As Rereported by the Senate Health Committee 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
SENATORS DRAKE-DIX-RAY-BLESSING 11
12
A B I L L
To amend sections 3702.30, 3702.51, 3727.01, 14
4723.41, and 4751.05 and to enact sections 5.2213 15
and 3701.75 of the Revised Code to establish 17
standards for using electronic signatures in 19
health care records, to extend exemptions from 20
hospital and nursing home regulations that apply 21
to Christian Science sanatoriums to other 23
institutions that meet similar criteria, to 24
eliminate an extension on the effective date of
the licensing requirement that applies to certain 25
health care facilities located in rural areas, to 27
modify the requirements to practice as a clinical 28
nurse specialist, and to designate "Ohio Breast
Cancer Awareness Month" and "Ohio Mammography 29
Day."
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 31
Section 1. That sections 3702.30, 3702.51, 3727.01, 33
4723.41, and 4751.05 be amended and sections 5.2213 and 3701.75 36
of the Revised Code be enacted to read as follows: 37
Sec. 5.2213. THE MONTH OF OCTOBER IS DESIGNATED AS "OHIO 40
BREAST CANCER AWARENESS MONTH," AND THE THIRD THURSDAY OF EACH 41
OCTOBER IS DESIGNATED AS "OHIO MAMMOGRAPHY DAY," TO PROMOTE THE 42
IMPORTANCE OF IDENTIFYING BREAST CANCER IN ITS EARLIEST STAGES. 43
2
Sec. 3701.75. (A) AS USED IN THIS SECTION: 45
(1) "ELECTRONIC RECORD" MEANS A RECORD COMMUNICATED, 48
RECEIVED, OR STORED BY ELECTRONIC, MAGNETIC, OPTICAL, OR SIMILAR 49
MEANS FOR STORAGE IN AN INFORMATION SYSTEM OR TRANSMISSION FROM 50
ONE INFORMATION SYSTEM TO ANOTHER. "ELECTRONIC RECORD" INCLUDES 51
A RECORD THAT IS COMMUNICATED, RECEIVED, OR STORED BY ELECTRONIC
DATA INTERCHANGE, ELECTRONIC MAIL, FACSIMILE, TELEX, OR SIMILAR 53
METHODS OF COMMUNICATION.
(2) "ELECTRONIC SIGNATURE" MEANS ANY OF THE FOLLOWING 55
ATTACHED TO OR ASSOCIATED WITH AN ELECTRONIC RECORD BY AN 57
INDIVIDUAL TO AUTHENTICATE THE RECORD:
(a) A CODE CONSISTING OF A COMBINATION OF LETTERS, 60
NUMBERS, CHARACTERS, OR SYMBOLS THAT IS ADOPTED OR EXECUTED BY AN 61
INDIVIDUAL AS THAT INDIVIDUAL'S ELECTRONIC SIGNATURE; 62
(b) A COMPUTER-GENERATED SIGNATURE CODE CREATED FOR AN 65
INDIVIDUAL;
(c) AN ELECTRONIC IMAGE OF AN INDIVIDUAL'S HANDWRITTEN 68
SIGNATURE CREATED BY USING A PEN COMPUTER.
(3) "HEALTH CARE RECORD" MEANS ANY DOCUMENT OR COMBINATION 71
OF DOCUMENTS PERTAINING TO A PATIENT'S MEDICAL HISTORY,
DIAGNOSIS, PROGNOSIS, OR MEDICAL CONDITION THAT IS GENERATED AND 72
MAINTAINED IN THE PROCESS OF THE PATIENT'S TREATMENT. 73
(B) ANY ENTRY INTO A HEALTH CARE RECORD MAY BE 77
AUTHENTICATED BY EXECUTING HANDWRITTEN SIGNATURES OR HANDWRITTEN 78
INITIALS DIRECTLY ON THE ENTRY OR BY EXECUTING AN ELECTRONIC 79
SIGNATURE. AN ELECTRONIC SIGNATURE EXECUTED IN ACCORDANCE WITH 80
AN ELECTRONIC SIGNATURE SYSTEM THAT IS CERTIFIED BY THE 82
DEPARTMENT OF HEALTH UNDER DIVISION (C) OF THIS SECTION SHALL BE 83
CONSIDERED FOR ALL LEGAL PURPOSES TO BE THE SAME AS HAVING 84
EXECUTED A HANDWRITTEN SIGNATURE OR HANDWRITTEN INITIALS, EXCEPT 85
WHEN ANY FEDERAL LAW GOVERNING STATE PARTICIPATION IN A FEDERAL 86
PROGRAM REQUIRES THAT ENTRIES INTO HEALTH CARE RECORDS BE 87
AUTHENTICATED ONLY BY HANDWRITTEN SIGNATURES OR HANDWRITTEN 88
INITIALS. THE ELECTRONIC SIGNATURE GENERATED BY A CERTIFIED 90
3
SYSTEM SHALL BE PRESUMED TO BE THE SIGNATURE OF THE INDIVIDUAL TO 92
WHOM IT IS ASSIGNED AND TO BE AFFIXED FOR THE PURPOSE OF 94
AUTHENTICATING AN ENTRY INTO A HEALTH CARE RECORD.
(C)(1) THE DEPARTMENT OF HEALTH SHALL ADMINISTER A PROGRAM 96
UNDER WHICH ENTITIES THAT CREATE AND MAINTAIN HEALTH CARE RECORDS 97
MAY RECEIVE CERTIFICATION FROM THE DEPARTMENT OF THEIR ELECTRONIC 98
SIGNATURE SYSTEMS. THE DEPARTMENT SHALL DETERMINE THE TYPES OF 99
ENTITIES THAT ARE ELIGIBLE TO HAVE THEIR ELECTRONIC SIGNATURE 100
SYSTEMS CERTIFIED UNDER THIS SECTION.
THE DEPARTMENT SHALL CERTIFY AN ELIGIBLE ENTITY'S 102
ELECTRONIC SIGNATURE SYSTEM IF ALL OF THE FOLLOWING APPLY: 103
(a) THE ENTITY ADOPTS A POLICY THAT PERMITS THE USE OF 107
ELECTRONIC SIGNATURES ON ELECTRONIC RECORDS. 108
(b) THE ENTITY'S ELECTRONIC SIGNATURE SYSTEM UTILIZES 111
EITHER A TWO-LEVEL ACCESS CONTROL MECHANISM THAT ASSIGNS A UNIQUE 112
IDENTIFIER TO EACH USER OR A BIOMETRIC ACCESS CONTROL DEVICE. 113
(c) THE ENTITY TAKES STEPS TO SAFEGUARD AGAINST 116
UNAUTHORIZED ACCESS TO THE SYSTEM AND FORGERY OF ELECTRONIC 118
SIGNATURES.
(d) THE SYSTEM INCLUDES A PROCESS TO VERIFY THAT THE 121
INDIVIDUAL AFFIXING THE ELECTRONIC SIGNATURE HAS REVIEWED THE 122
CONTENTS OF THE ENTRY AND DETERMINED THAT THE ENTRY CONTAINS WHAT 123
THAT INDIVIDUAL INTENDED.
(e) THE POLICY ADOPTED BY THE ENTITY PURSUANT TO DIVISION 126
(C)(1)(a) OF THIS SECTION PRESCRIBES ALL OF THE FOLLOWING: 127
(i) A PROCEDURE BY WHICH EACH USER OF THE SYSTEM MUST 129
CERTIFY IN WRITING THAT THE USER WILL FOLLOW THE CONFIDENTIALITY 132
AND SECURITY POLICIES MAINTAINED BY THE ENTITY FOR THE SYSTEM; 133
(ii) PENALTIES FOR MISUSING THE SYSTEM; 135
(iii) TRAINING FOR ALL USERS OF THE SYSTEM THAT INCLUDES 139
AN EXPLANATION OF THE APPROPRIATE USE OF THE SYSTEM AND THE
CONSEQUENCES FOR NOT COMPLYING WITH THE ENTITY'S CONFIDENTIALITY 141
AND SECURITY POLICIES.
(2) IN LIEU OF MAKING A DIRECT DETERMINATION OF COMPLIANCE 144
4
UNDER DIVISION (C)(1) OF THIS SECTION, THE DEPARTMENT MAY ACCEPT 146
THE APPROVAL OF ANY PRIVATE OR PUBLIC ORGANIZATION THAT HAS
REVIEWED THE ENTITY'S SYSTEM, IF THE DEPARTMENT DETERMINES THAT 147
THE ORGANIZATION HAS STANDARDS AT LEAST AS STRINGENT AS THOSE 148
SPECIFIED IN DIVISION (C)(1) OF THIS SECTION. ORGANIZATIONS WITH 150
STANDARDS FOR APPROVAL OF ELECTRONIC SIGNATURE SYSTEMS THAT THE
DEPARTMENT MAY ACCEPT INCLUDE THE JOINT COMMISSION ON 153
ACCREDITATION OF HEALTHCARE ORGANIZATIONS, THE AMERICAN 154
OSTEOPATHIC ASSOCIATION, THE UNITED STATES FOOD AND DRUG 156
ADMINISTRATION, AND THE UNITED STATES HEALTH CARE FINANCING 158
ADMINISTRATION. IF AN ENTITY RECEIVES APPROVAL OF ITS ELECTRONIC 159
SIGNATURE SYSTEM IN THIS MANNER, AND IS SUBSEQUENTLY CITED BY THE 161
PRIVATE OR PUBLIC ORGANIZATION FOR A VIOLATION THAT INVOLVES THE 162
ENTITY'S SYSTEM, THE ENTITY SHALL IMMEDIATELY NOTIFY THE 164
DEPARTMENT OF THE CITATION AND THE DEPARTMENT SHALL WITHDRAW ITS
CERTIFICATION. 165
(3) THE PUBLIC HEALTH COUNCIL SHALL ADOPT RULES IN 167
ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE AS NECESSARY FOR 168
THE DEPARTMENT'S ADMINISTRATION OF THE PROGRAM FOR CERTIFYING THE 169
ELECTRONIC SIGNATURE SYSTEMS OF ENTITIES THAT CREATE AND MAINTAIN 170
HEALTH CARE RECORDS.
Sec. 3702.30. (A) As used in this section: 179
(1) "Ambulatory surgical facility" means a facility, 181
whether or not part of the same organization as a hospital, that 182
is located in a building distinct from another in which inpatient 184
care is provided, and to which any of the following apply: 185
(a) Outpatient surgery is routinely performed in the 187
facility and the facility functions separately from a hospital's 189
inpatient surgical service and from the offices of private
physicians, podiatrists, and dentists; 190
(b) Anesthesia is administered in the facility by an 193
anesthesiologist or certified registered nurse anesthetist and 195
the facility functions separately from a hospital's inpatient
surgical service and from the offices of private physicians, 196
5
podiatrists, and dentists; 197
(c) The facility applies to be certified by the United 200
States health care financing administration as an ambulatory 201
surgical center for purposes of reimbursement under Part B of the 202
medicare program, Part B of Title XVIII of the "Social Security 204
Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended; 205
(d) The facility applies to be certified by a national 208
accrediting body approved by the health care financing
administration for purposes of deemed compliance with the 209
conditions for participating in the medicare program as an 210
ambulatory surgical center; 211
(e) The facility bills or receives from any third-party 214
payer, governmental health care program, or other person or
government entity any ambulatory surgical facility fee that is 216
billed or paid in addition to any fee for professional services; 217
(f) The facility is held out to any person or government 219
entity as an ambulatory surgical facility or similar facility by 220
means of signage, advertising, or other promotional efforts. 221
"Ambulatory surgical facility" does not include a hospital 224
emergency department.
(2) "Ambulatory surgical facility fee" means a fee for 227
certain overhead costs associated with providing surgical 228
services in an outpatient setting. A fee is an ambulatory 229
surgical facility fee only if it directly or indirectly pays for 230
costs associated with any of the following:
(a) Use of operating and recovery rooms, preparation 233
areas, and waiting rooms and lounges for patients and relatives; 234
(b) Administrative functions, record keeping, 236
housekeeping, utilities, and rent; 237
(c) Services provided by nurses, orderlies, technical 240
personnel, and others involved in patient care related to 241
providing surgery.
"Ambulatory surgical facility fee" does not include any 244
additional payment in excess of a professional fee that is 245
6
provided to encourage physicians, podiatrists, and dentists to 246
perform certain surgical procedures in their office or their 247
group practice's office rather than a health care facility, if 248
the purpose of the additional fee is to compensate for additional 249
cost incurred in performing office-based surgery.
(3) "Governmental health care program" has the same 251
meaning as in section 4731.65 of the Revised Code. 252
(4) "Health care facility" means any of the following: 254
(a) An ambulatory surgical facility; 256
(b) A freestanding dialysis center; 258
(c) A freestanding inpatient rehabilitation facility; 260
(d) A freestanding birthing center; 262
(e) A freestanding radiation therapy center; 264
(f) A freestanding or mobile diagnostic imaging center. 266
(5) "Metropolitan statistical area" has the same meaning 269
as in section 3702.51 of the Revised Code.
(6) "Third-party payer" has the same meaning as in section 272
3901.38 of the Revised Code.
(B) By rule adopted in accordance with sections 3702.12 275
and 3702.13 of the Revised Code, the director of health shall 276
establish quality standards for health care facilities. The 277
standards may incorporate accreditation standards or other
quality standards established by any entity recognized by the 278
director. The rules shall be adopted so as to cause the 279
standards to take effect on March 31, 1996. 280
(C) The director shall issue a license to each health care 282
facility that makes application for a license and demonstrates to 283
the director that it meets the quality standards established 284
under division (B) of this section, except that if a health care 285
facility located in a metropolitan statistical area applies for a 286
license on or after March 31, 1996, and at the time the license 288
is to take effect the quality standards are not yet in effect, 290
the director shall issue the license without a demonstration that 291
the health care facility meets quality standards.
7
(D) Effective March 31, 1996, no health care facility 293
located in a metropolitan statistical area shall operate without 294
a license issued under this section. Effective April 1, 1998, no 295
other NO health care facility shall operate without a license 297
issued under this section.
(E) The rules adopted under division (B) of this section 300
shall include provisions governing application for, renewal, 301
suspension, and revocation of licenses.
Sec. 3702.51. As used in sections 3702.51 to 3702.62 of 310
the Revised Code: 311
(A) "Applicant" means any person that submits an 313
application for a certificate of need and who is designated in 314
the application as the applicant. 315
(B) "Person" means any individual, corporation, business 317
trust, estate, firm, partnership, association, joint stock 318
company, insurance company, government unit, or other entity. 319
(C) "Certificate of need" means a written approval granted 321
by the director of health to an applicant to authorize conducting 322
a reviewable activity. 323
(D) "Health service area" means a geographic region 325
designated by the director of health under section 3702.58 of the 326
Revised Code. 327
(E) "Health service" means a clinically related service, 329
such as a diagnostic, treatment, rehabilitative, or preventive 330
service. 331
(F) "Health service agency" means an agency designated to 333
serve a health service area in accordance with section 3702.58 of 334
the Revised Code. 335
(G) "Health care facility" means: 337
(1) A hospital registered under section 3701.07 of the 339
Revised Code; 340
(2) A nursing home licensed under section 3721.02 of the 342
Revised Code, or by a political subdivision certified under 343
section 3721.09 of the Revised Code; 344
8
(3) A county home or a county nursing home as defined in 346
section 5155.31 of the Revised Code that is certified under Title 347
XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 348
42 U.S.C.A. 301, as amended; 349
(4) A freestanding dialysis center; 351
(5) A freestanding inpatient rehabilitation facility; 353
(6) An ambulatory surgical facility; 355
(7) A freestanding cardiac catheterization facility; 357
(8) A freestanding birthing center; 359
(9) A freestanding or mobile diagnostic imaging center; 361
(10) A freestanding radiation therapy center. 363
A health care facility does not include the offices of 365
private physicians and dentists whether for individual or group 366
practice, Christian Science sanitoriums operated or listed and 367
certified by the First Church of Christ, Scientist, Boston, 368
Massachusetts, residential facilities licensed under section 369
5123.19 of the Revised Code, or habilitation centers certified by 370
the director of mental retardation and developmental disabilities 371
under section 5123.041 of the Revised Code, OR AN INSTITUTION FOR 372
THE SICK THAT IS OPERATED EXCLUSIVELY FOR PATIENTS WHO USE 373
SPIRITUAL MEANS FOR HEALING AND FOR WHOM THE ACCEPTANCE OF 374
MEDICAL CARE IS INCONSISTENT WITH THEIR RELIGIOUS BELIEFS, 375
ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION, EXEMPT FROM 376
FEDERAL INCOME TAXATION UNDER SECTION 501 OF THE INTERNAL REVENUE 377
CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1, AS AMENDED, AND 379
PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO THE EXEMPTION
IN DIVISION (G) OF SECTION 4723.32 OF THE REVISED CODE FROM THE 380
LICENSING REQUIREMENTS OF CHAPTER 4723. OF THE REVISED CODE. 381
(H) "Medical equipment" means a single unit of medical 383
equipment or a single system of components with related functions 384
that is used to provide health services. 385
(I) "Third-party payer" means a health insuring 387
corporation licensed under Chapter 1751. of the Revised Code, a 390
health maintenance organization as defined in division (K) of 391
9
this section, an insurance company that issues sickness and 392
accident insurance in conformity with Chapter 3923. of the 393
Revised Code, a state-financed health insurance program under 394
Chapter 3701., 4123., or 5111. of the Revised Code, or any 395
self-insurance plan.
(J) "Government unit" means the state and any county, 397
municipal corporation, township, or other political subdivision 398
of the state, or any department, division, board, or other agency 399
of the state or a political subdivision. 400
(K) "Health maintenance organization" means a public or 402
private organization organized under the law of any state that is 403
qualified under section 1310(d) of Title XIII of the "Public 404
Health Service Act," 87 Stat. 931 (1973), 42 U.S.C. 300e--9 405
300e-9. 406
(L) "Existing health care facility" means a health care 408
facility that is licensed or otherwise approved to practice in 409
this state, in accordance with applicable law, is staffed and 410
equipped to provide health care services, and actively provides 411
health services or has not been actively providing health 412
services for less than twelve consecutive months. 413
(M) "State" means the state of Ohio, including, but not 415
limited to, the general assembly, the supreme court, the offices 416
of all elected state officers, and all departments, boards, 417
offices, commissions, agencies, institutions, and other 418
instrumentalities of the state of Ohio. "State" does not include 419
political subdivisions. 420
(N) "Political subdivision" means a municipal corporation, 422
township, county, school district, and all other bodies corporate 423
and politic responsible for governmental activities only in 424
geographic areas smaller than that of the state to which the 425
sovereign immunity of the state attaches. 426
(O) "Affected person" means: 428
(1) An applicant for a certificate of need, including an 430
applicant whose application was reviewed comparatively with the 431
10
application in question; 432
(2) The person that requested the reviewability ruling in 434
question;
(3) Any person that resides or regularly uses health care 436
facilities within the geographic area served or to be served by 437
the health care services that would be provided under the 438
certificate of need or reviewability ruling in question; 439
(4) Any health care facility that is located in the health 441
service area where the health care services would be provided 442
under the certificate of need or reviewability ruling in 443
question;
(5) Third-party payers that reimburse health care 445
facilities for services in the health service area where the 446
health care services would be provided under the certificate of 447
need or reviewability ruling in question; 448
(6) Any other person who testified at a public hearing 450
held under division (B) of section 3702.52 of the Revised Code or 451
submitted written comments in the course of review of the 452
certificate of need application in question. 453
(P) "Osteopathic hospital" means a hospital registered 455
under section 3701.07 of the Revised Code that advocates 456
osteopathic principles and the practice and perpetuation of 457
osteopathic medicine by doing any of the following: 458
(1) Maintaining a department or service of osteopathic 460
medicine or a committee on the utilization of osteopathic 461
principles and methods, under the supervision of an osteopathic 462
physician; 463
(2) Maintaining an active medical staff, the majority of 465
which is comprised of osteopathic physicians; 466
(3) Maintaining a medical staff executive committee that 468
has osteopathic physicians as a majority of its members. 469
(Q) "Ambulatory surgical facility" has the same meaning as 471
in section 3702.30 of the Revised Code. 472
(R) Except as otherwise provided in division (T) of this 474
11
section, and until the termination date specified in section 475
3702.511 of the Revised Code, "reviewable activity" means any of 476
the following:
(1) The addition by any person of any of the following 479
health services, regardless of the amount of operating costs or 480
capital expenditures: 481
(a) A heart, heart-lung, lung, liver, kidney, bowel, 483
pancreas, or bone marrow transplantation service, a stem cell 484
harvesting and reinfusion service, or a service for 485
transplantation of any other organ unless transplantation of the 486
organ is designated by public health council rule not to be a 487
reviewable activity; 488
(b) A cardiac catheterization service; 490
(c) An open-heart surgery service; 492
(d) Any new, experimental medical technology that is 495
designated by rule of the public health council.
(2) The acceptance of high-risk patients, as defined in 497
rules adopted under section 3702.57 of the Revised Code, by any 498
cardiac catheterization service that was initiated without a 499
certificate of need pursuant to division (R)(3)(b) of the version 501
of this section in effect immediately prior to April 20, 1995; 503
(3)(a) The establishment, development, or construction of 505
a new health care facility other than a new long-term care 506
facility or a new hospital; 507
(b) The establishment, development, or construction of a 509
new hospital or the relocation of an existing hospital; 510
(c) The relocation of hospital beds, other than long-term 512
care, perinatal, or pediatric intensive care beds, into or out of 513
a rural area. 514
(4)(a) The replacement of an existing hospital; 516
(b) The replacement of an existing hospital obstetric or 518
newborn care unit or freestanding birthing center. 520
(5)(a) The renovation of a hospital that involves a 524
capital expenditure, obligated on or after the effective date of
12
this amendment, of five million dollars or more, not including 526
expenditures for equipment, staffing, or operational costs. For
purposes of division (R)(5)(a) of this section, a capital 528
expenditure is obligated:
(i) When a contract enforceable under Ohio law is entered 530
into for the construction, acquisition, lease, or financing of a 531
capital asset; 532
(ii) When the governing body of a hospital takes formal 534
action to commit its own funds for a construction project 535
undertaken by the hospital as its own contractor; 536
(iii) In the case of donated property, on the date the 538
gift is completed under applicable Ohio law. 539
(b) The renovation of a hospital obstetric or newborn care 541
unit or freestanding birthing center that involves a capital 543
expenditure of five million dollars or more, not including 544
expenditures for equipment, staffing, or operational costs. 545
(6) Any change in the health care services, bed capacity, 547
or site, or any other failure to conduct the reviewable activity 548
in substantial accordance with the approved application for which 549
a certificate of need was granted, if the change is made prior to 550
the date the activity for which the certificate was issued ceases 551
to be a reviewable activity; 552
(7) Any of the following changes in perinatal bed capacity 554
or pediatric intensive care bed capacity: 555
(a) An increase in bed capacity; 557
(b) A change in service or service-level designation of 560
newborn care beds or obstetric beds in a hospital or freestanding 561
birthing center, other than a change of service that is provided
within the service-level designation of newborn care or obstetric 562
beds as registered by the department of health; 563
(c) A relocation of perinatal or pediatric intensive care 566
beds from one physical facility or site to another, excluding the 567
relocation of beds within a hospital or freestanding birthing 568
center or the relocation of beds among buildings of a hospital or 570
13
freestanding birthing center at the same site. 571
(8) The expenditure of more than one hundred ten per cent 573
of the maximum expenditure specified in a certificate of need; 574
(9) Any transfer of a certificate of need issued prior to 576
April 20, 1995, from the person to whom it was issued to another 578
person before the project that constitutes a reviewable activity 579
is completed, any agreement that contemplates the transfer of a 580
certificate of need issued prior to that date upon completion of 582
the project, and any transfer of the controlling interest in an 583
entity that holds a certificate of need issued prior to that
date. However, the transfer of a certificate of need issued 584
prior to that date or agreement to transfer such a certificate of 586
need from the person to whom the certificate of need was issued 587
to an affiliated or related person does not constitute a 588
reviewable transfer of a certificate of need for the purposes of 589
this division, unless the transfer results in a change in the 590
person that holds the ultimate controlling interest in the 591
certificate of need.
(10)(a) The acquisition by any person of any of the 593
following medical equipment, regardless of the amount of 595
operating costs or capital expenditure:
(i) A cobalt radiation therapy unit; 597
(ii) A linear accelerator; 599
(iii) A gamma knife unit. 601
(b) The acquisition by any person of medical equipment 603
with a cost of two million dollars or more. The cost of 604
acquiring medical equipment includes the sum of the following: 605
(i) The greater of its fair market value or the cost of 607
its lease or purchase; 608
(ii) The cost of installation and any other activities 610
essential to the acquisition of the equipment and its placement 611
into service.
(11) The addition of another cardiac catheterization 614
laboratory to an existing cardiac catheterization service. 615
14
(S) Except as provided in division (T) of this section, 618
"reviewable activity" also means any of the following activities, 620
none of which are subject to a termination date:
(1) The establishment, development, or construction of a 622
new long-term care facility; 623
(2) The replacement of an existing long-term care 625
facility; 626
(3) The renovation of a long-term care facility that 628
involves a capital expenditure of two million dollars or more, 629
not including expenditures for equipment, staffing, or 630
operational costs; 631
(4) Any of the following changes in long-term care bed 633
capacity: 634
(a) An increase in bed capacity; 636
(b) A relocation of beds from one physical facility or 639
site to another, excluding the relocation of beds within a 640
long-term care facility or among buildings of a long-term care 641
facility at the same site;
(c) A recategorization of hospital beds registered under 644
section 3701.07 of the Revised Code from another registration 646
category to skilled nursing beds or long-term care beds. 647
(5) Any change in the health services, bed capacity, or 649
site, or any other failure to conduct the reviewable activity in 650
substantial accordance with the approved application for which a 651
certificate of need concerning long-term care beds was granted, 652
if the change is made within five years after the implementation 653
of the reviewable activity for which the certificate was granted; 655
(6) The expenditure of more than one hundred ten per cent 657
of the maximum expenditure specified in a certificate of need 658
concerning long-term care beds; 659
(7) Any transfer of a certificate of need that concerns 661
long-term care beds and was issued prior to April 20, 1995, from 663
the person to whom it was issued to another person before the 664
project that constitutes a reviewable activity is completed, any 665
15
agreement that contemplates the transfer of such a certificate of 666
need upon completion of the project, and any transfer of the 667
controlling interest in an entity that holds such a certificate 668
of need. However, the transfer of a certificate of need that 669
concerns long-term care beds and was issued prior to April 20, 671
1995, or agreement to transfer such a certificate of need from 672
the person to whom the certificate was issued to an affiliated or 673
related person does not constitute a reviewable transfer of a 674
certificate of need for purposes of this division, unless the 675
transfer results in a change in the person that holds the 676
ultimate controlling interest in the certificate of need. 677
(T) "Reviewable activity" does not include any of the 679
following activities: 680
(1) Acquisition of computer hardware or software; 682
(2) Acquisition of a telephone system; 684
(3) Construction or acquisition of parking facilities; 686
(4) Correction of cited deficiencies that are in violation 688
of federal, state, or local fire, building, or safety laws and 689
rules and that constitute an imminent threat to public health or 690
safety; 691
(5) Acquisition of an existing health care facility that 693
does not involve a change in the number of the beds, by service, 694
or in the number or type of health services; 695
(6) Correction of cited deficiencies identified by 697
accreditation surveys of the joint commission on accreditation of 698
healthcare organizations or of the American osteopathic 699
association; 700
(7) Acquisition of medical equipment to replace the same 702
or similar equipment for which a certificate of need has been 703
issued if the replaced equipment is removed from service; 704
(8) Mergers, consolidations, or other corporate 706
reorganizations of health care facilities that do not involve a 707
change in the number of beds, by service, or in the number or 708
type of health services; 709
16
(9) Construction, repair, or renovation of bathroom 711
facilities; 712
(10) Construction of laundry facilities, waste disposal 714
facilities, dietary department projects, heating and air 715
conditioning projects, administrative offices, and portions of 716
medical office buildings used exclusively for physician services; 717
(11) Acquisition of medical equipment to conduct research 719
required by the United States food and drug administration or 720
clinical trials sponsored by the national institute of health. 721
Use of medical equipment that was acquired without a certificate 722
of need under division (T)(11) of this section and for which 724
premarket approval has been granted by the United States food and 725
drug administration to provide services for which patients or 726
reimbursement entities will be charged shall be a reviewable 727
activity. 728
(12) Removal of asbestos from a health care facility. 730
Only that portion of a project that meets the requirements 732
of division (T) of this section is not a reviewable activity. 734
(U) "Small rural hospital" means a hospital that is 736
located within a rural area, has fewer than one hundred beds, and 738
to which fewer than four thousand persons were admitted during 739
the most recent calendar year.
(V) "Children's hospital" means any of the following: 741
(1) A hospital registered under section 3701.07 of the 743
Revised Code that provides general pediatric medical and surgical 744
care, and in which at least seventy-five per cent of annual 745
inpatient discharges for the preceding two calendar years were 746
individuals less than eighteen years of age; 747
(2) A distinct portion of a hospital registered under 749
section 3701.07 of the Revised Code that provides general 750
pediatric medical and surgical care, has a total of at least one 751
hundred fifty registered pediatric special care and pediatric 752
acute care beds, and in which at least seventy-five per cent of 753
annual inpatient discharges for the preceding two calendar years 754
17
were individuals less than eighteen years of age; 755
(3) A distinct portion of a hospital, if the hospital is 757
registered under section 3701.07 of the Revised Code as a 758
children's hospital and the children's hospital meets all the 759
requirements of division (V)(1) of this section. 760
(W) "Long-term care facility" means any of the following: 762
(1) A nursing home licensed under section 3721.02 of the 764
Revised Code or by a political subdivision certified under 765
section 3721.09 of the Revised Code; 766
(2) The portion of any facility, including a county home 768
or county nursing home, that is certified as a skilled nursing 769
facility or a nursing facility under Title XVIII or XIX of the 770
"Social Security Act";
(3) The portion of any hospital that contains beds 772
registered under section 3701.07 of the Revised Code as skilled 773
nursing beds or long-term care beds. 774
(X) "Long-term care bed" means a bed in a long-term care 776
facility.
(Y) "Perinatal bed" means a bed in a hospital that is 778
registered under section 3701.07 of the Revised Code as a newborn 779
care bed or obstetric bed, or a bed in a freestanding birthing 780
center.
(Z) "Freestanding birthing center" means any facility in 782
which deliveries routinely occur, regardless of whether the 784
facility is located on the campus of another health care
facility, and which is not licensed under Chapter 3711. of the 786
Revised Code as a level one, two, or three maternity unit or a 788
limited maternity unit.
(AA)(1) "Reviewability ruling" means a ruling issued by 790
the director of health under division (A) of section 3702.52 of 791
the Revised Code as to whether a particular proposed project is 792
or is not a reviewable activity. 793
(2) "Nonreviewability ruling" means a ruling issued under 795
that division that a particular proposed project is not a 796
18
reviewable activity. 797
(BB)(1) "Metropolitan statistical area" means an area of 800
this state designated a metropolitan statistical area or primary 801
metropolitan statistical area in United States office of 803
management and budget bulletin No. 93-17, June 30, 1993, and its 805
attachments. 806
(2) "Rural area" means any area of this state not located 808
within a metropolitan statistical area. 809
Sec. 3727.01. As used in this section, "health maintenance 818
organization" means a public or private organization organized 819
under the law of any state that is qualified under section 820
1310(d) of Title XIII of the "Public Health Service Act," 87 821
Stat. 931 (1973), 42 U.S.C. 300e-9, or that does all of the 822
following: 823
(A) Provides or otherwise makes available to enrolled 825
participants health care services including at least the 826
following basic health care services: usual physician services, 827
hospitalization, laboratory, x-ray, emergency and preventive 828
service, and out-of-area coverage; 829
(B) Is compensated, except for copayments, for the 831
provision of basic health care services to enrolled participants 832
by a payment that is paid on a periodic basis without regard to 833
the date the health care services are provided and that is fixed 834
without regard to the frequency, extent, or kind of health 835
service actually provided; 836
(C) Provides physician services primarily in either of the 838
following ways: 839
(1) Directly through physicians who are either employees 841
or partners of the organization; 842
(2) Through arrangements with individual physicians or one 844
or more groups of physicians organized on a group practice or 845
individual practice basis. 846
As used in this chapter, "hospital" means an institution 848
classified as a hospital under section 3701.07 of the Revised 849
19
Code in which are provided to inpatients diagnostic, medical, 850
surgical, obstetrical, psychiatric, or rehabilitation care for a 851
continuous period longer than twenty-four hours; a tuberculosis 852
hospital; or a hospital operated by a health maintenance 853
organization. "Hospital" does not include a facility licensed 854
under Chapter 3721. of the Revised Code, a health care facility 855
operated by the department of mental health or the department of 856
mental retardation and developmental disabilities, a health 857
maintenance organization that does not operate a hospital, the 858
office of any private licensed health care professional, whether 859
organized for individual or group practice, a Christian Science 860
sanatorium operated or listed and certified by the First Church 861
of Christ, Scientist, Boston, Massachusetts, or a clinic that 862
provides ambulatory patient services and where patients are not 863
regularly admitted as inpatients. "HOSPITAL" ALSO DOES NOT 864
INCLUDE AN INSTITUTION FOR THE SICK THAT IS OPERATED EXCLUSIVELY 866
FOR PATIENTS WHO USE SPIRITUAL MEANS FOR HEALING AND FOR WHOM THE 867
ACCEPTANCE OF MEDICAL CARE IS INCONSISTENT WITH THEIR RELIGIOUS 868
BELIEFS, ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION,
EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501 OF THE 869
INTERNAL REVENUE CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1, AS 871
AMENDED, AND PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO 872
THE EXEMPTION IN DIVISION (G) OF SECTION 4723.32 OF THE REVISED 873
CODE FROM THE LICENSING REQUIREMENTS OF CHAPTER 4723. OF THE 874
REVISED CODE.
Sec. 4723.41. (A) Each person who desires to practice 883
nursing as a certified nurse-midwife and has not been authorized 885
to practice midwifery prior to December 1, 1967, and each person 886
who desires to practice nursing as a certified registered nurse 887
anesthetist, clinical nurse specialist, or certified nurse 888
practitioner shall file with the board of nursing a written 889
application for authorization to practice nursing in the desired 890
specialty, under oath, on a form prescribed by the board. 891
At EXCEPT AS PROVIDED IN DIVISIONS (B), (C), AND (D) OF 894
20
THIS SECTION, AT the time of making application, the applicant 895
shall meet all of the following requirements: 896
(1) Be a registered nurse; 898
(2) Except as provided in divisions (B) and (D) of this 901
section, submit SUBMIT documentation satisfactory to the board 903
that the applicant has earned at least a master's degree with a
major in a nursing specialty or in a related field that qualifies 904
the applicant to sit for the certification examination of a 905
national certifying organization listed in division (A)(3) of 906
this section or approved by the board under section 4723.46 of 908
the Revised Code; 909
(3) Except as provided in division (C) of this section, 912
submit SUBMIT documentation satisfactory to the board of having 913
passed the certification examination of one of the following: 914
(a) If the applicant is applying to practice nursing as a 916
certified nurse-midwife, the American college of nurse-midwives 917
or another national certifying organization approved by the board 918
under section 4723.46 of the Revised Code to examine and certify 920
nurse-midwives;
(b) If the applicant is applying to practice nursing as a 922
certified registered nurse anesthetist, the national council on 923
certification of nurse anesthetists of the American association 925
of nurse anesthetists, the national council on recertification of 926
nurse anesthetists of the American association of nurse 927
anesthetists, or another national certifying organization 928
approved by the board under section 4723.46 of the Revised Code 929
to examine and certify registered nurse anesthetists; 930
(c) If the applicant is applying to practice nursing as a 932
clinical nurse specialist, the American nurses credentialing 934
center or another national certifying organization approved by 935
the board under section 4723.46 of the Revised Code to examine 936
and certify clinical nurse specialists; 937
(d) If the applicant is applying to practice nursing as a 939
certified nurse practitioner, the American nurses credentialing 940
21
center, the national certification corporation, the national 941
board of pediatric nurse practitioners and associates, or another 942
national certifying organization approved by the board under 943
section 4723.46 of the Revised Code to examine and certify nurse 945
practitioners.
(4) Submit an affidavit with the application that states 948
all of the following:
(a) That the applicant is the person named in the 951
documents submitted under divisions (A)(2) and (3) of this 953
section and is the lawful possessor thereof;
(b) The applicant's age, residence, the school at which 955
the applicant obtained education in the applicant's nursing 958
specialty, and any other facts that the board requires; 960
(c) If the applicant is already engaged in the practice of 963
nursing as a certified registered nurse anesthetist, clinical 964
nurse specialist, certified nurse-midwife, or certified nurse 965
practitioner, the period during which and the place where the 966
applicant is engaged;
(d) If the applicant is already engaged in the practice of 969
nursing as a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner, the names and business addresses 970
of the applicant's current collaborating physicians and 971
podiatrists. If the applicant is not yet engaged in the practice 973
of nursing as a clinical nurse specialist, certified 974
nurse-midwife, or certified nurse practitioner, the applicant
shall submit the names and business addresses of the applicant's 975
collaborating physicians or podiatrists not later than thirty 976
days after first engaging in the practice. The applicant shall 977
give written notice to the board of any additions or deletions to 978
the affidavit of collaborating physicians or podiatrists not 979
later than thirty days after the change takes effect.
(B) On or before December 31, 2000, the board shall issue 982
to an applicant a certificate of authority to practice nursing as 983
a certified registered nurse anesthetist, certified 984
22
nurse-midwife, or certified nurse practitioner if the applicant
complies with all requirements of this section, other than the 986
requirement that the applicant has earned at least a master's 987
degree with a major in a nursing specialty or in a related field 988
that qualifies the applicant to sit for the certification 990
examination of a national certifying organization listed in 991
division (A)(3) of this section or approved by the board under 992
section 4723.46 of the Revised Code. 993
(C) On or before December 31, 2000, the board shall issue 996
to an applicant a certificate of authority to practice nursing as 997
a clinical nurse specialist if the applicant ONE OF THE FOLLOWING 998
APPLIES:
(1) THE APPLICANT HOLDS A MASTER'S OR HIGHER DEGREE WITH A 1,000
MAJOR IN A CLINICAL AREA OF NURSING FROM AN EDUCATIONAL 1,001
INSTITUTION ACCREDITED BY A NATIONAL OR REGIONAL ACCREDITING 1,002
ORGANIZATION AND complies with all requirements of this section, 1,004
other than the requirement of having passed a certification 1,005
examination.
(2) THE APPLICANT HOLDS A MASTER'S OR HIGHER DEGREE IN 1,007
NURSING OR A RELATED FIELD AND IS CERTIFIED AS A CLINICAL NURSE 1,010
SPECIALIST BY THE AMERICAN NURSES CREDENTIALING CENTER OR ANOTHER 1,011
NATIONAL CERTIFYING ORGANIZATION APPROVED BY THE BOARD UNDER 1,012
SECTION 4723.46 OF THE REVISED CODE.
(D) On or before December 31, 2008, the board shall issue 1,015
to an applicant a certificate of authority to practice nursing as 1,016
a certified nurse practitioner if the applicant has successfully 1,017
completed a nurse practitioner certificate program that receives 1,018
funding under and is employed by a public agency or a private, 1,019
nonprofit entity that receives funding under Title X of the 1,021
"Public Health Service Act," 42 U.S.C. 300 and 300a-1 (1991), and 1,024
complies with all requirements of this section, other than the 1,025
requirement that the applicant has earned at least a master's 1,026
degree with a major in a nursing specialty or in a related field 1,027
that qualifies the applicant to sit for the certification
23
examination of a national certifying organization listed in 1,028
division (A)(3) of this section or approved by the board under 1,030
section 4723.46 of the Revised Code.
(E) A certified registered nurse anesthetist, clinical 1,033
nurse specialist, certified nurse-midwife, or certified nurse 1,034
practitioner who is practicing as such in another jurisdiction 1,035
may apply for a certificate of authority to practice nursing as a 1,036
certified registered nurse anesthetist, clinical nurse 1,037
specialist, certified nurse-midwife, or certified nurse 1,038
practitioner in this state if the nurse meets the requirements
for a certificate of authority set forth in this section. The 1,039
application shall be submitted to the board in the form 1,041
prescribed by rules of the board and be accompanied by the 1,042
application fee required by section 4723.08 of the Revised Code. 1,044
The application shall include evidence that the applicant meets 1,045
the requirements of this section, holds a license or certificate 1,046
to practice nursing as a certified registered nurse anesthetist, 1,047
clinical nurse specialist, certified nurse-midwife, or certified 1,048
nurse practitioner in good standing in another jurisdiction 1,050
granted after meeting requirements approved by the entity of that 1,051
jurisdiction that licenses nurses, and other information required 1,052
by rules of the board of nursing. 1,053
If the applicant is a certified registered nurse 1,055
anesthetist, certified nurse-midwife, or certified nurse 1,056
practitioner who, on or before December 31, 2000, met the 1,058
requirements of this section to practice as such and has 1,059
maintained certification in the applicant's nursing specialty 1,060
with a national certifying organization listed in division (A)(3) 1,062
of section 4723.41 of the Revised Code or approved by the board 1,064
under section 4723.46 of the Revised Code, division (B) of this 1,068
section shall apply. 1,069
If the applicant is a clinical nurse specialist who, on or 1,071
before December 31, 2000, met the requirements of this section to 1,073
practice as such and has earned at least a master's degree with a 1,074
24
major in a nursing specialty or in a related field that qualifies 1,076
the applicant to sit for the certification examination of a 1,078
national certifying organization listed in division (A)(3) of 1,080
this section or approved by the board under section 4723.46 of 1,081
the Revised Code, division (C) of this section shall apply. 1,084
Sec. 4751.05. (A) The board of examiners of nursing home 1,093
administrators shall admit to examination for licensure as a 1,094
nursing home administrator any candidate who: 1,095
(1) Pays the application fee of fifty dollars; 1,097
(2) Submits evidence of good moral character and 1,099
suitability; 1,100
(3) Is at least eighteen years of age; 1,102
(4) Has completed educational requirements and work 1,104
experience satisfactory to the board; 1,105
(5) Submits an application on forms prescribed by the 1,107
board; 1,108
(6) Pays the examination fee of one hundred fifty dollars. 1,110
(B) Nothing in Chapter 4751. of the Revised Code or the 1,112
rules adopted thereunder shall be construed to require an 1,113
applicant for licensure or a temporary license, who is certified 1,114
EMPLOYED by a recognized church or religious denomination which 1,115
teaches reliance on spiritual means alone for healing and has 1,116
been approved to administer institutions certified by such church 1,117
or denomination AN INSTITUTION for the care and treatment of the 1,118
sick in accordance with its teachings, to demonstrate proficiency 1,120
in any medical techniques or to meet any medical educational 1,121
qualifications or medical standards not in accord with the 1,122
remedial care and treatment provided in such institutions BY THE 1,123
INSTITUTION IF THE INSTITUTION IS ALL OF THE FOLLOWING: 1,124
(1) OPERATED EXCLUSIVELY FOR PATIENTS WHO USE SPIRITUAL 1,126
MEANS FOR HEALING AND FOR WHOM THE ACCEPTANCE OF MEDICAL CARE IS 1,127
INCONSISTENT WITH THEIR RELIGIOUS BELIEFS; 1,128
(2) ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION; 1,130
(3) EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501 1,132
25
OF THE INTERNAL REVENUE CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1,134
1, AS AMENDED; 1,135
(4) PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO 1,137
THE EXEMPTION IN DIVISION (G) OF SECTION 4723.32 OF THE REVISED 1,138
CODE FROM THE LICENSING REQUIREMENTS OF CHAPTER 4723. OF THE 1,139
REVISED CODE.
(B)(C) If a person fails three times to attain a passing 1,141
grade on the examination, said person, before he THE PERSON may 1,142
again be admitted to examination, shall meet such additional 1,143
education or experience requirements, or both, as may be 1,144
prescribed by the board. 1,145
Section 2. That existing sections 3702.30, 3702.51, 1,147
3727.01, 4723.41, and 4751.05 of the Revised Code are hereby 1,150
repealed.