As Passed by the Senate

129th General Assembly
Regular Session
2011-2012
Sub. S. B. No. 83


Senator Oelslager 

Cosponsors: Senators Tavares, Cafaro, Brown, Coley, Daniels, Hughes, Niehaus, Sawyer, Schiavoni, Turner, Wilson 

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


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

       Section 1. That sections 3719.06, 4723.481, 4723.482, 6
4723.492, and 4723.50 of the Revised Code be amended to read as 7
follows: 8

       Sec. 3719.06.  (A)(1) A licensed health professional 9
authorized to prescribe drugs, if acting in the course of 10
professional practice, in accordance with the laws regulating the 11
professional's practice, and in accordance with rules adopted by 12
the state board of pharmacy, may, except as provided in division 13
(A)(2) or (3) of this section, do the following:14

       (a) Prescribe schedule II, III, IV, and V controlled 15
substances;16

       (b) Administer or personally furnish to patients schedule II, 17
III, IV, and V controlled substances;18

       (c) Cause schedule II, III, IV, and V controlled substances 19
to be administered under the prescriber's direction and 20
supervision.21

       (2) A licensed health professional authorized to prescribe 22
drugs who is a clinical nurse specialist, certified nurse-midwife, 23
or certified nurse practitioner is subject to both of the 24
following:25

       (a) A schedule II controlled substance may be prescribed only 26
for a patient with a terminal condition, as defined in section 27
2133.01 of the Revised Code, only if the nurse's collaborating 28
physician initially prescribed the substance for the patient, and 29
only in an amount that does not exceed the amount necessary for 30
the patient's use in a single, twenty-four-hour periodin 31
accordance with division (C) of section 4723.481 of the Revised 32
Code.33

       (b) No schedule II controlled substance shall be personally 34
furnished to any 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. 4723.481.  Under a certificate to prescribe issued under 58
section 4723.48 of the Revised Code, a clinical nurse specialist, 59
certified nurse-midwife, or certified nurse practitioner is 60
subject to all of the following:61

       (A) The clinical nurse specialist, certified nurse-midwife, 62
or certified nurse practitioner shall not prescribe any drug or 63
therapeutic device that is not included in the types of drugs and 64
devices listed on the formulary established in rules adopted under 65
section 4723.50 of the Revised Code.66

       (B) The nurse's prescriptive authority of the clinical nurse 67
specialist, certified nurse-midwife, or certified nurse 68
practitioner shall not exceed the prescriptive authority of the 69
collaborating physician or podiatrist.70

       (C) The nurse may prescribe a schedule II controlled 71
substance as specified in division (A)(2) of section 3719.06 of 72
the Revised Code, but shall not prescribe a schedule II controlled 73
substance in collaboration with a podiatrist(1) Except as 74
provided in division (C)(2) or (3) of this section, the clinical 75
nurse specialist, certified nurse-midwife, or certified nurse 76
practitioner may prescribe to a patient a schedule II controlled 77
substance only if all of the following are the case: 78

       (a) The patient has a terminal condition, as defined in 79
section 2133.01 of the Revised Code.80

       (b) The collaborating physician of the clinical nurse 81
specialist, certified nurse-midwife, or certified nurse 82
practitioner initially prescribed the substance for the patient.83

       (c) The prescription is for an amount that does not exceed 84
the amount necessary for the patient's use in a single, 85
twenty-four hour period. 86

       (2) The restrictions on prescriptive authority in division 87
(C)(1) of this section do not apply if a clinical nurse 88
specialist, certified nurse-midwife, or certified nurse 89
practitioner issues the prescription to the patient from any of 90
the following locations:91

       (a) A hospital registered under section 3701.07 of the 92
Revised Code;93

       (b) A health care facility operated by the department of 94
mental health or the department of developmental disabilities;95

       (c) A nursing home licensed under section 3721.02 of the 96
Revised Code or by a political subdivision certified under section 97
3721.09 of the Revised Code;98

       (d) A county home or district home operated under Chapter 99
5155. of the Revised Code that is certified under Title XVIII or 100
XIX of the Social Security Act of 1935;101

       (e) A hospice care program, as defined in section 3712.01 of 102
the Revised Code;103

       (f) A community mental health facility, as defined in section 104
5122.01 of the Revised Code;105

       (g) An ambulatory surgical facility, as defined in section 106
3702.30 of the Revised Code;107

       (h) A freestanding birthing center, as defined in section 108
3702.51 of the Revised Code;109

       (i) A federally qualified health center, as defined in 110
section 1905(l)(2)(B) of the "Social Security Act," 103 Stat. 2264 111
(1989), 42 U.S.C. 1396d(l)(2)(B);112

       (j) A health care office or facility operated by the board of 113
health of a city or general health district or the authority 114
having the duties of a board of health under section 3709.05 of 115
the Revised Code.116

       (3) A clinical nurse specialist, certified nurse-midwife, or 117
certified nurse practitioner shall not issue to a patient a 118
prescription for a schedule II controlled substance from a 119
convenience care clinic even if the clinic is owned or operated by 120
an entity specified in division (C)(2) of this section.121

       (D) The clinical nurse specialist, certified nurse-midwife, 122
or certified nurse practitioner may personally furnish to a 123
patient a sample of any drug or therapeutic device included in the 124
types of drugs and devices listed on the formulary, subject to125
except that all of the following conditions apply:126

       (1) The amount of the sample furnished shall not exceed a 127
seventy-two-hour supply, except when the minimum available 128
quantity of the sample is packaged in an amount that is greater 129
than a seventy-two-hour supply, in which case the nurse may 130
furnish the sample in the packaged amount may be furnished.131

       (2) No charge may be imposed for the sample or for furnishing 132
it.133

       (3) Samples of controlled substances may not be personally 134
furnished.135

       (E) The clinical nurse specialist, certified nurse-midwife, 136
or certified nurse practitioner may personally furnish to a 137
patient a complete or partial supply of a drug or therapeutic 138
device included in the types of drugs and devices listed on the 139
formulary, subject toexcept that all of the following conditions 140
apply:141

       (1) The clinical nurse specialist, certified nurse-midwife, 142
or certified nurse practitioner shall personally furnish only 143
antibiotics, antifungals, scabicides, contraceptives, prenatal 144
vitamins, antihypertensives, drugs and devices used in the 145
treatment of diabetes, drugs and devices used in the treatment of 146
asthma, and drugs used in the treatment of dyslipidemia.147

       (2) The clinical nurse specialist, certified nurse-midwife, 148
or certified nurse practitioner shall not furnish the drugs and 149
devices in locations other than a health department operated by 150
the board of health of a city or general health district or the 151
authority having the duties of a board of health under section 152
3709.05 of the Revised Code, a federally funded comprehensive 153
primary care clinic, or a nonprofit health care clinic or program.154

       (3) The clinical nurse specialist, certified nurse-midwife, 155
or certified nurse practitioner shall comply with all safety 156
standards for personally furnishing supplies of drugs and devices, 157
as established in rules adopted under section 4723.50 of the 158
Revised Code.159

       Sec. 4723.482.  (A) Except as provided in divisions (C) and 160
(D) of this section, an applicant shall include with the 161
application submitted under section 4723.48 of the Revised Code 162
all of the following: 163

       (1) Subject to section 4723.483 of the Revised Code, evidence 164
of holding a current, valid certificate of authority issued under 165
this chapter to practice as a clinical nurse specialist, certified 166
nurse-midwife, or certified nurse practitioner; 167

       (2) Except for a person who on May 17, 2000, was approved to 168
prescribe drugs and therapeutic devices under section 4723.56 of 169
the Revised Code, as that section existed on that date, evidence170
Evidence of successfully completing the instructioncourse of 171
study in advanced pharmacology and related topics in accordance 172
with the requirements specified in division (B) of this section; 173

       (3) The fee required by section 4723.08 of the Revised Code 174
for a certificate to prescribe; 175

       (4) Any additional information the board of nursing requires 176
pursuant to rules adopted under section 4723.50 of the Revised 177
Code. 178

       (B) AllWith respect to the course of study in advanced 179
pharmacology and related topics that must be successfully 180
completed to obtain a certificate to prescribe, all of the 181
following requirements apply to the instruction required under 182
division (A)(2) of this section: 183

       (1) The instruction mustcourse of study shall be obtained184
completed not longer than three years before the application for 185
the certificate to prescribe is filed. 186

       (2) The instruction must be obtained through a course of 187
study consistingshall consist of planned classroom and clinical 188
study that isinstruction for a total of not less than forty-five 189
contact hours.190

       (3) The course of study shall meet the requirements to be191
approved by the board of nursing in accordance with standards 192
established in rules adopted under section 4723.50 of the Revised 193
Code. 194

       (3)(4) The content of the instruction mustcourse of study 195
shall be specific to the applicant's nursing specialty and.196

       (5) The instruction provided in the course of study shall197
include all of the following: 198

       (a) A minimum of thirtythirty-six contact hours of training199
instruction in advanced pharmacology that includes pharmacokinetic 200
principles and clinical application and the use of drugs and 201
therapeutic devices in the prevention of illness and maintenance 202
of health; 203

       (b) TrainingInstruction in the fiscal and ethical 204
implications of prescribing drugs and therapeutic devices; 205

       (c) TrainingInstruction in the state and federal laws that 206
apply to the authority to prescribe; 207

       (d) Instruction that is specific to schedule II controlled 208
substances, including instruction in all of the following:209

       (i) Indications for the use of schedule II controlled 210
substances in drug therapies;211

        (ii) The most recent guidelines for pain management 212
therapies, as established by state and national organizations such 213
as the Ohio pain initiative and the American pain society;214

       (iii) Fiscal and ethical implications of prescribing schedule 215
II controlled substances;216

       (iv) State and federal laws that apply to the authority to 217
prescribe schedule II controlled substances;218

        (v) Prevention of abuse and diversion of schedule II 219
controlled substances, including identification of the risk of 220
abuse and diversion, recognition of abuse and diversion, types of 221
assistance available for prevention of abuse and diversion, and 222
methods of establishing safeguards against abuse and diversion.223

       (e) Any additional traininginstruction required pursuant to 224
rules adopted under section 4723.50 of the Revised Code. 225

       (C) An applicant who practiced or is practicing as a clinical 226
nurse specialist, certified nurse-midwife, or certified nurse 227
practitioner in another jurisdiction or as an employee of the 228
United States government, and is not seeking authority to 229
prescribe drugs and therapeutic devices by meeting the 230
requirements of division (A) or (D) of this section, shall include 231
with the application submitted under section 4723.48 of the 232
Revised Code all of the following: 233

       (1) Subject to section 4723.483 of the Revised Code, evidence 234
of holding a current, valid certificate of authority issued under 235
this chapter to practice as a clinical nurse specialist, certified 236
nurse-midwife, or certified nurse practitioner; 237

       (2) The fee required by section 4723.08 of the Revised Code 238
for a certificate to prescribe; 239

       (3) Either of the following: 240

       (a) Evidence of having held, for a continuous period of at 241
least one year during the three years immediately preceding the 242
date of application, valid authority issued by another 243
jurisdiction to prescribe therapeutic devices and drugs, including 244
at least some controlled substances; 245

       (b) Evidence of having been employed by the United States 246
government and authorized, for a continuous period of at least one 247
year during the three years immediately preceding the date of 248
application, to prescribe therapeutic devices and drugs, including 249
at least some controlled substances, in conjunction with that 250
employment. 251

       (4) If the applicant includes the evidence described in 252
division (C)(3)(a) of this section, documentation from a licensed 253
physician in a form acceptable to the board that the prescribing 254
component of the nurse's practice was overseen or supervised by a 255
licensed physician in the other jurisdiction; 256

       (5) If the applicant includes the evidence described in 257
division (C)(3)(b) of this section, documentation from a licensed 258
physician employed by the United States government in a form 259
acceptable to the board that the prescribing component of the 260
nurse's practice was overseen or supervised by a licensed 261
physician employed by the United States government; 262

        (6) Evidence of having completed a two-hour course of 263
instruction approved by the board in the laws of this state that 264
govern drugs and prescriptive authority;265

       (7) Any additional information the board requires pursuant to 266
rules adopted under section 4723.50 of the Revised Code. 267

       (D) An applicant who practiced or is practicing as a clinical 268
nurse specialist, certified nurse-midwife, or certified nurse 269
practitioner in another jurisdiction or as an employee of the 270
United States government, and is not seeking authority to 271
prescribe drugs and therapeutic devices by meeting the 272
requirements of division (A) or (C) of this section, shall include 273
with the application submitted under section 4723.48 of the 274
Revised Code all of the following: 275

       (1) Subject to section 4723.483 of the Revised Code, evidence 276
of holding a current, valid certificate of authority issued under 277
this chapter to practice as a clinical nurse specialist, certified 278
nurse-midwife, or certified nurse practitioner; 279

       (2) The fee required by section 4723.08 of the Revised Code 280
for a certificate to prescribe; 281

       (3) Either of the following: 282

       (a) Evidence of having held, for a continuous period of at 283
least one year during the three years immediately preceding the 284
date of application, valid authority issued by another 285
jurisdiction to prescribe therapeutic devices and drugs, excluding 286
controlled substances; 287

       (b) Evidence of having been employed by the United States 288
government and authorized, for a continuous period of at least one 289
year during the three years immediately preceding the date of 290
application, to prescribe therapeutic devices and drugs, excluding 291
controlled substances, in conjunction with that employment. 292

       (4) If the applicant includes the evidence described in 293
division (D)(3)(a) of this section, documentation from a licensed 294
physician in a form acceptable to the board that the prescribing 295
component of the nurse's practice was overseen or supervised by a 296
licensed physician in the other jurisdiction; 297

       (5) If the applicant includes the evidence described in 298
division (D)(3)(b) of this section, documentation from a licensed 299
physician employed by the United States government in a form 300
acceptable to the board that the prescribing component of the 301
nurse's practice was overseen or supervised by a licensed 302
physician employed by the United States government; 303

        (6) Any additional information the board requires pursuant to 304
rules adopted under section 4723.50 of the Revised Code.305

       Sec. 4723.492.  The committee on prescriptive governance 306
shall develop recommendations regarding the authority to prescribe 307
drugs and therapeutic devices pursuant to a certificate to 308
prescribe issued under section 4723.48 of the Revised Code. Not 309
later than fourteen months after the effective date of this 310
section, theThe recommendations shall include provisions that 311
apply specifically to the authority to prescribe schedule II 312
controlled substances.313

        The committee shall submit recommendations to the board of 314
nursing as necessary for the board to fulfill its duty to adopt 315
rules under section 4723.50 of the Revised Code. At the board's 316
request, the committee shall reconsider a recommendation it has 317
submitted and resubmit the recommendation to the board 318
accordingly. 319

       Sec. 4723.50.  (A) In accordance with Chapter 119. of the 320
Revised Code, the board of nursing shall adopt rules as necessary 321
to implement the provisions of this chapter pertaining to the 322
authority of clinical nurse specialists, certified nurse-midwives, 323
and certified nurse practitioners to prescribe drugs and 324
therapeutic devices and the issuance and renewal of certificates 325
to prescribe. Initial rules shall be adopted not later than twenty 326
months after May 17, 2000.327

       The board shall adopt rules that are consistent with the 328
recommendations the board receives from the committee on 329
prescriptive governance pursuant to section 4723.492 of the 330
Revised Code. After reviewing a recommendation submitted by the 331
committee, the board may either adopt the recommendation as a rule 332
or ask the committee to reconsider and resubmit the 333
recommendation. The board shall not adopt any rule that does not 334
conform to a recommendation made by the committee. 335

       (B) The board shall adopt rules under this section that do 336
all of the following: 337

       (1) Establish a formulary listing the types of drugs and 338
therapeutic devices that may be prescribed by a clinical nurse 339
specialist, certified nurse-midwife, or certified nurse 340
practitioner. The formulary may include controlled substances, as 341
defined in section 3719.01 of the Revised Code. The formulary 342
shall not permit the prescribing of any drug or device to perform 343
or induce an abortion. 344

       (2) Establish safety standards to be followed by a clinical 345
nurse specialist, certified nurse-midwife, or certified nurse 346
practitioner when personally furnishing to patients complete or 347
partial supplies of antibiotics, antifungals, scabicides, 348
contraceptives, prenatal vitamins, antihypertensives, drugs and 349
devices used in the treatment of diabetes, drugs and devices used 350
in the treatment of asthma, and drugs used in the treatment of 351
dyslipidemia.;352

       (3) Establish criteria for the components of the standard 353
care arrangements described in section 4723.431 of the Revised 354
Code that apply to a nurse'sthe authority to prescribe, including 355
the components that apply to the authority to prescribe schedule 356
II controlled substances. The rules shall be consistent with that 357
section and include all of the following: 358

       (a) Quality assurance standards; 359

       (b) Standards for periodic review by a collaborating 360
physician or podiatrist of the records of patients treated by the 361
clinical nurse specialist, certified nurse-midwife, or certified362
nurse practitioner; 363

       (c) Acceptable travel time between the location at which the 364
clinical nurse specialist, certified nurse-midwife, or certified365
nurse practitioner is engaging in the prescribing components of 366
the nurse's practice and the location of the nurse's collaborating 367
physician or podiatrist; 368

       (d) Any other criteria recommended by the committee on 369
prescriptive governance. 370

       (4) Establish standards and procedures for issuance and 371
renewal of a certificate to prescribe, including specification of 372
any additional information the board may require under division 373
(A)(4), (C)(7), or (D)(6) of section 4723.482 or division (B)(3) 374
of section 4723.485 of the Revised Code; 375

       (5) Establish requirementsstandards for board approval of 376
the instructioncourse of study in advanced pharmacology and 377
related topics required by section 4723.482 of the Revised Code; 378

       (6) Establish requirements for board approval of the two-hour 379
course of instruction in the laws of this state as required under 380
division (C)(6) of section 4723.482 of the Revised Code and 381
division (B)(2) of section 4723.484 of the Revised Code;382

       (7) Establish standards and procedures for the appropriate 383
conduct of an externship as described in section 4723.484 of the 384
Revised Code, including the following: 385

       (a) Standards and procedures to be used in evaluating a 386
nurse'san individual's participation in an externship; 387

       (b) Standards and procedures for the supervision that a 388
physician must provide during an externship, including supervision 389
provided by working with the nurseparticipant and supervision 390
provided by making timely reviews of the records of patients 391
treated by the nurseparticipant. The manner in which supervision 392
must be provided may vary according to the location where the 393
nurseparticipant is practicing and with the nurse'sparticipant's394
level of experience. 395

       Section 2. That existing sections 3719.06, 4723.481, 396
4723.482, 4723.492, and 4723.50 of the Revised Code are hereby 397
repealed. 398

       Section 3. (A) Notwithstanding the provisions of section 399
4723.486 of the Revised Code specifying the requirements for 400
renewal of a certificate to prescribe, or the provisions of 401
division (B) of section 4723.485 of the Revised Code specifying 402
the conditions of eligibility for a certificate to prescribe 403
issued after practicing under an externship certificate, a 404
clinical nurse specialist, certified nurse-midwife, or certified 405
nurse practitioner holding a certificate to prescribe that was 406
issued prior to the effective date of this act shall successfully 407
complete, as a condition of renewing the certificate or receiving 408
a new certificate, a minimum of six contact hours of instruction 409
regarding schedule II controlled substances as described in 410
section 4723.482 of the Revised Code, as amended by this act. In 411
the case of a certificate that is being renewed, the certificate 412
holder shall complete the instruction in addition to all other 413
continuing nursing education that must be completed by the 414
certificate holder not later than August 31, 2013. 415

       (B) Notwithstanding the amendments made by this act to 416
sections 3719.06 and 4723.481 of the Revised Code, until the 417
applicable requirements of division (A) of this section have been 418
complied with, a certificate holder shall not prescribe a schedule 419
II controlled substance to a patient unless all of the following 420
conditions are met: 421

       (1) The patient is in a terminal condition, as defined in 422
section 2133.01 of the Revised Code. 423

       (2) The certificate holder's collaborating physician 424
initially prescribed the substance for the patient. 425

       (3) The amount prescribed does not exceed the amount 426
necessary for the patient's use in a single, twenty-four-hour 427
period. 428

       Section 4. Not later than 90 days after the effective date of 429
this section, the Committee on Prescriptive Governance shall 430
develop recommendations under section 4723.492 of the Revised Code 431
regarding the authority to prescribe schedule II controlled 432
substances pursuant to a certificate to prescribe. The Committee 433
shall submit the recommendations to the Board of Nursing in 434
accordance with the procedures specified in section 4723.492 of 435
the Revised Code. 436

       Section 5. The Board of Nursing shall adopt rules under 437
section 4723.50 of the Revised Code as necessary to implement the 438
provisions of this act pertaining to the authority to prescribe 439
schedule II controlled substances pursuant to a certificate to 440
prescribe. The rules shall conform to the recommendations 441
submitted by the Committee on Prescriptive Governance. 442