As Passed by the House

128th General Assembly
Regular Session
2009-2010
Sub. H. B. No. 206


Representatives Boyd, Oelslager 

Cosponsors: Representatives Combs, Domenick, Wachtmann, Ujvagi, Letson, Yuko, Okey, Chandler, Brown, Celeste, Dyer, Evans, Gerberry, Heard, Hite, Koziura, Luckie, Mallory, Reece, Stewart, Szollosi, Walter, Williams, B., Williams, S. 

A BILL
To amend sections 3719.06, 4723.06, 4723.481, 1
4723.482, 4723.492, and 4723.50 and to enact 2
section 4723.486 of the Revised Code to modify 3
the authority of certain advanced practice 4
nurses to prescribe schedule II controlled 5
substances. 6


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

       Section 1. That sections 3719.06, 4723.06, 4723.481, 7
4723.482, 4723.492, and 4723.50 be amended and section 4723.486 8
of the Revised Code be enacted to read as follows: 9

       Sec. 3719.06.  (A)(1) A licensed health professional 10
authorized to prescribe drugs, if acting in the course of 11
professional practice, in accordance with the laws regulating the 12
professional's practice, and in accordance with rules adopted by 13
the state board of pharmacy, may, except as provided in division 14
(A)(2) or (3) of this section, do the following: 15

       (a) Prescribe schedule II, III, IV, and V controlled 16
substances; 17

       (b) Administer or personally furnish to patients schedule II, 18
III, IV, and V controlled substances; 19

       (c) Cause schedule II, III, IV, and V controlled substances 20
to be administered under the prescriber's direction and 21
supervision. 22

       (2) A licensed health professional authorized to prescribe 23
drugs who is a clinical nurse specialist, certified nurse-midwife, 24
or certified nurse practitioner is subject to both of the 25
following:26

       (a) A schedule II controlled substance may be prescribed only 27
for a patient with a terminal condition, as defined in section 28
2133.01 of the Revised Code, only if the nurse's collaborating 29
physician initially prescribed the substance for the patient, and 30
only in an amount that does not exceed the amount necessary for 31
the patient's use in a single, twenty-four-hour period.32

       (b) Noshall not personally furnish to patients any schedule 33
II controlled substance shall be personally furnished to any 34
patient. 35

       (3) A licensed health professional authorized to prescribe 36
drugs who is a physician assistant shall not prescribe or 37
personally furnish to patients any controlled substance that is 38
not included in the physician-delegated prescriptive authority 39
granted to the physician assistant in accordance with Chapter 40
4730. of the Revised Code. 41

       (B) No licensed health professional authorized to prescribe 42
drugs shall prescribe, administer, or personally furnish a 43
schedule III anabolic steroid for the purpose of human muscle 44
building or enhancing human athletic performance and no pharmacist 45
shall dispense a schedule III anabolic steroid for either purpose, 46
unless it has been approved for that purpose under the "Federal 47
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A. 48
301, as amended. 49

       (C) Each written prescription shall be properly executed, 50
dated, and signed by the prescriber on the day when issued and 51
shall bear the full name and address of the person for whom, or 52
the owner of the animal for which, the controlled substance is 53
prescribed and the full name, address, and registry number under 54
the federal drug abuse control laws of the prescriber. If the 55
prescription is for an animal, it shall state the species of the 56
animal for which the controlled substance is prescribed. 57

       Sec. 4723.06.  (A) The board of nursing shall: 58

       (1) Administer and enforce the provisions of this chapter, 59
including the taking of disciplinary action for violations of 60
section 4723.28 of the Revised Code, any other provisions of this 61
chapter, or rules adopted under this chapter; 62

       (2) Develop criteria that an applicant must meet to be 63
eligible to sit for the examination for licensure to practice as a 64
registered nurse or as a licensed practical nurse; 65

       (3) Issue and renew nursing licenses, dialysis technician 66
certificates, and community health worker certificates, as 67
provided in this chapter; 68

       (4) Define the minimum curricula and standards for 69
educational programs of the schools of professional nursing and 70
schools of practical nursing in this state; 71

       (5) Survey, inspect, and grant full approval to prelicensure 72
nursing education programs that meet the standards established by 73
rules adopted under section 4723.07 of the Revised Code. 74
Prelicensure nursing education programs include, but are not 75
limited to, associate degree, baccalaureate degree, diploma, and 76
doctor of nursing programs leading to initial licensure to 77
practice nursing as a registered nurse and practical nurse 78
programs leading to initial licensure to practice nursing as a 79
licensed practical nurse. 80

       (6) Grant conditional approval, by a vote of a quorum of the 81
board, to a new prelicensure nursing education program or a 82
program that is being reestablished after having ceased to 83
operate, if the program meets and maintains the minimum standards 84
of the board established by rules adopted under section 4723.07 of 85
the Revised Code. If the board does not grant conditional 86
approval, it shall hold an adjudication under Chapter 119. of the 87
Revised Code to consider conditional approval of the program. If 88
the board grants conditional approval, at its first meeting after 89
the first class has completed the program, the board shall 90
determine whether to grant full approval to the program. If the 91
board does not grant full approval or if it appears that the 92
program has failed to meet and maintain standards established by 93
rules adopted under section 4723.07 of the Revised Code, the board 94
shall hold an adjudication under Chapter 119. of the Revised Code 95
to consider the program. Based on results of the adjudication, the 96
board may continue or withdraw conditional approval, or grant full 97
approval. 98

       (7) Place on provisional approval, for a period of time 99
specified by the board, a program that has ceased to meet and 100
maintain the minimum standards of the board established by rules 101
adopted under section 4723.07 of the Revised Code. At the end of 102
the period, the board shall reconsider whether the program meets 103
the standards and shall grant full approval if it does. If it does 104
not, the board may withdraw approval, pursuant to an adjudication 105
under Chapter 119. of the Revised Code. 106

       (8) Approve continuing nursing education programs and courses 107
under standards established in rules adopted under section 4723.07 108
of the Revised Code; 109

       (9) Approve peer support programs, under rules adopted under 110
section 4723.07 of the Revised Code, for nurses, for dialysis 111
technicians, and for certified community health workers; 112

       (10) Establish a program for monitoring chemical dependency 113
in accordance with section 4723.35 of the Revised Code; 114

       (11) Establish the practice intervention and improvement 115
program in accordance with section 4723.282 of the Revised Code; 116

       (12) Issue and renew certificates of authority to practice 117
nursing as a certified registered nurse anesthetist, clinical 118
nurse specialist, certified nurse-midwife, or certified nurse 119
practitioner; 120

       (13) Approve under section 4723.46 of the Revised Code 121
national certifying organizations for examination and 122
certification of certified registered nurse anesthetists, clinical 123
nurse specialists, certified nurse-midwives, or certified nurse 124
practitioners; 125

       (14) Issue and renew certificates to prescribe in accordance 126
with sections 4723.48 and 4723.485 of the Revised Code; 127

       (15) Grant approval to the planned classroom and clinical 128
study required by section 4723.4834723.482 of the Revised Code to 129
be eligible for a certificate to prescribe; 130

       (16) Make an annual edition of the formulary established in 131
rules adopted under section 4723.50 of the Revised Code available 132
to the public either in printed form or by electronic means and, 133
as soon as possible after any revision of the formulary becomes 134
effective, make the revision available to the public in printed 135
form or by electronic means; 136

       (17) Provide guidance and make recommendations to the general 137
assembly, the governor, state agencies, and the federal government 138
with respect to the regulation of the practice of nursing and the 139
enforcement of this chapter; 140

       (18) Make an annual report to the governor, which shall be 141
open for public inspection; 142

       (19) Maintain and have open for public inspection the 143
following records: 144

       (a) A record of all its meetings and proceedings; 145

       (b) A file of holders of nursing licenses, registrations, and 146
certificates granted under this chapter; dialysis technician 147
certificates granted under this chapter; and community health 148
worker certificates granted under this chapter. The file shall be 149
maintained in the form prescribed by rule of the board. 150

       (c) A list of prelicensure nursing education programs 151
approved by the board; 152

       (d) A list of approved peer support programs for nurses, 153
dialysis technicians, and certified community health workers. 154

       (B) The board may fulfill the requirement of division (A)(8) 155
of this section by authorizing persons who meet the standards 156
established in rules adopted under section 4723.07 of the Revised 157
Code to approve continuing nursing education programs and courses. 158
Persons so authorized shall approve continuing nursing education 159
programs and courses in accordance with standards established in 160
rules adopted under section 4723.07 of the Revised Code. 161

       Persons seeking authorization to approve continuing nursing 162
education programs and courses shall apply to the board and pay 163
the appropriate fee established under section 4723.08 of the 164
Revised Code. Authorizations to approve continuing nursing 165
education programs and courses shall expire, and may be renewed 166
according to the schedule established in rules adopted under 167
section 4723.07 of the Revised Code. 168

       In addition to approving continuing nursing education 169
programs under division (A)(8) of this section, the board may 170
sponsor continuing education activities that are directly related 171
to the statutes and rules pertaining to the practice of nursing in 172
this state. 173

       Sec. 4723.481.  Under a certificate to prescribe issued under 174
section 4723.48 of the Revised Code, a clinical nurse specialist, 175
certified nurse-midwife, or certified nurse practitioner is 176
subject to all of the following: 177

       (A) The clinical nurse specialist, certified nurse-midwife, 178
or certified nurse practitioner shall not prescribe any drug or 179
therapeutic device that is not included in the types of drugs and 180
devices listed on the formulary established in rules adopted under 181
section 4723.50 of the Revised Code. 182

       (B) The nurse's prescriptive authority of the clinical nurse 183
specialist, certified nurse-midwife, or certified nurse 184
practitioner shall not exceed the prescriptive authority of the 185
collaborating physician or podiatrist. 186

       (C) The nurse may prescribe a schedule II controlled 187
substance as specified in division (A)(2) of section 3719.06 of 188
the Revised Code, but shall not prescribe a schedule II controlled 189
substance in collaboration with a podiatrist.190

       (D) The clinical nurse specialist, certified nurse-midwife, 191
or certified nurse practitioner may personally furnish to a 192
patient a sample of any drug or therapeutic device included in the 193
types of drugs and devices listed on the formulary, subject to all 194
of the following: 195

       (1) The amount of the sample furnished shall not exceed a 196
seventy-two-hour supply, except when the minimum available 197
quantity of the sample is packaged in an amount that is greater 198
than a seventy-two-hour supply, in which case the nurse may 199
furnish the sample in the packaged amount may be furnished. 200

       (2) No charge may be imposed for the sample or for furnishing 201
it. 202

       (3) Samples of controlled substances may not be personally 203
furnished. 204

       (E)(D) The clinical nurse specialist, certified 205
nurse-midwife, or certified nurse practitioner may personally 206
furnish to a patient a complete or partial supply of a drug or 207
therapeutic device included in the types of drugs and devices 208
listed on the formulary, subject to all of the following: 209

       (1) The clinical nurse specialist, certified nurse-midwife, 210
or certified nurse practitioner shall personally furnish only 211
antibiotics, antifungals, scabicides, contraceptives, prenatal 212
vitamins, antihypertensives, drugs and devices used in the 213
treatment of diabetes, drugs and devices used in the treatment of 214
asthma, and drugs used in the treatment of dyslipidemia. 215

       (2) The clinical nurse specialist, certified nurse-midwife, 216
or certified nurse practitioner shall not furnish the drugs and 217
devices in locations other than a health department operated by 218
the board of health of a city or general health district or the 219
authority having the duties of a board of health under section 220
3709.05 of the Revised Code, a federally funded comprehensive 221
primary care clinic, or a nonprofit health care clinic or program. 222

       (3) The clinical nurse specialist, certified nurse-midwife, 223
or certified nurse practitioner shall comply with all safety 224
standards for personally furnishing supplies of drugs and devices, 225
as established in rules adopted under section 4723.50 of the 226
Revised Code. 227

       Sec. 4723.482.  (A) An applicant shall include with the 228
application submitted under section 4723.48 of the Revised Code 229
all of the following: 230

       (1) Subject to section 4723.483 of the Revised Code, evidence 231
of holding a current, valid certificate of authority issued under 232
this chapter to practice as a clinical nurse specialist, certified 233
nurse-midwife, or certified nurse practitioner; 234

       (2) Except for a person who on May 17, 2000, was approved to 235
prescribe drugs and therapeutic devices under section 4723.56 of 236
the Revised Code, as that section existed on that date, evidence237
Evidence of successfully completing the instructioncourse of 238
study in advanced pharmacology and related topics in accordance 239
with the requirements specified in division (B) of this section; 240

       (3) The fee required by section 4723.08 of the Revised Code 241
for a certificate to prescribe; 242

       (4) Any additional information the board of nursing requires 243
pursuant to rules adopted under section 4723.50 of the Revised 244
Code. 245

       (B) AllWith respect to the course of study in advanced 246
pharmacology and related topics that must be successfully 247
completed to obtain a certificate to prescribe, all of the 248
following requirements apply to the instruction required under 249
division (A)(2) of this section: 250

       (1) The instruction mustcourse of study shall be obtained251
completed not longer than three years before the application for 252
the certificate to prescribe is filed. 253

       (2) The instruction must be obtained through a course of 254
study consistingshall consist of planned classroom and clinical 255
study that isinstruction for a total of not less than forty-five 256
contact hours.257

       (3) The course of study shall meet the requirements to be258
approved by the board of nursing in accordance with standards 259
established in rules adopted under section 4723.50 of the Revised 260
Code. 261

       (3)(4) The content of the instruction mustcourse of study 262
shall be specific to the applicant's nursing specialty and.263

       (5) The instruction provided in the course of study shall264
include all of the following: 265

       (a) A minimum of thirtythirty-six contact hours of training266
instruction in advanced pharmacology that includes pharmacokinetic 267
principles and clinical application and the use of drugs and 268
therapeutic devices in the prevention of illness and maintenance 269
of health; 270

       (b) TrainingInstruction in the fiscal and ethical 271
implications of prescribing drugs and therapeutic devices; 272

       (c) TrainingInstruction in the state and federal laws that 273
apply to the authority to prescribe; 274

       (d) Instruction that is specific to schedule II controlled 275
substances, including instruction in all of the following:276

       (i) Indications for the use of schedule II controlled 277
substances in drug therapies, including pain management therapies;278

        (ii) The most recent guidelines for pain management 279
therapies, as established by state and national organizations 280
such as the Ohio pain initiative and the American pain society;281

       (iii) Ethical and fiscal implications of prescribing schedule 282
II controlled substances;283

       (iv) State and federal laws that apply to the authority to 284
prescribe schedule II controlled substances;285

        (v) Prevention of abuse and diversion of schedule II 286
controlled substances, including identification of the risk of 287
abuse and diversion, recognition of abuse and diversion, types of 288
assistance available for prevention of abuse and diversion, and 289
methods of establishing safeguards against abuse and diversion.290

       (e) Any additional traininginstruction required pursuant to 291
rules adopted under section 4723.50 of the Revised Code. 292

       Sec. 4723.486. No holder of a certificate to prescribe issued 293
under section 4723.48 of the Revised Code shall prescribe in a 294
convenience care clinic any schedule II controlled substance to a 295
patient.296

       Sec. 4723.492.  The committee on prescriptive governance 297
shall develop recommendations regarding the authority to prescribe 298
drugs and therapeutic devices pursuant to a certificate to 299
prescribe issued under section 4723.48 of the Revised Code. Not 300
later than fourteen months after the effective date of this 301
section, theThe recommendations shall include provisions that 302
apply specifically to the authority to prescribe schedule II 303
controlled substances.304

        The committee shall submit recommendations to the board of 305
nursing as necessary for the board to fulfill its duty to adopt 306
rules under section 4723.50 of the Revised Code. At the board's 307
request, the committee shall reconsider a recommendation it has 308
submitted and resubmit the recommendation to the board 309
accordingly. 310

       Sec. 4723.50.  (A) In accordance with Chapter 119. of the 311
Revised Code, the board of nursing shall adopt rules as necessary 312
to implement the provisions of this chapter pertaining to the 313
authority of clinical nurse specialists, certified nurse-midwives, 314
and certified nurse practitioners to prescribe drugs and 315
therapeutic devices and the issuance and renewal of certificates 316
to prescribe. Initial rules shall be adopted not later than twenty 317
months after the effective date of this section.318

       The board shall adopt rules that are consistent with the 319
recommendations the board receives from the committee on 320
prescriptive governance pursuant to section 4723.492 of the 321
Revised Code. After reviewing a recommendation submitted by the 322
committee, the board may either adopt the recommendation as a rule 323
or ask the committee to reconsider and resubmit the 324
recommendation. The board shall not adopt any rule that does not 325
conform to a recommendation made by the committee. 326

       (B) The board shall adopt rules under this section that do 327
all of the following: 328

       (1) Establish a formulary listing the types of drugs and 329
therapeutic devices that may be prescribed by a clinical nurse 330
specialist, certified nurse-midwife, or certified nurse 331
practitioner. The formulary may include controlled substances, as 332
defined in section 3719.01 of the Revised Code. The formulary 333
shall not permit the prescribing of any drug or device to perform 334
or induce an abortion. 335

       (2) Establish safety standards to be followed by a clinical 336
nurse specialist, certified nurse-midwife, or certified nurse 337
practitioner when personally furnishing to patients complete or 338
partial supplies of antibiotics, antifungals, scabicides, 339
contraceptives, prenatal vitamins, antihypertensives, drugs and 340
devices used in the treatment of diabetes, drugs and devices used 341
in the treatment of asthma, and drugs used in the treatment of 342
dyslipidemia.;343

       (3) Establish criteria for the components of the standard 344
care arrangements described in section 4723.431 of the Revised 345
Code that apply to a nurse'sthe authority to prescribe, including 346
the components that apply to the authority to prescribe schedule 347
II controlled substances. The rules shall be consistent with that 348
section and include all of the following: 349

       (a) Quality assurance standards; 350

       (b) Standards for periodic review by a collaborating 351
physician or podiatrist of the records of patients treated by the 352
clinical nurse specialist, certified nurse-midwife, or certified353
nurse practitioner; 354

       (c) Acceptable travel time between the location at which the 355
clinical nurse specialist, certified nurse-midwife, or certified356
nurse practitioner is engaging in the prescribing components of 357
the nurse's practice and the location of the nurse's collaborating 358
physician or podiatrist; 359

       (d) Any other criteria recommended by the committee on 360
prescriptive governance. 361

       (4) Establish standards and procedures for issuance and 362
renewal of a certificate to prescribe, including specification of 363
any additional information the board may require under division 364
(A)(4) of section 4723.482 or division (B)(3) of section 4723.484 365
of the Revised Code; 366

       (5) Establish requirementsstandards for board approval of 367
the instructioncourse of study in advanced pharmacology and 368
related topics required by section 4723.482 of the Revised Code; 369

       (6) Establish standards and procedures for the appropriate 370
conduct of an externship required bythat must be completed to be 371
eligible for a subsequent certificate to prescribe, as provided in372
division (B)(1) of section 4723.484 of the Revised Code, 373
including the following: 374

       (a) Standards and procedures to be used in evaluating a 375
nurse'san individual's participation in an externship. Regardless 376
of the method of evaluation used, athe clinical nurse specialist, 377
certified nurse-midwife, or certified nurse practitioner shall not 378
be required to participate in an externship longer than one 379
thousand eight hundred hours. 380

       (b) Standards and procedures for the supervision that a 381
physician must provide during an externship, including supervision 382
provided by working with the nurseparticipant and supervision 383
provided by making timely reviews of the records of patients 384
treated by the nurseparticipant. The manner in which supervision 385
must be provided may vary according to the location where the 386
nurseparticipant is practicing and with the nurse'sparticipant's387
level of experience. 388

       Section 2. That existing sections 3719.06, 4723.06, 4723.481, 389
4723.482, 4723.492, and 4723.50 of the Revised Code are hereby 390
repealed. 391

       Section 3. (A) Notwithstanding the provisions of section 392
4723.485 of the Revised Code specifying the requirements for 393
renewal of a certificate to prescribe, or the provisions of 394
division (B) of section 4723.484 of the Revised Code specifying 395
the conditions of eligibility for a certificate to prescribe 396
issued after practicing under an externship certificate, a 397
clinical nurse specialist, certified nurse-midwife, or 398
certified nurse practitioner holding a certificate to prescribe 399
that was issued prior to the effective date of this act shall 400
successfully complete, as a condition of renewing the 401
certificate or receiving a new certificate, a minimum of six 402
contact hours of instruction regarding schedule II controlled 403
substances as described in section 4723.482 of the Revised 404
Code, as amended by this act. In the case of a certificate that 405
is being renewed, the certificate holder shall complete the 406
instruction in addition to all other continuing nursing 407
education that must be completed by the certificate holder not 408
later than August 31, 2011. 409

       (B) Notwithstanding the amendments made by this act to 410
section 3719.06 of the Revised Code, until the applicable 411
requirements of division (A) of this section have been complied 412
with, a certificate holder shall not prescribe a schedule II 413
controlled substance to a patient unless all of the following 414
conditions are met: 415

       (1) The patient is in a terminal condition, as defined in 416
section 2133.01 of the Revised Code. 417

       (2) The certificate holder's collaborating physician 418
initially prescribed the substance for the patient. 419

       (3) The amount prescribed does not exceed the amount 420
necessary for the patient's use in a single, twenty-four-hour 421
period. 422

       Section 4. Not later than 90 days after the effective date of 423
this section, the Committee on Prescriptive Governance shall 424
develop recommendations under section 4723.492 of the Revised 425
Code regarding the authority to prescribe schedule II controlled 426
substances pursuant to a certificate to prescribe. The Committee 427
shall submit the recommendations to the Board of Nursing in 428
accordance with the procedures specified in section 4723.492 of 429
the Revised Code. 430

       Section 5. The Board of Nursing shall adopt rules under 431
section 4723.50 of the Revised Code as necessary to implement the 432
provisions of this act pertaining to the authority to prescribe 433
schedule II controlled substances pursuant to a certificate to 434
prescribe. The rules shall conform to the recommendations 435
submitted by the Committee on Prescriptive Governance. 436