Bill Text: OH SB23 | 2011-2012 | 129th General Assembly | Introduced

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Bill Title: To provide that a terminally ill individual with an anticipated life expectancy of five years or less who is on a waiting list for the PACE program or a Medicaid waiver program providing home and community-based services is to have priority over other individuals on such a waiting list.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2011-02-01 - To Health, Human Services, & Aging [SB23 Detail]

Download: Ohio-2011-SB23-Introduced.html

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As Introduced

129th General Assembly Regular Session 2011-2012

S. B. No. 23

Senator Tavares 

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A BILL

To amend section 5111.851 and to enact section

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173.405 of the Revised Code to provide that a

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terminally ill individual with an anticipated life

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expectancy of five years or less who is on a

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waiting list for the PACE program or a Medicaid

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waiver program providing home and community-based

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services is to have priority over other

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individuals on such a waiting list.

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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That section 5111.851 be amended and section	9
173.405 of the Revised Code be enacted to read as follows:	10

Sec. 173.405.  An individual diagnosed as terminally ill with	11
an anticipated life expectancy of five years or less who is on the	12
unified waiting list established under section 173.404 of the	13
Revised Code shall have priority for enrollment in the PACE	14
program over other individuals on the waiting list.	15

Sec. 5111.851.  (A) As used in sections 5111.851 to 5111.855	16
of the Revised Code:	17

"Administrative agency" means, with respect to a home and	18
community-based services medicaid waiver component, the department	19
of job and family services or, if a state agency or political	20
subdivision contracts with the department under section 5111.91 of	21
the Revised Code to administer the component, that state agency or	22
political subdivision.	23

"Level of care determination" means a determination of	24
whether an individual needs the level of care provided by a	25
hospital, nursing facility, or intermediate care facility for the	26
mentally retarded and whether the individual, if determined to	27
need that level of care, would receive hospital, nursing facility,	28
or intermediate care facility for the mentally retarded services	29
if not for a home and community-based services medicaid waiver	30
component.	31

"Medicaid buy-in for workers with disabilities program" means	32
the component of the medicaid program established under sections	33
5111.70 to 5111.7011 of the Revised Code.	34

"Skilled nursing facility" means a facility certified as a	35
skilled nursing facility under Title XVIII of the "Social Security	36
Act," 79 Stat. 286 (1965), 42 U.S.C. 1395, as amended.	37

(B) The following requirements apply to each home and	38
community-based services medicaid waiver component:	39

(1) Only an individual who qualifies for a component shall	40
receive that component's services.	41

(2) A level of care determination shall be made as part of	42
the process of determining whether an individual qualifies for a	43
component and shall be made each year after the initial	44
determination if, during such a subsequent year, the	45
administrative agency determines there is a reasonable indication	46
that the individual's needs have changed.	47

(3) A written plan of care or individual service plan based	48
on an individual assessment of the services that an individual	49
needs to avoid needing admission to a hospital, nursing facility,	50
or intermediate care facility for the mentally retarded shall be	51
created for each individual determined eligible for a component.	52

(4) Each individual determined eligible for a component shall	53
receive that component's services in accordance with the	54
individual's level of care determination and written plan of care	55
or individual service plan.	56

(5) No individual may receive services under a component	57
while the individual is a hospital inpatient or resident of a	58
skilled nursing facility, nursing facility, or intermediate care	59
facility for the mentally retarded.	60

(6) No individual may receive prevocational, educational, or	61
supported employment services under a component if the individual	62
is eligible for such services that are funded with federal funds	63
provided under 29 U.S.C. 730 or the "Individuals with Disabilities	64
Education Act," 111 Stat. 37 (1997), 20 U.S.C. 1400, as amended.	65

(7) Safeguards shall be taken to protect the health and	66
welfare of individuals receiving services under a component,	67
including safeguards established in rules adopted under section	68
5111.85 of the Revised Code and safeguards established by	69
licensing and certification requirements that are applicable to	70
the providers of that component's services.	71

(8) No services may be provided under a component by a	72
provider that is subject to standards that 42 U.S.C. 1382e(e)(1)	73
requires be established if the provider fails to comply with the	74
standards applicable to the provider.	75

(9) Individuals determined to be eligible for a component, or	76
such individuals' representatives, shall be informed of that	77
component's services, including any choices that the individual or	78
representative may make regarding the component's services, and	79
given the choice of either receiving services under that component	80
or, as appropriate, hospital, nursing facility, or intermediate	81
care facility for the mentally retarded services.	82

(10) No individual shall lose eligibility for services under	83
a component, or have the services reduced or otherwise disrupted,	84
on the basis that the individual also receives services under the	85
medicaid buy-in for workers with disabilities program.	86

(11) No individual shall lose eligibility for services under	87
a component, or have the services reduced or otherwise disrupted,	88
on the basis that the individual's income or resources increase to	89
an amount above the eligibility limit for the component if the	90
individual is participating in the medicaid buy-in for workers	91
with disabilities program and the amount of the individual's	92
income or resources does not exceed the eligibility limit for the	93
medicaid buy-in for workers with disabilities program.	94

(12) No individual receiving services under a component shall	95
be required to pay any cost sharing expenses for the services for	96
any period during which the individual also participates in the	97
medicaid buy-in for workers with disabilities program.	98

(13) An individual diagnosed as terminally ill with an	99
anticipated life expectancy of five years or less who is on a	100
waiting list for a home and community-based services medicaid	101
waiver component shall have priority for enrollment in the	102
component over other individuals on the waiting list.	103

Section 2. That existing section 5111.851 of the Revised Code	104
is hereby repealed.	105