SENATORS Spada, White, Randy Gardner, Jacobson, Fingerhut, Prentiss, Armbruster, Austria, Blessing, Carnes, DiDonato, Finan, Hagan, Harris, Hottinger, Jordan, Mead, Mumper, Oelslager, Roberts, Shoemaker, Wachtmann, Herington, Robert Gardner, Ryan

To amend sections 4723.61, 5123.19, 5123.50, 5123.611,

1

5126.354, 5126.355, and 5126.357; to amend, for

2

the purpose of adopting new section numbers as

3

indicated in parentheses, 4723.61 (4723.071),

4

sections 5126.354 (5123.205), 5126.355 (5123.206),

5

and 5126.357 (5123.208); to enact sections

6

5123.201, 5123.202, 5123.203, 5123.204, 5123.207,

7

and 5126.36; and to repeal sections 4723.62,

8

5123.193, 5126.35, 5126.351, 5126.352, 5126.353,

9

and 5126.356 of the Revised Code to revise the law

10

governing the licensure of residential facilities

11

for individuals with mental retardation and

12

developmental disabilities and to revise the law

13

pertaining to the authority of certain personnel to

14

administer medications and perform health-related

15

activities for individuals with mental retardation

16

and developmental disabilities.

17

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

Section 1. That sections 4723.61, 5123.19, 5123.50, 5123.611,	18
5126.354, 5126.355, and 5126.357 be amended; sections 4723.61	19
(4723.071), 5126.354 (5123.205), 5126.355 (5123.206), and 5126.357	20
(5123.208) be amended for the purpose of adopting new section	21
numbers as indicated in parentheses; and sections 5123.201,	22
5123.202, 5123.203, 5123.204, 5123.207, and 5126.36 of the Revised	23
Code be enacted to read as follows:	24

Sec. 4723.61.        Sec. 4723.071.  (A) As used in this section, "ICF/MR	25
health-related activities," "MR/DD personnel," and "ICF/MR worker	26
prescribed medication" have the same meanings as in section	27
5123.1935123.201 of the Revised Code.	28

(B) The board of nursing shall adopt rules as necessary to	29
govern thenursing delegation specified inas it applies to MR/DD	30
personnel who administer prescribed medication and perform	31
health-related activities pursuant to the authority granted under	32
section 5123.1935123.202 of the Revised Code. The board shall	33
adopt initial rules not later than ninety days after the effective	34
date of thisnot establish any requirement in the rules that is	35
inconsistent with the authority of MR/DD personnel to perform	36
services pursuant to that section. The rules shall be adopted in	37
accordance with Chapter 119. of the Revised Code and establish the	38
following:	39

(1) Standards that an instructional program must meet to be	40
approved as a program that trains registered nurses to instruct	41
ICF/MR workers to give oral and apply topical medications,	42
including the minimum types of information that must be covered in	43
the program and the minimum qualifications the instructional	44
personnel must possess. To qualify for approval, a program must	45
be at least a one-day program and have been approved as a	46
faculty-directed continuing nursing education activity pursuant to	47
rules adopted under section 4723.07 of the Revised Code.	48

(2) Standards that a unit of instruction must meet to be	49
approved as an independent study module for nurses on the	50
instruction of medication courses for ICF/MR workers and the	51
statutes and rules applicable to those workers. To qualify for	52
approval, an independent study module must have been approved as a	53
continuing nursing education activity pursuant to rules adopted	54
under section 4723.07 of the Revised Code.	55

(3) Standards that a registered nurse must meet to be	56
eligible to teach ICF/MR workers to give oral or apply topical	57
medications. With regard to training, the nurse must successfully	58
complete one of the following:	59

(a) An approved training program that trains registered	60
nurses to instruct ICF/MR workers in giving oral and applying	61
topical medications;	62

(b) An approved training program given by the department of	63
mental retardation and developmental disabilities that trains	64
nurses to be instructors of the training program described in the	65
"program manual for implementation of the medication	66
administration by unlicensed personnel in ICF/MR group homes of 15	67
beds or less," as developed by the departments of health and	68
mental retardation and developmental disabilities, as well as an	69
independent study module for nurses on the instruction of	70
medication courses for ICF/MR workers and the statutes and rules	71
applicable to those workers.	72

(4) Standards that a nurse must meet to remain eligible to	73
instruct ICF/MR workers in giving oral and applying topical	74
medications;	75

(5) Standards that a course of instruction must meet to be	76
approved as a medication course for ICF/MR workers, including the	77
minimum types of information that must be covered in the course.	78
The course must be conducted by a registered nurse, except that	79
the board's standards may allow the use of other health care	80
professionals listed in division (A) of section 5123.193 of the	81
Revised Code to provide instruction within the scope of their	82
professions, including licensed practical nurses acting under the	83
direction of registered nurses.	84

(6) Standards an ICF/MR worker must meet to be eligible to	85
take the medication course for ICF/MR workers and to demonstrate	86
successful completion of the course;	87

(7) Standards for the annual training an ICF/MR worker must	88
complete to remain elegible to give oral and apply topical	89
medications;	90

(8) Standards nurses must follow in delegating authority to	91
give oral or apply topical medications in an ICF/MR, including any	92
conditions or limits pertaining to the delegation;	93

(9) Standards nurses must follow in providing on-site or	94
off-site direction and supervision of ICF/MR workers who have been	95
authorized to give oral or apply topical medications;	96

(10) Standards ICF/MR workers must follow when giving oral	97
or applying topical medications to ICF/MR residents.	98

(C) The approval of programs, courses, and training modules	99
pertaining to delegation of authority to give oral or apply	100
topical medications may be made by the board of nursing or by an	101
entity the board recognizes as an approver of instructional	102
programs.	103

(D) The board of nursing may accept complaints from any	104
person or entity regarding the performance or qualifications of an	105
ICF/MR worker to give oral or apply topical medicationsMR/DD	106
personnel who perform services pursuant to the authority granted	107
under section 5123.1935123.202 of the Revised Code. The board	108
shall refer all complaints received to the department of mental	109
retardation and developmental disabilities. The board may	110
participate in an investigation of a complaint being conducted by	111
the department under section 5123.1935123.202 of the Revised	112
Code.	113

Sec. 5123.19.  (A) As used in this section and in sections	114
5123.191, 5123.194, and 5123.20 of the Revised Code:	115

(1) "Residential facility" means a home or facility in which	116
a mentally retarded or developmentally disabled person resides,	117
except the home of a relative or legal guardian in which a	118
mentally retarded or developmentally disabled person resides, a	119
respite care home certified under section 5126.05 of the Revised	120
Code, a county home or district home operated pursuant to Chapter	121
5155. of the Revised Code, or a dwelling in which the only	122
mentally retarded or developmentally disabled residents are in an	123
independent living arrangement or are being provided supported	124
living.	125

(2) "Political subdivision" means a municipal corporation,	126
county, or township.	127

(3) "Independent living arrangement" means an arrangement in	128
which a mentally retarded or developmentally disabled person	129
resides in an individualized setting chosen by the person or the	130
person's guardian, which is not dedicated principally to the	131
provision of residential services for mentally retarded or	132
developmentally disabled persons, and for which no financial	133
support is received for rendering such service from any	134
governmental agency by a provider of residential services.	135

(4) "Supported living" has the same meaning as in section	136
5126.01 of the Revised Code.	137

(5) "Licensee" means the person or government agency that	138
has applied for a license to operate a residential facility and to	139
which the license was issued under this section.	140

(B) Every person or government agency desiring to operate a	141
residential facility shall apply for licensure of the facility to	142
the director of mental retardation and developmental disabilities	143
unless the residential facility is subject to section 3721.02,	144
3722.04, 5103.03, or 5119.20 of the Revised Code. Notwithstanding	145
Chapter 3721. of the Revised Code, a nursing home that is	146
certified as an intermediate care facility for the mentally	147
retarded under Title XIX of the "Social Security Act," 4979 Stat.	148
620286 (19351965), 42 U.S.C.A. 3011396, as amended, shall apply	149
for licensure of the portion of the home that is certified as an	150
intermediate care facility for the mentally retarded.	151

(C) The director of mental retardation and developmental	152
disabilities shall license and inspect the operation of	153
residential facilities. The director may deny or revoke such	154
licenses.An	155

Except as provided in divisions (G) and (O) of this section,	156
ainitial license is valid until it ismay be issued for a period	157
that does not exceed one year. A license may be renewed for a	158
period that does not exceed three years. The director, when	159
issuing or renewing a license, shall specify the period for which	160
the license is being issued or renewed. A license remains valid	161
for the length of the licensing period specified by the director,	162
unless the license is terminated, revoked, or voluntarily	163
surrendered. Appeals	164

(D) If it is determined that an applicant or licensee is	165
not in compliance with this section or the rules adopted under it,	166
the director may deny issuance of a license, refuse to renew a	167
license, terminate a license, revoke a license, issue an order for	168
the suspension of admissions to a facility, issue an order for the	169
placement of a monitor at a facility, issue an order for the	170
immediate removal of residents, or take any other action the	171
director considers necessary. In the director's selection and	172
administration of the sanction to be imposed, all of the following	173
apply:	174

(1) The director may deny, refuse to renew, or revoke a	175
license, if the director determines that the applicant or licensee	176
has demonstrated a pattern of serious noncompliance or that a	177
violation creates a substantial risk to the health and safety of	178
residents of a residential facility.	179

(2) The director may terminate a license if more than twelve	180
consecutive months have elapsed since the residential facility was	181
last occupied by a resident or the notice required by division (J)	182
of this section is not given.	183

(3) The director may issue an order for the suspension of	184
admissions to a facility for any violation that may result in	185
sanctions under division (D)(1) of this section and for any other	186
violation specified in rules adopted under division (G)(2) of this	187
section. If the suspension of admissions is imposed for a	188
violation that may result in sanctions under division (D)(1) of	189
this section, the director may impose the suspension before	190
providing an opportunity for an adjudication under Chapter 119. of	191
the Revised Code. The director shall rescind an order for the	192
suspension of admissions when the violation that formed the basis	193
for the order has been corrected.	194

(4) The director may order the placement of a monitor at a	195
residential facility for any violation specified in rules adopted	196
under division (G)(2) of this section. The director shall rescind	197
the order when the violation that formed the basis for the order	198
has been corrected.	199

(5) If the director determines that two or more residential	200
facilities owned or operated by the same person or government	201
entity are not being operated in compliance with this chapter or	202
the rules adopted under it, and the director's findings are based	203
on the same or a substantially similar action, practice,	204
circumstance, or incident that creates a substantial risk to the	205
health and safety of the residents, the director shall conduct a	206
survey as soon as practicable at each residential facility owned	207
or operated by that person or government entity. The director may	208
take any action authorized by this section with respect to any	209
facility found to be operating in violation of this section or the	210
rules adopted under it.	211

(6) When the director initiates license revocation	212
proceedings, no opportunity for submitting a plan of correction	213
shall be given. The director shall notify the licensee by letter	214
of the initiation of such proceedings. The letter shall list the	215
deficiencies of the residential facility and inform the licensee	216
that no plan of correction will be accepted. The director shall	217
also notify each affected resident, the resident's guardian if the	218
resident is an adult for whom a guardian has been appointed, the	219
resident's parent or guardian if the resident is a minor, and the	220
county board of mental retardation and developmental disabilities.	221

(7) Pursuant to rules which shall be adopted in accordance	222
with Chapter 119. of the Revised Code, the director may order the	223
immediate removal of residents from a residential facility	224
whenever conditions at the facility present an immediate danger of	225
physical or psychological harm to the residents.	226

(8) In determining whether a residential facility is being	227
operated in compliance with this chapter or the rules adopted	228
under it, or whether conditions at a residential facility present	229
an immediate danger of physical or psychological harm to the	230
residents, the director may rely on information obtained by a	231
county board of mental retardation and developmental disabilities	232
or other governmental agencies.	233

(9) In proceedings initiated to deny, refuse to renew, or	234
revoke licenses, the director may deny, refuse to renew, or revoke	235
a license regardless of whether some or all of the deficiencies	236
that prompted the proceedings have been corrected at the time of	237
the hearing.	238

(E) The director shall establish a program under which	239
public notification may be made when the director has initiated	240
license revocation proceedings or has issued an order for the	241
suspension of admissions, placement of a monitor, or removal of	242
residents. The director shall adopt rules in accordance with	243
Chapter 119. of the Revised Code as considered necessary to	244
implement this division. The rules shall establish the procedures	245
by which the public notification will be made and specify the	246
circumstances for which the notification must be made. At a	247
minimum, public notification shall be made if the director has	248
taken action against the facility in the eighteen-month period	249
immediately preceding the director's latest action against the	250
facility and the latest action is being taken for the same or	251
substantially similar violation of this section or the rules	252
adopted under it. The rules shall specify a method for removing	253
or amending the public notification if the director's action is	254
found to have been unjustified or the violation at the residential	255
facility has been corrected.	256

(F)(1) Except as provided in division (F)(2) of this section,	257
appeals from proceedings initiated to deny applications for	258
licenses or to revoke licensesimpose a sanction under division	259
(D) of this section shall be conducted in accordance with Chapter	260
119. of the Revised Code.	261

(2) Appeals from proceedings initiated to order the	262
suspension of admissions to a facility shall be conducted in	263
accordance with Chapter 119. of the Revised Code, unless the order	264
was issued before providing an opportunity for an adjudication, in	265
which case all of the following apply:	266

(a) The licensee may request a hearing not later than ten	267
days after receiving the notice specified in section 119.07 of the	268
Revised Code.	269

(b) If a timely request for a hearing is made, the hearing	270
shall commence not later than thirty days after the department	271
receives the request.	272

(c) After commencing, the hearing shall continue	273
uninterrupted, except for Saturdays, Sundays, and legal holidays,	274
unless other interruptions are agreed to by the licensee and the	275
director.	276

(d) If the hearing is conducted by a hearing examiner, the	277
hearing examiner shall file a report and recommendations not later	278
than ten days after the close of the hearing.	279

(e) Not later than five days after the hearing examiner	280
files the report and recommendations, the licensee may file	281
objections to the report and recommendations.	282

(f) Not later than fifteen days after the hearing examiner	283
files the report and recommendations, the director shall issue an	284
order approving, modifying, or disapproving the report and	285
recommendations.	286

(g) Notwithstanding the pendency of the hearing, the	287
director shall rescind the order for the suspension of admissions	288
when the violation that formed the basis for the order is	289
corrected.	290

(G) In accordance with Chapter 119. of the Revised Code, the	291
director shall adopt and may amend and rescind rules for licensing	292
and regulating the operation of residential facilities. The rules	293
shall establish and specify the following:	294

(1) Procedures and criteria for issuing,and renewing	295
licenses, including procedures and criteria for determining the	296
length of the licensing period that the director must specify for	297
each license when it is issued or renewed;	298

(2) Procedures and criteria for denying, refusing to renew,	299
terminating, and revoking licenses and for ordering the suspension	300
of admissions to a facility, placement of a monitor at a facility,	301
and the immediate removal of residents from a facility;	302

(2)(3) Fees for issuing and renewing licenses;

303

(3)(4) Procedures for the inspection ofsurveying	304
residential facilities;	305

(4)(5) Requirements for the training of residential facility	306
personnel;	307

(5)(6) Classifications for the various types of residential	308
facilities;	309

(6)(7) Certification procedures for licensees and management	310
contractors that the director determines are necessary to ensure	311
that they have the skills and qualifications to properly operate	312
or manage residential facilities;	313

(7)(8) The maximum number of persons who may be served in a	314
particular type of residential facility;	315

(8)(9) Uniform procedures for admission of persons to and	316
transfers and discharges of persons from residential facilities;	317

(9)(10) Other standards for the operation of residential	318
facilities and the services provided at residential facilities;	319

(10)(11) Procedures for waiving any provision of any rule	320
adopted under this section.	321

(D)(H) Before issuing a license, the director of the	322
department or the director's designee shall conduct an inspection	323
a survey of the residential facility for which application is	324
made. The director or the director's designee shall conduct an	325
inspectiona survey of each licensed residential facility at least	326
once each yearduring the period the license is valid and may	327
conduct additional inspections as needed. An inspectionA survey	328
includes but is not limited to an on-site examination and	329
evaluation of the residential facility, its personnel, and the	330
services provided there.	331

In conducting inspectionssurveys, the director or the	332
director's designee shall be given access to the residential	333
facility; all records, accounts, and any other documents related	334
to the operation of the facility; the licensee; the residents of	335
the facility; and all persons acting on behalf of, under the	336
control of, or in connection with the licensee. The licensee and	337
all persons on behalf of, under the control of, or in connection	338
with the licensee shall cooperate with the director or the	339
director's designee in conducting the inspectionsurvey.	340

Following each inspectionsurvey, unless the director	341
initiates a license revocation proceeding, the director or the	342
director's designee shall provide the licensee with a report	343
listing any deficiencies, specifying a timetable within which the	344
licensee shall submit a plan of correction describing how the	345
deficiencies will be corrected, and, when appropriate, specifying	346
a timetable within which the licensee must correct the	347
deficiencies. After a plan of correction is submitted, the	348
director or the director's designee shall approve or disapprove	349
the plan. A copy of the report and any approved plan of	350
correction shall be provided to any person who requests it.	351

If it is determined that a residential facility is not being	352
operated in compliance with this chapter or the rules adopted	353
under it, the director may take such steps as are necessary,	354
including, but not limited to, suspension of admissions to the	355
residential facility, placement of a monitor at the residential	356
facility, and the initiation of license revocation proceedings.	357

When the director initiates license revocation proceedings,	358
no opportunity for submitting a plan of correction shall be given.	359
The director shall notify the licensee by letter of the initiation	360
of such proceedings. The letter shall list the deficiencies of	361
the residential facility and inform the licensee that no plan of	362
correction will be accepted. The director shall also notify each	363
affected resident, the resident's guardian if the resident is an	364
adult for whom a guardian has been appointed, the resident's	365
parent or guardian if the resident is a minor, and the county	366
board of mental retardation and developmental disabilities.	367

Pursuant to rules which shall be adopted in accordance with	368
Chapter 119. of the Revised Code, the director may order the	369
immediate removal of residents from a residential facility	370
whenever conditions at the facility present an immediate danger of	371
physical or psychological harm to the residents.	372

In determining whether a residential facility is being	373
operated in compliance with this chapter or the rules adopted	374
under it, or whether conditions at a residential facility present	375
an immediate danger of physical or psychological harm to the	376
residents, the director may rely on information obtained by a	377
county board of mental retardation and developmental disabilities	378
or other governmental agencies in the course of investigating	379
major unusual incidents. The director shall adopt rules in	380
accordance with Chapter 119. of the Revised Code that specify what	381
constitute "major unusual incidents."	382

The director shall suspend without pay for a period of at	383
least three daysinitiate disciplinary action against any	384
department employee who notifies or causes the notification to any	385
unauthorized person of an unannounced inspectionsurvey of a	386
residential facility by an authorized representative of the	387
department.	388

(E) In proceedings initiated to deny or revoke licenses	389
under this section, the director may deny or revoke a license	390
regardless of whether some or all of the deficiencies that	391
prompted the proceedings have been corrected at the time of the	392
hearing.	393

(F)(I) In addition to any other information which may be	394
required of applicants for a license pursuant to this section, the	395
director shall require each applicant to provide a copy of an	396
approved plan for a proposed residential facility pursuant to	397
section 5123.042 of the Revised Code. This division does not apply	398
to renewal of a license.	399

(G)(J) Pursuant to rules which shall be adopted in	400
accordance with Chapter 119. of the Revised Code, the director may	401
require notification to the department of any significant change	402
in the ownership of a residential facility or in the identity of	403
the licensee or management contractor. When such notification is	404
not given, the director may cancel the residential facility's	405
license. If the director determines that a significant change of	406
ownership is proposed, the director shall consider the proposed	407
change to be an application for development by a new operator	408
pursuant to section 5123.042 of the Revised Code and shall advise	409
the applicant within sixty days of such notification that the	410
current license shall continue in effect or a new license will be	411
required pursuant to this section. If the director requires a new	412
license, the director shall permit the facility to continue to	413
operate under the current license until the new license is issued,	414
unless the current license is revoked, refused to be renewed, or	415
terminated in accordance with Chapter 119. of the Revised Code.	416

(H)(K) A county board of mental retardation and	417
developmental disabilities, the legal rights service, and any	418
interested person may file complaints alleging violations of	419
statute or department rule relating to residential facilities with	420
the department. All complaints shall be in writing and shall	421
state the facts constituting the basis of the allegation. The	422
department shall not reveal the source of any complaint unless the	423
complainant agrees in writing to waive the right to	424
confidentiality or until so ordered by a court of competent	425
jurisdiction.	426

The department shall acknowledge receipt of the complaint and	427
notify the complainant of the action that will be taken with	428
respect to it within five working days of receiving itadopt rules	429
in accordance with Chapter 119. of the Revised Code establishing	430
procedures for the receipt, referral, investigation, and	431
disposition of complaints filed with the department under this	432
division.	433

The substance of a complaint shall not be provided to a	434
licensee until the commencement of an inspection or investigation.	435

(I)(L) The department shall establish procedures for the	436
notification of interested parties of the transfer or interim care	437
of residents from residential facilities that are closing or are	438
losing their license.	439

(J)(M) Before issuing a license under this section to a	440
residential facility that will accommodate at any time more than	441
one mentally retarded or developmentally disabled individual, the	442
director shall, by first class mail, notify the following:	443

(1) If the facility will be located in a municipal	444
corporation, the clerk of the legislative authority of the	445
municipal corporation;	446

(2) If the facility will be located in unincorporated	447
territory, the clerk of the appropriate board of county	448
commissioners and the clerk of the appropriate board of township	449
trustees.	450

The director shall not issue the license for ten days after	451
mailing the notice, excluding Saturdays, Sundays, and legal	452
holidays, in order to give the notified local officials time in	453
which to comment on the proposed issuance.	454

Any legislative authority of a municipal corporation, board	455
of county commissioners, or board of township trustees that	456
receives notice under this division of the proposed issuance of a	457
license for a residential facility may comment on it in writing to	458
the director within ten days after the director mailed the notice,	459
excluding Saturdays, Sundays, and legal holidays. If the director	460
receives written comments from any notified officials within the	461
specified time, the director shall make written findings	462
concerning the comments and the director's decision on the	463
issuance of the license. If the director does not receive written	464
comments from any notified local officials within the specified	465
time, the director shall continue the process for issuance of the	466
license.	467

(K)(N) Any person may operate a licensed residential	468
facility that provides room and board, personal care, habilitation	469
services, and supervision in a family setting for at least six but	470
not more than eight persons with mental retardation or a	471
developmental disability as a permitted use in any residential	472
district or zone, including any single-family residential district	473
or zone, of any political subdivision. These residential	474
facilities may be required to comply with area, height, yard, and	475
architectural compatibility requirements that are uniformly	476
imposed upon all single-family residences within the district or	477
zone.	478

(L)(O) Any person may operate a licensed residential	479
facility that provides room and board, personal care, habilitation	480
services, and supervision in a family setting for at least nine	481
but not more than sixteen persons with mental retardation or a	482
developmental disability as a permitted use in any multiple-family	483
residential district or zone of any political subdivision, except	484
that a political subdivision that has enacted a zoning ordinance	485
or resolution establishing planned unit development districts may	486
exclude these residential facilities from such districts, and a	487
political subdivision that has enacted a zoning ordinance or	488
resolution may regulate these residential facilities in	489
multiple-family residential districts or zones as a conditionally	490
permitted use or special exception, in either case, under	491
reasonable and specific standards and conditions set out in the	492
zoning ordinance or resolution to:	493

(1) Require the architectural design and site layout of the	494
residential facility and the location, nature, and height of any	495
walls, screens, and fences to be compatible with adjoining land	496
uses and the residential character of the neighborhood;	497

(2) Require compliance with yard, parking, and sign	498
regulation;	499

(3) Limit excessive concentration of these residential	500
facilities.	501

(M)(P) This section does not prohibit a political	502
subdivision from applying to residential facilities	503
nondiscriminatory regulations requiring compliance with health,	504
fire, and safety regulations and building standards and	505
regulations.	506

(N)(Q) Divisions (K)(N) and (L)(O) of this section are not	507
applicable to municipal corporations that had in effect on June	508
15, 1977, an ordinance specifically permitting in residential	509
zones licensed residential facilities by means of permitted uses,	510
conditional uses, or special exception, so long as such ordinance	511
remains in effect without any substantive modification.	512

(O)(R)(1) The director may issue an interim license to	513
operate a residential facility to an applicant for a license under	514
this section if alleither of the following conditions are met	515
applies:	516

(1)(a) The director determines that an emergency exists that	517
requiresrequiring immediate placement of persons in a residential	518
facility, andthat insufficient licensed beds are available.	519

(2) The residential facility meets standards in rules for	520
interim licenses that the director shall adopt in accordance with	521
Chapter 119. of the Revised Code.	522

(3) The director determines, and that the residential	523
facility is likely to receive a permanent license under this	524
section within thirty days after issuance of the interim license.	525

(b) The director determines that the issuance of an interim	526
license is necessary to meet a temporary need for a residential	527
facility.	528

(2) To be eligible to receive an interim license, an	529
applicant must meet the same criteria that must be met to receive	530
a permanent license under this section, except for any differing	531
procedures and time frames that may apply to issuance of a	532
permanent license.	533

(3) An interim license shall be valid for thirty days and	534
may be renewed by the director no more than twicefor a period not	535
to exceed one hundred fifty days.	536

(4) The director shall adopt rules in accordance with	537
Chapter 119. of the Revised Code as the director considers	538
necessary to administer the issuance of interim licenses.	539

(P)(S) Notwithstanding rules adopted pursuant to this	540
section establishing the maximum number of persons who may be	541
served in a particular type of residential facility, a residential	542
facility shall be permitted to serve the same number of persons	543
being served by the facility on the effective date of such rules	544
or the number of persons for which the facility is authorized	545
pursuant to a current application for a certificate of need with a	546
letter of support from the department of mental retardation and	547
developmental disabilities and which is in the review process	548
prior to April 4, 1986.	549

(Q)(T) The director or the director's designee may enter at	550
any time, for purposes of investigation, any home, facility, or	551
other structure that has been reported to the director or that the	552
director has reasonable cause to believe is being operated as a	553
residential facility without a license issued under this section.	554

The director may petition the court of common pleas of the	555
county in which an unlicensed residential facility is located for	556
an order enjoining the person or governmental agency operating the	557
facility from continuing to operate without a license. The court	558
may grant the injunction on a showing that the person or	559
governmental agency named in the petition is operating a	560
residential facility without a license. The court may grant the	561
injunction, regardless of whether the residential facility meets	562
the requirements for receiving a license under this section.	563

Sec. 5123.201.  As used in this section and sections	564
5123.202 to 5123.208 of the Revised Code:	565

(A) "Drug" and "licensed health professional authorized to	566
prescribe drugs" have the same meanings as in section 4729.01 of	567
the Revised Code.	568

(B) "Health-related activities" means the following:

569

(1) Taking vital signs;

570

(2) Application of clean dressings that do not require	571
health assessment;	572

(3) Basic measurement of bodily intake and output;

573

(4) Oral suctioning;

574

(5) Routine mouth care;

575

(6) Routine care of hair, nails, and skin;

576

(7) Use of glucometers;

577

(8) External urinary catheter care;

578

(9) Emptying and replacing colostomy bags;

579

(10) Collection of specimens by noninvasive means.

580

(C) "MR/DD personnel" means the individuals who provide	581
specialized services to individuals with mental retardation and	582
developmental disabilities. "MR/DD personnel" includes all of the	583
following:	584

(1) Individuals who provide specialized services through	585
direct employment with the department of mental retardation and	586
developmental disabilities or a county board of mental retardation	587
and developmental disabilities;	588

(2) Individuals who provide specialized services through an	589
entity under contract with the department of mental retardation	590
and developmental disabilities or a county board of mental	591
retardation and developmental disabilities;	592

(3) Individuals who provide specialized services through	593
direct employment or by being under contract with private	594
entities, including private entities that operate residential	595
facilities licensed under section 5123.19 of the Revised Code and	596
private entities that operate facilities subject to section	597
5123.192 of the Revised Code.	598

(D) "Nursing delegation" means the process established in	599
rules adopted by the board of nursing pursuant to Chapter 4723. of	600
the Revised Code under which a registered nurse or licensed	601
practical nurse acting at the direction of a registered nurse	602
transfers the performance of a particular nursing activity or task	603
to another individual who is not otherwise authorized to perform	604
the activity or task.	605

(E) "Prescribed medication" means a drug that is to be	606
administered according to the instructions of a licensed health	607
professional authorized to prescribe drugs.	608

(F) "Residential facility" has the same meaning as in	609
section 5123.19 of the Revised Code.	610

(G) "Specialized services" has the same meaning as in	611
section 5123.50 of the Revised Code.	612

(H) "Supported living" has the same meaning as in section	613
5126.01 of the Revised Code.	614

Sec. 5123.202.  (A) MR/DD personnel who are not	615
specifically authorized by other provisions of the Revised Code to	616
administer prescribed medication or perform health-related	617
activities may, under this section, administer prescribed	618
medication, perform health-related activities, or do both, as part	619
of the services that the personnel provide to the following:	620

(1) Recipients of supported living;

621

(2) Recipients of sheltered workshop services;

622

(3) Residents of a residential facility with sixteen or fewer	623
resident beds that is licensed as a residential facility under	624
section 5123.19 of the Revised Code or subject to section 5123.192	625
of the Revised Code.	626

(B) The authority established by division (A) of this	627
section is subject to all of the following:	628

(1) To administer prescribed medication, perform	629
health-related activities, or do both, MR/DD personnel must be	630
appropriately certified in accordance with the certification	631
program established under section 5123.205 of the Revised Code. An	632
individual shall provide only those services for which the	633
individual's certification was issued.	634

(2) Before a particular individual may receive services	635
from MR/DD personnel pursuant to this section, the MR/DD	636
personnel's employer or other entity with primary responsibility	637
for the services being provided shall ensure that each individual	638
providing the services has been trained specifically with respect	639
to the individual receiving the services.	640

(3) In the case of services provided to recipients of	641
supported living, all of the following apply:	642

(a) Without nursing delegation, MR/DD personnel may perform	643
health-related activities and administer topical and oral	644
prescribed medications.	645

(b) With nursing delegation, MR/DD personnel may administer	646
prescribed medication and perform routine feedings through stable,	647
labeled gastrostomy and jejunostomy tubes.	648

(c) With nursing delegation, MR/DD personnel may administer	649
routine doses of insulin through subcutaneous injections and	650
insulin pumps.	651

(4) In the case of services provided to residents of a	652
residential facility with five or fewer resident beds, all of the	653
following apply:	654

(a) Without nursing delegation, MR/DD personnel, may	655
perform health-related activities and administer topical and oral	656
prescribed medications.	657

(b) With nursing delegation, MR/DD personnel may administer	658
prescribed medication and perform routine feedings through stable,	659
labeled gastrostomy and jejunostomy tubes.	660

(c) With nursing delegation, MR/DD personnel may administer	661
routine doses of insulin through subcutaneous injections and	662
insulin pumps.	663

(5) In the case of services provided to residents of a	664
residential facility with six but not more than sixteen resident	665
beds, both of the following apply:	666

(a) With nursing delegation, MR/DD personnel may perform	667
health-related activities and administer topical and oral	668
prescribed medications.	669

(b) With nursing delegation, MR/DD personnel may administer	670
prescribed medications and perform routine feedings through	671
stable, labeled gastrostomy and jejunostomy tubes.	672

(6) In the case of services provided to recipients of	673
sheltered workshop services, both of the following apply:	674

(a) With nursing delegation, MR/DD personnel may perform	675
health-related activities and administer topical and oral	676
prescribed medications.	677

(b) With nursing delegation, MR/DD personnel may administer	678
prescribed medications and perform routine feedings through	679
stable, labeled gastrostomy and jejunostomy tubes.	680

(C) In accordance with section 5123.207 of the Revised	681
Code, the department of mental retardation and developmental	682
disabilities shall adopt rules as it considers necessary to	683
implement this section. The rules shall include the following:	684

(1) Requirements for documentation of each service provided	685
pursuant to the authority granted under this section;	686

(2) Procedures for reporting errors that occur in the	687
administration of medication or performance of health-related	688
activities by MR/DD personnel;	689

(3) Procedures for the department to follow in accepting	690
complaints regarding the performance of services by MR/DD	691
personnel pursuant to the authority granted under this section and	692
procedures for conducting investigations of those complaints.	693

Sec. 5123.203.  (A) For the purpose of providing training	694
with respect to the authority of MR/DD personnel to perform	695
services pursuant to section 5123.202 of the Revised Code, the	696
department of mental retardation and developmental disabilities	697
shall develop courses for training MR/DD personnel and courses	698
for training registered nurses to conduct the MR/DD personnel	699
training courses.	700

In accordance with section 5123.207 of the Revised Code, the	701
department shall adopt rules that specify the content and length	702
of the courses and establish any other standards for training	703
considered necessary by the department.	704

(B) The medication administration training courses developed	705
under division (A) of this section shall address at least all of	706
the following:	707

(1) Infection control and universal precautions;

708

(2) Correct and safe practices, procedures, and techniques	709
for administering prescribed medication;	710

(3) Assessment of drug reaction, including known side	711
effects, interactions, and the proper course of action if a side	712
effect occurs;	713

(4) Requirements for documentation of medication	714
administered to each individual;	715

(5) Requirements for documentation and notification of	716
medication errors;	717

(6) Information regarding the proper storage and care of	718
medications;	719

(7) Requirements for successful demonstration of	720
proficiency in medication administration;	721

(8) Information about proper receipt of prescriptions and	722
transcription of prescriptions into an individual's medication	723
administration record.	724

Sec. 5123.204. (A)(1) The department of mental retardation	725
and developmental disabilities shall establish a program under	726
which the department issues certificates to MR/DD personnel to	727
perform service pursuant to section 5123.202 of the Revised Code	728
and certificates to registered nurses to conduct training courses	729
for MR/DD personnel. Except as provided in division (A)(2) of this	730
section, to be eligible for a certificate, an individual must	731
successfully complete the applicable training course developed	732
under section 5123.203 of the Revised Code and meet all other	733
applicable requirements established in rules adopted pursuant to	734
this section.	735

(2) The program shall include provisions for issuing	736
certificates to the following:	737

(a) MR/DD personnel who, prior to the effective date of this	738
section, administered medication or performed tasks, or both,	739
pursuant to former section 5123.193 or former sections 5126.351 to	740
5126.354 of the Revised Code;	741

(b) Registered nurses who, prior to the effective date of	742
this section, trained individuals pursuant to former sections	743
4723.61, 4723.62, 5123.193, and 5126.351 to 5126.354 of the	744
Revised Code. A registered nurse who receives a certificate under	745
division (A)(2) of this section shall not train MR/DD personnel to	746
administer insulin unless the registered nurse completes a	747
refresher course developed under section 5123.203 of the Revised	748
Code that enables the registered nurse to receive a certificate to	749
train MR/DD personnel to administer insulin.	750

(B) Certificates issued to MR/DD personnel and registered	751
nurses are valid for one year and may be renewed. To be eligible	752
for renewal, MR/DD personnel and registered nurses must meet the	753
applicable continued competency requirements and continuing	754
education requirements specified in rules adopted under division	755
(C) of this section.	756

(C) In accordance with section 5123.207 of the Revised	757
Code, the department shall adopt rules that establish all of the	758
following:	759

(1) Requirements that MR/DD personnel and registered nurses	760
must meet to be eligible to take a training course;	761

(2) Standards that must be met to receive a certificate,	762
including requirements pertaining to an applicant's criminal	763
background;	764

(3) Procedures to be followed in applying for a certificate	765
and issuing a certificate;	766

(4) Standards and procedures for renewing a certificate,	767
including requirements for continuing education and, in the case	768
of MR/DD personnel who administer medication, requirements for	769
successful demonstration of medication administration;	770

(5) Standards and procedures for suspending or revoking a	771
certificate;	772

(6) Standards and procedures for suspending a certificate	773
without a hearing pending the outcome of an investigation;	774

(7) Any other standards or procedures the department	775
considers necessary to administer the certification program.	776

(D) The department shall establish and maintain a registry	777
that lists each individual who holds a valid certificate issued	778
pursuant to this section. The registry shall specify the type of	779
certificate held and any limitations that apply to the individual	780
holding the certificate.	781

Sec. 5126.354.        Sec. 5123.205. A county board workerAn individual	782
authorized pursuant to section 5123.202 of the Revised Code to	783
give or applyadminister prescribed medication or perform a	784
delegated nursing taskhealth-related activity, or both, is not	785
liable for any injury caused by the medication or taskactivity if	786
allboth of the following apply:	787

(A) Prior to giving or applying the medication or peforming	788
the nursing task, the county board worker received a copy of the	789
statement or the revised statement required to be given under	790
division (C) of section 5126.353 of the Revised Code;	791

(B) The county board worker gave or appliedindividual	792
administered the medication or performed the nursing task	793
activities in accordance with the methods taught in training	794
completed to receive certification pursuant to division (D)(2) of	795
section 5126.3515123.205 of the Revised Code;	796

(C)(B) The county board workerindividual did not act in a	797
manner that constitutes wanton or reckless misconduct.	798

Sec. 5126.355.        Sec. 5123.206. A county board of mental retardation	799
and developmental disabilities may permit a county board worker to	800
assist a county board client(A) MR/DD personnel who are not	801
specifically authorized by other provisions of the Revised Code to	802
provide assistance in the self-administration of prescribed	803
medication. Whenmay, under this section, provide that assistance	804
as part of the services they provide to individuals with mental	805
retardation and developmental disabilities. To provide assistance	806
with self-administration of medication, MR/DD personnel are not	807
required to be trained or certified in accordance with sections	808
5123.203 and 5123.204 of the Revised Code.	809

(B) When assisting a county board client in	810
self-administration of prescribed medication, a county board	811
workerMR/DD personnel shall take only thosethe following actions	812
authorized by the board of nursing pursuant to rules adopted under	813
section 4723.62 of the Revised Code:	814

(1) Remind an individual when to take medication and	815
observe the individual to ensure that the individual follows the	816
directions on the container;	817

(2) Assist an individual by taking the medication in its	818
container from the area where it is stored, handing the container	819
with the medication in it to the individual, and opening the	820
container, if the individual is physically unable to open the	821
container;	822

(3) Assist, on request by or with the consent of, a	823
physically impaired but mentally alert individual, with removal of	824
oral or topical medication from the container and with the	825
individual's taking or applying of the medication. If an	826
individual is physically unable to place a dose of medication to	827
the individual's mouth without spilling or dropping it, MR/DD	828
personnel may place the dose in another container and place that	829
container to the individual's mouth.	830

Sec. 5123.207.  All rules adopted under sections 5123.202	831
to 5123.206 of the Revised Code shall be adopted in consultation	832
with the board of nursing and the Ohio nurses association. The	833
rules shall be adopted in accordance with Chapter 119. of the	834
Revised Code.	835

Sec. 5126.357.        Sec. 5123.208.  (A) As used in this section:

836

(1) "In-home care" means the supportive services provided	837
within the home of an individual who receives funding for the	838
services asthrough a county board clientof mental retardation	839
and developmental disabilities, including any client who receives	840
recipient of residential services funded through home and	841
community-based services, family support services provided under	842
section 5126.11 of the Revised Code, or supported living provided	843
in accordance with sections 5126.41 to 5126.47 of the Revised	844
Code. "In-home care" includes care that is provided outside a	845
client'san individual's home in places incidental to the home,	846
and while traveling to places incidental to the home, except that	847
"in-home care" does not include care provided in the facilities of	848
a county board of mental retardation and developmental	849
disabilities or care provided in schools.	850

(2) "Parent" means either parent of a child, including an	851
adoptive parent but not a foster parent.	852

(3) "Unlicensed in-home care worker" means an individual who	853
provides in-home care but is not a health care professional. A	854
county board workerMR/DD personnel may be an unlicensed in-home	855
care workerworkers.	856

(4) "Family member" means a parent, sibling, spouse, son,	857
daughter, grandparent, aunt, uncle, cousin, or guardian of the	858
individual with mental retardation or a developmental disability	859
if the individual with mental retardation or developmental	860
disabilities lives with the person and is dependent on the person	861
to the extent that, if the supports were withdrawn, another living	862
arrangement would have to be found.	863

(B) Except as provided in division (D) of this section, a	864
family member of an individual with mental retardation or a	865
developmental disability may authorize an unlicensed in-home care	866
worker to give or apply prescribed medication or perform other	867
health care tasks as part of the in-home care provided to the	868
individual, if the family member is the primary supervisor of the	869
care and the unlicensed in-home care worker has been selected by	870
the family member and is under the direct supervision of the	871
family member. Sections 4723.62 and 5126.351 to 5126.356 of the	872
Revised Code do not apply to the in-home care authorized by a	873
family member under this section. Instead, aA family member	874
shall obtain a prescription, if applicable, and written	875
instructions from a health care professional for the care to be	876
provided to the individual. The family member shall authorize the	877
unlicensed in-home care worker to provide the care by preparing a	878
written document granting the authority. The family member shall	879
provide the unlicensed in-home care worker with appropriate	880
training and written instructions in accordance with the	881
instructions obtained from the health care professional.	882

(C) A family member who authorizes an unlicensed in-home	883
care worker to give or apply prescribed medication or perform	884
other health care tasks retains full responsibility for the health	885
and safety of the individual receiving the care and for ensuring	886
that the worker provides the care appropriately and safely. No	887
entity that funds or monitors the provision of in-home care may be	888
held liable for the results of the care provided under this	889
section by an unlicensed in-home care worker, including such	890
entities as the county board of mental retardation and	891
developmental disabilities, any other entity that employs an	892
unlicensed in-home care worker, and the department of mental	893
retardation and developmental disabilities.	894

An unlicensed in-home care worker who is authorized under	895
this section by a family member to provide care to an individual	896
may not be held liable for any injury caused in providing the	897
care, unless the worker provides the care in a manner that is not	898
in accordance with the training and instructions received or the	899
worker acts in a manner that constitutes wanton or reckless	900
misconduct.	901

(D) A county board of mental retardation and developmental	902
disabilities may evaluate the authority granted by a family member	903
under this section to an unlicensed in-home care worker at any	904
time it considers necessary and shall evaluate the authority on	905
receipt of a complaint. If the board determines that a family	906
member has acted in a manner that is inappropriate for the health	907
and safety of the individual receiving the services, the	908
authorization granted by the family member to an unlicensed	909
in-home care worker is void, and the family member may not	910
authorize other unlicensed in-home care workers to provide the	911
care. In making such a determination, the board shall use	912
appropriately licensed health care professionals and shall provide	913
the family member an opportunity to file a complaint under section	914
5126.06 of the Revised Code.	915

Sec. 5123.50.  As used in this section and sections 5123.51	916
and 5123.52 of the Revised Code:	917

(A) "Abuse" means all of the following:

918

(1) The use of physical force that can reasonably be	919
expected to result in physical harm or serious physical harm;	920

(2) Sexual abuse;

921

(3) Verbal abuse.

922

(B) "Misappropriation" means depriving, defrauding, or	923
otherwise obtaining the real or personal property of an individual	924
by any means prohibited by the Revised Code, including violations	925
of Chapter 2911. or 2913. of the Revised Code.	926

(C) "MR/DD employee" means all of the following:

927

(1) An employee of the department of mental retardation and	928
developmental disabilities;	929

(2) An employee of a county board of mental retardation and	930
developmental disabilities;	931

(3) An "ICF/MR worker," as defined in section 5123.193 of the	932
Revised Code;	933

(4) An individual who is employed in a position that	934
includes providing specialized services to an individual with	935
mental retardation or a developmental disability.	936

(D) "Neglect" means, when there is a duty to do so, failing	937
to provide an individual with any treatment, care, goods, or	938
services that are necessary to maintain the health and safety of	939
the individual.	940

(E) "Physical harm" and "serious physical harm" have the	941
same meanings as in section 2901.01 of the Revised Code.	942

(F) "Sexual abuse" means unlawful sexual conduct or sexual	943
contact, as those terms are defined in section 2907.01 of the	944
Revised Code.	945

(G) "Specialized services" means any program or service	946
designed and operated to serve primarily individuals with mental	947
retardation or a developmental disability, including a program or	948
service provided by an entity licensed or certified by the	949
department of mental retardation and developmental disabilities	950
and facilities subject to section 5123.192 of the Revised Code. A	951
program or service available to the general public is not a	952
specialized service.	953

(H) "Verbal abuse" means purposely using words to threaten,	954
coerce, intimidate, harass, or humiliate an individual.	955

Sec. 5123.611.  (A) As used in this section, MR/DD employee	956
means all of the following:	957

(1) An employee of the department of mental retardation and	958
developmental disabilities;	959

(2) An employee of a county board of mental retardation and	960
developmental disabilities;	961

(3) An "ICF/MR worker," as defined in section 5123.193 of the	962
Revised Code;	963

(4) An individual who is employed in a position that	964
includes providing specialized services, as defined in section	965
5123.50 of the Revised Code, to an individual with mental	966
retardation or a developmental disability.	967

(B) At the conclusion of a review of a report of abuse,	968
neglect, or a major unusual incident that is conducted by a review	969
committee established pursuant to section 5123.61 of the Revised	970
Code, the committee shall issue recommendations to the department.	971
The department shall review the committee's recommendations and	972
issue a report of its findings. The department shall make the	973
report available to all of the following:	974

(1) The person who is the subject of the report;

975

(2) That person's guardian or legal counsel;

976

(3) The licensee, as defined in section 5123.19 of the	977
Revised Code, of a residential facility in which the person	978
resides;	979

(4) The employer of any MR/DD employee who allegedly	980
committed or was responsible for the abuse, neglect, or major	981
unusual incident.	982

(C) Except as provided in this section, the department shall	983
not disclose its report to any person or government entity that is	984
not authorized to investigate reports of abuse, neglect, or other	985
major unusual incidents, unless the person who is the subject of	986
the report or the person's guardian gives the department written	987
consent.	988

Sec. 5126.36. Any individual employed by a county board of	989
mental retardation or developmental disabilities or an entity	990
under contract with the board who meets the requirements of	991
sections 5123.201 through 5123.208 of the Revised Code may engage	992
in any of the activities authorized under those sections,	993
including the administration of oral and topical prescribed	994
medication, performance of health-related activities, and	995
provision of assistance with self-administration of medication.	996

Section 2. That existing sections 4723.61, 5123.19, 5123.50,	998
5123.611, 5126.354, 5126.355, and 5126.357 and sections 4723.62,	999
5123.193, 5126.35, 5126.351, 5126.352, 5126.353, and 5126.356 of	1000
the Revised Code are hereby repealed.	1001

Section 3. The Director of Mental Retardation and	1002
Developmental Disabilities shall adopt rules in accordance with	1003
Chapter 119. of the Revised Code establishing a schedule for	1004
residential facilities licensed under section 5123.19 of the	1005
Revised Code on the effective date of this section to seek renewal	1006
of the license in accordance with the amendments made by this act	1007
to that section. Notwithstanding division (C) of section 5123.19	1008
of the Revised Code, as amended by this act, a residential	1009
facility license in effect on this section's effective date shall	1010
remain in effect until the Director renews or refuses to renew the	1011
license, unless the license is terminated, revoked, or voluntarily	1012
surrendered.	1013

Section 4. Notwithstanding the provisions of section 5123.202	1014
of the Revised Code that permit MR/DD personnel to administer	1015
insulin with nursing delegation, MR/DD personnel shall not	1016
administer insulin until being trained by a registered nurse who	1017
has received a certificate under section 5123.204 of the Revised	1018
Code that allows the registered nurse to train MR/DD personnel to	1019
administer insulin.	1020