Establish and operate the Ohio Health Care Plan

As Introduced

136th
General Assembly

Regular
Session
S. B. No. 78

2025-2026

Senators Hicks-Hudson, DeMora

Cosponsors: Senators Weinstein,
Liston, Smith, Antonio, Craig

A
BILL

To
amend section 109.02 and to enact sections 3920.01, 3920.02, 3920.03,
3920.04, 3920.05, 3920.06, 3920.07, 3920.08, 3920.09, 3920.10,
3920.11, 3920.12, 3920.13, 3920.14, 3920.15, 3920.21, 3920.22,
3920.23, 3920.24, 3920.25, 3920.26, 3920.27, 3920.28, 3920.31,
3920.32, and 3920.33 of the Revised Code

to establish and operate the Ohio Health Care Plan to provide
universal health care coverage to all Ohio residents.

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

Section
1.
That
section 109.02 be amended and sections 3920.01, 3920.02, 3920.03,
3920.04, 3920.05, 3920.06, 3920.07, 3920.08, 3920.09, 3920.10,
3920.11, 3920.12, 3920.13, 3920.14, 3920.15, 3920.21, 3920.22,
3920.23, 3920.24, 3920.25, 3920.26, 3920.27, 3920.28, 3920.31,
3920.32, and 3920.33 of the Revised Code be enacted to read as
follows:

Sec.
109.02.
The
attorney general is the chief law officer for the state and all its
departments and shall be provided with adequate office space in
Columbus. Except as provided in division (E) of section 120.06 and in
sections 101.55, 107.13,
and

3517.152
to 3517.157
,
and 3920.04

of the Revised Code, no state officer or board, or head of a
department or institution of the state shall employ, or be
represented by, other counsel or attorneys at law. The attorney
general shall appear for the state in the trial and argument of all
civil and criminal causes in the supreme court in which the state is
directly or indirectly interested. When required by the governor or
the general assembly, the attorney general shall appear for the state
in any court or tribunal in a cause in which the state is a party, or
in which the state is directly interested. Upon the written request
of the governor, the attorney general shall prosecute any person
indicted for a crime.

Sec.
3920.01.
As
used in this chapter:

(A)
"Health care facility" means any facility, except a health
care practitioner's office, that provides preventive, diagnostic,
therapeutic, acute convalescent, rehabilitation, mental health,
intellectual disability, intermediate care, or skilled nursing
services.

(B)
"Provider" means a hospital or other health care facility,
and a physician, podiatrist, dentist, pharmacist, chiropractor, or
other health care personnel, licensed, certified, accredited, or
otherwise authorized in this state to furnish health care services.

Sec.
3920.02.
(A)(1)
There is hereby created the Ohio health care plan, which shall be
administered by the Ohio health care agency under the direction of
the Ohio health care board.

(2)
The Ohio health care plan shall provide universal and affordable
health care coverage for all residents of this state, consisting of a
comprehensive benefit package that includes benefits for prescription
drugs. The Ohio health care plan shall work simultaneously to control
health care costs, control health care spending, achieve measurable
improvement in health care outcomes, increase all parties'
satisfaction with the health care system, implement policies that
strengthen and improve culturally and linguistically sensitive care,
and develop an integrated health care database to support health care
planning.

(B)
There is hereby created the Ohio health care agency. The Ohio health
care agency shall administer the Ohio health care plan and is the
sole agency authorized to accept applicable grants-in-aid from the
federal and state government, using the funds in order to secure full
compliance with provisions of state and federal law and to carry out
the purposes of this chapter. All grants-in-aid accepted by the Ohio
health care agency shall be deposited into the Ohio health care fund
established under section 3920.09 of the Revised Code.

(C)
Sections 101.82 and 101.83 of the Revised Code do not apply to the
Ohio health care agency.

Sec.
3920.03.
(A)
There is hereby created the Ohio health care board. The Ohio health
care board shall consist of fifteen voting members, consisting of the
director of health as an ex officio voting member and fourteen
members elected in accordance with this section.

(B)
For purposes of representation on the Ohio health care board, the
state shall be divided into seven regions each composed of designated
counties as follows:

(1)
Region 1: Ashtabula, Cuyahoga, Geauga, Lake, Lorain;

(2)
Region 2: Allen, Auglaize, Defiance, Erie, Fulton, Hancock, Henry,
Huron, Lucas, Mercer, Ottawa, Paulding, Putnam, Sandusky, Seneca, Van
Wert, Williams, Wood;

(3)
Region 3: Athens, Belmont, Coshocton, Gallia, Guernsey, Harrison,
Hocking, Jackson, Jefferson, Lawrence, Meigs, Monroe, Morgan,
Muskingum, Noble, Perry, Pike, Ross, Scioto, Vinton, Washington;

(4)
Region 4: Adams, Brown, Butler, Clermont, Clinton, Hamilton,
Highland, Warren;

(5)
Region 5: Crawford, Delaware, Fairfield, Fayette, Franklin, Hardin,
Knox, Licking, Logan, Madison, Marion, Morrow, Pickaway, Union,
Wyandot;

(6)
Region 6: Ashland, Carroll, Columbiana, Holmes, Mahoning, Medina,
Portage, Richland, Stark, Summit, Trumbull, Tuscarawas, Wayne;

(7)
Region 7: Champaign, Clark, Darke, Greene, Miami, Montgomery, Preble,
Shelby.

(C)(1)
The health commissioner of the most populous county in each region
shall convene a meeting of all county and city health commissioners
in the region within ninety days following the effective date of this
section. If there are two or more health districts located wholly or
partially in the most populous county of the region, the health
commissioner of the health district with the largest territorial
jurisdiction in that county shall convene the meeting of all county
and city health commissioners within ninety days following the
effective date of this section.

(2)
At the meeting called pursuant to division (C)(1) of this section,
the county and city health commissioners in each region shall elect
one resident from each county in the region to represent the county
on a regional health advisory committee established for that region.
The county and city health commissioners also shall set a date, not
sooner than one hundred days and not later than one hundred ten days
after the effective date of this section, for the initial meeting of
the regional health advisory committee.

(3)
Following the initial meetings of county and city health
commissioners called pursuant to division (C)(1) of this section, the
county and city health commissioners in each region shall convene a
meeting every two years to elect representatives to the regional
health advisory committee. Each biennial meeting shall be held within
five days of the same day of the same month as the initial meeting.

(4)
Each representative elected under division (C)(2) or (3) of this
section shall hold office for two years, starting on the date of the
representative's election. Any individual appointed to fill a vacancy
occurring prior to the expiration of the term for which a
representative is elected shall hold office for the remainder of the
predecessor's term.

(D)(1)
At its initial meeting on the date set pursuant to division (C)(2) of
this section, each regional health advisory committee shall elect a
chairperson from among the representatives to the committee. At the
initial meeting, each committee's representatives shall elect two
residents from the region to represent that region as members of the
Ohio health care board. One of the two residents elected from each
region to serve on the Ohio health care board shall be a resident of
the region's most populous county and the other shall be a resident
of any county in the region other than the region's most populous
county.

Except
for the elections to the Ohio health care board at the initial
meeting of each regional health advisory committee, each resident
elected to the board shall be elected to a two-year term of office.
At the initial meeting, the resident from the most populous county in
the region shall be elected to a term of three years.

(2)
Annually, beginning in the second year following the initial
elections to the Ohio health care board, the chairperson of each
regional health advisory committee shall convene a meeting within
five calendar days of the same date of the same month as the initial
meeting of that regional health advisory committee to elect a
resident from the region to serve as a member of the Ohio health care
board. The regional health advisory committee shall elect a resident
of a county as is necessary to meet the representation requirements
set by division (D)(1) of this section. No individual may serve as a
member of the Ohio health care board for more than four consecutive
terms.

(3)
In addition to meeting for the election of Ohio health care board
members, each regional health advisory committee shall meet as
necessary to fulfill any functions and responsibilities assigned
under sections 3920.01 to 3920.15 of the Revised Code. With the
exception of the initial meeting described in division (D)(1) of this
section, each meeting shall be held at the call of the chairperson
and as may be provided by procedures adopted by the regional health
advisory committee.

(E)(1)
The director of health shall set the time, place, and date for the
initial meeting of the Ohio health care board and shall preside over
the Ohio health care board's initial meeting. The initial meeting
shall be held not sooner than one hundred fifteen days and not later
than one hundred twenty-five days after the effective date of this
section.

(2)
The members of the Ohio health care board annually shall elect a
member of the board to serve as chairperson at meetings of the board.
Meetings shall be held upon the call of the chairperson and as
provided by procedures prescribed by the Ohio health care board.
Two-thirds of the members of the Ohio health care board shall
constitute a quorum for the conduct of business at meetings of the
board. Decisions at meetings of the Ohio health care board shall be
reached by majority vote of those present.

(3)
All meetings of the Ohio health care board are open to the public
unless questions of patient confidentiality arise. The Ohio health
care board may go into closed executive session with regard to issues
related to confidential patient information. The fourteen members of
the Ohio health care board elected by the regional health advisory
committees shall receive an annual salary and benefits established in
accordance with division (J) of section 124.15 of the Revised Code.

(F)
The seven regional health advisory committees shall act as advisory
bodies to the Ohio health care board, representing their individual
regions. The regional health advisory committees shall oversee the
management of consumer and provider complaints originating in their
respective regions and shall hold a hearing on all such complaints.
The regional health advisory committees shall offer assistance to
resolve consumer and provider disputes and shall seek the agreement
of all parties to the dispute to submit the dispute to negotiation or
binding arbitration. A regional health advisory committee shall
transfer any dispute that is not resolved at the regional level to
the director of the Ohio health care agency's department of consumer
affairs within six months of the filing of the complaint; however,
the committee may vote to transfer individual disputes at an earlier
date.

(G)(1)
If a vacancy occurs on the Ohio health care board for any reason,
resulting in a region being without full representation on the board,
that region's health advisory committee shall elect a resident of
that region to fill the vacancy. Any resident elected to fill a
vacancy shall serve the remainder of the departing member's term. The
health advisory committee shall elect a resident of a county as
necessary to meet the representation requirements set by division
(D)(1) of this section.

(2)
A serving member of the Ohio health care board shall continue to
serve following the expiration of the member's term until a successor
takes office or a period of ninety days has elapsed, whichever occurs
first.

(H)(1)
The members and staff of the Ohio health care board and employees of
the Ohio health care agency, and their immediate families, are
prohibited from having any pecuniary interest in any business with a
contract, or in negotiation for a contract, with either the Ohio
health care board or Ohio health care agency, or in any business that
is subject to the Ohio health care board's oversight. The members and
staff of the Ohio health care board and employees of the Ohio health
care agency shall not knowingly receive remuneration for health care
services of any kind during their term of service or employment. The
members and staff of the Ohio health care board and employees of the
Ohio health care agency, and their immediate families, shall not
knowingly receive consulting fees of any kind from any source that is
directly or indirectly related to the delivery of health care
services pursuant to the Ohio health care plan. The members and staff
of the Ohio health care board and employees of the Ohio health care
agency, and their immediate families, are prohibited from knowingly
owning stock in, and from investing in mutual funds holding stock in,
pharmaceutical companies, health maintenance organizations, health
insuring corporations, or other businesses that relate directly or
indirectly to the delivery of health care services, unless the stock
or mutual funds are in a blind trust.

As
used in division (H)(1) of this section, "blind trust"
means an independently managed trust in which the beneficiary has no
management rights and in which the beneficiary is not given notice of
alterations in or other dispositions of the stock, mutual funds, or
other property subject to the trust.

(2)
No member of the Ohio health care board other than the director of
health shall knowingly hold any other salaried public position with
the state, either elected or appointed, during the member's tenure on
the board. The director of health shall receive no salary or benefits
by virtue of the director's service on the Ohio health care board.

(3)
The chairperson of the Ohio health care board may conduct hearings to
determine if a violation of division (H)(1) or (2) of this section
has occurred. If the alleged violator is the chairperson, the
director of health may conduct the hearings. If the director of
health is the chairperson, the member of the board not alleged to
have committed a violation with the greatest seniority may hold the
hearings. Notice of any hearing, the conduct of the hearing, and all
other matters relating to the holding of the hearing shall be
governed by Chapter 119. of the Revised Code.

If
a member of the Ohio health care board, or of the member's immediate
family, is found to have violated division (H)(1) of this section, or
a member of the Ohio health care board is found to have violated
division (H)(2) of this section, the chairperson of the Ohio health
care board, the director of health, or senior board member, as
applicable, shall remove the member from the Ohio health care board.

If
a staffer of the Ohio health care board or an employee of the Ohio
health care agency, or a member of the staffer's or employee's
immediate family, is found to have violated division (H)(1) of this
section, the Ohio health care board or Ohio health care agency shall
take appropriate disciplinary action against the staffer or employee,
which action may include termination of employment.

(I)
Sections 101.82 and 101.83 of the Revised Code do not apply to the
Ohio health care board and the regional health advisory committees.

Sec.
3920.04.
(A)
The Ohio health care board shall direct the Ohio health care agency
in the performance of all duties, the exercise of all powers, and the
assumption and discharge of all functions vested in the Ohio health
care agency. The Ohio health care board shall adopt rules in
accordance with Chapter 119. of the Revised Code as needed to carry
out the purposes of, and to enforce, this chapter.

(B)
The duties and functions of the Ohio health care board include the
following:

(1)
Implementing statutory eligibility standards for benefits;

(2)
Annually adopting a benefits package for participants of the Ohio
health care plan;

(3)
Acting directly or through one or more contractors as the single
payer for all claims for health care services made under the Ohio
health care plan;

(4)
Developing and implementing separate formulas for determining budgets
under sections 3920.21 to 3920.28 of the Revised Code;

(5)
Annually reviewing the formulas for determining the appropriateness
and sufficiency of rates, fees, and prices;

(6)
Providing for timely payments to providers through a structure that
is well organized and that eliminates unnecessary administrative
costs;

(7)
Implementing, to the extent permitted by federal law, standardized
claims and reporting methods for use by the Ohio health care plan;

(8)
Developing a system of centralized electronic claims and payments;

(9)
Establishing an enrollment system that will ensure that all eligible
residents of this state, including those who travel frequently, those
who cannot read, and those who do not speak English, are aware of
their right to health care and are formally enrolled in the Ohio
health care plan;

(10)
Reporting annually to the general assembly and the governor, on or
before the first day of October, on the performance of the Ohio
health care plan, the fiscal condition of the Ohio health care plan,
any need for rate adjustments, recommendations for statutory changes,
the receipt of payments from the federal government, whether current
year goals and priorities were met, future goals and priorities, and
major new technology or prescription drugs that may affect the cost
of the health care services provided by the Ohio health care plan;

(11)
Administering the revenues of the Ohio health care fund pursuant to
section 3920.09 of the Revised Code;

(12)
Obtaining appropriate liability and other forms of insurance to
provide coverage for the Ohio health care plan, the Ohio health care
board, the Ohio health care agency, and employees and agents of the
foregoing;

(13)
Establishing, appointing, and funding appropriate staff for the Ohio
health care agency throughout this state;

(14)
Procuring requisite office space and administrative support;

(15)
Administering aspects of the Ohio health care agency by taking
actions that include the following:

(a)
Establishing standards and criteria for the allocation of operating
funds;

(b)
Meeting regularly with the executive director and administrators of
the Ohio health care agency to review the impact of the agency and
its policies on the regions established under section 3920.03 of the
Revised Code;

(c)
Establishing measurable goals for the health care system established
pursuant to the Ohio health care plan;

(d)
Establishing statewide health care databases to support health care
services planning;

(e)
Implementing policies and developing mechanisms and incentives to
assure culturally and linguistically sensitive care;

(f)
Establishing standards and criteria for the determination of
appropriate compensation and training for residents of this state who
are displaced from work due to the implementation of the Ohio health
care plan;

(g)
Establishing methods for the recovery of costs for health care
services provided pursuant to the Ohio health care plan to a
participant that are covered under the terms of a policy of
insurance, a health benefit plan, or other collateral source
available to the participant under which the participant has a right
of action for compensation. Receipt of health care services pursuant
to the Ohio health care plan shall be deemed an assignment by the
participant of any right to payment for services from any policy,
plan, or other source. The other source of health care benefits shall
pay to the Ohio health care fund all amounts it is obligated to pay
to the participant for covered health care services. The Ohio health
care board may commence any action necessary to recover the amounts
due.

(16)
Appointing a technical and medical advisory board. The members of the
technical and medical advisory board shall represent a cross section
of the medical and provider community and consumers, and shall
include two persons, one being a provider and the other representing
consumers, from each region designated in section 3920.03 of the
Revised Code. The members of the technical and medical advisory board
shall be reimbursed for actual and necessary expenses incurred in the
performance of the members' duties. The technical and medical
advisory board's duties include:

(a)
Advising the Ohio health care board on the establishment of policy on
medical issues, population-based public health issues, research
priorities, scope of services, expanding access to health care
services, and evaluating the performance of the Ohio health care
plan;

(b)
Investigating proposals for innovative approaches to the promotion of
health, the prevention of disease and injury, patient education,
research, and health care delivery;

(c)
Advising the Ohio health care board on the establishment of standards
and criteria to evaluate requests from health care facilities for
capital improvements.

(C)
The Ohio health care board shall employ and fix the compensation of
Ohio health care agency personnel, with the approval of the
department of administrative services, as needed by the agency to
properly discharge the agency's duties. The employment of personnel
by the Ohio health care board is subject to the civil service laws of
this state. The Ohio health care board shall employ personnel that
include the following:

(1)
Executive director;

(2)
Administrator of planning, research, and development;

(3)
Administrator of consumer affairs;

(4)
Administrator of quality assurance;

(5)
Administrator of finance;

(6)
Legal counsel to represent the Ohio health care agency and Ohio
health care board in any legal action brought by or against the
agency or board under or pursuant to any provision of the Revised
Code under the agency's or board's jurisdiction.

(D)
No member of the Ohio health care board or individual on the staff of
the Ohio health care board or Ohio health care agency shall use for
personal benefit any information filed with or obtained by the Ohio
health care board that is not then readily available to the public.
No member of the Ohio health care board shall use or in any way
attempt to use their position as a member to influence a decision of
any other governmental body.

(E)
Sections 101.82 and 101.83 of the Revised Code do not apply to the
technical and medical advisory board established pursuant to division
(B)(16) of this section.

Sec.
3920.05.
The
executive director of the Ohio health care agency is the chief
administrator of the Ohio health care plan and shall administer and
enforce this chapter. The executive director shall oversee the
operation of the Ohio health care agency and the agency's performance
of any duties assigned by the Ohio health care board.

Sec.
3920.06.
(A)
The executive director of the Ohio health care agency shall determine
the duties of the administrator of planning, research, and
development. Those duties shall include the following:

(1)
Establishing policy on medical issues, population-based public health
issues, research priorities, scope of services, the expansion of
participants' access to health care services, and evaluating the
performance of the Ohio health care plan;

(2)
Investigating proposals for innovative approaches for the promotion
of health, the prevention of disease and injury, patient education,
research, and the delivery of health care services;

(3)
Establishing standards and criteria for evaluating applications from
health care facilities for capital improvements.

(B)(1)
The executive director shall determine the duties of the
administrator of consumer affairs. Those duties shall include the
following:

(a)
Developing educational and informational guides for consumers that
describe consumer rights and responsibilities and that inform
consumers of effective ways to exercise consumer rights to obtain
health care services. The guides must be easy to read and understand
and must be available in English and in other languages. The Ohio
health care agency shall make the guides available to the public
through public outreach and educational programs and through the
internet web site of the Ohio health care agency.

(b)
Establishing a toll-free telephone number to receive questions and
complaints regarding the Ohio health care agency and the agency's
services. The Ohio health care agency's internet web site shall
provide complaint forms and instructions online.

(c)
Examining suggestions from the public;

(d)
Making recommendations for improvements to the Ohio health care
board;

(e)
Examining the extent to which individual health care facilities in a
region meet the needs of the community in which they are located;

(f)
Receiving, investigating, and responding to all complaints about any
aspect of the Ohio health care plan and referring the results of all
investigations into the provision of health care services by health
care providers or facilities to the appropriate provider or health
care facility licensing board, or when appropriate, to a law
enforcement agency;

(g)
Publishing an annual report for the public and the general assembly
that contains a statewide evaluation of the Ohio health care agency
and of the delivery of health care services in each region
established under section 3920.03 of the Revised Code;

(h)
Holding public hearings, at least annually, within each region
established under section 3920.03 of the Revised Code for public
suggestions and complaints.

(2)
The administrator of consumer affairs shall work closely with the
seven regional health advisory committees on the resolution of
complaints. In the discharge of the administrator's duties, the
administrator shall have unlimited access to all nonconfidential and
nonprivileged documents in the custody and control of the agency.
Nothing in this chapter prohibits a consumer or class of consumers,
or the administrator of consumer affairs, from seeking relief through
the courts.

(C)
The executive director, in consultation with the technical and
medical advisory board, shall determine the duties of the
administrator of quality assurance. Those duties shall include the
following:

(1)
Studying and reporting on the efficacy of health care treatments and
medications for particular conditions;

(2)
Identifying causes of medical errors and devising procedures to
decrease medical errors;

(3)
Establishing an evidence-based formulary;

(4)
Identifying treatments and medications that are unsafe or have no
proven value;

(5)
Establishing a process for soliciting information on medical
standards from providers and consumers for purposes of division (C)
of this section.

(D)
The executive director shall determine the duties of the
administrator of finance. Those duties shall include the following:

(1)
Administering the Ohio health care fund;

(2)
Making prompt payments to providers;

(3)
Developing a system of centralized claims and payments;

(4)
Communicating to the treasurer of state when funds are needed for the
operation of the Ohio health care plan;

(5)
Developing information systems for utilization review;

(6)
Investigating possible provider or consumer fraud.

Sec.
3920.07.
(A)
All residents of this state and individuals employed in this state,
including the homeless and migrant workers, are eligible for coverage
under the Ohio health care plan. The Ohio health care board shall
establish standards and a simplified procedure to demonstrate proof
of residency. The Ohio health care board shall establish a procedure
to enroll eligible residents and employees and to provide each
individual covered under the Ohio health care plan with
identification that providers may use to determine eligibility for
health care services under the Ohio health care plan.

(B)
If waivers are not obtained under sections 3920.31 to 3920.33 of the
Revised Code from the medical assistance and medicare programs
operated under Title XVIII or XIX of the "Social Security Act,"
42 U.S.C. 1395 et seq., or whenever a necessary waiver is not in
effect, the medical assistance program, medicare program, CHIP
program, and federal employees health benefits program, as defined in
section 3920.31 of the Revised Code, shall act as the primary
insurers for residents of this state and individuals employed in this
state for health coverage and the Ohio health care plan shall serve
as the secondary or supplemental plan of health coverage. When the
Ohio health care plan serves as a secondary or supplemental plan of
health coverage the Ohio health care plan shall not provide coverage
to a resident of this state or individual employed in this state for
any covered health care service that the resident or worker is then
eligible to receive under the primary program.

(C)
A plan of employee health coverage provided by an out-of-state
employer to a resident of this state working outside of this state
shall serve as the employee's primary plan of health coverage and the
Ohio health care plan shall serve as the employee's secondary plan of
health coverage.

(D)
The Ohio health care agency shall bill an out-of-state employer or
the employer's insurer for the cost of covered health care services
provided in accordance with the Ohio health care plan to residents of
this state employed by the out-of-state employer when the health care
services provided are covered under the terms of the employer's plan
of employee health coverage.

(E)
The Ohio health care plan shall reimburse Ohio health care board
approved providers practicing outside of this state at Ohio health
care plan rates for health care services rendered to a plan
participant while the participant is out of state.

(F)
Any employer operating in this state may purchase coverage under the
Ohio health care plan for an employee who lives out of state but who
works in this state.

(G)(1)
Any institution of higher education located in this state may
purchase coverage under the Ohio health care plan for a student who
does not otherwise have status as a resident of this state.

(2)
As used in this section, "institution of higher education"
means an institution of higher education, as defined in section
3345.12 of the Revised Code, and a private college, university, or
other postsecondary institution located in this state that possesses
a certificate of authorization issued pursuant to Chapter 1713. of
the Revised Code or a certificate of registration issued by the state
board of career colleges and schools under Chapter 3332. of the
Revised Code.

(H)
Any individual who arrives at a health care facility unconscious or
otherwise unable due to their mental or physical condition to
document eligibility for coverage under the Ohio health care plan
shall be presumed to be eligible.

Sec.
3920.08.
(A)
The Ohio health care board shall establish a single health benefits
package that shall include all of the following:

(1)
Inpatient and outpatient provider care, both primary and secondary;

(2)
Emergency services, as defined in section 3923.65 of the Revised
Code, twenty-four hours each day on a prudent layperson standard.
Residents who are temporarily out of state may receive benefits for
emergency services rendered in that state. The Ohio health care
agency shall make timely emergency services, including hospital care
and triage, available to all residents of this state, including all
residents not enrolled in the Ohio health care plan.

(3)
Emergency and other transportation to receive covered health care
services, subject to division (B) of this section;

(4)
Rehabilitation services, including speech, occupational, and physical
therapy;

(5)
Inpatient and outpatient mental health services and substance abuse
treatment;

(6)
Hospice care;

(7)
Prescription drugs and prescribed medical nutrition;

(8)
Vision care, aids, and equipment;

(9)
Hearing care, hearing aids, and equipment;

(10)
Diagnostic medical tests, including laboratory tests and imaging
procedures;

(11)
Medical supplies and prescribed medical equipment, both durable and
nondurable;

(12)
Immunizations, preventive care, health maintenance care, and
screening;

(13)
Dental care;

(14)
Home health care services.

(B)
The Ohio health care plan shall provide necessary transportation in
each county to receive covered health care services. Independent
transportation providers shall be reimbursed on a fee-for-service
basis. Fee schedules for covered transportation may take into account
the recognized differences among geographic areas regarding cost. A
covered transportation benefits account is hereby created within the
Ohio health care fund.

(C)
The Ohio health care plan shall not exclude or limit coverage of its
participants' pre-existing conditions.

(D)
Residents enrolled in the Ohio health care plan are not subject to
copayments, point-of-service charges, or any other fee or charge. No
provider shall directly bill an enrollee for a covered health care
service.

(E)
The Ohio health care board, with the consent of the technical and
medical advisory board, shall remove or exclude procedures and
treatments, equipment, and prescription drugs from the Ohio health
care plan's benefit package that the board finds unsafe,
experimental, of no proven value, or that add no therapeutic value.

(F)
The Ohio health care board shall exclude coverage for any surgical,
orthodontic, or other medical procedure, or prescription drug, that
the technical and medical advisory board determines was or will be
provided primarily for cosmetic purposes, unless required to correct
a congenital defect, to restore or correct disfigurements resulting
from injury or disease, or that is determined to be medically
necessary by a qualified, licensed provider.

(G)
Participants shall have free choice of the providers eligible to
participate in the Ohio health care plan.

(H)
No provider shall be compelled by the Ohio health care agency to
offer any particular service, provided that the provider does not
discriminate among patients in providing health care services.

(I)
The Ohio health care plan and the providers participating in the plan
shall not discriminate on the basis of race, color, religion,
national origin, sexual orientation, health status, employment
status, or occupation or sex, military status, disability, or age.

Sec.
3920.09.
(A)
The Ohio health care fund is hereby established in the state
treasury. The administrator of finance of the Ohio health care agency
shall administer and monitor the Ohio health care fund. All moneys
collected and received by the Ohio health care plan shall be
transmitted to the treasurer of state for deposit into the Ohio
health care fund, to be used to finance the Ohio health care plan and
to pay the costs of compensation and training for displaced workers
pursuant to section 3920.11 of the Revised Code.

(B)
The treasurer of state may invest the interest earned by the Ohio
health care fund in any manner authorized by the Revised Code for the
investment of state moneys. Any revenue or interest earned from the
investments shall be credited to the Ohio health care fund.

(C)
All provider claims for payment for health care services rendered
under the Ohio health care plan shall be transmitted to the Ohio
health care fund by the provider or the provider's agent. The format
of, and the method of transmitting, provider claims shall be
determined by the Ohio health care board.

(D)
All payments for health care services rendered under the Ohio health
care plan shall be disbursed from the Ohio health care fund. The
administrator of finance of the Ohio health care agency shall
establish a reserve account within the Ohio health care fund. When
the revenue available to the Ohio health care plan in any biennium
exceeds the total amount expended or obligated during that biennium,
the excess revenue shall be transferred to the reserve account. The
Ohio health care board may use the money in the reserve account for
expenses of the Ohio health care agency or the Ohio health care plan.

(E)
The administrator of finance of the Ohio health care agency shall
notify the Ohio health care board when the annual expenditures or
anticipated future expenditures of the Ohio health care plan appear
to be in excess of the revenues or anticipated revenues for the same
period. The Ohio health care board shall implement appropriate cost
control measures based on the notification. The Ohio health care
board shall seek a special appropriation for the Ohio health care
fund if the cost control measures implemented do not reduce the Ohio
health care plan's expenditures to an amount that may be covered by
its revenue.

Sec.
3920.10.
(A)
The Ohio health care board shall establish written procedures for the
receipt and resolution of disputes and grievances. The procedures
shall provide for an initial hearing before the appropriate regional
health advisory committee in accordance with division (F) of section
3920.03 of the Revised Code. The board shall accord to the
complainant and the person who is the subject of a complaint the
right to be heard at the hearing.

(B)
Any party aggrieved by an order or decision issued pursuant to the
procedures established in division (A) of this section may appeal the
order or decision to the court of common pleas of the county in which
the consumer resides. The appellant shall file a notice of appeal
with the Ohio health care board within fifteen days of the filing of
the appeal with the court of common pleas. The appellant shall file
evidence of the notice with the court of common pleas within twenty
days of the filing. If the court of common pleas does not receive
such evidence, proceedings shall be stayed until the court receives
the required evidence.

(C)
Appeals of denied claims may be submitted by Ohio health care plan
beneficiaries or providers, or businesses selling medical equipment
and supplies to the Ohio health care board. The board shall conduct
appeals in compliance with its written procedures and both laws of
this state and federal laws.

Sec.
3920.11.
(A)
The department of job and family services shall determine which
residents of this state employed by a health care insurer, health
insuring corporation, or other health care related business, have
lost employment as a result of the implementation and operation of
the Ohio health care plan. The department also shall determine the
amount of monthly wages that the resident lost due to the plan's
implementation. The department shall attempt to position these
displaced workers in comparable positions of employment with the Ohio
health care agency.

(B)
The department of job and family services shall forward the
information on the amount of monthly wages lost by residents of this
state due to the implementation of the Ohio health care plan to the
Ohio health care agency. The Ohio health care agency shall determine
the amount of compensation and training that each displaced worker
shall receive and shall submit a claim to the Ohio health care fund
for payment. A displaced worker shall not receive compensation from
the Ohio health care fund in excess of sixty thousand dollars per
year for two years. Compensation paid to the displaced worker under
this section shall serve as a supplement to any compensation the
worker receives from the department of job and family services.

Sec.
3920.12.
(A)
Any employer operating in this state and providing employees with
benefits under a public or private health care policy, plan, or
agreement as of the date that benefits are initially provided
pursuant to this chapter, which benefits are less valuable than those
provided by the Ohio health care plan, may participate in the Ohio
health care plan or shall provide additional benefits so that, until
the expiration of the policy, plan, or agreement, the benefits
provided by the employer at least equal the amount and scope of the
benefits provided by the Ohio health care plan. If an employer
chooses to provide additional benefits to match or exceed the
benefits provided by the Ohio health care plan, the additional
benefits shall include the employer's payment of any employee premium
contributions, copayments, and deductible payments called for by the
policy, contract, or agreement. Employers are exempt from all health
taxes imposed under this chapter until the expiration of the policy,
plan, or agreement, at which point the employer and the employer's
employees become participants in the Ohio health care plan.

(B)
A person covered by a health care policy, plan, or agreement that has
its premiums paid for in any part with public money, including money
from the state, a political subdivision, state educational
institution, public school, or other entity, shall be covered by the
Ohio health care plan on the day that benefits become available under
the Ohio health care plan.

(C)
Health care insurers, health insuring corporations, and other persons
selling or providing health care benefits may deliver, issue for
delivery, renew, or provide health benefit packages that do not
duplicate the health benefit package provided by the Ohio health care
plan, but shall not, except as provided by division (A) of this
section, deliver, issue for delivery, renew, or provide health
benefit packages that duplicate the health benefit package provided
by the Ohio health care plan.

Sec.
3920.13.
The
Ohio health care agency is subrogated to all rights of a participant
who has received benefits, or who has a right to benefits, under any
other policy or contract of health care.

Sec.
3920.14.
(A)
All providers may participate in the Ohio health care plan.

(B)
The Ohio health care board and the technical and medical advisory
board shall assess the number of primary and specialty providers
needed to supply adequate health care services to all participants in
the Ohio health care plan, and shall develop a plan to meet that
need. The Ohio health care board shall develop incentives for
providers in order to increase residents' access to health care
services in unserved or underserved areas of the state.

(C)
The Ohio health care board annually shall evaluate residents' access
to trauma care, and shall establish measures to ensure participants
have equitable access to trauma care and to specialized medical
procedures and technology.

(D)
The Ohio health care board, with the advice of the technical and
medical advisory board and the administrator of quality assurance,
shall define performance criteria and goals for the Ohio health care
plan and shall report to the general assembly at least annually on
the plan's performance. The Ohio health care board shall establish a
system to monitor the quality of health care and patient and provider
satisfaction with that care and a system to devise improvements to
the provision of health care services.

(E)
All providers subject to the Ohio health care plan shall provide data
upon request to the Ohio health care board, which data the board
requires to devise methods to maintain and improve the provision of
health care services.

(F)
The Ohio health care board, with the advice of the technical and
medical advisory board, shall coordinate the Ohio health care plan's
provision of health care services with any other state and local
agencies that provide health care services directly to their
residents.

Sec.
3920.15.
In
the absence of fraud or bad faith, county and city health
commissioners, regional health advisory committees, and the Ohio
health care board and Ohio health care agency, and their members and
employees, shall incur no liability in relation to the performance of
their duties and responsibilities under sections 3920.01 to 3920.15
of the Revised Code. The state shall incur no liability in relation
to the implementation and operation of the Ohio health care plan.

Sec.
3920.21.
(A)
The Ohio health care board shall prepare and recommend to the general
assembly an annual budget for health care that specifies and
establishes a limit on total annual state expenditures for health
care provided pursuant to sections 3920.01 to 3920.15 of the Revised
Code. The budget shall include all of the following components:

(1)
A system budget covering all expenditures for the system, in
accordance with section 3920.22 of the Revised Code;

(2)
Provider budgets for the fee-for-service and integrated health
delivery systems and for individual health care facilities and their
associated clinics, in accordance with section 3920.23 of the Revised
Code;

(3)
A capital investment budget in accordance with section 3920.24 of the
Revised Code;

(4)
A purchasing budget in accordance with section 3920.25 of the Revised
Code;

(5)
A research and innovation budget in accordance with section 3920.26
of the Revised Code.

(B)
In preparing the budget, the Ohio health care board shall consider
anticipated increased expenditures and savings, including projected
increases in expenditures due to improved access for underserved
populations and improved reimbursement for primary care, projected
administrative savings under the single-payer mechanism, projected
savings in prescription drug expenditures under competitive bidding
and a single buyer, and projected savings due to provision of primary
care rather than emergency room treatment.

Sec.
3920.22.
(A)
The system budget referred to in division (A)(1) of section 3920.21
of the Revised Code shall comprise the cost of the system, services
and benefits provided, administration, data gathering, planning and
other activities, and revenues deposited with the system account of
the Ohio health care fund.

The
Ohio health care board shall limit administrative costs to five per
cent of the system budget and shall annually evaluate methods to
reduce administrative costs and report the results of that evaluation
to the general assembly. The board shall also limit growth of health
care costs in the system budget by reference to changes in state
gross domestic product, population, employment rates, and other
demographic indicators, as appropriate. Money in the reserve account
of the Ohio health care fund shall not be considered as available
revenues for purposes of preparing the system budget.

(B)
The Ohio health care board shall implement cost control measures
pursuant to division (A) of this section. However, no cost control
measure shall limit access to care that is needed on an emergency
basis or that is determined by a patient's provider to be medically
appropriate for a patient's condition.

Possible
mandatory cost control measures shall include the following:

(1)
Postponement of the introduction of new benefits or benefit
improvements;

(2)
Postponement of new capital investment;

(3)
Adjustment of provider budgets to correct for inappropriate provider
utilization;

(4)
Establishment of a limit on provider reimbursement above a specified
amount of aggregate billing;

(5)
Deferred funding of the reserve account;

(6)
Establishment of a limit on aggregate reimbursements to
pharmaceutical manufacturers;

(7)
Imposition of an eligibility waiting period in the event of
substantial influx of individuals into the state for purposes of
obtaining health care through the Ohio health care plan.

Sec.
3920.23.
(A)
The provider budgets referred to in division (A)(2) of section
3920.21 of the Revised Code shall include allocations for
fee-for-service providers and capitated providers. These allocations
shall consider the relative usage of fee-for-service providers and
capitated providers. Each annual provider budget shall include
adjustments to reflect changes in the utilization of services and the
addition or exclusion of covered services made by the Ohio health
care board upon the recommendation of the technical and medical
advisory board and its staff.

(B)
A provider shall choose whether the provider will be compensated as
fee-for-service providers or as part of a capitated provider network.

(1)
The budget for fee-for-service providers shall be divided among
categories of licensed health care providers in order to establish a
total annual budget for each category. Each of these category budgets
shall be sufficient to cover all included services anticipated to be
required by eligible individuals choosing fee-for-service at the
rates negotiated or set by the Ohio health care board, except as
necessary for cost containment purposes pursuant to section 3920.22
of the Revised Code.

The
board shall negotiate fee-for-service reimbursement rates or salaries
for licensed health care providers. In the event negotiations are not
concluded in a timely manner, the board shall establish the
reimbursement rates. Reimbursement rates shall reflect the goals of
the system.

(2)
The budget shall detail all operating expenses for health care
facilities or clinics that are not part of a capitated provider
network. In establishing a health care facility budget, the Ohio
health care board shall develop and utilize separate formulas that
reflect the differences in cost of primary, secondary, and tertiary
care services and health care services provided by academic medical
centers. The board shall negotiate reimbursement rates with
facilities and clinics. Reimbursement rates shall reflect the goals
of the system.

(C)(1)
The budget for capitated providers shall be sufficient to cover all
included services anticipated to be required by eligible individuals
choosing an integrated health care delivery system at the rates
negotiated or set by the Ohio health care board. All health care
facilities, group practices, and integrated health care systems shall
submit annual operating budget requests to the board and may choose
to be reimbursed through a global facility budget or on a capitated
basis. The board shall adjust budgets on the basis of the health risk
of enrollees; the scope of services provided; proposed innovative
programs that improve quality, workplace safety, or consumer,
provider, or employee satisfaction; costs of providing care for
nonmembers; and an appropriate operating margin.

(2)
Providers that choose to operate a health care facility on a
capitated basis shall not be paid additionally on a fee-for-service
basis unless they are providing services in a separate private
medical practice or health care facility. Providers and health care
facilities that operate on a capitated basis shall report immediately
any projected operating deficits to the Ohio health care board. The
board shall determine whether the projected deficits reflect
appropriate increases in health care needs, in which case the board
shall adjust the provider or health care facility budget
appropriately. If the board determines that the deficit is not
justifiable, no adjustment shall be made.

(3)
The board may terminate the funding for health care facilities, group
practices, and integrated health care systems or particular services
provided by them if they fail to meet standards of care and practice
established by the board. The board shall make future funding
contingent on measurable improvements in quality of care and health
care outcomes.

(D)
The Ohio health care board shall prohibit charges to the Ohio health
care plan or to patients for covered health care services other than
those established by regulation, negotiation, or the appeals process.
Licensed health care providers who provide services not covered by
sections 3920.01 to 3920.15 of the Revised Code may charge patients
for those services.

Sec.
3920.24.
(A)
The capital investment budget referred to in division (A)(3) of
section 3920.21 of the Revised Code shall be established by the Ohio
health care board, with the advice of the technical and medical
advisory board and its staff, and shall provide for capital
maintenance and development. In preparing the budget, the Ohio health
care board shall determine capital investment priorities and evaluate
whether the capital investment program has improved access to
services and has eliminated redundant capital investments.

(B)
All capital investments valued at five hundred thousand dollars or
greater, including the costs of studies, surveys, design plans and
working drawing specifications, and other activities essential to
planning and execution of capital investment, and all capital
investments that change the bed capacity of a health care facility or
add a new service or license category incurred by any health system
entity, shall require the approval of the Ohio health care board.
When a health care facility, or individual acting on behalf of a
health care facility, or any other purchaser, obtains by lease or
comparable arrangement any health care facility or part of a health
care facility, or any equipment for a health care facility, the
market value of which would have been a capital expenditure, the
lease or arrangement shall be considered a capital expenditure for
purposes of sections 3920.01 to 3920.15 of the Revised Code.

(C)
Health care facilities shall provide the Ohio health care board with
at least three-months' advance notice of any planned capital
investment of more than fifty thousand dollars but less than five
hundred thousand dollars. These capital investments shall minimize
unneeded expansion of health care facilities and services based on
the priorities and goals for capital investment established by the
board.

(D)
No capital investment shall be undertaken using funds from a health
care facility operating budget.

Sec.
3920.25.
The
purchasing budget referred to in division (A)(4) of section 3920.21
of the Revised Code shall provide for the purchase of prescription
drugs and durable and nondurable medical equipment for the system.
The Ohio health care board shall purchase all prescription drugs and
durable and nondurable medical equipment for the system from this
budget.

Sec.
3920.26.
The
research and innovation budget referred to in division (A)(5) of
section 3920.21 of the Revised Code shall support research and
innovation that has been recommended by the Ohio health care board,
the technical and medical advisory board, or the administrator of
consumer affairs. This research and innovation includes methods for
improving the administration of the system, improving the quality of
health care, educating patients, and improving communication among
health care providers.

Sec.
3920.27.
The
Ohio health care board shall establish a capital account in the Ohio
health care fund as part of the Ohio health care plan. Moneys in the
account shall be used solely to pay for the establishment and
maintenance of a loan program for health care facilities and
equipment for use by health care professionals who desire to
establish practices in areas of the state in which, according to
criteria established by the board, the level of health care services
is inadequate.

Sec.
3920.28.
Funding
of the Ohio health care plan shall be obtained from the following
sources:

(A)
Funds made available to the Ohio health care plan pursuant to
sections 3920.31 to 3920.33 of the Revised Code;

(B)
Funds obtained from other federal, state, and local governmental
sources and programs;

(C)
Receipts from taxes levied on employers' payrolls to be paid by
employers. The tax rate in the first year shall not exceed three and
eighty-five hundredths per cent of the payroll.

(D)
Receipts from additional taxes levied on businesses' gross receipts.
The tax rate in the first year shall not exceed three per cent of the
gross receipts.

(E)
Receipts from additional income taxes, equal to six and two-tenths
per cent of an individual's compensation in excess of the amount
subject to the social security payroll tax;

(F)
Receipts from additional income taxes, equal to five per cent of all
of an individual's Ohio adjusted gross income, less the exemptions
allowed under section 5747.025 of the Revised Code, in excess of two
hundred thousand dollars.

Sec.
3920.31.
(A)
As used in sections 3920.31 to 3920.33 of the Revised Code:

(1)
"CHIP" has the same meaning as in section 5161.01 of the
Revised Code.

(2)
"Federal employees health benefits program" means the
program of health insurance benefits available to employees of the
federal government that the United States office of personnel
management is authorized to contract for under 5 U.S.C. 8902.

(3)
"Federal poverty guidelines" has the same meaning as in
section 5101.46 of the Revised Code.

(4)
"Medicaid" and "medicare" have the same meanings
as in section 5162.01 of the Revised Code.

(B)
At the request of the Ohio health care board, the executive director
of the Ohio health care agency shall seek federal financial
participation in the Ohio health care plan, including funding
otherwise available under medicare, medicaid, CHIP, and the federal
employees health benefits program. The executive director shall
request that the amount of the federal financial participation be at
least equal to the medicaid federal financial participation rate in
effect for this state on the effective date of this section. The
executive director shall periodically seek adjustments to the federal
financial participation rate for the Ohio health care plan to reflect
changes in the state gross domestic product, the state's population
including changes in age groups, and the number of residents with
income below the federal poverty guidelines.

Sec.
3920.32.
At
the request of the Ohio health care board, the Ohio health care
agency's executive director shall negotiate with the United States
office of personnel management to have included in the Ohio health
care plan residents of this state who would otherwise be covered by
the federal employees health benefits program. As part of the
negotiations, the executive director shall seek to have the federal
government provide the Ohio health care plan with amounts equal to
the amount federal employees participating in the Ohio health care
plan would otherwise pay as premiums under the federal employees
health benefits program.

Sec.
3920.33.
At
the request of the Ohio health care board, the medicaid director
shall seek any federal waivers necessary for the Ohio health care
plan to receive federal financial participation under section 3920.31
of the Revised Code otherwise available under the medicaid and CHIP
programs. Upon receipt of federal approval, the medicaid director
shall implement the medicaid and CHIP programs in accordance with the
waiver.

Section
2.
That
existing section 109.02 of the Revised Code is hereby repealed.

Section
3.
In
the first two years following the effective date of sections 3920.01
to 3920.33 of the Revised Code, the Ohio Health Care Board shall
prepare for the delivery of universal, affordable health care
coverage to all eligible Ohio residents and individuals employed in
Ohio. The Ohio Health Care Board shall appoint a Transition Advisory
Group to assist with the transition to the provision of care under
the Ohio Health Care Plan. The Transition Advisory Group shall
include a broad selection of experts in health care finance and
administration, providers from a variety of medical fields,
representatives of Ohio's counties, employers and employees,
representatives of hospitals and clinics, and representatives from
state regulatory bodies. Members of the Transition Advisory Group
shall be reimbursed by the Ohio Health Care Agency for necessary and
actual expenses incurred in the performance of their duties as
members.