As Reported by the House Health, Retirement and Aging Committee 1
122nd General Assembly 4
Regular Session Sub. H. B. No. 243 5
1997-1998 6
REPRESENTATIVES VAN VYVEN-BRADING-CORBIN-HAINES-SCHURING- 8
TAYLOR-TERWILLEGER-TIBERI-OLMAN-WACHTMANN-VESPER 9
11
A B I L L
To amend sections 3702.51, 3727.01, and 4751.05 and 13
to enact section 3702.40 of the Revised Code to 14
establish standards for using electronic 15
signatures and computer-generated signature codes 16
in records of health care facilities and to 18
extend existing exemptions from hospital and 19
nursing home regulations that apply to Christian 20
Science sanitoriums to other institutions that 21
meet similar criteria. 22
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 24
Section 1. That sections 3702.51, 3727.01, and 4751.05 be 26
amended and section 3702.40 of the Revised Code be enacted to 28
read as follows:
Sec. 3702.40. (A) AS USED IN THIS SECTION: 30
(1) "ELECTRONIC RECORD" MEANS A RECORD COMMUNICATED, 33
RECEIVED, OR STORED BY ELECTRONIC, MAGNETIC, OPTICAL, OR SIMILAR 34
MEANS FOR STORAGE IN AN INFORMATION SYSTEM OR TRANSMISSION FROM 35
ONE INFORMATION SYSTEM TO ANOTHER. "ELECTRONIC RECORD" INCLUDES 36
ELECTRONIC DATA INTERCHANGE, ELECTRONIC MAIL, FACSIMILE, AND
TELEX. 37
(2) "ELECTRONIC SIGNATURE" MEANS ANY LETTERS, CHARACTERS, 39
NUMBERS, OR SYMBOLS ATTACHED TO OR ASSOCIATED WITH AN ELECTRONIC 40
RECORD AND EXECUTED OR ADOPTED BY AN INDIVIDUAL TO AUTHENTICATE 41
AN ELECTRONIC RECORD.
(3) "HEALTH CARE FACILITY" MEANS ANY OF THE FOLLOWING: 44
2
(a) A HOSPITAL, AS DEFINED IN SECTION 3727.01 OF THE 47
REVISED CODE;
(b) AN AMBULATORY SURGICAL FACILITY, AS DEFINED IN SECTION 49
3702.30 OF THE REVISED CODE; 52
(c) A FREESTANDING BIRTHING CENTER; 54
(d) A FREESTANDING CARDIAC CATHETERIZATION FACILITY; 56
(e) A FREESTANDING OR MOBILE DIAGNOSTIC IMAGING CENTER; 58
(f) A FREESTANDING DIALYSIS CENTER; 60
(g) A FREESTANDING EMERGENCY FACILITY; 62
(h) AN URGENT CARE CENTER; 64
(i) A FREESTANDING EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY 66
CENTER; 67
(j) A FREESTANDING RADIATION THERAPY CENTER; 69
(k) A HOME HEALTH AGENCY; 71
(l) A HOSPICE CARE PROGRAM, AS DEFINED IN SECTION 3712.01 73
OF THE REVISED CODE; 74
(m) A NURSING HOME, RESIDENTIAL CARE FACILITY, OR HOME FOR 76
THE AGING, ALL AS DEFINED IN SECTION 3721.01 OF THE REVISED CODE; 79
(n) AN ADULT CARE FACILITY, AS DEFINED IN SECTION 3722.01 81
OF THE REVISED CODE; 82
(o) A NURSING FACILITY OR INTERMEDIATE CARE FACILITY FOR 84
THE MENTALLY RETARDED, BOTH AS DEFINED IN SECTION 5111.20 OF THE 86
REVISED CODE; 87
(p) A FACILITY OR PORTION OF A FACILITY CERTIFIED AS A 89
SKILLED NURSING FACILITY UNDER TITLE XVIII OF THE "SOCIAL 92
SECURITY ACT," 49 STAT. 620 (1935), 42 U.S.C.A. 301, AS AMENDED; 94
(q) A STATE INSTITUTION FOR THE CARE AND TREATMENT OF 96
MENTALLY ILL PERSONS, OPERATED BY THE DEPARTMENT OF MENTAL HEALTH 97
PURSUANT TO SECTION 5119.02 OF THE REVISED CODE; 98
(r) A COMMUNITY MENTAL HEALTH FACILITY, AS DEFINED IN 100
SECTION 5119.01 OF THE REVISED CODE; 102
(s) A RESIDENTIAL FACILITY, AS DEFINED IN SECTION 5119.22 104
OF THE REVISED CODE; 105
(t) A COMMUNITY-BASED CLINIC, AS DEFINED IN SECTION 107
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5111.17 OF THE REVISED CODE; 108
(u) AN OUTPATIENT HEALTH FACILITY, AS DEFINED IN SECTION 110
5111.04 OF THE REVISED CODE; 111
(v) AN ALCOHOL AND DRUG ADDICTION PROGRAM, AS DEFINED IN 114
SECTION 3793.01 OF THE REVISED CODE;
(w) THE PRIVATE OFFICE OF ANY HEALTH CARE PROFESSIONAL, 116
INCLUDING: 117
(i) PHYSICIANS AUTHORIZED UNDER CHAPTER 4731. OF THE 121
REVISED CODE TO PRACTICE MEDICINE AND SURGERY OR OSTEOPATHIC 122
MEDICINE AND SURGERY;
(ii) REGISTERED NURSES AND LICENSED PRACTICAL NURSES 124
LICENSED UNDER CHAPTER 4723. OF THE REVISED CODE; 127
(iii) PHYSICIAN ASSISTANTS AUTHORIZED TO PRACTICE UNDER 130
CHAPTER 4730. OF THE REVISED CODE; 132
(iv) DENTISTS AND DENTAL HYGIENIST LICENSED UNDER CHAPTER 135
4715. OF THE REVISED CODE; 137
(v) PHYSICAL THERAPISTS LICENSED UNDER CHAPTER 4755. OF 140
THE REVISED CODE; 142
(vi) CHIROPRACTORS LICENSED UNDER CHAPTER 4734. OF THE 146
REVISED CODE; 147
(vii) OPTOMETRISTS LICENSED UNDER CHAPTER 4725. OF THE 151
REVISED CODE; 152
(viii) PODIATRISTS AUTHORIZED UNDER CHAPTER 4731. OF THE 156
REVISED CODE TO PRACTICE PODIATRY; 157
(ix) DIETITIANS LICENSED UNDER CHAPTER 4759. OF THE 161
REVISED CODE; 162
(x) PHARMACISTS REGISTERED UNDER CHAPTER 4729. OF THE 166
REVISED CODE. 167
(x) THE PRIVATE OFFICE OF A PSYCHOLOGIST LICENSED UNDER 170
CHAPTER 4372. OF THE REVISED CODE OR A COUNSELOR OR SOCIAL WORKER 171
LICENSED UNDER CHAPTER 4757. OF THE REVISED CODE; 172
(y) ANY OTHER HEALTH CARE FACILITY RECOGNIZED BY THE 174
PUBLIC HEALTH COUNCIL BY RULE ADOPTED UNDER CHAPTER 119. OF THE 176
REVISED CODE. 177
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(4) "HEALTH CARE RECORD" MEANS ANY DOCUMENT OR COMBINATION 180
OF DOCUMENTS PERTAINING TO A PATIENT'S MEDICAL HISTORY,
DIAGNOSIS, PROGNOSIS, OR MEDICAL CONDITION THAT IS GENERATED AND 181
MAINTAINED IN THE PROCESS OF THE PATIENT'S TREATMENT AT A HEALTH 182
CARE FACILITY.
(B) ALL WRITTEN NOTES, ORDERS, AND OBSERVATIONS ENTERED 184
INTO A HEALTH CARE RECORD AT A HEALTH CARE FACILITY, INCLUDING 185
ANY INTERPRETIVE REPORTS OF DIAGNOSTIC TESTS OR SPECIFIC 187
TREATMENTS, SUCH AS RADIOLOGIC OR ELECTROCARDIOGRAPHIC REPORTS, 188
OPERATIVE REPORTS, REPORTS OF PATHOLOGIC EXAMINATION OF TISSUE, 189
AND SIMILAR REPORTS, SHALL BE AUTHENTICATED BY THE INDIVIDUAL WHO 190
MADE OR AUTHORIZED THE ENTRY. HEALTH CARE RECORD ENTRIES MAY BE 191
AUTHENTICATED BY HANDWRITTEN SIGNATURES OR HANDWRITTEN INITIALS. 192
THEY ALSO MAY BE AUTHENTICATED BY ELECTRONIC SIGNATURES OR 193
COMPUTER-GENERATED SIGNATURE CODES IF ALL OF THE FOLLOWING APPLY:
(1) THE HEALTH CARE FACILITY ADOPTS A POLICY THAT PERMITS 196
THE USE OF ELECTRONIC SIGNATURES OR COMPUTER-GENERATED SIGNATURE 197
CODES;
(2) THE FACILITY'S ELECTRONIC SIGNATURE OR 200
COMPUTER-GENERATED SIGNATURE CODE SYSTEM UTILIZES A TWO-LEVEL OR
BIOMETRIC ACCESS MECHANISM THAT ASSIGNS A UNIQUE IDENTIFIER TO 201
EACH USER;
(3) THE FACILITY TAKES STEPS TO SAFEGUARD AGAINST USE OF A 204
UNIQUE IDENTIFIER BY ANY INDIVIDUAL OTHER THAN THE ONE TO WHOM IT 205
IS ASSIGNED;
(4) THE SYSTEM INCLUDES A PROCESS TO VERIFY THAT THE 208
INDIVIDUAL AFFIXING THE ELECTRONIC SIGNATURE OR
COMPUTER-GENERATED SIGNATURE CODE HAS REVIEWED THE CONTENTS OF 209
THE ENTRY AND DETERMINED THAT THEY ARE WHAT THAT INDIVIDUAL 210
INTENDED;
(5) THE POLICY ADOPTED BY THE FACILITY PURSUANT TO 213
DIVISION (B)(1) OF THIS SECTION PRESCRIBES ALL OF THE FOLLOWING: 214
(a) A PROCEDURE BY WHICH EACH USER OF THE SYSTEM MUST 216
CERTIFY IN WRITING THAT THE USER WILL KEEP THE USER'S UNIQUE 218
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IDENTIFIER STRICTLY CONFIDENTIAL; 219
(b) PENALTIES FOR MISUSING THE SYSTEM OR A UNIQUE 222
IDENTIFIER ALLOWING ACCESS TO IT;
(c) TRAINING THAT THE FACILITY MUST PROVIDE TO ALL USERS 224
OF THE SYSTEM AND THAT INCLUDES AN EXPLANATION OF THE APPROPRIATE 226
USE OF THE SYSTEM AND THE CONSEQUENCES FOR NONCOMPLIANCE WITH THE 228
FACILITY'S CONFIDENTIALITY AND SECURITY POLICIES.
THE USE OF AN ELECTRONIC SIGNATURE OR COMPUTER-GENERATED 230
SIGNATURE CODE IN ACCORDANCE WITH THIS SECTION SHALL BE 231
CONSIDERED FOR ALL LEGAL PURPOSES TO BE THE SAME AS A HANDWRITTEN 232
SIGNATURE OR HANDWRITTEN INITIALS.
(C) THE PUBLIC HEALTH COUNCIL SHALL ESTABLISH AND ADOPT 234
PROTOCOLS FOR THE USE OF ELECTRONIC SIGNATURE AND 236
COMPUTER-GENERATED SIGNATURE CODE SYSTEMS. THE COUNCIL SHALL 237
CERTIFY A HEALTH CARE FACILITY'S ELECTRONIC SIGNATURE OR 238
COMPUTER-GENERATED SIGNATURE CODE SYSTEM IF IT COMPLIES WITH THE
PROTOCOL ADOPTED BY THE COUNCIL OR BY THE JOINT COMMISSION ON 239
HEALTH CARE ORGANIZATIONS. 240
(D) AN ELECTRONIC SIGNATURE GENERATED BY AN ELECTRONIC 242
SIGNATURE OR COMPUTER-GENERATED SIGNATURE CODE SYSTEM CERTIFIED 243
BY THE COUNCIL SHALL BE PRESUMED TO BE THE SIGNATURE OF THE 244
INDIVIDUAL TO WHOM IT IS ASSIGNED AND TO BE AFFIXED TO 246
AUTHENTICATE THE DOCUMENT.
Sec. 3702.51. As used in sections 3702.51 to 3702.62 of 255
the Revised Code: 256
(A) "Applicant" means any person that submits an 258
application for a certificate of need and who is designated in 259
the application as the applicant. 260
(B) "Person" means any individual, corporation, business 262
trust, estate, firm, partnership, association, joint stock 263
company, insurance company, government unit, or other entity. 264
(C) "Certificate of need" means a written approval granted 266
by the director of health to an applicant to authorize conducting 267
a reviewable activity. 268
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(D) "Health service area" means a geographic region 270
designated by the director of health under section 3702.58 of the 271
Revised Code. 272
(E) "Health service" means a clinically related service, 274
such as a diagnostic, treatment, rehabilitative, or preventive 275
service. 276
(F) "Health service agency" means an agency designated to 278
serve a health service area in accordance with section 3702.58 of 279
the Revised Code. 280
(G) "Health care facility" means: 282
(1) A hospital registered under section 3701.07 of the 284
Revised Code; 285
(2) A nursing home licensed under section 3721.02 of the 287
Revised Code, or by a political subdivision certified under 288
section 3721.09 of the Revised Code; 289
(3) A county home or a county nursing home as defined in 291
section 5155.31 of the Revised Code that is certified under Title 292
XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 293
42 U.S.C.A. 301, as amended; 294
(4) A freestanding dialysis center; 296
(5) A freestanding inpatient rehabilitation facility; 298
(6) An ambulatory surgical facility; 300
(7) A freestanding cardiac catheterization facility; 302
(8) A freestanding birthing center; 304
(9) A freestanding or mobile diagnostic imaging center; 306
(10) A freestanding radiation therapy center. 308
A health care facility does not include the offices of 310
private physicians and dentists whether for individual or group 311
practice, Christian Science sanitoriums operated or listed and 312
certified by the First Church of Christ, Scientist, Boston, 313
Massachusetts, residential facilities licensed under section 314
5123.19 of the Revised Code, or habilitation centers certified by 315
the director of mental retardation and developmental disabilities 316
under section 5123.041 of the Revised Code, OR AN INSTITUTION FOR 317
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THE SICK THAT IS OPERATED EXCLUSIVELY FOR PATIENTS WHO USE 318
SPIRITUAL MEANS FOR HEALING AND FOR WHOM THE ACCEPTANCE OF 319
MEDICAL CARE IS INCONSISTENT WITH THEIR RELIGIOUS BELIEFS, 320
ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION, EXEMPT FROM 321
FEDERAL INCOME TAXATION UNDER SECTION 501 OF THE INTERNAL REVENUE 322
CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1, AS AMENDED, AND 324
PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO THE EXEMPTION
IN DIVISION (G) OF SECTION 4723.32 OF THE REVISED CODE FROM THE 325
LICENSING REQUIREMENTS OF CHAPTER 4723. OF THE REVISED CODE. 326
(H) "Medical equipment" means a single unit of medical 328
equipment or a single system of components with related functions 329
that is used to provide health services. 330
(I) "Third-party payer" means a medical care corporation 332
or health care corporation licensed under Chapter 1737. or 1738. 333
of the Revised Code, a health maintenance organization, an 334
insurance company that issues sickness and accident insurance in 335
conformity with Chapter 3923. of the Revised Code, a 336
state-financed health insurance program under Chapter 3701., 337
4123., or 5111. of the Revised Code, or any self-insurance plan. 338
(J) "Government unit" means the state and any county, 340
municipal corporation, township, or other political subdivision 341
of the state, or any department, division, board, or other agency 342
of the state or a political subdivision. 343
(K) "Health maintenance organization" means a public or 345
private organization organized under the law of any state that is 346
qualified under section 1310(d) of Title XIII of the "Public 347
Health Service Act," 87 Stat. 931 (1973), 42 U.S.C. 300e--9 or 348
that does all of the following: 349
(1) Provides or otherwise makes available to enrolled 351
participants health care services including at least the 352
following basic health care services: usual physician services, 353
hospitalization, laboratory, x-ray, emergency and preventive 354
services, and out-of-area coverage; 355
(2) Is compensated, except for copayments, for the 357
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provision of basic health care services listed in division (K)(1) 358
of this section to enrolled participants by a payment that is 359
paid on a periodic basis without regard to the date the health 360
care services are provided and that is fixed without regard to 361
the frequency, extent, or kind of health service actually 362
provided; 363
(3) Provides physician services primarily either: 365
(a) Directly through physicians who are either employees 367
or partners of the organization; 368
(b) Through arrangements with individual physicians or one 370
or more groups of physicians organized on a group practice or 371
individual practice basis. 372
(L) "Existing health care facility" means a health care 374
facility that is licensed or otherwise approved to practice in 375
this state, in accordance with applicable law, is staffed and 376
equipped to provide health care services, and actively provides 377
health services or has not been actively providing health 378
services for less than twelve consecutive months. 379
(M) "State" means the state of Ohio, including, but not 381
limited to, the general assembly, the supreme court, the offices 382
of all elected state officers, and all departments, boards, 383
offices, commissions, agencies, institutions, and other 384
instrumentalities of the state of Ohio. "State" does not include 385
political subdivisions. 386
(N) "Political subdivision" means a municipal corporation, 388
township, county, school district, and all other bodies corporate 389
and politic responsible for governmental activities only in 390
geographic areas smaller than that of the state to which the 391
sovereign immunity of the state attaches. 392
(O) "Affected person" means: 394
(1) An applicant for a certificate of need, including an 396
applicant whose application was reviewed comparatively with the 397
application in question; 398
(2) The person that requested the reviewability ruling in 400
9
question;
(3) Any person that resides or regularly uses health care 402
facilities within the geographic area served or to be served by 403
the health care services that would be provided under the 404
certificate of need or reviewability ruling in question; 405
(4) Any health care facility that is located in the health 407
service area where the health care services would be provided 408
under the certificate of need or reviewability ruling in 409
question;
(5) Third-party payers that reimburse health care 411
facilities for services in the health service area where the 412
health care services would be provided under the certificate of 413
need or reviewability ruling in question; 414
(6) Any other person who testified at a public hearing 416
held under division (B) of section 3702.52 of the Revised Code or 417
submitted written comments in the course of review of the 418
certificate of need application in question. 419
(P) "Osteopathic hospital" means a hospital registered 421
under section 3701.07 of the Revised Code that advocates 422
osteopathic principles and the practice and perpetuation of 423
osteopathic medicine by doing any of the following: 424
(1) Maintaining a department or service of osteopathic 426
medicine or a committee on the utilization of osteopathic 427
principles and methods, under the supervision of an osteopathic 428
physician; 429
(2) Maintaining an active medical staff, the majority of 431
which is comprised of osteopathic physicians; 432
(3) Maintaining a medical staff executive committee that 434
has osteopathic physicians as a majority of its members. 435
(Q) "Ambulatory surgical facility" has the same meaning as 437
in section 3702.30 of the Revised Code. 438
(R) Except as otherwise provided in division (T) of this 440
section, and until the termination date specified in section 441
3702.511 of the Revised Code, "reviewable activity" means any of 442
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the following:
(1) The addition by any person of any of the following 445
health services, regardless of the amount of operating costs or 446
capital expenditures: 447
(a) A heart, heart-lung, lung, liver, kidney, bowel, 449
pancreas, or bone marrow transplantation service, a stem cell 450
harvesting and reinfusion service, or a service for 451
transplantation of any other organ unless transplantation of the 452
organ is designated by public health council rule not to be a 453
reviewable activity; 454
(b) A cardiac catheterization service; 456
(c) An open-heart surgery service; 458
(d) Any new, experimental medical technology that is 461
designated by rule of the public health council.
(2) The acceptance of high-risk patients, as defined in 463
rules adopted under section 3702.57 of the Revised Code, by any 464
cardiac catheterization service that was initiated without a 465
certificate of need pursuant to division (R)(3)(b) of the version 467
of this section in effect immediately prior to April 20, 1995; 469
(3)(a) The establishment, development, or construction of 471
a new health care facility other than a new long-term care 472
facility or a new hospital; 473
(b) The establishment, development, or construction of a 475
new hospital or the relocation of an existing hospital; 476
(c) The relocation of hospital beds, other than long-term 478
care, perinatal, or pediatric intensive care beds, into or out of 479
a rural area. 480
(4)(a) The replacement of an existing hospital; 482
(b) The replacement of an existing hospital obstetric or 484
newborn care unit or freestanding birthing center. 486
(5)(a) The renovation of a hospital that involves a 490
capital expenditure, obligated on or after the effective date of
this amendment, of five million dollars or more, not including 492
expenditures for equipment, staffing, or operational costs. For
11
purposes of division (R)(5)(a) of this section, a capital 494
expenditure is obligated:
(i) When a contract enforceable under Ohio law is entered 496
into for the construction, acquisition, lease, or financing of a 497
capital asset; 498
(ii) When the governing body of a hospital takes formal 500
action to commit its own funds for a construction project 501
undertaken by the hospital as its own contractor; 502
(iii) In the case of donated property, on the date the 504
gift is completed under applicable Ohio law. 505
(b) The renovation of a hospital obstetric or newborn care 507
unit or freestanding birthing center that involves a capital 509
expenditure of five million dollars or more, not including 510
expenditures for equipment, staffing, or operational costs. 511
(6) Any change in the health care services, bed capacity, 513
or site, or any other failure to conduct the reviewable activity 514
in substantial accordance with the approved application for which 515
a certificate of need was granted, if the change is made prior to 516
the date the activity for which the certificate was issued ceases 517
to be a reviewable activity; 518
(7) Any of the following changes in perinatal bed capacity 520
or pediatric intensive care bed capacity: 521
(a) An increase in bed capacity; 523
(b) A change in service or service-level designation of 526
newborn care beds or obstetric beds in a hospital or freestanding 527
birthing center, other than a change of service that is provided
within the service-level designation of newborn care or obstetric 528
beds as registered by the department of health; 529
(c) A relocation of perinatal or pediatric intensive care 532
beds from one physical facility or site to another, excluding the 533
relocation of beds within a hospital or freestanding birthing 534
center or the relocation of beds among buildings of a hospital or 536
freestanding birthing center at the same site. 537
(8) The expenditure of more than one hundred ten per cent 539
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of the maximum expenditure specified in a certificate of need; 540
(9) Any transfer of a certificate of need issued prior to 542
April 20, 1995, from the person to whom it was issued to another 544
person before the project that constitutes a reviewable activity 545
is completed, any agreement that contemplates the transfer of a 546
certificate of need issued prior to that date upon completion of 548
the project, and any transfer of the controlling interest in an 549
entity that holds a certificate of need issued prior to that
date. However, the transfer of a certificate of need issued 550
prior to that date or agreement to transfer such a certificate of 552
need from the person to whom the certificate of need was issued 553
to an affiliated or related person does not constitute a 554
reviewable transfer of a certificate of need for the purposes of 555
this division, unless the transfer results in a change in the 556
person that holds the ultimate controlling interest in the 557
certificate of need.
(10)(a) The acquisition by any person of any of the 559
following medical equipment, regardless of the amount of 561
operating costs or capital expenditure:
(i) A cobalt radiation therapy unit; 563
(ii) A linear accelerator; 565
(iii) A gamma knife unit. 567
(b) The acquisition by any person of medical equipment 569
with a cost of two million dollars or more. The cost of 570
acquiring medical equipment includes the sum of the following: 571
(i) The greater of its fair market value or the cost of 573
its lease or purchase; 574
(ii) The cost of installation and any other activities 576
essential to the acquisition of the equipment and its placement 577
into service.
(11) The addition of another cardiac catheterization 580
laboratory to an existing cardiac catheterization service. 581
(S) Except as provided in division (T) of this section, 584
"reviewable activity" also means any of the following activities, 586
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none of which are subject to a termination date:
(1) The establishment, development, or construction of a 588
new long-term care facility; 589
(2) The replacement of an existing long-term care 591
facility; 592
(3) The renovation of a long-term care facility that 594
involves a capital expenditure of two million dollars or more, 595
not including expenditures for equipment, staffing, or 596
operational costs; 597
(4) Any of the following changes in long-term care bed 599
capacity: 600
(a) An increase in bed capacity; 602
(b) A relocation of beds from one physical facility or 605
site to another, excluding the relocation of beds within a 606
long-term care facility or among buildings of a long-term care 607
facility at the same site;
(c) A recategorization of hospital beds registered under 610
section 3701.07 of the Revised Code from another registration 612
category to skilled nursing beds or long-term care beds. 613
(5) Any change in the health services, bed capacity, or 615
site, or any other failure to conduct the reviewable activity in 616
substantial accordance with the approved application for which a 617
certificate of need concerning long-term care beds was granted, 618
if the change is made within five years after the implementation 619
of the reviewable activity for which the certificate was granted; 621
(6) The expenditure of more than one hundred ten per cent 623
of the maximum expenditure specified in a certificate of need 624
concerning long-term care beds; 625
(7) Any transfer of a certificate of need that concerns 627
long-term care beds and was issued prior to April 20, 1995, from 629
the person to whom it was issued to another person before the 630
project that constitutes a reviewable activity is completed, any 631
agreement that contemplates the transfer of such a certificate of 632
need upon completion of the project, and any transfer of the 633
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controlling interest in an entity that holds such a certificate 634
of need. However, the transfer of a certificate of need that 635
concerns long-term care beds and was issued prior to April 20, 637
1995, or agreement to transfer such a certificate of need from 638
the person to whom the certificate was issued to an affiliated or 639
related person does not constitute a reviewable transfer of a 640
certificate of need for purposes of this division, unless the 641
transfer results in a change in the person that holds the 642
ultimate controlling interest in the certificate of need. 643
(T) "Reviewable activity" does not include any of the 645
following activities: 646
(1) Acquisition of computer hardware or software; 648
(2) Acquisition of a telephone system; 650
(3) Construction or acquisition of parking facilities; 652
(4) Correction of cited deficiencies that are in violation 654
of federal, state, or local fire, building, or safety laws and 655
rules and that constitute an imminent threat to public health or 656
safety; 657
(5) Acquisition of an existing health care facility that 659
does not involve a change in the number of the beds, by service, 660
or in the number or type of health services; 661
(6) Correction of cited deficiencies identified by 663
accreditation surveys of the joint commission on accreditation of 664
healthcare organizations or of the American osteopathic 665
association; 666
(7) Acquisition of medical equipment to replace the same 668
or similar equipment for which a certificate of need has been 669
issued if the replaced equipment is removed from service; 670
(8) Mergers, consolidations, or other corporate 672
reorganizations of health care facilities that do not involve a 673
change in the number of beds, by service, or in the number or 674
type of health services; 675
(9) Construction, repair, or renovation of bathroom 677
facilities; 678
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(10) Construction of laundry facilities, waste disposal 680
facilities, dietary department projects, heating and air 681
conditioning projects, administrative offices, and portions of 682
medical office buildings used exclusively for physician services; 683
(11) Acquisition of medical equipment to conduct research 685
required by the United States food and drug administration or 686
clinical trials sponsored by the national institute of health. 687
Use of medical equipment that was acquired without a certificate 688
of need under division (T)(11) of this section and for which 690
premarket approval has been granted by the United States food and 691
drug administration to provide services for which patients or 692
reimbursement entities will be charged shall be a reviewable 693
activity. 694
(12) Removal of asbestos from a health care facility. 696
Only that portion of a project that meets the requirements 698
of division (T) of this section is not a reviewable activity. 700
(U) "Small rural hospital" means a hospital that is 702
located within a rural area, has fewer than one hundred beds, and 704
to which fewer than four thousand persons were admitted during 705
the most recent calendar year.
(V) "Children's hospital" means any of the following: 707
(1) A hospital registered under section 3701.07 of the 709
Revised Code that provides general pediatric medical and surgical 710
care, and in which at least seventy-five per cent of annual 711
inpatient discharges for the preceding two calendar years were 712
individuals less than eighteen years of age; 713
(2) A distinct portion of a hospital registered under 715
section 3701.07 of the Revised Code that provides general 716
pediatric medical and surgical care, has a total of at least one 717
hundred fifty registered pediatric special care and pediatric 718
acute care beds, and in which at least seventy-five per cent of 719
annual inpatient discharges for the preceding two calendar years 720
were individuals less than eighteen years of age; 721
(3) A distinct portion of a hospital, if the hospital is 723
16
registered under section 3701.07 of the Revised Code as a 724
children's hospital and the children's hospital meets all the 725
requirements of division (V)(1) of this section. 726
(W) "Long-term care facility" means any of the following: 728
(1) A nursing home licensed under section 3721.02 of the 730
Revised Code or by a political subdivision certified under 731
section 3721.09 of the Revised Code; 732
(2) The portion of any facility, including a county home 734
or county nursing home, that is certified as a skilled nursing 735
facility or a nursing facility under Title XVIII or XIX of the 736
"Social Security Act";
(3) The portion of any hospital that contains beds 738
registered under section 3701.07 of the Revised Code as skilled 739
nursing beds or long-term care beds. 740
(X) "Long-term care bed" means a bed in a long-term care 742
facility.
(Y) "Perinatal bed" means a bed in a hospital that is 744
registered under section 3701.07 of the Revised Code as a newborn 745
care bed or obstetric bed, or a bed in a freestanding birthing 746
center.
(Z) "Freestanding birthing center" means any facility in 748
which deliveries routinely occur, regardless of whether the 750
facility is located on the campus of another health care
facility, and which is not licensed under Chapter 3711. of the 752
Revised Code as a level one, two, or three maternity unit or a 754
limited maternity unit.
(AA)(1) "Reviewability ruling" means a ruling issued by 756
the director of health under division (A) of section 3702.52 of 757
the Revised Code as to whether a particular proposed project is 758
or is not a reviewable activity. 759
(2) "Nonreviewability ruling" means a ruling issued under 761
that division that a particular proposed project is not a 762
reviewable activity. 763
(BB)(1) "Metropolitan statistical area" means an area of 766
17
this state designated a metropolitan statistical area or primary 767
metropolitan statistical area in United States office of 769
management and budget bulletin No. 93-17, June 30, 1993, and its 771
attachments. 772
(2) "Rural area" means any area of this state not located 774
within a metropolitan statistical area. 775
Sec. 3727.01. As used in this section, "health maintenance 784
organization" means a public or private organization organized 785
under the law of any state that is qualified under section 786
1310(d) of Title XIII of the "Public Health Service Act," 87 787
Stat. 931 (1973), 42 U.S.C. 300e-9, or that does all of the 788
following: 789
(A) Provides or otherwise makes available to enrolled 791
participants health care services including at least the 792
following basic health care services: usual physician services, 793
hospitalization, laboratory, x-ray, emergency and preventive 794
service, and out-of-area coverage; 795
(B) Is compensated, except for copayments, for the 797
provision of basic health care services to enrolled participants 798
by a payment that is paid on a periodic basis without regard to 799
the date the health care services are provided and that is fixed 800
without regard to the frequency, extent, or kind of health 801
service actually provided; 802
(C) Provides physician services primarily in either of the 804
following ways: 805
(1) Directly through physicians who are either employees 807
or partners of the organization; 808
(2) Through arrangements with individual physicians or one 810
or more groups of physicians organized on a group practice or 811
individual practice basis. 812
As used in this chapter, "hospital" means an institution 814
classified as a hospital under section 3701.07 of the Revised 815
Code in which are provided to inpatients diagnostic, medical, 816
surgical, obstetrical, psychiatric, or rehabilitation care for a 817
18
continuous period longer than twenty-four hours; a tuberculosis 818
hospital; or a hospital operated by a health maintenance 819
organization. "Hospital" does not include a facility licensed 820
under Chapter 3721. of the Revised Code, a health care facility 821
operated by the department of mental health or the department of 822
mental retardation and developmental disabilities, a health 823
maintenance organization that does not operate a hospital, the 824
office of any private licensed health care professional, whether 825
organized for individual or group practice, a Christian Science 826
sanatorium operated or listed and certified by the First Church 827
of Christ, Scientist, Boston, Massachusetts, or a clinic that 828
provides ambulatory patient services and where patients are not 829
regularly admitted as inpatients. NOR DOES "HOSPITAL" INCLUDE AN 830
INSTITUTION FOR THE SICK THAT IS OPERATED EXCLUSIVELY FOR 832
PATIENTS WHO USE SPIRITUAL MEANS FOR HEALING AND FOR WHOM THE 833
ACCEPTANCE OF MEDICAL CARE IS INCONSISTENT WITH THEIR RELIGIOUS 834
BELIEFS, ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION,
EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501 OF THE 835
INTERNAL REVENUE CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1, AS 837
AMENDED, AND PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO 838
THE EXEMPTION IN DIVISION (G) OF SECTION 4723.32 OF THE REVISED 839
CODE FROM THE LICENSING REQUIREMENTS OF CHAPTER 4723. OF THE 840
REVISED CODE.
Sec. 4751.05. (A) The board of examiners of nursing home 849
administrators shall admit to examination for licensure as a 850
nursing home administrator any candidate who: 851
(1) Pays the application fee of fifty dollars; 853
(2) Submits evidence of good moral character and 855
suitability; 856
(3) Is at least eighteen years of age; 858
(4) Has completed educational requirements and work 860
experience satisfactory to the board; 861
(5) Submits an application on forms prescribed by the 863
board; 864
19
(6) Pays the examination fee of one hundred fifty dollars. 866
(B) Nothing in Chapter 4751. of the Revised Code or the 868
rules adopted thereunder shall be construed to require an 869
applicant for licensure or a temporary license, who is certified 870
EMPLOYED by a recognized church or religious denomination which 871
teaches reliance on spiritual means alone for healing and has 872
been approved to administer institutions certified by such church 873
or denomination AN INSTITUTION for the care and treatment of the 874
sick in accordance with its teachings, to demonstrate proficiency 876
in any medical techniques or to meet any medical educational 877
qualifications or medical standards not in accord with the 878
remedial care and treatment provided in such institutions BY THE 879
INSTITUTION IF THE INSTITUTION IS ALL OF THE FOLLOWING: 880
(1) OPERATED EXCLUSIVELY FOR PATIENTS WHO USE SPIRITUAL 882
MEANS FOR HEALING AND FOR WHOM THE ACCEPTANCE OF MEDICAL CARE IS 883
INCONSISTENT WITH THEIR RELIGIOUS BELIEFS; 884
(2) ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION; 886
(3) EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501 888
OF THE INTERNAL REVENUE CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 890
1, AS AMENDED; 891
(4) PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO 893
THE EXEMPTION IN DIVISION (G) OF SECTION 4723.32 OF THE REVISED 894
CODE FROM THE LICENSING REQUIREMENTS OF CHAPTER 4723. OF THE 895
REVISED CODE.
(B)(C) If a person fails three times to attain a passing 897
grade on the examination, said person, before he THE PERSON may 898
again be admitted to examination, shall meet such additional 899
education or experience requirements, or both, as may be 900
prescribed by the board. 901
Section 2. That existing sections 3702.51, 3727.01, and 903
4751.05 of the Revised Code are hereby repealed. 904