As Passed by the House 1
122nd General Assembly 4
Regular Session Am. Sub. H. B. No. 243 5
1997-1998 6
REPRESENTATIVES VAN VYVEN-BRADING-CORBIN-HAINES-SCHURING- 8
TAYLOR-TERWILLEGER-TIBERI-OLMAN-WACHTMANN-VESPER-SAWYER- 9
GARCIA-LEWIS-AMSTUTZ-O'BRIEN-HOUSEHOLDER-REID-HARRIS 10
12
A B I L L
To amend sections 3702.51, 3727.01, and 4751.05 and 14
to enact section 3702.40 of the Revised Code to 15
establish standards for using electronic 16
signatures and computer-generated signature codes 17
in records of health care facilities and to 19
extend existing exemptions from hospital and 20
nursing home regulations that apply to Christian 21
Science sanitoriums to other institutions that 22
meet similar criteria. 23
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 25
Section 1. That sections 3702.51, 3727.01, and 4751.05 be 27
amended and section 3702.40 of the Revised Code be enacted to 29
read as follows:
Sec. 3702.40. (A) AS USED IN THIS SECTION: 31
(1) "ELECTRONIC RECORD" MEANS A RECORD COMMUNICATED, 34
RECEIVED, OR STORED BY ELECTRONIC, MAGNETIC, OPTICAL, OR SIMILAR 35
MEANS FOR STORAGE IN AN INFORMATION SYSTEM OR TRANSMISSION FROM 36
ONE INFORMATION SYSTEM TO ANOTHER. "ELECTRONIC RECORD" INCLUDES 37
ELECTRONIC DATA INTERCHANGE, ELECTRONIC MAIL, FACSIMILE, AND
TELEX. 38
(2) "ELECTRONIC SIGNATURE" MEANS ANY LETTERS, CHARACTERS, 40
NUMBERS, OR SYMBOLS ATTACHED TO OR ASSOCIATED WITH AN ELECTRONIC 41
RECORD AND EXECUTED OR ADOPTED BY AN INDIVIDUAL TO AUTHENTICATE 42
AN ELECTRONIC RECORD.
2
(3) "HEALTH CARE FACILITY" MEANS ANY OF THE FOLLOWING: 45
(a) A HOSPITAL, AS DEFINED IN SECTION 3727.01 OF THE 48
REVISED CODE;
(b) AN AMBULATORY SURGICAL FACILITY, AS DEFINED IN SECTION 50
3702.30 OF THE REVISED CODE; 53
(c) A FREESTANDING BIRTHING CENTER; 55
(d) A FREESTANDING CARDIAC CATHETERIZATION FACILITY; 57
(e) A FREESTANDING OR MOBILE DIAGNOSTIC IMAGING CENTER; 59
(f) A FREESTANDING DIALYSIS CENTER; 61
(g) A FREESTANDING EMERGENCY FACILITY; 63
(h) AN URGENT CARE CENTER; 65
(i) A FREESTANDING EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY 67
CENTER; 68
(j) A FREESTANDING RADIATION THERAPY CENTER; 70
(k) A HOME HEALTH AGENCY; 72
(l) A HOSPICE CARE PROGRAM, AS DEFINED IN SECTION 3712.01 74
OF THE REVISED CODE; 75
(m) A NURSING HOME, RESIDENTIAL CARE FACILITY, OR HOME FOR 77
THE AGING, ALL AS DEFINED IN SECTION 3721.01 OF THE REVISED CODE; 80
(n) AN ADULT CARE FACILITY, AS DEFINED IN SECTION 3722.01 82
OF THE REVISED CODE; 83
(o) A NURSING FACILITY OR INTERMEDIATE CARE FACILITY FOR 85
THE MENTALLY RETARDED, BOTH AS DEFINED IN SECTION 5111.20 OF THE 87
REVISED CODE; 88
(p) A FACILITY OR PORTION OF A FACILITY CERTIFIED AS A 90
SKILLED NURSING FACILITY UNDER TITLE XVIII OF THE "SOCIAL 93
SECURITY ACT," 49 STAT. 620 (1935), 42 U.S.C.A. 301, AS AMENDED; 95
(q) A STATE INSTITUTION FOR THE CARE AND TREATMENT OF 97
MENTALLY ILL PERSONS, OPERATED BY THE DEPARTMENT OF MENTAL HEALTH 98
PURSUANT TO SECTION 5119.02 OF THE REVISED CODE; 99
(r) A COMMUNITY MENTAL HEALTH FACILITY, AS DEFINED IN 101
SECTION 5119.01 OF THE REVISED CODE; 103
(s) A RESIDENTIAL FACILITY, AS DEFINED IN SECTION 5119.22 105
OF THE REVISED CODE; 106
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(t) A COMMUNITY-BASED CLINIC, AS DEFINED IN SECTION 108
5111.17 OF THE REVISED CODE; 109
(u) AN OUTPATIENT HEALTH FACILITY, AS DEFINED IN SECTION 111
5111.04 OF THE REVISED CODE; 112
(v) AN ALCOHOL AND DRUG ADDICTION PROGRAM, AS DEFINED IN 115
SECTION 3793.01 OF THE REVISED CODE;
(w) THE PRIVATE OFFICE OF ANY HEALTH CARE PROFESSIONAL, 117
INCLUDING: 118
(i) PHYSICIANS AUTHORIZED UNDER CHAPTER 4731. OF THE 122
REVISED CODE TO PRACTICE MEDICINE AND SURGERY OR OSTEOPATHIC 123
MEDICINE AND SURGERY;
(ii) REGISTERED NURSES AND LICENSED PRACTICAL NURSES 125
LICENSED UNDER CHAPTER 4723. OF THE REVISED CODE; 128
(iii) PHYSICIAN ASSISTANTS AUTHORIZED TO PRACTICE UNDER 131
CHAPTER 4730. OF THE REVISED CODE; 133
(iv) DENTISTS AND DENTAL HYGIENISTS LICENSED UNDER CHAPTER 136
4715. OF THE REVISED CODE; 138
(v) PHYSICAL THERAPISTS LICENSED UNDER CHAPTER 4755. OF 141
THE REVISED CODE; 143
(vi) CHIROPRACTORS LICENSED UNDER CHAPTER 4734. OF THE 147
REVISED CODE; 148
(vii) OPTOMETRISTS LICENSED UNDER CHAPTER 4725. OF THE 152
REVISED CODE; 153
(viii) PODIATRISTS AUTHORIZED UNDER CHAPTER 4731. OF THE 157
REVISED CODE TO PRACTICE PODIATRY; 158
(ix) DIETITIANS LICENSED UNDER CHAPTER 4759. OF THE 162
REVISED CODE; 163
(x) PHARMACISTS REGISTERED UNDER CHAPTER 4729. OF THE 167
REVISED CODE. 168
(x) THE PRIVATE OFFICE OF A PSYCHOLOGIST LICENSED UNDER 171
CHAPTER 4372. OF THE REVISED CODE OR A COUNSELOR OR SOCIAL WORKER 172
LICENSED UNDER CHAPTER 4757. OF THE REVISED CODE; 173
(y) ANY OTHER HEALTH CARE FACILITY RECOGNIZED BY THE 175
PUBLIC HEALTH COUNCIL BY RULE ADOPTED UNDER CHAPTER 119. OF THE 177
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REVISED CODE. 178
(4) "HEALTH CARE RECORD" MEANS ANY DOCUMENT OR COMBINATION 181
OF DOCUMENTS PERTAINING TO A PATIENT'S MEDICAL HISTORY,
DIAGNOSIS, PROGNOSIS, OR MEDICAL CONDITION THAT IS GENERATED AND 182
MAINTAINED IN THE PROCESS OF THE PATIENT'S TREATMENT AT A HEALTH 183
CARE FACILITY.
(B) ALL WRITTEN NOTES, ORDERS, AND OBSERVATIONS ENTERED 185
INTO A HEALTH CARE RECORD AT A HEALTH CARE FACILITY, INCLUDING 186
ANY INTERPRETIVE REPORTS OF DIAGNOSTIC TESTS OR SPECIFIC 188
TREATMENTS, SUCH AS RADIOLOGIC OR ELECTROCARDIOGRAPHIC REPORTS, 189
OPERATIVE REPORTS, REPORTS OF PATHOLOGIC EXAMINATION OF TISSUE, 190
AND SIMILAR REPORTS, SHALL BE AUTHENTICATED BY THE INDIVIDUAL WHO 191
MADE OR AUTHORIZED THE ENTRY. HEALTH CARE RECORD ENTRIES MAY BE 192
AUTHENTICATED BY HANDWRITTEN SIGNATURES OR HANDWRITTEN INITIALS. 193
THEY ALSO MAY BE AUTHENTICATED BY ELECTRONIC SIGNATURES OR 194
COMPUTER-GENERATED SIGNATURE CODES IF ALL OF THE FOLLOWING APPLY:
(1) THE HEALTH CARE FACILITY ADOPTS A POLICY THAT PERMITS 197
THE USE OF ELECTRONIC SIGNATURES OR COMPUTER-GENERATED SIGNATURE 198
CODES;
(2) THE FACILITY'S ELECTRONIC SIGNATURE OR 201
COMPUTER-GENERATED SIGNATURE CODE SYSTEM UTILIZES A TWO-LEVEL OR
BIOMETRIC ACCESS MECHANISM THAT ASSIGNS A UNIQUE IDENTIFIER TO 202
EACH USER;
(3) THE FACILITY TAKES STEPS TO SAFEGUARD AGAINST USE OF A 205
UNIQUE IDENTIFIER BY ANY INDIVIDUAL OTHER THAN THE ONE TO WHOM IT 206
IS ASSIGNED;
(4) THE SYSTEM INCLUDES A PROCESS TO VERIFY THAT THE 209
INDIVIDUAL AFFIXING THE ELECTRONIC SIGNATURE OR
COMPUTER-GENERATED SIGNATURE CODE HAS REVIEWED THE CONTENTS OF 210
THE ENTRY AND DETERMINED THAT THEY ARE WHAT THAT INDIVIDUAL 211
INTENDED;
(5) THE POLICY ADOPTED BY THE FACILITY PURSUANT TO 214
DIVISION (B)(1) OF THIS SECTION PRESCRIBES ALL OF THE FOLLOWING: 215
(a) A PROCEDURE BY WHICH EACH USER OF THE SYSTEM MUST 217
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CERTIFY IN WRITING THAT THE USER WILL KEEP THE USER'S UNIQUE 219
IDENTIFIER STRICTLY CONFIDENTIAL; 220
(b) PENALTIES FOR MISUSING THE SYSTEM OR A UNIQUE 223
IDENTIFIER ALLOWING ACCESS TO IT;
(c) TRAINING THAT THE FACILITY MUST PROVIDE TO ALL USERS 225
OF THE SYSTEM AND THAT INCLUDES AN EXPLANATION OF THE APPROPRIATE 227
USE OF THE SYSTEM AND THE CONSEQUENCES FOR NONCOMPLIANCE WITH THE 229
FACILITY'S CONFIDENTIALITY AND SECURITY POLICIES.
THE USE OF AN ELECTRONIC SIGNATURE OR COMPUTER-GENERATED 231
SIGNATURE CODE IN ACCORDANCE WITH THIS SECTION SHALL BE 232
CONSIDERED FOR ALL LEGAL PURPOSES TO BE THE SAME AS A HANDWRITTEN 233
SIGNATURE OR HANDWRITTEN INITIALS.
(C) THE PUBLIC HEALTH COUNCIL SHALL ESTABLISH AND ADOPT 235
PROTOCOLS FOR THE USE OF ELECTRONIC SIGNATURE AND 237
COMPUTER-GENERATED SIGNATURE CODE SYSTEMS. THE COUNCIL SHALL 238
CERTIFY A HEALTH CARE FACILITY'S ELECTRONIC SIGNATURE OR 239
COMPUTER-GENERATED SIGNATURE CODE SYSTEM IF IT COMPLIES WITH THE
PROTOCOL ADOPTED BY THE COUNCIL OR BY THE JOINT COMMISSION ON 240
HEALTH CARE ORGANIZATIONS. 241
(D) AN ELECTRONIC SIGNATURE GENERATED BY AN ELECTRONIC 243
SIGNATURE OR COMPUTER-GENERATED SIGNATURE CODE SYSTEM CERTIFIED 244
BY THE COUNCIL SHALL BE PRESUMED TO BE THE SIGNATURE OF THE 245
INDIVIDUAL TO WHOM IT IS ASSIGNED AND TO BE AFFIXED TO 247
AUTHENTICATE THE DOCUMENT.
Sec. 3702.51. As used in sections 3702.51 to 3702.62 of 256
the Revised Code: 257
(A) "Applicant" means any person that submits an 259
application for a certificate of need and who is designated in 260
the application as the applicant. 261
(B) "Person" means any individual, corporation, business 263
trust, estate, firm, partnership, association, joint stock 264
company, insurance company, government unit, or other entity. 265
(C) "Certificate of need" means a written approval granted 267
by the director of health to an applicant to authorize conducting 268
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a reviewable activity. 269
(D) "Health service area" means a geographic region 271
designated by the director of health under section 3702.58 of the 272
Revised Code. 273
(E) "Health service" means a clinically related service, 275
such as a diagnostic, treatment, rehabilitative, or preventive 276
service. 277
(F) "Health service agency" means an agency designated to 279
serve a health service area in accordance with section 3702.58 of 280
the Revised Code. 281
(G) "Health care facility" means: 283
(1) A hospital registered under section 3701.07 of the 285
Revised Code; 286
(2) A nursing home licensed under section 3721.02 of the 288
Revised Code, or by a political subdivision certified under 289
section 3721.09 of the Revised Code; 290
(3) A county home or a county nursing home as defined in 292
section 5155.31 of the Revised Code that is certified under Title 293
XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 294
42 U.S.C.A. 301, as amended; 295
(4) A freestanding dialysis center; 297
(5) A freestanding inpatient rehabilitation facility; 299
(6) An ambulatory surgical facility; 301
(7) A freestanding cardiac catheterization facility; 303
(8) A freestanding birthing center; 305
(9) A freestanding or mobile diagnostic imaging center; 307
(10) A freestanding radiation therapy center. 309
A health care facility does not include the offices of 311
private physicians and dentists whether for individual or group 312
practice, Christian Science sanitoriums operated or listed and 313
certified by the First Church of Christ, Scientist, Boston, 314
Massachusetts, residential facilities licensed under section 315
5123.19 of the Revised Code, or habilitation centers certified by 316
the director of mental retardation and developmental disabilities 317
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under section 5123.041 of the Revised Code, OR AN INSTITUTION FOR 318
THE SICK THAT IS OPERATED EXCLUSIVELY FOR PATIENTS WHO USE 319
SPIRITUAL MEANS FOR HEALING AND FOR WHOM THE ACCEPTANCE OF 320
MEDICAL CARE IS INCONSISTENT WITH THEIR RELIGIOUS BELIEFS, 321
ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION, EXEMPT FROM 322
FEDERAL INCOME TAXATION UNDER SECTION 501 OF THE INTERNAL REVENUE 323
CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1, AS AMENDED, AND 325
PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO THE EXEMPTION
IN DIVISION (G) OF SECTION 4723.32 OF THE REVISED CODE FROM THE 326
LICENSING REQUIREMENTS OF CHAPTER 4723. OF THE REVISED CODE. 327
(H) "Medical equipment" means a single unit of medical 329
equipment or a single system of components with related functions 330
that is used to provide health services. 331
(I) "Third-party payer" means a medical care corporation 333
or health care corporation licensed under Chapter 1737. or 1738. 334
of the Revised Code, a health maintenance organization, an 335
insurance company that issues sickness and accident insurance in 336
conformity with Chapter 3923. of the Revised Code, a 337
state-financed health insurance program under Chapter 3701., 338
4123., or 5111. of the Revised Code, or any self-insurance plan. 339
(J) "Government unit" means the state and any county, 341
municipal corporation, township, or other political subdivision 342
of the state, or any department, division, board, or other agency 343
of the state or a political subdivision. 344
(K) "Health maintenance organization" means a public or 346
private organization organized under the law of any state that is 347
qualified under section 1310(d) of Title XIII of the "Public 348
Health Service Act," 87 Stat. 931 (1973), 42 U.S.C. 300e--9 or 349
that does all of the following: 350
(1) Provides or otherwise makes available to enrolled 352
participants health care services including at least the 353
following basic health care services: usual physician services, 354
hospitalization, laboratory, x-ray, emergency and preventive 355
services, and out-of-area coverage; 356
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(2) Is compensated, except for copayments, for the 358
provision of basic health care services listed in division (K)(1) 359
of this section to enrolled participants by a payment that is 360
paid on a periodic basis without regard to the date the health 361
care services are provided and that is fixed without regard to 362
the frequency, extent, or kind of health service actually 363
provided; 364
(3) Provides physician services primarily either: 366
(a) Directly through physicians who are either employees 368
or partners of the organization; 369
(b) Through arrangements with individual physicians or one 371
or more groups of physicians organized on a group practice or 372
individual practice basis. 373
(L) "Existing health care facility" means a health care 375
facility that is licensed or otherwise approved to practice in 376
this state, in accordance with applicable law, is staffed and 377
equipped to provide health care services, and actively provides 378
health services or has not been actively providing health 379
services for less than twelve consecutive months. 380
(M) "State" means the state of Ohio, including, but not 382
limited to, the general assembly, the supreme court, the offices 383
of all elected state officers, and all departments, boards, 384
offices, commissions, agencies, institutions, and other 385
instrumentalities of the state of Ohio. "State" does not include 386
political subdivisions. 387
(N) "Political subdivision" means a municipal corporation, 389
township, county, school district, and all other bodies corporate 390
and politic responsible for governmental activities only in 391
geographic areas smaller than that of the state to which the 392
sovereign immunity of the state attaches. 393
(O) "Affected person" means: 395
(1) An applicant for a certificate of need, including an 397
applicant whose application was reviewed comparatively with the 398
application in question; 399
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(2) The person that requested the reviewability ruling in 401
question;
(3) Any person that resides or regularly uses health care 403
facilities within the geographic area served or to be served by 404
the health care services that would be provided under the 405
certificate of need or reviewability ruling in question; 406
(4) Any health care facility that is located in the health 408
service area where the health care services would be provided 409
under the certificate of need or reviewability ruling in 410
question;
(5) Third-party payers that reimburse health care 412
facilities for services in the health service area where the 413
health care services would be provided under the certificate of 414
need or reviewability ruling in question; 415
(6) Any other person who testified at a public hearing 417
held under division (B) of section 3702.52 of the Revised Code or 418
submitted written comments in the course of review of the 419
certificate of need application in question. 420
(P) "Osteopathic hospital" means a hospital registered 422
under section 3701.07 of the Revised Code that advocates 423
osteopathic principles and the practice and perpetuation of 424
osteopathic medicine by doing any of the following: 425
(1) Maintaining a department or service of osteopathic 427
medicine or a committee on the utilization of osteopathic 428
principles and methods, under the supervision of an osteopathic 429
physician; 430
(2) Maintaining an active medical staff, the majority of 432
which is comprised of osteopathic physicians; 433
(3) Maintaining a medical staff executive committee that 435
has osteopathic physicians as a majority of its members. 436
(Q) "Ambulatory surgical facility" has the same meaning as 438
in section 3702.30 of the Revised Code. 439
(R) Except as otherwise provided in division (T) of this 441
section, and until the termination date specified in section 442
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3702.511 of the Revised Code, "reviewable activity" means any of 443
the following:
(1) The addition by any person of any of the following 446
health services, regardless of the amount of operating costs or 447
capital expenditures: 448
(a) A heart, heart-lung, lung, liver, kidney, bowel, 450
pancreas, or bone marrow transplantation service, a stem cell 451
harvesting and reinfusion service, or a service for 452
transplantation of any other organ unless transplantation of the 453
organ is designated by public health council rule not to be a 454
reviewable activity; 455
(b) A cardiac catheterization service; 457
(c) An open-heart surgery service; 459
(d) Any new, experimental medical technology that is 462
designated by rule of the public health council.
(2) The acceptance of high-risk patients, as defined in 464
rules adopted under section 3702.57 of the Revised Code, by any 465
cardiac catheterization service that was initiated without a 466
certificate of need pursuant to division (R)(3)(b) of the version 468
of this section in effect immediately prior to April 20, 1995; 470
(3)(a) The establishment, development, or construction of 472
a new health care facility other than a new long-term care 473
facility or a new hospital; 474
(b) The establishment, development, or construction of a 476
new hospital or the relocation of an existing hospital; 477
(c) The relocation of hospital beds, other than long-term 479
care, perinatal, or pediatric intensive care beds, into or out of 480
a rural area. 481
(4)(a) The replacement of an existing hospital; 483
(b) The replacement of an existing hospital obstetric or 485
newborn care unit or freestanding birthing center. 487
(5)(a) The renovation of a hospital that involves a 491
capital expenditure, obligated on or after the effective date of
this amendment, of five million dollars or more, not including 493
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expenditures for equipment, staffing, or operational costs. For
purposes of division (R)(5)(a) of this section, a capital 495
expenditure is obligated:
(i) When a contract enforceable under Ohio law is entered 497
into for the construction, acquisition, lease, or financing of a 498
capital asset; 499
(ii) When the governing body of a hospital takes formal 501
action to commit its own funds for a construction project 502
undertaken by the hospital as its own contractor; 503
(iii) In the case of donated property, on the date the 505
gift is completed under applicable Ohio law. 506
(b) The renovation of a hospital obstetric or newborn care 508
unit or freestanding birthing center that involves a capital 510
expenditure of five million dollars or more, not including 511
expenditures for equipment, staffing, or operational costs. 512
(6) Any change in the health care services, bed capacity, 514
or site, or any other failure to conduct the reviewable activity 515
in substantial accordance with the approved application for which 516
a certificate of need was granted, if the change is made prior to 517
the date the activity for which the certificate was issued ceases 518
to be a reviewable activity; 519
(7) Any of the following changes in perinatal bed capacity 521
or pediatric intensive care bed capacity: 522
(a) An increase in bed capacity; 524
(b) A change in service or service-level designation of 527
newborn care beds or obstetric beds in a hospital or freestanding 528
birthing center, other than a change of service that is provided
within the service-level designation of newborn care or obstetric 529
beds as registered by the department of health; 530
(c) A relocation of perinatal or pediatric intensive care 533
beds from one physical facility or site to another, excluding the 534
relocation of beds within a hospital or freestanding birthing 535
center or the relocation of beds among buildings of a hospital or 537
freestanding birthing center at the same site. 538
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(8) The expenditure of more than one hundred ten per cent 540
of the maximum expenditure specified in a certificate of need; 541
(9) Any transfer of a certificate of need issued prior to 543
April 20, 1995, from the person to whom it was issued to another 545
person before the project that constitutes a reviewable activity 546
is completed, any agreement that contemplates the transfer of a 547
certificate of need issued prior to that date upon completion of 549
the project, and any transfer of the controlling interest in an 550
entity that holds a certificate of need issued prior to that
date. However, the transfer of a certificate of need issued 551
prior to that date or agreement to transfer such a certificate of 553
need from the person to whom the certificate of need was issued 554
to an affiliated or related person does not constitute a 555
reviewable transfer of a certificate of need for the purposes of 556
this division, unless the transfer results in a change in the 557
person that holds the ultimate controlling interest in the 558
certificate of need.
(10)(a) The acquisition by any person of any of the 560
following medical equipment, regardless of the amount of 562
operating costs or capital expenditure:
(i) A cobalt radiation therapy unit; 564
(ii) A linear accelerator; 566
(iii) A gamma knife unit. 568
(b) The acquisition by any person of medical equipment 570
with a cost of two million dollars or more. The cost of 571
acquiring medical equipment includes the sum of the following: 572
(i) The greater of its fair market value or the cost of 574
its lease or purchase; 575
(ii) The cost of installation and any other activities 577
essential to the acquisition of the equipment and its placement 578
into service.
(11) The addition of another cardiac catheterization 581
laboratory to an existing cardiac catheterization service. 582
(S) Except as provided in division (T) of this section, 585
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"reviewable activity" also means any of the following activities, 587
none of which are subject to a termination date:
(1) The establishment, development, or construction of a 589
new long-term care facility; 590
(2) The replacement of an existing long-term care 592
facility; 593
(3) The renovation of a long-term care facility that 595
involves a capital expenditure of two million dollars or more, 596
not including expenditures for equipment, staffing, or 597
operational costs; 598
(4) Any of the following changes in long-term care bed 600
capacity: 601
(a) An increase in bed capacity; 603
(b) A relocation of beds from one physical facility or 606
site to another, excluding the relocation of beds within a 607
long-term care facility or among buildings of a long-term care 608
facility at the same site;
(c) A recategorization of hospital beds registered under 611
section 3701.07 of the Revised Code from another registration 613
category to skilled nursing beds or long-term care beds. 614
(5) Any change in the health services, bed capacity, or 616
site, or any other failure to conduct the reviewable activity in 617
substantial accordance with the approved application for which a 618
certificate of need concerning long-term care beds was granted, 619
if the change is made within five years after the implementation 620
of the reviewable activity for which the certificate was granted; 622
(6) The expenditure of more than one hundred ten per cent 624
of the maximum expenditure specified in a certificate of need 625
concerning long-term care beds; 626
(7) Any transfer of a certificate of need that concerns 628
long-term care beds and was issued prior to April 20, 1995, from 630
the person to whom it was issued to another person before the 631
project that constitutes a reviewable activity is completed, any 632
agreement that contemplates the transfer of such a certificate of 633
14
need upon completion of the project, and any transfer of the 634
controlling interest in an entity that holds such a certificate 635
of need. However, the transfer of a certificate of need that 636
concerns long-term care beds and was issued prior to April 20, 638
1995, or agreement to transfer such a certificate of need from 639
the person to whom the certificate was issued to an affiliated or 640
related person does not constitute a reviewable transfer of a 641
certificate of need for purposes of this division, unless the 642
transfer results in a change in the person that holds the 643
ultimate controlling interest in the certificate of need. 644
(T) "Reviewable activity" does not include any of the 646
following activities: 647
(1) Acquisition of computer hardware or software; 649
(2) Acquisition of a telephone system; 651
(3) Construction or acquisition of parking facilities; 653
(4) Correction of cited deficiencies that are in violation 655
of federal, state, or local fire, building, or safety laws and 656
rules and that constitute an imminent threat to public health or 657
safety; 658
(5) Acquisition of an existing health care facility that 660
does not involve a change in the number of the beds, by service, 661
or in the number or type of health services; 662
(6) Correction of cited deficiencies identified by 664
accreditation surveys of the joint commission on accreditation of 665
healthcare organizations or of the American osteopathic 666
association; 667
(7) Acquisition of medical equipment to replace the same 669
or similar equipment for which a certificate of need has been 670
issued if the replaced equipment is removed from service; 671
(8) Mergers, consolidations, or other corporate 673
reorganizations of health care facilities that do not involve a 674
change in the number of beds, by service, or in the number or 675
type of health services; 676
(9) Construction, repair, or renovation of bathroom 678
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facilities; 679
(10) Construction of laundry facilities, waste disposal 681
facilities, dietary department projects, heating and air 682
conditioning projects, administrative offices, and portions of 683
medical office buildings used exclusively for physician services; 684
(11) Acquisition of medical equipment to conduct research 686
required by the United States food and drug administration or 687
clinical trials sponsored by the national institute of health. 688
Use of medical equipment that was acquired without a certificate 689
of need under division (T)(11) of this section and for which 691
premarket approval has been granted by the United States food and 692
drug administration to provide services for which patients or 693
reimbursement entities will be charged shall be a reviewable 694
activity. 695
(12) Removal of asbestos from a health care facility. 697
Only that portion of a project that meets the requirements 699
of division (T) of this section is not a reviewable activity. 701
(U) "Small rural hospital" means a hospital that is 703
located within a rural area, has fewer than one hundred beds, and 705
to which fewer than four thousand persons were admitted during 706
the most recent calendar year.
(V) "Children's hospital" means any of the following: 708
(1) A hospital registered under section 3701.07 of the 710
Revised Code that provides general pediatric medical and surgical 711
care, and in which at least seventy-five per cent of annual 712
inpatient discharges for the preceding two calendar years were 713
individuals less than eighteen years of age; 714
(2) A distinct portion of a hospital registered under 716
section 3701.07 of the Revised Code that provides general 717
pediatric medical and surgical care, has a total of at least one 718
hundred fifty registered pediatric special care and pediatric 719
acute care beds, and in which at least seventy-five per cent of 720
annual inpatient discharges for the preceding two calendar years 721
were individuals less than eighteen years of age; 722
16
(3) A distinct portion of a hospital, if the hospital is 724
registered under section 3701.07 of the Revised Code as a 725
children's hospital and the children's hospital meets all the 726
requirements of division (V)(1) of this section. 727
(W) "Long-term care facility" means any of the following: 729
(1) A nursing home licensed under section 3721.02 of the 731
Revised Code or by a political subdivision certified under 732
section 3721.09 of the Revised Code; 733
(2) The portion of any facility, including a county home 735
or county nursing home, that is certified as a skilled nursing 736
facility or a nursing facility under Title XVIII or XIX of the 737
"Social Security Act";
(3) The portion of any hospital that contains beds 739
registered under section 3701.07 of the Revised Code as skilled 740
nursing beds or long-term care beds. 741
(X) "Long-term care bed" means a bed in a long-term care 743
facility.
(Y) "Perinatal bed" means a bed in a hospital that is 745
registered under section 3701.07 of the Revised Code as a newborn 746
care bed or obstetric bed, or a bed in a freestanding birthing 747
center.
(Z) "Freestanding birthing center" means any facility in 749
which deliveries routinely occur, regardless of whether the 751
facility is located on the campus of another health care
facility, and which is not licensed under Chapter 3711. of the 753
Revised Code as a level one, two, or three maternity unit or a 755
limited maternity unit.
(AA)(1) "Reviewability ruling" means a ruling issued by 757
the director of health under division (A) of section 3702.52 of 758
the Revised Code as to whether a particular proposed project is 759
or is not a reviewable activity. 760
(2) "Nonreviewability ruling" means a ruling issued under 762
that division that a particular proposed project is not a 763
reviewable activity. 764
17
(BB)(1) "Metropolitan statistical area" means an area of 767
this state designated a metropolitan statistical area or primary 768
metropolitan statistical area in United States office of 770
management and budget bulletin No. 93-17, June 30, 1993, and its 772
attachments. 773
(2) "Rural area" means any area of this state not located 775
within a metropolitan statistical area. 776
Sec. 3727.01. As used in this section, "health maintenance 785
organization" means a public or private organization organized 786
under the law of any state that is qualified under section 787
1310(d) of Title XIII of the "Public Health Service Act," 87 788
Stat. 931 (1973), 42 U.S.C. 300e-9, or that does all of the 789
following: 790
(A) Provides or otherwise makes available to enrolled 792
participants health care services including at least the 793
following basic health care services: usual physician services, 794
hospitalization, laboratory, x-ray, emergency and preventive 795
service, and out-of-area coverage; 796
(B) Is compensated, except for copayments, for the 798
provision of basic health care services to enrolled participants 799
by a payment that is paid on a periodic basis without regard to 800
the date the health care services are provided and that is fixed 801
without regard to the frequency, extent, or kind of health 802
service actually provided; 803
(C) Provides physician services primarily in either of the 805
following ways: 806
(1) Directly through physicians who are either employees 808
or partners of the organization; 809
(2) Through arrangements with individual physicians or one 811
or more groups of physicians organized on a group practice or 812
individual practice basis. 813
As used in this chapter, "hospital" means an institution 815
classified as a hospital under section 3701.07 of the Revised 816
Code in which are provided to inpatients diagnostic, medical, 817
18
surgical, obstetrical, psychiatric, or rehabilitation care for a 818
continuous period longer than twenty-four hours; a tuberculosis 819
hospital; or a hospital operated by a health maintenance 820
organization. "Hospital" does not include a facility licensed 821
under Chapter 3721. of the Revised Code, a health care facility 822
operated by the department of mental health or the department of 823
mental retardation and developmental disabilities, a health 824
maintenance organization that does not operate a hospital, the 825
office of any private licensed health care professional, whether 826
organized for individual or group practice, a Christian Science 827
sanatorium operated or listed and certified by the First Church 828
of Christ, Scientist, Boston, Massachusetts, or a clinic that 829
provides ambulatory patient services and where patients are not 830
regularly admitted as inpatients. NOR DOES "HOSPITAL" INCLUDE AN 831
INSTITUTION FOR THE SICK THAT IS OPERATED EXCLUSIVELY FOR 833
PATIENTS WHO USE SPIRITUAL MEANS FOR HEALING AND FOR WHOM THE 834
ACCEPTANCE OF MEDICAL CARE IS INCONSISTENT WITH THEIR RELIGIOUS 835
BELIEFS, ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION,
EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501 OF THE 836
INTERNAL REVENUE CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1, AS 838
AMENDED, AND PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO 839
THE EXEMPTION IN DIVISION (G) OF SECTION 4723.32 OF THE REVISED 840
CODE FROM THE LICENSING REQUIREMENTS OF CHAPTER 4723. OF THE 841
REVISED CODE.
Sec. 4751.05. (A) The board of examiners of nursing home 850
administrators shall admit to examination for licensure as a 851
nursing home administrator any candidate who: 852
(1) Pays the application fee of fifty dollars; 854
(2) Submits evidence of good moral character and 856
suitability; 857
(3) Is at least eighteen years of age; 859
(4) Has completed educational requirements and work 861
experience satisfactory to the board; 862
(5) Submits an application on forms prescribed by the 864
19
board; 865
(6) Pays the examination fee of one hundred fifty dollars. 867
(B) Nothing in Chapter 4751. of the Revised Code or the 869
rules adopted thereunder shall be construed to require an 870
applicant for licensure or a temporary license, who is certified 871
EMPLOYED by a recognized church or religious denomination which 872
teaches reliance on spiritual means alone for healing and has 873
been approved to administer institutions certified by such church 874
or denomination AN INSTITUTION for the care and treatment of the 875
sick in accordance with its teachings, to demonstrate proficiency 877
in any medical techniques or to meet any medical educational 878
qualifications or medical standards not in accord with the 879
remedial care and treatment provided in such institutions BY THE 880
INSTITUTION IF THE INSTITUTION IS ALL OF THE FOLLOWING: 881
(1) OPERATED EXCLUSIVELY FOR PATIENTS WHO USE SPIRITUAL 883
MEANS FOR HEALING AND FOR WHOM THE ACCEPTANCE OF MEDICAL CARE IS 884
INCONSISTENT WITH THEIR RELIGIOUS BELIEFS; 885
(2) ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION; 887
(3) EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501 889
OF THE INTERNAL REVENUE CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 891
1, AS AMENDED; 892
(4) PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO 894
THE EXEMPTION IN DIVISION (G) OF SECTION 4723.32 OF THE REVISED 895
CODE FROM THE LICENSING REQUIREMENTS OF CHAPTER 4723. OF THE 896
REVISED CODE.
(B)(C) If a person fails three times to attain a passing 898
grade on the examination, said person, before he THE PERSON may 899
again be admitted to examination, shall meet such additional 900
education or experience requirements, or both, as may be 901
prescribed by the board. 902
Section 2. That existing sections 3702.51, 3727.01, and 904
4751.05 of the Revised Code are hereby repealed. 905