SENATORS Jordan, Amstutz, Austria, DiDonato, Randy Gardner, Harris, Hottinger, Jacobson, Spada, Wachtmann

To amend sections 3702.30 and 3702.31 and to enact

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section 3702.32 of the Revised Code relative to

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sanctions for a health care facility's violations

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of licensing requirements and quality standards,

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injunctions to enjoin such violations, information

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and informed consent compliance requirements for

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ambulatory surgical facility physicians, and

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expanded health care facility rule making

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authority of the Director of Health.

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

Section 1. That sections 3702.30 and 3702.31 be amended and	10
section 3702.32 of the Revised Code be enacted to read as follows:	11

Sec. 3702.30.  (A) As used in this section:

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(1) "Ambulatory surgical facility" means a facility, whether	13
or not part of the same organization as a hospital, that is	14
located in a building distinct from another in which inpatient	15
care is provided, and to which any of the following apply:	16

(a) Outpatient surgery is routinely performed in the	17
facility, and the facility functions separately from a hospital's	18
inpatient surgical service and from the offices of private	19
physicians, podiatrists, and dentists;.	20

(b) Anesthesia is administered in the facility by an	21
anesthesiologist or certified registered nurse anesthetist, and	22
the facility functions separately from a hospital's inpatient	23
surgical service and from the offices of private physicians,	24
podiatrists, and dentists;.	25

(c) The facility applies to be certified by the United	26
States health care financing administration as an ambulatory	27
surgical center for purposes of reimbursement under Part B of the	28
medicare program, Part B of Title XVIII of the "Social Security	29
Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended;.	30

(d) The facility applies to be certified by a national	31
accrediting body approved by the health care financing	32
administration for purposes of deemed compliance with the	33
conditions for participating in the medicare program as an	34
ambulatory surgical center;.	35

(e) The facility bills or receives from any third-party	36
payer, governmental health care program, or other person or	37
government entity any ambulatory surgical facility fee that is	38
billed or paid in addition to any fee for professional services;.	39

(f) The facility is held out to any person or government	40
entity as an ambulatory surgical facility or similar facility by	41
means of signage, advertising, or other promotional efforts.	42

"Ambulatory surgical facility" does not include a hospital	43
emergency department.	44

(2) "Ambulatory surgical facility fee" means a fee for	45
certain overhead costs associated with providing surgical services	46
in an outpatient setting. A fee is an ambulatory surgical	47
facility fee only if it directly or indirectly pays for costs	48
associated with any of the following:	49

(a) Use of operating and recovery rooms, preparation areas,	50
and waiting rooms and lounges for patients and relatives;	51

(b) Administrative functions, record keeping, housekeeping,	52
utilities, and rent;	53

(c) Services provided by nurses, orderlies, technical	54
personnel, and others involved in patient care related to	55
providing surgery.	56

"Ambulatory surgical facility fee" does not include any	57
additional payment in excess of a professional fee that is	58
provided to encourage physicians, podiatrists, and dentists to	59
perform certain surgical procedures in their office or their group	60
practice's office rather than a health care facility, if the	61
purpose of the additional fee is to compensate for additional cost	62
incurred in performing office-based surgery.	63

(3) "Governmental health care program" has the same meaning	64
as in section 4731.65 of the Revised Code.	65

(4) "Health care facility" means any of the following:

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(a) An ambulatory surgical facility;

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(b) A freestanding dialysis center;

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(c) A freestanding inpatient rehabilitation facility;

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(d) A freestanding birthing center;

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(e) A freestanding radiation therapy center;

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(f) A freestanding or mobile diagnostic imaging center.

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(5) "Metropolitan statistical area" has the same meaning as	73
in section 3702.51 of the Revised Code.	74

(6) "Third-party payer" has the same meaning as in section	75
3901.38 of the Revised Code.	76

(B) By rule adopted in accordance with sections 3702.12 and	77
3702.13 of the Revised Code, the director of health shall	78
establish quality standards for health care facilities. The	79
standards may incorporate accreditation standards or other quality	80
standards established by any entity recognized by the director.	81
The rules shall be adopted so as to cause the standards to take	82
effect on March 31, 1996.	83

(C) Every ambulatory surgical facility shall require that	84
each physician who practices at the facility comply with all	85
relevant provisions in the Revised Code that relate to the	86
providing of information to, and the obtaining of informed consent	87
from, a patient.	88

(D) The director shall issue a license to each health care	89
facility that makes application for a license and demonstrates to	90
the director that it meets the quality standards established by	91
the rules adopted under division (B) of this section, except that	92
if a health care facility located in a metropolitan statistical	93
area applies for a license on or after March 31, 1996, and at the	94
time the license is to take effect the quality standards are not	95
yet in effect, the director shall issue the license without a	96
demonstration that the health care facility meets quality	97
standardsand satisfies the information and informed consent	98
compliance requirements specified in division (C) of this section.	99

(D)(E) No health care facility shall operate without a	100
license issued under this section.	101

(E)(F) The rules adopted under division (B) of this section	102
shall include provisionsall of the following:	103

(1) Provisions governing application for, renewal,	104
suspension, and revocation of licensesa license under this	105
section;	106

(2) Provisions governing orders issued pursuant to section	107
3702.32 of the Revised Code for a health care facility to cease	108
its operations or to prohibit certain types of services provided	109
by a health care facility;	110

(3) Provisions governing the imposition under section	111
3702.32 of the Revised Code of civil penalties for violations of	112
this section or the rules adopted under this section, including a	113
scale for determining the amount of the penalties.	114

Sec. 3702.31.  (A) The quality monitoring and inspection	115
fund is hereby created in the state treasury. The director of	116
health shall use the fund to administer and enforce this section	117
and sections 3702.11 to 3702.20 and, 3702.30, and 3702.32 of the	118
Revised Code and rules adopted pursuant to those sections. The	119
director shall deposit in the fund any moneys collected pursuant	120
to this section or section 3702.32 of the Revised Code. All	121
investment earnings of the fund shall be credited to the fund.	122

(B) The director of health shall adopt rules pursuant to	123
Chapter 119. of the Revised Code establishing fees for both of the	124
following:	125

(1) Initial and renewal license applications submitted under	126
section 3702.30 of the Revised Code. The fees established under	127
division (B)(1) of this section shall not exceed the actual and	128
necessary costs of performing the activities described in division	129
(A) of this section.	130

(2) Inspections conducted under section 3702.15 or 3702.30	131
of the Revised Code. The fees established under division (B)(2)	132
of this section shall not exceed the actual and necessary costs	133
incurred during an inspection, including any indirect costs	134
incurred by the department for staff, salary, or other	135
administrative costs. The director of health shall provide to	136
each health care facility or provider inspected pursuant to	137
section 3702.15 or 3702.30 of the Revised Code a written statement	138
of the fee. The statement shall itemize and total the costs	139
incurred. Within fifteen days after receiving a statement from	140
the director, the facility or provider shall forward the total	141
amount of the fee to the director.	142

(3) The fees described in divisions (B)(1) and (2) of this	143
section shall meet both of the following requirements:	144

(a) For each service described in section 3702.11 of the	145
Revised Code, the fee shall not exceed one thousand dollars two	146
hundred fifty dollars annually, except that the total fees charged	147
to a health care provider under this section shall not exceed five	148
thousand dollars annually.	149

(b) The fee shall exclude any costs reimbursable by the	150
United States health care financing administration as part of the	151
certification process for the medicare program established under	152
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42	153
U.S.C.A. 301, as amended, and the medicaid program established	154
under Title XIX of that act.	155

(4) The director shall not establish a fee for any service	156
for which a licensure or inspection fee is paid by the health care	157
provider to a state agency for the same or similar licensure or	158
inspection.	159

Sec. 3702.32. (A) If the director of health determines that	160
a health care facility is operating without a license in violation	161
of division (E) of section 3702.30 of the Revised Code, the	162
director shall do one or more of the following:	163

(1) Issue an order that the health care facility cease its	164
operations;	165

(2) Issue an order that prohibits the health care facility	166
from performing certain types of services;	167

(3) Impose a civil penalty of not less than one thousand	168
dollars and not more than two hundred fifty thousand dollars upon	169
the health care facility for operating without a license;	170

(4) Impose an additional civil penalty of not less than one	171
thousand dollars and not more than ten thousand dollars for each	172
day that the health care facility operates without a license.	173

(B)(1) If a health care facility subject to an order issued	174
under division (A)(1) of this section continues to operate, the	175
director of health may file a petition in the court of common	176
pleas of the county in which the health care facility is located	177
for an injunction enjoining the facility from operating. The	178
court shall grant an injunction upon a showing that the respondent	179
named in the petition is operating without a license.	180

(2) If a health care facility subject to an order issued	181
under division (A)(2) of this section continues to provide the	182
types of services prohibited by the order, the director of health	183
may file a petition in the court of common pleas of the county in	184
which the health care facility is located for an injunction	185
enjoining the facility from performing those types of services.	186
The court shall grant an injunction upon a showing that the	187
respondent named in the petition is providing the types of	188
services prohibited by the director's order.	189

(C) If the director of health determines that a health care	190
facility has violated any provision of section 3702.30 of the	191
Revised Code, other than a violation of division (E) of that	192
section, any provision of Chapter 3701-83 of the Administrative	193
Code, or any other rule adopted by the director of health under	194
section 3702.30 of the Revised Code, the director may do any or	195
all of the following:	196

(1) Revoke, suspend, or refuse to renew the health care	197
facility's license;	198

(2) Prior to or during the pendency of an administrative	199
hearing under Chapter 119. of the Revised Code, issue an order	200
that prohibits the health care facility from performing certain	201
types of services;	202

(3) Provide an opportunity for the health care facility to	203
correct the violation;	204

(4) Impose a civil penalty of not less than one thousand	205
dollars and not more than two hundred fifty thousand dollars upon	206
the health care facility for the violation;	207

(5) Impose an additional civil penalty of not less than five	208
hundred dollars and not more than ten thousand dollars for each	209
day that the health care facility fails to correct the violation.	210

(D) If a health care facility subject to an order issued	211
under division (C)(2) of this section continues to provide the	212
types of services prohibited by the order, the director of health	213
may file a petition in the court of common pleas of the county in	214
which the facility is located for an injunction enjoining the	215
facility from performing those types of services. The court shall	216
grant an injunction upon a showing that the respondent named in	217
the petition is providing the types of services prohibited by the	218
director's order.	219

(E) The director shall deposit all moneys collected as civil	220
penalties under this section into the quality monitoring and	221
inspection fund created under section 3702.31 of the Revised Code	222
for use in accordance with that section.	223

Section 2. That existing sections 3702.30 and 3702.31 of the	224
Revised Code are hereby repealed.	225