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

To amend sections 3702.30 and 3702.31 and to enact

1

section 3702.32 of the Revised Code relative to

2

sanctions for a health care facility's violations

3

of licensing requirements and quality standards,

4

injunctions to enjoin such violations, information

5

and informed consent compliance requirements for

6

ambulatory surgical facility physicians, and

7

expanded health care facility rule making authority

8

of the Director of Health.

9

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:

12

(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:

66

(a) An ambulatory surgical facility;

67

(b) A freestanding dialysis center;

68

(c) A freestanding inpatient rehabilitation facility;

69

(d) A freestanding birthing center;

70

(e) A freestanding radiation therapy center;

71

(f) A freestanding or mobile diagnostic imaging center.

72

(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
obtaining of informed consent from a patient.	87

(D) The director shall issue a license to each health care	88
facility that makes application for a license and demonstrates to	89
the director that it meets the quality standards established by	90
the rules adopted under division (B) of this section, except that	91
if a health care facility located in a metropolitan statistical	92
area applies for a license on or after March 31, 1996, and at the	93
time the license is to take effect the quality standards are not	94
yet in effect, the director shall issue the license without a	95
demonstration that the health care facility meets quality	96
standardsand satisfies the informed consent compliance	97
requirements specified in division (C) of this section.	98

(D)(E) No health care facility shall operate without a	99
license issued under this section.	100

(E)(F) The rules adopted under division (B) of this section	101
shall include provisionsall of the following:	102

(1) Provisions governing application for, renewal,	103
suspension, and revocation of licensesa license under this	104
section;	105

(2) Provisions governing orders issued pursuant to section	106
3702.32 of the Revised Code for a health care facility to cease	107
its operations or to prohibit certain types of services provided	108
by a health care facility;	109

(3) Provisions governing the imposition under section	110
3702.32 of the Revised Code of civil penalties for violations of	111
this section or the rules adopted under this section, including a	112
scale for determining the amount of the penalties.	113

Sec. 3702.31.  (A) The quality monitoring and inspection	114
fund is hereby created in the state treasury. The director of	115
health shall use the fund to administer and enforce this section	116
and sections 3702.11 to 3702.20 and, 3702.30, and 3702.32 of the	117
Revised Code and rules adopted pursuant to those sections. The	118
director shall deposit in the fund any moneys collected pursuant	119
to this section or section 3702.32 of the Revised Code. All	120
investment earnings of the fund shall be credited to the fund.	121

(B) The director of health shall adopt rules pursuant to	122
Chapter 119. of the Revised Code establishing fees for both of the	123
following:	124

(1) Initial and renewal license applications submitted under	125
section 3702.30 of the Revised Code. The fees established under	126
division (B)(1) of this section shall not exceed the actual and	127
necessary costs of performing the activities described in division	128
(A) of this section.	129

(2) Inspections conducted under section 3702.15 or 3702.30	130
of the Revised Code. The fees established under division (B)(2)	131
of this section shall not exceed the actual and necessary costs	132
incurred during an inspection, including any indirect costs	133
incurred by the department for staff, salary, or other	134
administrative costs. The director of health shall provide to	135
each health care facility or provider inspected pursuant to	136
section 3702.15 or 3702.30 of the Revised Code a written statement	137
of the fee. The statement shall itemize and total the costs	138
incurred. Within fifteen days after receiving a statement from	139
the director, the facility or provider shall forward the total	140
amount of the fee to the director.	141

(3) The fees described in divisions (B)(1) and (2) of this	142
section shall meet both of the following requirements:	143

(a) For each service described in section 3702.11 of the	144
Revised Code, the fee shall not exceed one thousand dollars two	145
hundred fifty dollars annually, except that the total fees charged	146
to a health care provider under this section shall not exceed five	147
thousand dollars annually.	148

(b) The fee shall exclude any costs reimbursable by the	149
United States health care financing administration as part of the	150
certification process for the medicare program established under	151
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42	152
U.S.C.A. 301, as amended, and the medicaid program established	153
under Title XIX of that act.	154

(4) The director shall not establish a fee for any service	155
for which a licensure or inspection fee is paid by the health care	156
provider to a state agency for the same or similar licensure or	157
inspection.	158

Sec. 3702.32. (A) If the director of health determines that	159
a health care facility is operating without a license in violation	160
of division (E) of section 3702.30 of the Revised Code, the	161
director shall do one or more of the following:	162

(1) Issue an order that the health care facility cease its	163
operations;	164

(2) Issue an order that prohibits the health care facility	165
from performing certain types of services;	166

(3) Impose a civil penalty of not less than one thousand	167
dollars and not more than two hundred fifty thousand dollars upon	168
the health care facility for operating without a license;	169

(4) Impose an additional civil penalty of not less than one	170
thousand dollars and not more than ten thousand dollars for each	171
day that the health care facility operates without a license.	172

(B)(1) If a health care facility subject to an order issued	173
under division (A)(1) of this section continues to operate, the	174
director of health may file a petition in the court of common	175
pleas of the county in which the health care facility is located	176
for an injunction enjoining the facility from operating. The	177
court shall grant an injunction upon a showing that the respondent	178
named in the petition is operating without a license.	179

(2) If a health care facility subject to an order issued	180
under division (A)(2) of this section continues to provide the	181
types of services prohibited by the order, the director of health	182
may file a petition in the court of common pleas of the county in	183
which the health care facility is located for an injunction	184
enjoining the facility from performing those types of services.	185
The court shall grant an injunction upon a showing that the	186
respondent named in the petition is providing the types of	187
services prohibited by the director's order.	188

(C) If the director of health determines that a health care	189
facility has violated any provision of section 3702.30 of the	190
Revised Code, other than a violation of division (E) of that	191
section, any provision of Chapter 3701-83 of the Administrative	192
Code, or any other rule adopted by the director of health under	193
section 3702.30 of the Revised Code, the director may do any or	194
all of the following:	195

(1) Revoke, suspend, or refuse to renew the health care	196
facility's license;	197

(2) Prior to or during the pendency of an administrative	198
hearing under Chapter 119. of the Revised Code, issue an order	199
that prohibits the health care facility from performing certain	200
types of services;	201

(3) Provide an opportunity for the health care facility to	202
correct the violation;	203

(4) Impose a civil penalty of not less than one thousand	204
dollars and not more than two hundred fifty thousand dollars upon	205
the health care facility for the violation;	206

(5) Impose an additional civil penalty of not less than five	207
hundred dollars and not more than ten thousand dollars for each	208
day that the health care facility fails to correct the violation.	209

(D) If a health care facility subject to an order issued	210
under division (C)(2) of this section continues to provide the	211
types of services prohibited by the order, the director of health	212
may file a petition in the court of common pleas of the county in	213
which the facility is located for an injunction enjoining the	214
facility from performing those types of services. The court shall	215
grant an injunction upon a showing that the respondent named in	216
the petition is providing the types of services prohibited by the	217
director's order.	218

(E) The director shall deposit all moneys collected as civil	219
penalties under this section into the quality monitoring and	220
inspection fund created under section 3702.31 of the Revised Code	221
for use in accordance with that section.	222

Section 2. That existing sections 3702.30 and 3702.31 of the	223
Revised Code are hereby repealed.	224