H. B. No. 287 As Passed by the House

Representatives Aslanides, Kearns, Carmichael, Gibbs, Perry, McGregor, J., Dolan, Collier, Hood, Beatty, Reidelbach, Barrett, Boccieri, Brown, Carano, Daniels, DeBose, Domenick, Evans, D., Flowers, Hagan, Hughes, Law, Sayre, Schlichter, Schneider, Stewart, J., Uecker, Wagoner

A BILL

To amend sections 3702.30 and 3702.31 and to enact 1
section 3702.301 of the Revised Code to exempt 2
certain freestanding birthing centers from the 3
requirement that a center obtain a health care 4
facility license from the Director of Health. 5

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

       Section 1. That sections 3702.30 and 3702.31 be amended and 6
section 3702.301 of the Revised Code be enacted to read as 7
follows: 8

       Sec. 3702.30. (A) As used in this section: 9

       (1) "Ambulatory surgical facility" means a facility, whether 10
or not part of the same organization as a hospital, that is 11
located in a building distinct from another in which inpatient 12
care is provided, and to which any of the following apply: 13

       (a) Outpatient surgery is routinely performed in the 14
facility, and the facility functions separately from a hospital's 15
inpatient surgical service and from the offices of private 16
physicians, podiatrists, and dentists. 17

       (b) Anesthesia is administered in the facility by an 18
anesthesiologist or certified registered nurse anesthetist, and 19
the facility functions separately from a hospital's inpatient 20
surgical service and from the offices of private physicians, 21
podiatrists, and dentists. 22

       (c) The facility applies to be certified by the United States 23
~~health care financing administration~~centers for medicare and 24
medicaid services as an ambulatory surgical center for purposes of 25
reimbursement under Part B of the medicare program, Part B of 26
Title XVIII of the "Social Security Act," 4979 Stat. ~~620~~286 27
(~~1935~~1965), 42 U.S.C.A. ~~301~~1395, as amended. 28

       (d) The facility applies to be certified by a national 29
accrediting body approved by the ~~health care financing~~ 30
~~administration~~centers for medicare and medicaid services for 31
purposes of deemed compliance with the conditions for 32
participating in the medicare program as an ambulatory surgical 33
center. 34

       (e) The facility bills or receives from any third-party 35
payer, governmental health care program, or other person or 36
government entity any ambulatory surgical facility fee that is 37
billed or paid in addition to any fee for professional services. 38

       (f) The facility is held out to any person or government 39
entity as an ambulatory surgical facility or similar facility by 40
means of signage, advertising, or other promotional efforts. 41

       "Ambulatory surgical facility" does not include a hospital 42
emergency department. 43

       (2) "Ambulatory surgical facility fee" means a fee for 44
certain overhead costs associated with providing surgical services 45
in an outpatient setting. A fee is an ambulatory surgical facility 46
fee only if it directly or indirectly pays for costs associated 47
with any of the following: 48

       (a) Use of operating and recovery rooms, preparation areas, 49
and waiting rooms and lounges for patients and relatives; 50

       (b) Administrative functions, record keeping, housekeeping, 51
utilities, and rent; 52

       (c) Services provided by nurses, orderlies, technical 53
personnel, and others involved in patient care related to 54
providing surgery. 55

       "Ambulatory surgical facility fee" does not include any 56
additional payment in excess of a professional fee that is 57
provided to encourage physicians, podiatrists, and dentists to 58
perform certain surgical procedures in their office or their group 59
practice's office rather than a health care facility, if the 60
purpose of the additional fee is to compensate for additional cost 61
incurred in performing office-based surgery. 62

       (3) "Governmental health care program" has the same meaning 63
as in section 4731.65 of the Revised Code. 64

       (4) "Health care facility" means any of the following: 65

       (a) An ambulatory surgical facility; 66

       (b) A freestanding dialysis center; 67

       (c) A freestanding inpatient rehabilitation facility; 68

       (d) A freestanding birthing center; 69

       (e) A freestanding radiation therapy center; 70

       (f) A freestanding or mobile diagnostic imaging center. 71

       (5) "Third-party payer" has the same meaning as in section 72
3901.38 of the Revised Code. 73

       (B) By rule adopted in accordance with sections 3702.12 and 74
3702.13 of the Revised Code, the director of health shall 75
establish quality standards for health care facilities. The 76
standards may incorporate accreditation standards or other quality 77
standards established by any entity recognized by the director. 78

       (C) Every ambulatory surgical facility shall require that 79
each physician who practices at the facility comply with all 80
relevant provisions in the Revised Code that relate to the 81
obtaining of informed consent from a patient. 82

       (D) The director shall issue a license to each health care 83
facility that makes application for a license and demonstrates to 84
the director that it meets the quality standards established by 85
the rules adopted under division (B) of this section and satisfies 86
the informed consent compliance requirements specified in division 87
(C) of this section. 88

       (E)(1) NoExcept as provided in section 3702.301 of the 89
Revised Code, no health care facility shall operate without a 90
license issued under this section. 91

       (2) If the department of health finds that a physician who 92
practices at a health care facility is not complying with any 93
provision of the Revised Code related to the obtaining of informed 94
consent from a patient, the department shall report its finding to 95
the state medical board, the physician, and the health care 96
facility. 97

       (3) This division does not create, and shall not be construed 98
as creating, a new cause of action or substantive legal right 99
against a health care facility and in favor of a patient who 100
allegedly sustains harm as a result of the failure of the 101
patient's physician to obtain informed consent from the patient 102
prior to performing a procedure on or otherwise caring for the 103
patient in the health care facility. 104

       (F) The rules adopted under division (B) of this section 105
shall include all of the following: 106

       (1) Provisions governing application for, renewal, 107
suspension, and revocation of a license under this section; 108

       (2) Provisions governing orders issued pursuant to section 109
3702.32 of the Revised Code for a health care facility to cease 110
its operations or to prohibit certain types of services provided 111
by a health care facility; 112

       (3) Provisions governing the imposition under section 3702.32 113
of the Revised Code of civil penalties for violations of this 114
section or the rules adopted under this section, including a scale 115
for determining the amount of the penalties. 116

       Sec. 3702.301. (A) Except as provided in division (C) of 117
this section, a freestanding birthing center is not required to 118
obtain a license under section 3702.30 of the Revised Code if all 119
of the following are the case: 120

       (1) A religious denomination, sect, or group owns and 121
operates the center. 122

       (2) Requiring that the center be licensed significantly 123
abridges or infringes on the religious practices or beliefs of 124
that religious denomination, sect, or group. 125

       (3) The center provides care only during low-risk pregnancy, 126
delivery, and the immediate postpartum period exclusively to women 127
who are members of that religious denomination, sect, or group. 128

       (4) The center monitors and evaluates the care provided to 129
its patients in accordance with at least the minimum patient 130
safety monitoring and evaluation requirements established in rules 131
adopted under division (D) of this section. 132

       (5) The center meets the quality assessment and improvement 133
standards established in rules adopted under division (D) of this 134
section. 135

       (B) If the director determines that a freestanding birthing 136
center is no longer exempt from the requirement to obtain a 137
license under section 3702.30 of the Revised Code because the 138
center ceases to comply with division (A)(4) or (5) of this 139
section, the director may order the center to come into 140
compliance. In the order, the director may do all of the 141
following: 142

       (1) Identify what the center is not in compliance with and 143
what the center needs to do to come into compliance; 144

       (2) Require that the center come into compliance within a 145
period of time specified in the order; 146

       (3) Require that the center provide the director a written 147
notice within a period of time specified in the order that 148
contains all of the following: 149

       (a) Certification that the center has come into compliance; 150

       (b) The signature of the center's administrator or medical 151
director and certification that the administrator or medical 152
director, whichever signs the notice, is the center's authorized 153
representative; 154

       (c) Certification that the information contained in the 155
notice and any accompanying documentation are true and accurate; 156

       (d) Any other information or documentation that the director 157
may require to verify that the center has come into compliance. 158

       (C) If the director issues an order to a freestanding 159
birthing center under division (B) of this section and the center 160
fails to comply with the order within the time specified in the 161
order, the director may issue a second order that requires the 162
center to cease operations until the center obtains a license 163
under section 3702.30 of the Revised Code. 164

       (D) The director of health shall adopt rules in accordance 165
with Chapter 119. of the Revised Code as necessary to implement 166
this section. The rules shall establish all of the following: 167

       (1) Minimum patient safety monitoring and evaluation 168
requirements; 169

       (2) Quality assessment and improvement standards; 170

       (3) Procedures for determining whether freestanding birthing 171
centers are in compliance with the rules. 172

       Sec. 3702.31. (A) The quality monitoring and inspection fund 173
is hereby created in the state treasury. The director of health 174
shall use the fund to administer and enforce this section and 175
sections 3702.11 to 3702.20, 3702.30, 3702.301, and 3702.32 of the 176
Revised Code and rules adopted pursuant to those sections. The 177
director shall deposit in the fund any moneys collected pursuant 178
to this section or section 3702.32 of the Revised Code. All 179
investment earnings of the fund shall be credited to the fund. 180

       (B) The director of health shall adopt rules pursuant to 181
Chapter 119. of the Revised Code establishing fees for both of the 182
following: 183

       (1) Initial and renewal license applications submitted under 184
section 3702.30 of the Revised Code. The fees established under 185
division (B)(1) of this section shall not exceed the actual and 186
necessary costs of performing the activities described in division 187
(A) of this section. 188

       (2) Inspections conducted under section 3702.15 or 3702.30 of 189
the Revised Code. The fees established under division (B)(2) of 190
this section shall not exceed the actual and necessary costs 191
incurred during an inspection, including any indirect costs 192
incurred by the department for staff, salary, or other 193
administrative costs. The director of health shall provide to each 194
health care facility or provider inspected pursuant to section 195
3702.15 or 3702.30 of the Revised Code a written statement of the 196
fee. The statement shall itemize and total the costs incurred. 197
Within fifteen days after receiving a statement from the director, 198
the facility or provider shall forward the total amount of the fee 199
to the director. 200

       (3) The fees described in divisions (B)(1) and (2) of this 201
section shall meet both of the following requirements: 202

       (a) For each service described in section 3702.11 of the 203
Revised Code, the fee shall not exceed one thousand seven hundred 204
fifty dollars annually, except that the total fees charged to a 205
health care provider under this section shall not exceed five 206
thousand dollars annually. 207

       (b) The fee shall exclude any costs reimbursable by the 208
United States ~~health care financing administration~~centers for 209
medicare and medicaid services as part of the certification 210
process for the medicare program established under Title XVIII of 211
the "Social Security Act," 4979 Stat. ~~620~~286 (1935), 42 U.S.C.A. 212
~~301~~1395, as amended, and the medicaid program established under 213
Title XIX of ~~that act~~the "Social Security Act," 79 Stat. 286 214
(1965), 42 U.S.C. 1396. 215

       (4) The director shall not establish a fee for any service 216
for which a licensure or inspection fee is paid by the health care 217
provider to a state agency for the same or similar licensure or 218
inspection. 219

       Section 2. That existing sections 3702.30 and 3702.31 of the 220
Revised Code are hereby repealed. 221

Section 1. That sections 3702.30 and 3702.31 be amended and	6
section 3702.301 of the Revised Code be enacted to read as	7
follows:	8

(1) "Ambulatory surgical facility" means a facility, whether	10
or not part of the same organization as a hospital, that is	11
located in a building distinct from another in which inpatient	12
care is provided, and to which any of the following apply:	13

(a) Outpatient surgery is routinely performed in the	14
facility, and the facility functions separately from a hospital's	15
inpatient surgical service and from the offices of private	16
physicians, podiatrists, and dentists.	17

(b) Anesthesia is administered in the facility by an	18
anesthesiologist or certified registered nurse anesthetist, and	19
the facility functions separately from a hospital's inpatient	20
surgical service and from the offices of private physicians,	21
podiatrists, and dentists.	22

(c) The facility applies to be certified by the United States	23
~~health care financing administration~~centers for medicare and	24
medicaid services as an ambulatory surgical center for purposes of	25
reimbursement under Part B of the medicare program, Part B of	26
Title XVIII of the "Social Security Act," 4979 Stat. ~~620~~286	27
(~~1935~~1965), 42 U.S.C.A. ~~301~~1395, as amended.	28

(d) The facility applies to be certified by a national	29
accrediting body approved by the ~~health care financing~~	30
~~administration~~centers for medicare and medicaid services for	31
purposes of deemed compliance with the conditions for	32
participating in the medicare program as an ambulatory surgical	33
center.	34

(e) The facility bills or receives from any third-party	35
payer, governmental health care program, or other person or	36
government entity any ambulatory surgical facility fee that is	37
billed or paid in addition to any fee for professional services.	38

(f) The facility is held out to any person or government	39
entity as an ambulatory surgical facility or similar facility by	40
means of signage, advertising, or other promotional efforts.	41

"Ambulatory surgical facility" does not include a hospital	42
emergency department.	43

(2) "Ambulatory surgical facility fee" means a fee for	44
certain overhead costs associated with providing surgical services	45
in an outpatient setting. A fee is an ambulatory surgical facility	46
fee only if it directly or indirectly pays for costs associated	47
with any of the following:	48

(a) Use of operating and recovery rooms, preparation areas,	49
and waiting rooms and lounges for patients and relatives;	50

(b) Administrative functions, record keeping, housekeeping,	51
utilities, and rent;	52

(c) Services provided by nurses, orderlies, technical	53
personnel, and others involved in patient care related to	54
providing surgery.	55

"Ambulatory surgical facility fee" does not include any	56
additional payment in excess of a professional fee that is	57
provided to encourage physicians, podiatrists, and dentists to	58
perform certain surgical procedures in their office or their group	59
practice's office rather than a health care facility, if the	60
purpose of the additional fee is to compensate for additional cost	61
incurred in performing office-based surgery.	62

(3) "Governmental health care program" has the same meaning	63
as in section 4731.65 of the Revised Code.	64

(5) "Third-party payer" has the same meaning as in section	72
3901.38 of the Revised Code.	73

(B) By rule adopted in accordance with sections 3702.12 and	74
3702.13 of the Revised Code, the director of health shall	75
establish quality standards for health care facilities. The	76
standards may incorporate accreditation standards or other quality	77
standards established by any entity recognized by the director.	78

(C) Every ambulatory surgical facility shall require that	79
each physician who practices at the facility comply with all	80
relevant provisions in the Revised Code that relate to the	81
obtaining of informed consent from a patient.	82

(D) The director shall issue a license to each health care	83
facility that makes application for a license and demonstrates to	84
the director that it meets the quality standards established by	85
the rules adopted under division (B) of this section and satisfies	86
the informed consent compliance requirements specified in division	87
(C) of this section.	88

(E)(1) NoExcept as provided in section 3702.301 of the	89
Revised Code, no health care facility shall operate without a	90
license issued under this section.	91

(2) If the department of health finds that a physician who	92
practices at a health care facility is not complying with any	93
provision of the Revised Code related to the obtaining of informed	94
consent from a patient, the department shall report its finding to	95
the state medical board, the physician, and the health care	96
facility.	97

(3) This division does not create, and shall not be construed	98
as creating, a new cause of action or substantive legal right	99
against a health care facility and in favor of a patient who	100
allegedly sustains harm as a result of the failure of the	101
patient's physician to obtain informed consent from the patient	102
prior to performing a procedure on or otherwise caring for the	103
patient in the health care facility.	104

(F) The rules adopted under division (B) of this section	105
shall include all of the following:	106

(1) Provisions governing application for, renewal,	107
suspension, and revocation of a license under this section;	108

(2) Provisions governing orders issued pursuant to section	109
3702.32 of the Revised Code for a health care facility to cease	110
its operations or to prohibit certain types of services provided	111
by a health care facility;	112

(3) Provisions governing the imposition under section 3702.32	113
of the Revised Code of civil penalties for violations of this	114
section or the rules adopted under this section, including a scale	115
for determining the amount of the penalties.	116

Sec. 3702.301. (A) Except as provided in division (C) of	117
this section, a freestanding birthing center is not required to	118
obtain a license under section 3702.30 of the Revised Code if all	119
of the following are the case:	120

(1) A religious denomination, sect, or group owns and	121
operates the center.	122

(2) Requiring that the center be licensed significantly	123
abridges or infringes on the religious practices or beliefs of	124
that religious denomination, sect, or group.	125

(3) The center provides care only during low-risk pregnancy,	126
delivery, and the immediate postpartum period exclusively to women	127
who are members of that religious denomination, sect, or group.	128