Sub. H. B. No. 170 As Passed by the Senate

As Passed by the Senate

130th General Assembly

Regular Session

2013-2014

Sub. H. B. No. 170

Representatives Johnson, Stinziano

Cosponsors: Representatives Amstutz, Antonio, Gonzales, Grossman, Letson, Lynch, Maag, Milkovich, Phillips, Reece, Rogers, Sprague, Stebelton, Ramos, Barnes, Bishoff, Brown, Schuring, Sears, Smith, Adams, R., Anielski, Ashford, Baker, Beck, Blair, Blessing, Boose, Boyd, Buchy, Budish, Burkley, Butler, Carney, Celebrezze, Curtin, Damschroder, Derickson, DeVitis, Dovilla, Driehaus, Fedor, Gerberry, Green, Hackett, Hagan, C., Hall, Hayes, Heard, Henne, Hill, Huffman, Landis, Lundy, Mallory, McClain, Patterson, Perales, Redfern, Rosenberger, Ruhl, Sheehy, Slaby, Strahorn, Terhar, Thompson, Winburn, Young Speaker Batchelder
Senators Tavares, Bacon, Balderson, Beagle, Brown, Burke, Cafaro, Eklund, Faber, Gardner, Hite, Hughes, Jones, LaRose, Lehner, Manning, Obhof, Oelslager, Sawyer, Schaffer, Schiavoni, Seitz, Smith, Turner, Uecker, Widener

A BILL

To amend sections 4723.482 and 4762.03 and to enact

sections 2925.61, 4723.488, 4729.511, 4730.431,

and 4731.94 of the Revised Code to provide for

increased access to naloxone, to ensure English

proficiency in licensed practitioners of Oriental

medicine and acupuncture, to permit certain nurses

seeking prescriptive authority to complete a

portion of their study through Internet-based

study and to declare an emergency.

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

Section 1. That sections 4723.482 and 4762.03 be amended and	10
sections 2925.61, 4723.488, 4729.511, 4730.431, and 4731.94 of the	11
Revised Code be enacted to read as follows:	12

Sec. 2925.61. (A) As used in this section:

(1) "Administer naloxone" means to give naloxone to a person	14
by either of the following routes:	15

(a) Using a device manufactured for the intranasal	16
administration of liquid drugs;	17

(b) Using an autoinjector in a manufactured dosage form.

(2) "Law enforcement agency" means a government entity that	19
employs peace officers to perform law enforcement duties.	20

(3) "Licensed health professional" means all of the	21
following:	22

(a) A physician who is authorized under Chapter 4731. of the	23
Revised Code to practice medicine and surgery, osteopathic	24
medicine and surgery, or podiatric medicine and surgery;	25

(b) A physician assistant who holds a certificate to	26
prescribe issued under Chapter 4730. of the Revised Code;	27

(c) A clinical nurse specialist, certified nurse-midwife, or	28
certified nurse practitioner who holds a certificate to prescribe	29
issued under section 4723.48 of the Revised Code.	30

(4) "Peace officer" has the same meaning as in section	31
2921.51 of the Revised Code.	32

(B) A family member, friend, or other individual who is in a	33
position to assist an individual who is apparently experiencing or	34
at risk of experiencing an opioid-related overdose, is not subject	35
to criminal prosecution for a violation of section 4731.41 of the	36
Revised Code or criminal prosecution under this chapter if the	37
individual, acting in good faith, does all of the following:	38

(1) Obtains naloxone from a licensed health professional or a	39
prescription for naloxone from a licensed health professional;	40

(2) Administers that naloxone to an individual who is	41
apparently experiencing an opioid-related overdose;	42

(3) Attempts to summon emergency services either immediately	43
before or immediately after administering the naloxone.	44

(C) Division (B) of this section does not apply to a peace	45
officer or to an emergency medical technician-basic, emergency	46
medical technician-intermediate, or emergency medical	47
technician-paramedic, as defined in section 4765.01 of the Revised	48
Code.	49

(D) A peace officer employed by a law enforcement agency	50
licensed under Chapter 4729. of the Revised Code as a terminal	51
distributor of dangerous drugs is not subject to administrative	52
action, criminal prosecution for a violation of section 4731.41 of	53
the Revised Code, or criminal prosecution under this chapter if	54
the peace officer, acting in good faith, obtains naloxone from the	55
peace officer's law enforcement agency and administers the	56
naloxone to an individual who is apparently experiencing an	57
opioid-related overdose.	58

Sec. 4723.482. (A) Except as provided in divisions (C) and	59
(D) of this section, an applicant shall include with the	60
application submitted under section 4723.48 of the Revised Code	61
all of the following:	62

(1) Evidence of holding a current, valid certificate of	63
authority to practice as a clinical nurse specialist, certified	64
nurse-midwife, or certified nurse practitioner that was issued by	65
meeting the requirements of division (A) of section 4723.41 of the	66
Revised Code;	67

(2) Evidence of successfully completing the course of study	68
in advanced pharmacology and related topics in accordance with the	69
requirements specified in division (B) of this section;	70

(3) The fee required by section 4723.08 of the Revised Code	71
for a certificate to prescribe;	72

(4) Any additional information the board of nursing requires	73
pursuant to rules adopted under section 4723.50 of the Revised	74
Code.	75

(B) With respect to the course of study in advanced	76
pharmacology and related topics that must be successfully	77
completed to obtain a certificate to prescribe, all of the	78
following requirements apply:	79

(1) The course of study shall be completed not longer than	80
three years before the application for the certificate to	81
prescribe is filed.	82

(2) ~~The~~Except as provided in division (E) of this section,	83
the course of study shall consist of planned classroom and	84
clinical instruction ~~for a~~. The total length of the course of	85
study shall be not less than forty-five contact hours.	86

(3) The course of study shall meet the requirements to be	87
approved by the board in accordance with standards established in	88
rules adopted under section 4723.50 of the Revised Code.	89

(4) The content of the course of study shall be specific to	90
the applicant's nursing specialty.	91

(5) The instruction provided in the course of study shall	92
include all of the following:	93

(a) A minimum of thirty-six contact hours of instruction in	94
advanced pharmacology that includes pharmacokinetic principles and	95
clinical application and the use of drugs and therapeutic devices	96
in the prevention of illness and maintenance of health;	97

(b) Instruction in the fiscal and ethical implications of	98
prescribing drugs and therapeutic devices;	99

(c) Instruction in the state and federal laws that apply to	100
the authority to prescribe;	101

(d) Instruction that is specific to schedule II controlled	102
substances, including instruction in all of the following:	103

(i) Indications for the use of schedule II controlled	104
substances in drug therapies;	105

(ii) The most recent guidelines for pain management	106
therapies, as established by state and national organizations such	107
as the Ohio pain initiative and the American pain society;	108

(iii) Fiscal and ethical implications of prescribing schedule	109
II controlled substances;	110

(iv) State and federal laws that apply to the authority to	111
prescribe schedule II controlled substances;	112

(v) Prevention of abuse and diversion of schedule II	113
controlled substances, including identification of the risk of	114
abuse and diversion, recognition of abuse and diversion, types of	115
assistance available for prevention of abuse and diversion, and	116
methods of establishing safeguards against abuse and diversion.	117

(e) Any additional instruction required pursuant to rules	118
adopted under section 4723.50 of the Revised Code.	119

(C) An applicant who practiced or is practicing as a clinical	120
nurse specialist, certified nurse-midwife, or certified nurse	121
practitioner in another jurisdiction or as an employee of the	122
United States government, and is not seeking authority to	123
prescribe drugs and therapeutic devices by meeting the	124
requirements of division (A) or (D) of this section, shall include	125
with the application submitted under section 4723.48 of the	126
Revised Code all of the following:	127

(1) Evidence of holding a current, valid certificate of	128
authority issued under this chapter to practice as a clinical	129
nurse specialist, certified nurse-midwife, or certified nurse	130
practitioner;	131

(2) The fee required by section 4723.08 of the Revised Code	132
for a certificate to prescribe;	133

(3) Either of the following:

134

(a) Evidence of having held, for a continuous period of at	135
least one year during the three years immediately preceding the	136
date of application, valid authority issued by another	137
jurisdiction to prescribe therapeutic devices and drugs, including	138
at least some controlled substances;	139

(b) Evidence of having been employed by the United States	140
government and authorized, for a continuous period of at least one	141
year during the three years immediately preceding the date of	142
application, to prescribe therapeutic devices and drugs, including	143
at least some controlled substances, in conjunction with that	144
employment.	145

(4) Evidence of having completed a two-hour course of	146
instruction approved by the board in the laws of this state that	147
govern drugs and prescriptive authority;	148

(5) Any additional information the board requires pursuant to	149
rules adopted under section 4723.50 of the Revised Code.	150

(D) An applicant who practiced or is practicing as a clinical	151
nurse specialist, certified nurse-midwife, or certified nurse	152
practitioner in another jurisdiction or as an employee of the	153
United States government, and is not seeking authority to	154
prescribe drugs and therapeutic devices by meeting the	155
requirements of division (A) or (C) of this section, shall include	156
with the application submitted under section 4723.48 of the	157
Revised Code all of the following:	158

(1) Evidence of holding a current, valid certificate of	159
authority issued under this chapter to practice as a clinical	160
nurse specialist, certified nurse-midwife, or certified nurse	161
practitioner;	162

(2) The fee required by section 4723.08 of the Revised Code	163
for a certificate to prescribe;	164

(3) Either of the following:

165

(a) Evidence of having held, for a continuous period of at	166
least one year during the three years immediately preceding the	167
date of application, valid authority issued by another	168
jurisdiction to prescribe therapeutic devices and drugs, excluding	169
controlled substances;	170

(b) Evidence of having been employed by the United States	171
government and authorized, for a continuous period of at least one	172
year during the three years immediately preceding the date of	173
application, to prescribe therapeutic devices and drugs, excluding	174
controlled substances, in conjunction with that employment.	175

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

(E) In the case of an applicant who meets the requirements of	178
division (C) or (D) of this section other than the requirements of	179
division (C)(3) or (D)(3) of this section and is seeking authority	180
to prescribe drugs and therapeutic devices by meeting the	181
requirements of division (A) of this section, the applicant may	182
complete the instruction that is specific to schedule II	183
controlled substances, as required by division (B)(5)(d) of this	184
section, through an internet-based course of study in lieu of	185
completing the instruction through a course of study consisting of	186
planned classroom and clinical instruction.	187

Sec. 4723.488. (A) Notwithstanding any provision of this	188
chapter or rule adopted by the board of nursing, a clinical nurse	189
specialist, certified nurse-midwife, or certified nurse	190
practitioner who holds a certificate to prescribe issued under	191
section 4723.48 of the Revised Code may personally furnish a	192
supply of naloxone, or issue a prescription for naloxone, without	193
having examined the individual to whom it may be administered if	194
all of the following conditions are met:	195

(1) The naloxone supply is furnished to, or the prescription	196
is issued to and in the name of, a family member, friend, or other	197
individual in a position to assist an individual who there is	198
reason to believe is at risk of experiencing an opioid-related	199
overdose.	200

(2) The nurse instructs the individual receiving the naloxone	201
supply or prescription to summon emergency services either	202
immediately before or immediately after administering naloxone to	203
an individual apparently experiencing an opioid-related overdose.	204

(3) The naloxone is personally furnished or prescribed in	205
such a manner that it may be administered by only either of the	206
following routes:	207

(a) Using a device manufactured for the intranasal	208
administration of liquid drugs;	209

(b) Using an autoinjector in a manufactured dosage form.

210

(B) A nurse who under division (A) of this section in good	211
faith furnishes a supply of naloxone or issues a prescription for	212
naloxone is not liable for or subject to any of the following for	213
any action or omission of the individual to whom the naloxone is	214
furnished or the prescription is issued: damages in any civil	215
action, prosecution in any criminal proceeding, or professional	216
disciplinary action.	217

Sec. 4729.511. (A) As used in this section, "naloxone	218
distributor" means either of the following:	219

(1) A wholesale distributor of dangerous drugs;

220

(2) A terminal distributor of dangerous drugs that supplies	221
naloxone to any entity under division (B)(1) of this section.	222

(B)(1) A naloxone distributor shall prioritize the sale,	223
distribution, and delivery of naloxone to all of the following:	224

(a) A children's hospital, as defined in section 3727.01 of	225
the Revised Code;	226

(b) A hospital, as defined in section 3727.01 of the Revised	227
Code;	228

(c) An emergency medical service organization, as defined in	229
section 4765.01 of the Revised Code;	230

(d) A facility that is operated as an urgent care center.

231

(2) The order in which the entities are listed in division	232
(B)(1) of this section does not establish levels of priority among	233
the listed entities.	234

(C) A naloxone distributor who in good faith complies with	235
division (B) of this section is not liable for or subject to any	236
of the following for an act or omission arising from that	237
compliance: damages in any civil action, prosecution in any	238
criminal proceeding, or professional disciplinary action.	239

Sec. 4730.431. (A) Notwithstanding any provision of this	240
chapter or rule adopted by the state medical board, a physician	241
assistant who holds a certificate to prescribe issued under this	242
chapter may personally furnish a supply of naloxone, or issue a	243
prescription for naloxone, without having examined the individual	244
to whom it may be administered if all of the following conditions	245
are met:	246

(1) The naloxone supply is furnished to, or the prescription	247
is issued to and in the name of, a family member, friend, or other	248
individual in a position to assist an individual who there is	249
reason to believe is at risk of experiencing an opioid-related	250
overdose.	251

(2) The physician assistant instructs the individual	252
receiving the naloxone supply or prescription to summon emergency	253
services either immediately before or immediately after	254
administering naloxone to an individual apparently experiencing an	255
opioid-related overdose.	256

(3) The naloxone is personally furnished or prescribed in	257
such a manner that it may be administered by only either of the	258
following routes:	259

(a) Using a device manufactured for the intranasal	260
administration of liquid drugs;	261

(b) Using an autoinjector in a manufactured dosage form.

262

(B) A physician assistant who under division (A) of this	263
section in good faith furnishes a supply of naloxone or issues a	264
prescription for naloxone is not liable for or subject to any of	265
the following for any action or omission of the individual to whom	266
the naloxone is furnished or the prescription is issued: damages	267
in any civil action, prosecution in any criminal proceeding, or	268
professional disciplinary action.	269

Sec. 4731.94. (A) As used in this section, "physician" means	270
an individual authorized under this chapter to practice medicine	271
and surgery, osteopathic medicine and surgery, or podiatric	272
medicine and surgery.	273

(B) Notwithstanding any provision of this chapter or rule	274
adopted by the state medical board, a physician may personally	275
furnish a supply of naloxone, or issue a prescription for	276
naloxone, without having examined the individual to whom it may be	277
administered if all of the following conditions are met:	278

(1) The naloxone supply is furnished to, or the prescription	279
is issued to and in the name of, a family member, friend, or other	280
individual in a position to assist an individual who there is	281
reason to believe is at risk of experiencing an opioid-related	282
overdose.	283

(2) The physician instructs the individual receiving the	284
naloxone supply or prescription to summon emergency services	285
either immediately before or immediately after administering the	286
naloxone to an individual apparently experiencing an	287
opioid-related overdose.	288

(3) The naloxone is personally furnished or prescribed in	289
such a manner that it may be administered by only either of the	290
following routes:	291

(a) Using a device manufactured for the intranasal	292
administration of liquid drugs;	293

(b) Using an autoinjector in a manufactured dosage form.

294

(C) A physician who under division (B) of this section in	295
good faith furnishes a supply of naloxone or issues a prescription	296
for naloxone is not liable for or subject to any of the following	297
for any action or omission of the individual to whom the naloxone	298
is furnished or the prescription is issued: damages in any civil	299
action, prosecution in any criminal proceeding, or professional	300
disciplinary action.	301

Sec. 4762.03. (A) An individual seeking a certificate to	302
practice as an oriental medicine practitioner or certificate to	303
practice as an acupuncturist shall file with the state medical	304
board a written application on a form prescribed and supplied by	305
the board.	306

(B) To be eligible for the certificate to practice, an	307
applicant shall meet all of the following conditions, as	308
applicable:	309

(1) The applicant shall submit evidence satisfactory to the	310
board that the applicant is at least eighteen years of age and of	311
good moral character.	312

(2) In the case of an applicant seeking a certificate to	313
practice as an oriental medicine practitioner, the applicant shall	314
submit evidence satisfactory to the board of both of the	315
following:	316

(a) That the applicant holds a current and active designation	317
from the national certification commission for acupuncture and	318
oriental medicine as either a diplomate in oriental medicine or	319
diplomate of acupuncture and Chinese herbology;	320

(b) That the applicant has successfully completed, in the	321
two-year period immediately preceding application for the	322
certificate to practice, one course approved by the commission on	323
federal food and drug administration dispensary and compounding	324
guidelines and procedures.	325

(3) In the case of an applicant seeking a certificate to	326
practice as an acupuncturist, the applicant shall submit evidence	327
satisfactory to the board that the applicant holds a current and	328
active designation from the national certification commission for	329
acupuncture and oriental medicine as a diplomate in acupuncture.	330

(4) The applicant shall demonstrate to the board proficiency	331
in spoken English by ~~either passing~~satisfying one of the	332
following requirements:	333

(a) Passing the examination described in section 4731.142 of	334
the Revised Code ~~or submitting~~;	335

(b) Submitting evidence satisfactory to the board that the	336
applicant was required to demonstrate proficiency in spoken	337
English as a condition of obtaining designation from the national	338
certification commission for acupuncture and oriental medicine as	339
a diplomate in oriental medicine, diplomate of acupuncture and	340
Chinese herbology, or diplomate in acupuncture;	341

(c) Submitting evidence satisfactory to the board that the	342
applicant, in seeking a designation from the national	343
certification commission for acupuncture and oriental medicine as	344
a diplomate of oriental medicine, diplomate of acupuncture and	345
Chinese herbology, or diplomate of acupuncture, has successfully	346
completed in English the examination required for such a	347
designation by the national certification commission for	348
acupuncture and oriental medicine;	349

(d) In the case of an applicant seeking a certificate to	350
practice as an oriental medicine practitioner, submitting evidence	351
satisfactory to the board that the applicant has previously held a	352
certificate to practice as an acupuncturist issued under section	353
4762.04 of the Revised Code.	354

(5) The applicant shall submit to the board any other	355
information the board requires.	356

(6) The applicant shall pay to the board a fee of one hundred	357
dollars, no part of which may be returned to the applicant.	358

(C) The board shall review all applications received under	359
this section. The board shall determine whether an applicant meets	360
the requirements to receive a certificate to practice not later	361
than sixty days after receiving a complete application. The	362
affirmative vote of not fewer than six members of the board is	363
required to determine that an applicant meets the requirements for	364
a certificate.	365

Section 2. That existing sections 4723.482 and 4762.03 of the	366
Revised Code are hereby repealed.	367

Section 3. This act is hereby declared to be an emergency	368
measure necessary for the immediate preservation of the public	369
peace, health, and safety. The reason for such necessity is to	370
enhance the delivery of health services in this state by promptly	371
increasing access to certain forms of care, including Oriental	372
medicine, acupuncture, services of certain nurses with	373
prescriptive authority, and emergency treatments for drug	374
overdoses. Therefore, this act shall go into immediate effect.	375