determine the sum of the products determined under divisions (B)(1) and (2) of this section. (C) The applicable rate or rates to be used in the calculation under division (B)(1) of this section for a health insuring corporation for a month shall depend on the cumulative total number of Ohio medicaid member months the health insuring corporation had for all of a fiscal year's months that ended before the beginning of the month in which the franchise fee is due. The following table shows the applicable rate or rates: CUMULATIVE TOTAL NUMBER OF OHIO MEDICAID MEMBER MONTHS APPLICABLE RATE For the first 250,000 $56 For 250,001 to 500,000 $45 8

9 Page 9 For 500,001 and above $26 (D) The applicable rate or rates to be used in the calculation under division (B)(2) of this section for a health insuring corporation for a month shall depend on the cumulative total number of other Ohio member months the health insuring corporation had for all of a fiscal year's months that ended before the beginning of the month in which the franchise fee is due. The following table shows the applicable rate or rates: CUMULATIVE TOTAL NUMBER OF OTHER OHIO APPLICABLE RATE MEMBER MONTHS For the first 150,000 $2 For 150,001 and above $1 Sec Beginning in August 2017, each health insuring corporation shall do both of the following not later than the fifth business day of each month: (A) Inform the department of medicaid of both of the following in a manner the department prescribes: (1) The cumulative total number of Ohio medicaid member months the health insuring corporation had for all of a fiscal year's months that ended before the beginning of the month in which the information is being provided; (2) The cumulative total number of other Ohio member months the health insuring corporation had for all of a fiscal year's months that ended before the beginning of the month in which the information is being provided. (B) Pay to the department the amount of its franchise fee for the immediately preceding month. Sec The department of medicaid may request that a health insuring corporation provide the department documentation the department needs to verify the health insuring corporation's cumulative total number of Ohio medicaid member months and other Ohio member months. On receipt of the request, the health insuring corporation shall provide the department the requested documentation. The department also may review relevant documentation possessed by other entities for the purpose of making such verifications. 9

10 Page 10 Sec If the department of medicaid determines that the amount of the franchise fee that a health insuring corporation pays for a month is less than the amount it should have paid, the department shall notify the health insuring corporation. Except as otherwise provided by the results of a reconsideration conducted under section of the Revised Code, the health insuring corporation shall pay the amount due. Sec A health insuring corporation may request a reconsideration of a determination made by the department of medicaid under section of the Revised Code. A reconsideration may be requested solely on the grounds that the department made a material error in making the determination. A request for a reconsideration must be received by the department not later than fifteen days after the date the department notifies the health insuring corporation of the department's determination and must include written materials setting forth the basis for the reconsideration. If a health insuring corporation requests a reconsideration within the time required, the department shall reconsider the determination and issue a final decision not later than thirty days after the date the department receives the request. Sec If a health insuring corporation fails to pay the full amount of a franchise fee when due, the department of medicaid may assess a ten per cent penalty on the amount due for each month or fraction thereof that the franchise fee is overdue. Sec The franchise fee shall not be imposed on any health insuring corporation unless there is in effect a waiver authorizing the franchise fee issued by the United States secretary of health and human services pursuant to section 1903(w)(3)(E) of the "Social Security Act," 42 U.S.C. 1396b(w)(3)(E). Sec If the total amount of franchise fees imposed on all health insuring corporations under section of the Revised Code during a fiscal year exceeds the indirect guarantee percentage of the net patient revenue for all health insuring corporations for that fiscal year and seventy-five per cent or more of all health insuring corporations receive enhanced medicaid payments or other state payments equal to seventy-five per cent or more of their total franchise fees, the department of medicaid shall refund the excess amount of the franchise fees to the health insuring corporations. 10

11 Page 11 Sec If the United States centers for medicare and medicaid services determines that the franchise fee is an impermissible health care-related tax under the section 1903(w) of the "Social Security Act," 42 U.S.C. 1396b(w), the department of medicaid shall do either of the following as appropriate: (A) Modify the imposition of the franchise fee, including (if necessary) the amount of the franchise fee, in a manner needed for the United States centers to reverse its determination; (B) Take all necessary actions to cease the imposition of the franchise fee until the determination is reversed. Sec (A) There is hereby created in the state treasury the health insuring corporation franchise fee fund. All payments and penalties paid by health insuring corporations under sections , , and of the Revised Code shall be deposited into the fund. Money in the fund shall be used to make medicaid payments to medicaid providers and medicaid managed care organizations. (B) Any money remaining in the health insuring corporation franchise fee fund after payments specified in division (A) of this section are made shall be retained in the fund. Any interest or other investment proceeds earned on money in the fund shall be credited to the fund and used to make medicaid payments in accordance with division (A) of this section. Sec The medicaid director may adopt rules in accordance with Chapter 119. as necessary to implement sections to of the Revised Code. [p ] HOSPITAL FRANCHISE FEE PROGRAM (P.508) MCDCD14 SAME AS EXECUTIVE Permits the OBM Director to authorize additional expenditures from appropriation items , Medicaid Services - Federal; , Medicaid Health Care Services, and , Medicaid Services - Hospital/UPL, to implement the hospital assessment fee. Appropriates any authorized amounts. Section HOSPITAL FRANCHISE FEE PROGRAM The Director of Budget and Management may authorize additional expenditures from appropriation item , Medicaid Services - Federal, appropriation item , Medicaid Health Care Services, and appropriation item , Medicaid Services - Hospital/UPL, in order to implement the programs 11

12 Page 12 authorized by sections through of the Revised Code. Any amounts authorized are hereby appropriated. [p. 4364] COVERAGE OF TELEMEDICINE SERVICES (P.422) INSCD6 Requires a health benefit plan to cover telemedicine services on the same basis and to the same extent that the plan covers in-person health services, and prohibits such plans from excluding coverage for a service solely because it is provided as a telemedicine service. Stipulates that these requirements are not to be construed as prohibiting a health benefit plan from assessing costsharing requirements to a covered individual for telemedicine services, provided that such cost sharing requirements for telemedicine services are not greater than those for comparable in-person services. Stipulates that these requirements are not to be construed as requiring a health plan issuer to reimburse a physician for any costs or fees associated with the provision of telemedicine services that would be in addition to or greater than the standard reimbursement for a comparable in-person service. Applies these requirements to health benefit plans issued, offered, or renewed on or after January 1, Fiscal effect: "Health benefit plan" is defined as in section of the Revised Code, and includes a nonfederal, government health plan. The requirement may increase costs for the state, counties, municipalities, townships, and school districts statewide to provide health benefits to their employees and their dependents. The magnitude of the fiscal impact on any of these entities is unknown at this time. Sec (A) As used in this section: (1) "Health benefit plan" and "health plan issuer" have the same meanings as under section of the Revised Code. (2) "In-person services" means a medical service delivered by a physician through the use of any communication method where the physician and patient are simultaneously present in the same geographic location. (3) "Physician" means an individual authorized under Chapter of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery, including the holder of a telemedicine certificate issued under section of the Revised Code. (4) "Telemedicine service" means a medical service delivered by a physician through the use of any communication method where the physician and patient are not simultaneously present in the same location, including oral, written, or electronic communication. (B)(1) A health benefit plan shall provide coverage for the cost of telemedicine services on the same basis and to the same extent that the plan provides coverage for the provision of in-person health services. 12

13 Page 13 (2) A health benefit plan shall not exclude coverage for a service solely because it is provided as a telemedicine service. (C) A health benefit plan shall not impose any annual or lifetime benefit maximum in relation to telemedicine services other than such a benefit maximum imposed on all benefits offered under the plan. (D) This section shall not be construed as prohibiting a health benefit plan from assessing costsharing requirements to a covered individual for telemedicine services, provided that such cost sharing requirements for telemedicine services are not greater than those for comparable in-person services. (E) This section shall not be construed as requiring a health plan issuer to reimburse a physician for any costs or fees associated with the provision of telemedicine services that would be in addition to or greater than the standard reimbursement for a comparable in-person service. (F) This section shall apply to all health benefit plans issued, offered, or renewed on or after January 1, [p ] PATIENT-CENTERED MEDICAL HOME PROGRAM (P. 491) MCDCD60 Eliminates the authority of the ODM Director to implement as part of the Medicaid program a system under which individuals with chronic conditions receive health home services and the Director's authority to implement a similar system for individuals with developmental disabilities. Abolishes ODM's patient-centered medical home program. (The program is often called the Comprehensive Primary Care Program). Fiscal effect: Decreases expenditures in GRF appropriation item , Medicaid/Health Care Services, by $51.6 million ($13.6 million state share) in FY 2018 and $72 million ($19.1 million state share) in FY Repealed , Section PATIENT-CENTERED MEDICAL HOME PROGRAM The Department of Medicaid's patient-centered medical home program, also known as the Comprehensive Primary Care Program, is hereby abolished. [p.4372] BIENNIAL REVIEW AND SUBMISSION OF HOSPITAL NURSE STAFFING PLAN (P. 322) DOHCD32 Requires each hospital to have its nursing services staffing plan reviewed by the hospital's nursing care committee at least once every two years rather than annually. 13

14 Page 14 Requires a hospital, not later than March 1 each even-numbered year, to submit to ODH its nursing services staffing plan in effect at that time. Fiscal effect: Potential decrease in administrative costs for government-owned hospitals since staffing plans will be reviewed every two years instead of annually; potential minimal increase in administrative costs for ODH to review staffing plans. Sec (A) At least once a year every two years, the hospital-wide nursing care committee convened pursuant to section of the Revised Code shall do both of the following: (A)(1) Review how the most current nursing services staffing plan in effect at the time of the review does all of the following: (1)(a) Affects inpatient care outcomes; (2)(b) Affects clinical management; (3)(c) Facilitates a delivery system that provides, on a cost-effective basis, quality nursing care consistent with acceptable and prevailing standards of safe nursing care and evidenced-based evidence-based guidelines established by national nursing organizations. (B)(2) Make recommendations, based on the most recent review conducted under division (A)(1) of this section, regarding how the most current nursing services staffing plan should be revised, if at all. (B) Beginning in 2018, a hospital shall submit to the department of health, by March 1 of each evennumbered year, a copy of the hospital's nursing services staffing plan in effect at that time. [p.1665] HOSPITAL DATA COLLECTION AND DISCLOSURE (P. 322) DOHCD3 SAME AS EXECUTIVE Repeals provisions requiring hospitals to submit the following to the ODH Director: (1) for inpatient services, information pertaining to admission, length of stay, discharge, and hospital charges, (2) for outpatient services, information pertaining to the number of patients receiving those services and hospital charges, and (3) for both inpatient and outpatient services, certain performance measure information. Fiscal effect: Government-owned hospitals and ODH could experience a decrease in administrative costs. Repealed Sec The director of health may apply to the court of common pleas of the county in which a hospital is located for a temporary or permanent injunction restraining the hospital from failure to comply with sections , , and section of the Revised Code. [p ] 14

15 Page 15 HOSPITAL CARE ASSURANCE MATCH (P. 509) MCDCD17 SAME AS EXECUTIVE Permits the OBM Director, at the request of the ODM Director, to authorize additional expenditures from the Health Care Federal Fund (Fund 3F00) if receipts credited to the fund exceed the amounts appropriated. Appropriates any authorized amounts. Same as the Executive. Requires that appropriation item , Medicaid Services Hospital Care Assurance Program, be used by ODM for distributing the state share of all HCAP funds to hospitals. Permits the OBM Director, at the request of the ODM Director, to authorize additional expenditures from the Hospital Care Assurance Program Fund (Fund 6510) if receipts credited to the fund exceed the amounts appropriated. Appropriates any authorized amounts. Section HOSPITAL CARE ASSURANCE MATCH If receipts credited to the Health Care Federal Fund (Fund 3F00) exceed the amounts appropriated from the fund for making the hospital care assurance program distribution, the Medicaid Director may request the Director of Budget and Management to authorize expenditures from the fund in excess of the amounts appropriated. Upon the approval of the Director of Budget and Management, the additional amounts are hereby appropriated. The foregoing appropriation item , Medicaid Services Health Care Assurance Program, shall be used by the Department of Medicaid for distributing the state share of all hospital care assurance program funds to hospitals under section of the Revised Code. If receipts credited to the Hospital Care Assurance Program Fund (Fund 6510) exceed the amounts appropriated from the fund for making the hospital care assurance program distribution, the Medicaid Director may request the Director of Budget and Management to authorize expenditures from the fund in excess of the amounts appropriated. Upon the approval of the Director of Budget and Management, the additional amounts are hereby appropriated. [p ] MEDICAID RATES FOR NEONATAL AND NEWBORN SERVICES (P.491) MCDCD50 Requires that the Medicaid rates for certain neonatal and newborn services equal 75% of the Medicare rates for the services. Requires that the Medicaid rates for other services selected by the ODM Director be reduced to avoid an increase in Medicaid expenditures. Fiscal effect: None. Sec (A) The medicaid payment rates for the following neonatal and newborn services shall equal seventy-five per cent of the medicare payment rates for the services in effect on the date the services are provided to medicaid recipients eligible for the services: 15

16 Page 16 (1) Initial care for normal newborns; (2) Subsequent day, hospital care for normal newborns; (3) Same day, initial history and physical examination and discharge for normal newborns; (4) Initial neonatal critical care for children not more than twenty-eight days old; (5) Subsequent day, neonatal critical care for children not more than twenty-eight days old; (6) Subsequent day, pediatric critical care for children at least twenty-nine days but less than two years old; (7) Initial neonatal intensive care; (8) Subsequent day, neonatal intensive noncritical care for children weighing less than one thousand five hundred grams; (9) Subsequent day, neonatal intensive noncritical care for children weighing at least one thousand five hundred grams but not more than two thousand five hundred grams; (10) Subsequent day, neonatal noncritical care for children weighing more than two thousand five hundred grams but not more than five thousand grams. (B) The medicaid payment rates for other medicaid services selected by the medicaid director shall be less than the amount of the rates in effect on the effective date of this section so that the cost of the rates set pursuant to division (A) of this section do not increase medicaid expenditures. The director may not select any medicaid service for which the medicaid payment rate is determined in accordance with state statutes. [p ] TRANSFER OF CERTAIN ODH PROGRAM ENROLLEES TO MEDICAID AND NEW NON-MEDICAID PROGRAM (P. 484) MCDCD45 NO PROVISION (MAINTAINS CURRENT LAW) MEDICAID WAIVER TO PROVIDE SERVICES AT INSTITUTIONS FOR MENTAL DISEASES (P. 498) MCDCD54 Requires ODM to create and administer a Medicaid waiver component to provide services to eligible individuals between the ages of 21 and 64 at institutions for mental diseases, which are hospitals and other facilities of more than 16 beds primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases. Fiscal effect: Potential increase in Medicaid costs for a new waiver program; the increase will depend on the number of eligible individuals and the services being provided. 16

17 Page 17 Sec As used in this section, "institution for mental diseases" has the same meaning as in 42 C.F.R The department of medicaid shall create and administer a medicaid waiver component under which services are provided to eligible individuals at least twenty-one years of age but less than sixty-five years of age who are in need of care at an institution for mental diseases [p. 2839] 17