130th Ohio General Assembly
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As Reported by the House Health, Retirement and Aging Committee

122nd General Assembly
Regular Session
1997-1998
Sub. H. B. No. 243

REPRESENTATIVES VAN VYVEN-BRADING-CORBIN-HAINES-SCHURING- TAYLOR-TERWILLEGER-TIBERI-OLMAN-WACHTMANN-VESPER


A BILL
To amend sections 3702.51, 3727.01, and 4751.05 and to enact section 3702.40 of the Revised Code to establish standards for using electronic signatures and computer-generated signature codes in records of health care facilities and to extend existing exemptions from hospital and nursing home regulations that apply to Christian Science sanitoriums to other institutions that meet similar criteria.

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


Section 1. That sections 3702.51, 3727.01, and 4751.05 be amended and section 3702.40 of the Revised Code be enacted to read as follows:

Sec. 3702.40. (A) AS USED IN THIS SECTION:

(1) "ELECTRONIC RECORD" MEANS A RECORD COMMUNICATED, RECEIVED, OR STORED BY ELECTRONIC, MAGNETIC, OPTICAL, OR SIMILAR MEANS FOR STORAGE IN AN INFORMATION SYSTEM OR TRANSMISSION FROM ONE INFORMATION SYSTEM TO ANOTHER. "ELECTRONIC RECORD"INCLUDES ELECTRONIC DATA INTERCHANGE, ELECTRONIC MAIL, FACSIMILE, AND TELEX.

(2) "ELECTRONIC SIGNATURE" MEANS ANY LETTERS, CHARACTERS, NUMBERS, OR SYMBOLS ATTACHED TO OR ASSOCIATED WITH AN ELECTRONIC RECORD AND EXECUTED OR ADOPTED BY AN INDIVIDUAL TO AUTHENTICATE AN ELECTRONIC RECORD.

(3) "HEALTH CARE FACILITY" MEANS ANY OF THE FOLLOWING:

(a) A HOSPITAL, AS DEFINED IN SECTION 3727.01 OF THE REVISED CODE;

(b) AN AMBULATORY SURGICAL FACILITY, AS DEFINED IN SECTION 3702.30 OF THE REVISED CODE;

(c) A FREESTANDING BIRTHING CENTER;

(d) A FREESTANDING CARDIAC CATHETERIZATION FACILITY;

(e) A FREESTANDING OR MOBILE DIAGNOSTIC IMAGING CENTER;

(f) A FREESTANDING DIALYSIS CENTER;

(g) A FREESTANDING EMERGENCY FACILITY;

(h) AN URGENT CARE CENTER;

(i) A FREESTANDING EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY CENTER;

(j) A FREESTANDING RADIATION THERAPY CENTER;

(k) A HOME HEALTH AGENCY;

(l) A HOSPICE CARE PROGRAM, AS DEFINED IN SECTION 3712.01 OF THE REVISED CODE;

(m) A NURSING HOME, RESIDENTIAL CARE FACILITY, OR HOME FOR THE AGING, ALL AS DEFINED IN SECTION 3721.01 OF THE REVISED CODE;

(n) AN ADULT CARE FACILITY, AS DEFINED IN SECTION 3722.01 OF THE REVISED CODE;

(o) A NURSING FACILITY OR INTERMEDIATE CARE FACILITY FOR THE MENTALLY RETARDED, BOTH AS DEFINED IN SECTION 5111.20 OF THE REVISED CODE;

(p) A FACILITY OR PORTION OF A FACILITY CERTIFIED AS A SKILLED NURSING FACILITY UNDER TITLE XVIII OF THE "SOCIAL SECURITY ACT," 49 STAT. 620 (1935), 42 U.S.C.A. 301, AS AMENDED;

(q) A STATE INSTITUTION FOR THE CARE AND TREATMENT OF MENTALLY ILL PERSONS, OPERATED BY THE DEPARTMENT OF MENTAL HEALTH PURSUANT TO SECTION 5119.02 OF THE REVISED CODE;

(r) A COMMUNITY MENTAL HEALTH FACILITY, AS DEFINED IN SECTION 5119.01 OF THE REVISED CODE;

(s) A RESIDENTIAL FACILITY, AS DEFINED IN SECTION 5119.22 OF THE REVISED CODE;

(t) A COMMUNITY-BASED CLINIC, AS DEFINED IN SECTION 5111.17 OF THE REVISED CODE;

(u) AN OUTPATIENT HEALTH FACILITY, AS DEFINED IN SECTION 5111.04 OF THE REVISED CODE;

(v) AN ALCOHOL AND DRUGADDICTION PROGRAM, AS DEFINED IN SECTION 3793.01 OF THE REVISED CODE;

(w) THE PRIVATE OFFICE OF ANY HEALTH CARE PROFESSIONAL, INCLUDING:

(i) PHYSICIANS AUTHORIZED UNDER CHAPTER 4731. OF THE REVISED CODE TO PRACTICE MEDICINE AND SURGERY OR OSTEOPATHIC MEDICINE AND SURGERY;

(ii) REGISTERED NURSES AND LICENSED PRACTICAL NURSES LICENSED UNDER CHAPTER 4723. OF THE REVISED CODE;

(iii) PHYSICIAN ASSISTANTS AUTHORIZED TO PRACTICE UNDER CHAPTER 4730. OF THE REVISED CODE;

(iv) DENTISTS AND DENTAL HYGIENIST LICENSED UNDER CHAPTER 4715. OF THE REVISED CODE;

(v) PHYSICAL THERAPISTS LICENSED UNDER CHAPTER 4755. OF THE REVISED CODE;

(vi) CHIROPRACTORS LICENSED UNDER CHAPTER 4734. OF THE REVISED CODE;

(vii) OPTOMETRISTS LICENSED UNDER CHAPTER 4725. OF THE REVISED CODE;

(viii) PODIATRISTS AUTHORIZED UNDER CHAPTER 4731. OF THE REVISED CODE TO PRACTICE PODIATRY;

(ix) DIETITIANS LICENSED UNDER CHAPTER 4759. OF THE REVISED CODE;

(x) PHARMACISTS REGISTERED UNDER CHAPTER 4729. OF THE REVISED CODE.

(x) THE PRIVATE OFFICE OF A PSYCHOLOGIST LICENSED UNDER CHAPTER 4372. OF THE REVISED CODE OR A COUNSELOR OR SOCIAL WORKER LICENSED UNDER CHAPTER 4757. OF THE REVISED CODE;

(y) ANY OTHER HEALTH CARE FACILITY RECOGNIZED BY THE PUBLIC HEALTH COUNCIL BY RULE ADOPTED UNDER CHAPTER 119. OF THE REVISED CODE.

(4) "HEALTH CARE RECORD" MEANS ANY DOCUMENT OR COMBINATION OF DOCUMENTS PERTAINING TO A PATIENT'S MEDICAL HISTORY, DIAGNOSIS, PROGNOSIS, OR MEDICAL CONDITION THAT IS GENERATED AND MAINTAINED IN THE PROCESS OF THE PATIENT'S TREATMENT AT A HEALTH CARE FACILITY.

(B) ALL WRITTEN NOTES, ORDERS, AND OBSERVATIONS ENTERED INTO A HEALTH CARE RECORD AT A HEALTH CARE FACILITY, INCLUDING ANY INTERPRETIVE REPORTS OF DIAGNOSTIC TESTS OR SPECIFIC TREATMENTS, SUCH AS RADIOLOGIC OR ELECTROCARDIOGRAPHIC REPORTS, OPERATIVE REPORTS, REPORTS OF PATHOLOGIC EXAMINATION OF TISSUE, AND SIMILAR REPORTS, SHALL BE AUTHENTICATED BY THE INDIVIDUAL WHO MADE OR AUTHORIZED THE ENTRY. HEALTH CARE RECORD ENTRIES MAY BE AUTHENTICATED BY HANDWRITTEN SIGNATURES OR HANDWRITTEN INITIALS. THEY ALSO MAY BE AUTHENTICATED BY ELECTRONIC SIGNATURES OR COMPUTER-GENERATED SIGNATURE CODES IF ALL OF THE FOLLOWING APPLY:

(1) THE HEALTH CARE FACILITY ADOPTS A POLICY THAT PERMITS THE USE OF ELECTRONIC SIGNATURES OR COMPUTER-GENERATED SIGNATURE CODES;

(2) THE FACILITY'S ELECTRONIC SIGNATURE OR COMPUTER-GENERATED SIGNATURE CODE SYSTEM UTILIZES A TWO-LEVEL OR BIOMETRIC ACCESS MECHANISM THAT ASSIGNS A UNIQUE IDENTIFIER TO EACH USER;

(3) THE FACILITY TAKES STEPS TO SAFEGUARD AGAINST USE OF A UNIQUE IDENTIFIER BY ANY INDIVIDUAL OTHER THAN THE ONE TO WHOM IT IS ASSIGNED;

(4) THE SYSTEM INCLUDES A PROCESS TO VERIFY THAT THE INDIVIDUAL AFFIXING THE ELECTRONIC SIGNATURE OR COMPUTER-GENERATED SIGNATURE CODE HAS REVIEWED THE CONTENTS OF THE ENTRY AND DETERMINED THAT THEY ARE WHAT THAT INDIVIDUAL INTENDED;

(5) THE POLICY ADOPTED BY THE FACILITY PURSUANT TO DIVISION (B)(1) OF THIS SECTION PRESCRIBES ALL OF THE FOLLOWING:

(a) A PROCEDURE BY WHICH EACH USER OF THE SYSTEM MUST CERTIFY IN WRITING THAT THE USER WILL KEEP THE USER'S UNIQUE IDENTIFIER STRICTLY CONFIDENTIAL;

(b) PENALTIES FOR MISUSING THE SYSTEM OR A UNIQUE IDENTIFIER ALLOWING ACCESS TO IT;

(c) TRAINING THAT THE FACILITY MUST PROVIDE TO ALL USERS OF THE SYSTEM AND THAT INCLUDES AN EXPLANATION OF THE APPROPRIATE USE OF THE SYSTEM AND THE CONSEQUENCES FOR NONCOMPLIANCE WITH THE FACILITY'S CONFIDENTIALITY AND SECURITY POLICIES.

THE USE OF AN ELECTRONIC SIGNATURE OR COMPUTER-GENERATED SIGNATURE CODE IN ACCORDANCE WITH THIS SECTION SHALL BE CONSIDERED FOR ALL LEGAL PURPOSES TO BE THE SAME AS A HANDWRITTEN SIGNATURE OR HANDWRITTEN INITIALS.

(C) THE PUBLIC HEALTH COUNCIL SHALL ESTABLISH AND ADOPT PROTOCOLS FOR THEUSE OF ELECTRONIC SIGNATURE AND COMPUTER-GENERATED SIGNATURE CODE SYSTEMS. THE COUNCIL SHALL CERTIFY A HEALTH CARE FACILITY'S ELECTRONIC SIGNATURE OR COMPUTER-GENERATED SIGNATURE CODE SYSTEM IF IT COMPLIES WITH THE PROTOCOL ADOPTED BY THE COUNCIL OR BY THE JOINT COMMISSION ON HEALTH CARE ORGANIZATIONS.

(D) AN ELECTRONIC SIGNATURE GENERATED BY AN ELECTRONIC SIGNATURE OR COMPUTER-GENERATED SIGNATURE CODE SYSTEM CERTIFIED BY THE COUNCIL SHALL BE PRESUMED TO BE THE SIGNATURE OF THE INDIVIDUAL TO WHOM IT IS ASSIGNED AND TO BE AFFIXED TO AUTHENTICATE THE DOCUMENT.

Sec. 3702.51. As used in sections 3702.51 to 3702.62 of the Revised Code:

(A) "Applicant" means any person that submits an application for a certificate of need and who is designated in the application as the applicant.

(B) "Person" means any individual, corporation, business trust, estate, firm, partnership, association, joint stock company, insurance company, government unit, or other entity.

(C) "Certificate of need" means a written approval granted by the director of health to an applicant to authorize conducting a reviewable activity.

(D) "Health service area" means a geographic region designated by the director of health under section 3702.58 of the Revised Code.

(E) "Health service" means a clinically related service, such as a diagnostic, treatment, rehabilitative, or preventive service.

(F) "Health service agency" means an agency designated to serve a health service area in accordance with section 3702.58 of the Revised Code.

(G) "Health care facility" means:

(1) A hospital registered under section 3701.07 of the Revised Code;

(2) A nursing home licensed under section 3721.02 of the Revised Code, or by a political subdivision certified under section 3721.09 of the Revised Code;

(3) A county home or a county nursing home as defined in section 5155.31 of the Revised Code that is certified under Title XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended;

(4) A freestanding dialysis center;

(5) A freestanding inpatient rehabilitation facility;

(6) An ambulatory surgical facility;

(7) A freestanding cardiac catheterization facility;

(8) A freestanding birthing center;

(9) A freestanding or mobile diagnostic imaging center;

(10) A freestanding radiation therapy center.

A health care facility does not include the offices of private physicians and dentists whether for individual or group practice, Christian Science sanitoriums operated or listed and certified by the First Church of Christ, Scientist, Boston, Massachusetts, residential facilities licensed under section 5123.19 of the Revised Code, or habilitation centers certified by the director of mental retardation and developmental disabilities under section 5123.041 of the Revised Code, OR AN INSTITUTION FOR THE SICK THAT IS OPERATED EXCLUSIVELY FOR PATIENTS WHO USE SPIRITUAL MEANS FOR HEALING AND FOR WHOM THE ACCEPTANCE OF MEDICAL CARE IS INCONSISTENT WITH THEIR RELIGIOUS BELIEFS, ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION, EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501 OF THE INTERNAL REVENUE CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1, AS AMENDED, AND PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO THE EXEMPTION IN DIVISION (G) OF SECTION 4723.32 of the Revised Code FROM THE LICENSING REQUIREMENTS OF CHAPTER 4723. of the Revised Code.

(H) "Medical equipment" means a single unit of medical equipment or a single system of components with related functions that is used to provide health services.

(I) "Third-party payer" means a medical care corporation or health care corporation licensed under Chapter 1737. or 1738. of the Revised Code, a health maintenance organization, an insurance company that issues sickness and accident insurance in conformity with Chapter 3923. of the Revised Code, a state-financed health insurance program under Chapter 3701., 4123., or 5111. of the Revised Code, or any self-insurance plan.

(J) "Government unit" means the state and any county, municipal corporation, township, or other political subdivision of the state, or any department, division, board, or other agency of the state or a political subdivision.

(K) "Health maintenance organization" means a public or private organization organized under the law of any state that is qualified under section 1310(d) of Title XIII of the "Public Health Service Act," 87 Stat. 931 (1973), 42 U.S.C. 300e--9 or that does all of the following:

(1) Provides or otherwise makes available to enrolled participants health care services including at least the following basic health care services: usual physician services, hospitalization, laboratory, x-ray, emergency and preventive services, and out-of-area coverage;

(2) Is compensated, except for copayments, for the provision of basic health care services listed in division (K)(1) of this section to enrolled participants by a payment that is paid on a periodic basis without regard to the date the health care services are provided and that is fixed without regard to the frequency, extent, or kind of health service actually provided;

(3) Provides physician services primarily either:

(a) Directly through physicians who are either employees or partners of the organization;

(b) Through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis.

(L) "Existing health care facility" means a health care facility that is licensed or otherwise approved to practice in this state, in accordance with applicable law, is staffed and equipped to provide health care services, and actively provides health services or has not been actively providing health services for less than twelve consecutive months.

(M) "State" means the state of Ohio, including, but not limited to, the general assembly, the supreme court, the offices of all elected state officers, and all departments, boards, offices, commissions, agencies, institutions, and other instrumentalities of the state of Ohio. "State" does not include political subdivisions.

(N) "Political subdivision" means a municipal corporation, township, county, school district, and all other bodies corporate and politic responsible for governmental activities only in geographic areas smaller than that of the state to which the sovereign immunity of the state attaches.

(O) "Affected person" means:

(1) An applicant for a certificate of need, including an applicant whose application was reviewed comparatively with the application in question;

(2) The person that requested the reviewability ruling in question;

(3) Any person that resides or regularly uses health care facilities within the geographic area served or to be served by the health care services that would be provided under the certificate of need or reviewability ruling in question;

(4) Any health care facility that is located in the health service area where the health care services would be provided under the certificate of need or reviewability ruling in question;

(5) Third-party payers that reimburse health care facilities for services in the health service area where the health care services would be provided under the certificate of need or reviewability ruling in question;

(6) Any other person who testified at a public hearing held under division (B) of section 3702.52 of the Revised Code or submitted written comments in the course of review of the certificate of need application in question.

(P) "Osteopathic hospital" means a hospital registered under section 3701.07 of the Revised Code that advocates osteopathic principles and the practice and perpetuation of osteopathic medicine by doing any of the following:

(1) Maintaining a department or service of osteopathic medicine or a committee on the utilization of osteopathic principles and methods, under the supervision of an osteopathic physician;

(2) Maintaining an active medical staff, the majority of which is comprised of osteopathic physicians;

(3) Maintaining a medical staff executive committee that has osteopathic physicians as a majority of its members.

(Q) "Ambulatory surgical facility" has the same meaning as in section 3702.30 of the Revised Code.

(R) Except as otherwise provided in division (T) of this section, and until the termination date specified in section 3702.511 of the Revised Code, "reviewable activity" means any of the following:

(1) The addition by any person of any of the following health services, regardless of the amount of operating costs or capital expenditures:

(a) A heart, heart-lung, lung, liver, kidney, bowel, pancreas, or bone marrow transplantation service, a stem cell harvesting and reinfusion service, or a service for transplantation of any other organ unless transplantation of the organ is designated by public health council rule not to be a reviewable activity;

(b) A cardiac catheterization service;

(c) An open-heart surgery service;

(d) Any new, experimental medical technology that is designated by rule of the public health council.

(2) The acceptance of high-risk patients, as defined in rules adopted under section 3702.57 of the Revised Code, by any cardiac catheterization service that was initiated without a certificate of need pursuant to division (R)(3)(b) of the version of this section in effect immediately prior to April 20, 1995;

(3)(a) The establishment, development, or construction of a new health care facility other than a new long-term care facility or a new hospital;

(b) The establishment, development, or construction of a new hospital or the relocation of an existing hospital;

(c) The relocation of hospital beds, other than long-term care, perinatal, or pediatric intensive care beds, into or out of a rural area.

(4)(a) The replacement of an existing hospital;

(b) The replacement of an existing hospital obstetric or newborn care unit or freestanding birthing center.

(5)(a) The renovation of a hospital that involves a capital expenditure, obligated on or after the effective date of this amendment, of five million dollars or more, not including expenditures for equipment, staffing, or operational costs. For purposes of division (R)(5)(a) of this section, a capital expenditure is obligated:

(i) When a contract enforceable under Ohio law is entered into for the construction, acquisition, lease, or financing of a capital asset;

(ii) When the governing body of a hospital takes formal action to commit its own funds for a construction project undertaken by the hospital as its own contractor;

(iii) In the case of donated property, on the date the gift is completed under applicable Ohio law.

(b) The renovation of a hospital obstetric or newborn care unit or freestanding birthing center that involves a capital expenditure of five million dollars or more, not including expenditures for equipment, staffing, or operational costs.

(6) Any change in the health care services, bed capacity, or site, or any other failure to conduct the reviewable activity in substantial accordance with the approved application for which a certificate of need was granted, if the change is made prior to the date the activity for which the certificate was issued ceases to be a reviewable activity;

(7) Any of the following changes in perinatal bed capacity or pediatric intensive care bed capacity:

(a) An increase in bed capacity;

(b) A change in service or service-level designation of newborn care beds or obstetric beds in a hospital or freestanding birthing center, other than a change of service that is provided within the service-level designation of newborn care or obstetric beds as registered by the department of health;

(c) A relocation of perinatal or pediatric intensive care beds from one physical facility or site to another, excluding the relocation of beds within a hospital or freestanding birthing center or the relocation of beds among buildings of a hospital or freestanding birthing center at the same site.

(8) The expenditure of more than one hundred ten per cent of the maximum expenditure specified in a certificate of need;

(9) Any transfer of a certificate of need issued prior to April 20, 1995, from the person to whom it was issued to another person before the project that constitutes a reviewable activity is completed, any agreement that contemplates the transfer of a certificate of need issued prior to that date upon completion of the project, and any transfer of the controlling interest in an entity that holds a certificate of need issued prior to that date. However, the transfer of a certificate of need issued prior to that date or agreement to transfer such a certificate of need from the person to whom the certificate of need was issued to an affiliated or related person does not constitute a reviewable transfer of a certificate of need for the purposes of this division, unless the transfer results in a change in the person that holds the ultimate controlling interest in the certificate of need.

(10)(a) The acquisition by any person of any of the following medical equipment, regardless of the amount of operating costs or capital expenditure:

(i) A cobalt radiation therapy unit;

(ii) A linear accelerator;

(iii) A gamma knife unit.

(b) The acquisition by any person of medical equipment with a cost of two million dollars or more. The cost of acquiring medical equipment includes the sum of the following:

(i) The greater of its fair market value or the cost of its lease or purchase;

(ii) The cost of installation and any other activities essential to the acquisition of the equipment and its placement into service.

(11) The addition of another cardiac catheterization laboratory to an existing cardiac catheterization service.

(S) Except as provided in division (T) of this section, "reviewable activity" also means any of the following activities, none of which are subject to a termination date:

(1) The establishment, development, or construction of a new long-term care facility;

(2) The replacement of an existing long-term care facility;

(3) The renovation of a long-term care facility that involves a capital expenditure of two million dollars or more, not including expenditures for equipment, staffing, or operational costs;

(4) Any of the following changes in long-term care bed capacity:

(a) An increase in bed capacity;

(b) A relocation of beds from one physical facility or site to another, excluding the relocation of beds within a long-term care facility or among buildings of a long-term care facility at the same site;

(c) A recategorization of hospital beds registered under section 3701.07 of the Revised Code from another registration category to skilled nursing beds or long-term care beds.

(5) Any change in the health services, bed capacity, or site, or any other failure to conduct the reviewable activity in substantial accordance with the approved application for which a certificate of need concerning long-term care beds was granted, if the change is made within five years after the implementation of the reviewable activity for which the certificate was granted;

(6) The expenditure of more than one hundred ten per cent of the maximum expenditure specified in a certificate of need concerning long-term care beds;

(7) Any transfer of a certificate of need that concerns long-term care beds and was issued prior to April 20, 1995, from the person to whom it was issued to another person before the project that constitutes a reviewable activity is completed, any agreement that contemplates the transfer of such a certificate of need upon completion of the project, and any transfer of the controlling interest in an entity that holds such a certificate of need. However, the transfer of a certificate of need that concerns long-term care beds and was issued prior to April 20, 1995, or agreement to transfer such a certificate of need from the person to whom the certificate was issued to an affiliated or related person does not constitute a reviewable transfer of a certificate of need for purposes of this division, unless the transfer results in a change in the person that holds the ultimate controlling interest in the certificate of need.

(T) "Reviewable activity" does not include any of the following activities:

(1) Acquisition of computer hardware or software;

(2) Acquisition of a telephone system;

(3) Construction or acquisition of parking facilities;

(4) Correction of cited deficiencies that are in violation of federal, state, or local fire, building, or safety laws and rules and that constitute an imminent threat to public health or safety;

(5) Acquisition of an existing health care facility that does not involve a change in the number of the beds, by service, or in the number or type of health services;

(6) Correction of cited deficiencies identified by accreditation surveys of the joint commission on accreditation of healthcare organizations or of the American osteopathic association;

(7) Acquisition of medical equipment to replace the same or similar equipment for which a certificate of need has been issued if the replaced equipment is removed from service;

(8) Mergers, consolidations, or other corporate reorganizations of health care facilities that do not involve a change in the number of beds, by service, or in the number or type of health services;

(9) Construction, repair, or renovation of bathroom facilities;

(10) Construction of laundry facilities, waste disposal facilities, dietary department projects, heating and air conditioning projects, administrative offices, and portions of medical office buildings used exclusively for physician services;

(11) Acquisition of medical equipment to conduct research required by the United States food and drug administration or clinical trials sponsored by the national institute of health. Use of medical equipment that was acquired without a certificate of need under division (T)(11) of this section and for which premarket approval has been granted by the United States food and drug administration to provide services for which patients or reimbursement entities will be charged shall be a reviewable activity.

(12) Removal of asbestos from a health care facility.

Only that portion of a project that meets the requirements of division (T) of this section is not a reviewable activity.

(U) "Small rural hospital" means a hospital that is located within a rural area, has fewer than one hundred beds, and to which fewer than four thousand persons were admitted during the most recent calendar year.

(V) "Children's hospital" means any of the following:

(1) A hospital registered under section 3701.07 of the Revised Code that provides general pediatric medical and surgical care, and in which at least seventy-five per cent of annual inpatient discharges for the preceding two calendar years were individuals less than eighteen years of age;

(2) A distinct portion of a hospital registered under section 3701.07 of the Revised Code that provides general pediatric medical and surgical care, has a total of at least one hundred fifty registered pediatric special care and pediatric acute care beds, and in which at least seventy-five per cent of annual inpatient discharges for the preceding two calendar years were individuals less than eighteen years of age;

(3) A distinct portion of a hospital, if the hospital is registered under section 3701.07 of the Revised Code as a children's hospital and the children's hospital meets all the requirements of division (V)(1) of this section.

(W) "Long-term care facility" means any of the following:

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

(2) The portion of any facility, including a county home or county nursing home, that is certified as a skilled nursing facility or a nursing facility under Title XVIII or XIX of the "Social Security Act";

(3) The portion of any hospital that contains beds registered under section 3701.07 of the Revised Code as skilled nursing beds or long-term care beds.

(X) "Long-term care bed" means a bed in a long-term care facility.

(Y) "Perinatal bed" means a bed in a hospital that is registered under section 3701.07 of the Revised Code as a newborn care bed or obstetric bed, or a bed in a freestanding birthing center.

(Z) "Freestanding birthing center" means any facility in which deliveries routinely occur, regardless of whether the facility is located on the campus of another health care facility, and which is not licensed under Chapter 3711. of the Revised Code as a level one, two, or three maternity unit or a limited maternity unit.

(AA)(1) "Reviewability ruling" means a ruling issued by the director of health under division (A) of section 3702.52 of the Revised Code as to whether a particular proposed project is or is not a reviewable activity.

(2) "Nonreviewability ruling" means a ruling issued under that division that a particular proposed project is not a reviewable activity.

(BB)(1) "Metropolitan statistical area" means an area of this state designated a metropolitan statistical area or primary metropolitan statistical area in United States office of management and budget bulletin No. 93-17, June 30, 1993, and its attachments.

(2) "Rural area" means any area of this state not located within a metropolitan statistical area.

Sec. 3727.01. As used in this section, "health maintenance organization" means a public or private organization organized under the law of any state that is qualified under section 1310(d) of Title XIII of the "Public Health Service Act," 87 Stat. 931 (1973), 42 U.S.C. 300e-9, or that does all of the following:

(A) Provides or otherwise makes available to enrolled participants health care services including at least the following basic health care services: usual physician services, hospitalization, laboratory, x-ray, emergency and preventive service, and out-of-area coverage;

(B) Is compensated, except for copayments, for the provision of basic health care services to enrolled participants by a payment that is paid on a periodic basis without regard to the date the health care services are provided and that is fixed without regard to the frequency, extent, or kind of health service actually provided;

(C) Provides physician services primarily in either of the following ways:

(1) Directly through physicians who are either employees or partners of the organization;

(2) Through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis.

As used in this chapter, "hospital" means an institution classified as a hospital under section 3701.07 of the Revised Code in which are provided to inpatients diagnostic, medical, surgical, obstetrical, psychiatric, or rehabilitation care for a continuous period longer than twenty-four hours; a tuberculosis hospital; or a hospital operated by a health maintenance organization. "Hospital" does not include a facility licensed under Chapter 3721. of the Revised Code, a health care facility operated by the department of mental health or the department of mental retardation and developmental disabilities, a health maintenance organization that does not operate a hospital, the office of any private licensed health care professional, whether organized for individual or group practice, a Christian Science sanatorium operated or listed and certified by the First Church of Christ, Scientist, Boston, Massachusetts, or a clinic that provides ambulatory patient services and where patients are not regularly admitted as inpatients. NOR DOES "HOSPITAL" INCLUDE AN INSTITUTION FOR THE SICK THAT IS OPERATED EXCLUSIVELY FOR PATIENTS WHO USE SPIRITUAL MEANS FOR HEALING AND FOR WHOM THE ACCEPTANCE OF MEDICAL CARE IS INCONSISTENT WITH THEIR RELIGIOUS BELIEFS, ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION, EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501 OF THE INTERNAL REVENUE CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1, AS AMENDED, AND PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO THE EXEMPTION IN DIVISION (G) OF SECTION 4723.32 of the Revised Code FROM THE LICENSING REQUIREMENTS OF CHAPTER 4723. of the Revised Code.

Sec. 4751.05. (A) The board of examiners of nursing home administrators shall admit to examination for licensure as a nursing home administrator any candidate who:

(1) Pays the application fee of fifty dollars;

(2) Submits evidence of good moral character and suitability;

(3) Is at least eighteen years of age;

(4) Has completed educational requirements and work experience satisfactory to the board;

(5) Submits an application on forms prescribed by the board;

(6) Pays the examination fee of one hundred fifty dollars.

(B) Nothing in Chapter 4751. of the Revised Code or the rules adopted thereunder shall be construed to require an applicant for licensure or a temporary license, who is certified EMPLOYED by a recognized church or religious denomination which teaches reliance on spiritual means alone for healing and has been approved to administer institutions certified by such church or denomination AN INSTITUTION for the care and treatment of the sick in accordance with its teachings, to demonstrate proficiency in any medical techniques or to meet any medical educational qualifications or medical standards not in accord with the remedial care and treatment provided in such institutions BY THE INSTITUTION IF THE INSTITUTION IS ALL OF THE FOLLOWING:

(1) OPERATED EXCLUSIVELY FOR PATIENTS WHO USE SPIRITUAL MEANS FOR HEALING AND FOR WHOM THE ACCEPTANCE OF MEDICAL CARE IS INCONSISTENT WITH THEIR RELIGIOUS BELIEFS;

(2) ACCREDITED BY A NATIONAL ACCREDITING ORGANIZATION;

(3) EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501 OF THE INTERNAL REVENUE CODE OF 1986, 100 STAT. 2085, 26 U.S.C.A. 1, AS AMENDED;

(4) PROVIDING TWENTY-FOUR HOUR NURSING CARE PURSUANT TO THE EXEMPTION IN DIVISION (G) OF SECTION 4723.32 of the Revised Code FROM THE LICENSING REQUIREMENTS OF CHAPTER 4723. of the Revised Code.

(B)(C) If a person fails three times to attain a passing grade on the examination, said person, before he THE PERSON may again be admitted to examination, shall meet such additional education or experience requirements, or both, as may be prescribed by the board.


Section 2. That existing sections 3702.51, 3727.01, and 4751.05 of the Revised Code are hereby repealed.
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