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As Rereported by the Senate Health Committee
122nd General Assembly
Regular Session
1997-1998 | Am. Sub. H. B. No. 243 |
REPRESENTATIVES VAN VYVEN-BRADING-CORBIN-HAINES-SCHURING-
TAYLOR-TERWILLEGER-TIBERI-OLMAN-WACHTMANN-VESPER-SAWYER-
GARCIA-LEWIS-AMSTUTZ-O'BRIEN-HOUSEHOLDER-REID-HARRIS-
SENATORS DRAKE-DIX-RAY-BLESSING
A BILL
To amend sections 3702.30, 3702.51, 3727.01, 4723.41, and 4751.05 and
to enact sections 5.2213 and
3701.75
of the Revised Code to establish
standards for using electronic signatures
in health care records,
to extend exemptions from
hospital and nursing home regulations that apply to
Christian Science
sanatoriums to other institutions that meet similar
criteria, to eliminate an extension on the effective date of the
licensing requirement that applies to certain health care
facilities located in rural areas,
to modify the requirements to
practice as a clinical nurse specialist, and to designate "Ohio Breast Cancer
Awareness Month" and "Ohio Mammography Day."
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3702.30, 3702.51, 3727.01, 4723.41, and
4751.05 be amended and
sections 5.2213 and
3701.75 of the Revised Code be
enacted to read as follows:
Sec. 5.2213. THE MONTH OF OCTOBER IS DESIGNATED AS "OHIO
BREAST CANCER AWARENESS MONTH," AND THE
THIRD THURSDAY OF EACH OCTOBER IS DESIGNATED AS
"OHIO MAMMOGRAPHY DAY," TO PROMOTE THE IMPORTANCE
OF IDENTIFYING BREAST CANCER IN ITS EARLIEST STAGES.
Sec. 3701.75. (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 A RECORD THAT IS COMMUNICATED, RECEIVED, OR STORED BY ELECTRONIC DATA
INTERCHANGE, ELECTRONIC MAIL, FACSIMILE,
TELEX, OR SIMILAR METHODS OF COMMUNICATION.
(2) "ELECTRONIC SIGNATURE" MEANS ANY OF THE FOLLOWING
ATTACHED TO OR ASSOCIATED WITH AN ELECTRONIC RECORD
BY AN INDIVIDUAL TO AUTHENTICATE THE RECORD:
(a) A CODE CONSISTING OF A COMBINATION OF
LETTERS, NUMBERS, CHARACTERS, OR SYMBOLS THAT IS ADOPTED OR
EXECUTED BY AN INDIVIDUAL AS THAT INDIVIDUAL'S ELECTRONIC
SIGNATURE;
(b) A COMPUTER-GENERATED SIGNATURE CODE CREATED
FOR AN INDIVIDUAL;
(c) AN ELECTRONIC IMAGE OF AN INDIVIDUAL'S
HANDWRITTEN SIGNATURE CREATED BY USING A PEN COMPUTER.
(3) "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.
(B) ANY ENTRY INTO A HEALTH CARE
RECORD
MAY BE AUTHENTICATED BY EXECUTING HANDWRITTEN SIGNATURES OR
HANDWRITTEN INITIALS DIRECTLY ON THE ENTRY
OR BY EXECUTING AN ELECTRONIC SIGNATURE.
AN ELECTRONIC SIGNATURE EXECUTED IN ACCORDANCE WITH AN
ELECTRONIC SIGNATURE
SYSTEM THAT IS CERTIFIED BY THE
DEPARTMENT OF HEALTH UNDER DIVISION (C) OF THIS SECTION SHALL BE
CONSIDERED FOR ALL LEGAL PURPOSES TO BE THE SAME AS HAVING
EXECUTED A HANDWRITTEN SIGNATURE OR HANDWRITTEN INITIALS, EXCEPT WHEN ANY
FEDERAL LAW GOVERNING STATE PARTICIPATION IN A FEDERAL PROGRAM REQUIRES THAT
ENTRIES INTO HEALTH CARE RECORDS BE AUTHENTICATED ONLY BY HANDWRITTEN
SIGNATURES OR HANDWRITTEN INITIALS. THE ELECTRONIC
SIGNATURE GENERATED BY A
CERTIFIED SYSTEM
SHALL BE
PRESUMED TO BE THE SIGNATURE OF THE INDIVIDUAL TO WHOM IT IS ASSIGNED AND TO
BE
AFFIXED FOR THE PURPOSE OF AUTHENTICATING AN ENTRY INTO A HEALTH CARE RECORD.
(C)(1) THE DEPARTMENT OF HEALTH SHALL ADMINISTER A PROGRAM UNDER
WHICH ENTITIES THAT CREATE AND MAINTAIN HEALTH CARE RECORDS MAY RECEIVE
CERTIFICATION FROM THE DEPARTMENT OF THEIR ELECTRONIC SIGNATURE SYSTEMS. THE
DEPARTMENT SHALL DETERMINE THE TYPES OF ENTITIES THAT ARE ELIGIBLE TO HAVE
THEIR ELECTRONIC SIGNATURE SYSTEMS CERTIFIED UNDER THIS SECTION.
THE DEPARTMENT SHALL CERTIFY AN ELIGIBLE ENTITY'S ELECTRONIC SIGNATURE
SYSTEM IF ALL OF THE FOLLOWING APPLY:
(a) THE
ENTITY ADOPTS A
POLICY THAT PERMITS THE USE OF ELECTRONIC SIGNATURES
ON ELECTRONIC RECORDS.
(b) THE ENTITY'S ELECTRONIC SIGNATURE
SYSTEM UTILIZES EITHER A TWO-LEVEL
ACCESS CONTROL MECHANISM THAT ASSIGNS A UNIQUE IDENTIFIER TO EACH USER OR A
BIOMETRIC ACCESS CONTROL DEVICE.
(c) THE ENTITY TAKES STEPS TO
SAFEGUARD AGAINST
UNAUTHORIZED ACCESS TO THE SYSTEM AND FORGERY OF
ELECTRONIC SIGNATURES.
(d) THE SYSTEM INCLUDES A PROCESS TO
VERIFY THAT THE INDIVIDUAL AFFIXING THE ELECTRONIC SIGNATURE
HAS REVIEWED THE CONTENTS OF THE ENTRY AND
DETERMINED THAT THE ENTRY CONTAINS WHAT THAT INDIVIDUAL INTENDED.
(e) THE POLICY ADOPTED BY THE ENTITY
PURSUANT TO DIVISION (C)(1)(a) OF THIS SECTION
PRESCRIBES ALL OF THE FOLLOWING:
(i) A PROCEDURE BY WHICH EACH USER OF THE SYSTEM MUST CERTIFY IN
WRITING
THAT THE USER WILL
FOLLOW THE CONFIDENTIALITY AND SECURITY POLICIES
MAINTAINED BY THE ENTITY FOR THE SYSTEM;
(ii) PENALTIES FOR MISUSING THE SYSTEM;
(iii) TRAINING FOR ALL USERS OF THE
SYSTEM
THAT INCLUDES AN EXPLANATION OF THE APPROPRIATE USE OF THE SYSTEM AND THE
CONSEQUENCES FOR
NOT COMPLYING WITH THE ENTITY'S CONFIDENTIALITY AND SECURITY POLICIES.
(2) IN LIEU OF
MAKING A DIRECT DETERMINATION OF COMPLIANCE UNDER DIVISION (C)(1) OF
THIS SECTION, THE DEPARTMENT MAY
ACCEPT THE APPROVAL OF ANY PRIVATE OR PUBLIC ORGANIZATION THAT HAS REVIEWED
THE ENTITY'S SYSTEM, IF THE DEPARTMENT DETERMINES THAT THE
ORGANIZATION HAS STANDARDS AT LEAST AS STRINGENT AS THOSE
SPECIFIED IN DIVISION (C)(1) OF THIS SECTION. ORGANIZATIONS
WITH STANDARDS FOR APPROVAL OF ELECTRONIC SIGNATURE SYSTEMS THAT THE
DEPARTMENT
MAY ACCEPT INCLUDE
THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE
ORGANIZATIONS, THE AMERICAN OSTEOPATHIC ASSOCIATION, THE
UNITED
STATES FOOD AND DRUG
ADMINISTRATION, AND THE UNITED
STATES HEALTH CARE FINANCING
ADMINISTRATION. IF AN ENTITY RECEIVES APPROVAL OF ITS ELECTRONIC SIGNATURE
SYSTEM IN THIS MANNER, AND IS
SUBSEQUENTLY CITED BY THE PRIVATE OR PUBLIC ORGANIZATION FOR A VIOLATION THAT
INVOLVES THE ENTITY'S SYSTEM, THE ENTITY SHALL
IMMEDIATELY
NOTIFY THE DEPARTMENT OF THE CITATION AND THE DEPARTMENT SHALL WITHDRAW ITS
CERTIFICATION.
(3) THE PUBLIC HEALTH COUNCIL SHALL ADOPT RULES IN ACCORDANCE WITH
CHAPTER 119. of the Revised Code AS NECESSARY FOR THE DEPARTMENT'S ADMINISTRATION OF
THE PROGRAM FOR CERTIFYING THE ELECTRONIC SIGNATURE SYSTEMS OF ENTITIES THAT
CREATE AND MAINTAIN HEALTH CARE RECORDS.
Sec. 3702.30. (A) As used in this section:
(1) "Ambulatory surgical facility" means a facility,
whether or not part of the same organization as a hospital, that
is located in a building distinct from
another in which inpatient care is provided, and to which any of the
following apply:
(a) Outpatient surgery is routinely performed in the facility and
the facility functions separately from a
hospital's inpatient surgical service and from the offices of private
physicians, podiatrists, and dentists;
(b) Anesthesia is administered in the facility by
an
anesthesiologist or certified registered nurse anesthetist
and the facility functions separately from a hospital's inpatient surgical
service and from the offices of private physicians, podiatrists, and
dentists;
(c) The facility applies to be certified by the
United States health care financing
administration as an ambulatory surgical center for purposes of
reimbursement under Part B of the medicare
program, Part B of Title XVIII
of the "Social Security Act," 49 Stat. 620 (1935),
42 U.S.C.A. 301, as amended;
(d) The facility applies to be certified by a
national accrediting body approved by the health care financing
administration for purposes of deemed compliance with the
conditions for participating in the medicare program as an
ambulatory surgical center;
(e) The facility bills or receives from any
third-party payer, governmental health care program, or other person or
government entity any ambulatory surgical
facility fee that is billed or paid in addition to any fee for
professional services;
(f) The facility is held out to any person or government
entity as an ambulatory surgical facility or similar facility by means of
signage, advertising, or other promotional efforts.
"Ambulatory surgical facility" does not include
a hospital emergency department.
(2) "Ambulatory surgical facility
fee" means a fee for certain overhead costs associated with
providing surgical services in an outpatient setting. A fee is
an ambulatory surgical facility fee only if it directly or
indirectly pays for costs associated with any of the following:
(a) Use of operating and recovery rooms,
preparation areas, and waiting rooms and lounges for patients and
relatives;
(b) Administrative functions, record keeping,
housekeeping, utilities, and rent;
(c) Services provided by nurses, orderlies,
technical personnel, and others involved in patient care related
to providing surgery.
"Ambulatory surgical facility fee" does
not include any additional payment in excess of a professional
fee that is provided to encourage physicians, podiatrists, and
dentists to perform certain surgical procedures in their office
or their group practice's office rather than a health care
facility, if the purpose of the additional fee is to compensate
for additional cost incurred in performing office-based surgery.
(3) "Governmental health care program" has the same
meaning as in section 4731.65 of the Revised Code.
(4) "Health care facility" means any of the following:
(a) An ambulatory surgical facility;
(b) A freestanding dialysis center;
(c) A freestanding inpatient rehabilitation facility;
(d) A freestanding birthing center;
(e) A freestanding radiation therapy center;
(f) A freestanding or mobile diagnostic imaging center.
(5) "Metropolitan statistical area"
has the same meaning as in section 3702.51 of the Revised Code.
(6) "Third-party payer" has the same meaning as in
section 3901.38 of the Revised Code.
(B) By rule adopted in accordance with sections
3702.12 and 3702.13 of the Revised Code, the
director of health shall establish quality standards for health care
facilities. The standards may incorporate accreditation standards or other
quality standards established by any entity recognized by the director. The
rules shall be adopted so as to cause the standards to take effect on
March 31, 1996.
(C) The director shall issue a license to each health care
facility that makes application for a license and demonstrates to the director
that it meets the quality standards established under division (B) of
this section, except that if a health care facility located in a metropolitan
statistical area applies for a license on or after
March
31, 1996, and at the time the license is to take effect
the quality standards
are not yet in effect, the director shall issue the license without a
demonstration that the health care facility meets quality standards.
(D) Effective March 31, 1996, no health care facility
located in a metropolitan statistical area shall operate without a license
issued under this section. Effective April 1, 1998, no other NO
health
care facility shall operate without a license issued under this section.
(E) The rules adopted under division
(B) of this section shall include provisions governing
application for, renewal, suspension, and revocation of licenses.
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 health insuring corporation
licensed under Chapter
1751.
of the Revised Code, a health maintenance organization as defined in
division (K) of this section, 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
300e-9.
(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. "HOSPITAL" ALSO DOES NOT 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. 4723.41. (A) Each person who desires to practice
nursing as a certified nurse-midwife and has not been
authorized to practice midwifery prior to December 1,
1967, and each person who desires to practice nursing as a
certified registered nurse anesthetist, clinical nurse
specialist, or certified nurse practitioner shall file with the board
of nursing a written application for authorization to practice
nursing in the desired specialty,
under oath, on a form prescribed by the board.
At EXCEPT AS PROVIDED IN DIVISIONS (B), (C), AND
(D) OF THIS SECTION, AT the time of making application, the
applicant shall
meet all of the following requirements:
(1) Be a registered nurse;
(2) Except as provided in divisions (B) and
(D) of this section, submit SUBMIT documentation satisfactory
to
the board that the applicant has earned at least a master's degree with a
major in a nursing specialty or in a related field that qualifies
the applicant to sit for the certification examination of a national
certifying organization listed in division (A)(3) of
this
section or approved by the board under section 4723.46 of the
Revised Code;
(3) Except as provided in division (C) of this
section, submit SUBMIT documentation satisfactory to
the board of having passed the certification examination of
one of the following:
(a) If the applicant is applying to practice nursing as a
certified nurse-midwife, the American college of nurse-midwives or
another national certifying organization approved by the board
under section 4723.46 of the Revised Code to
examine and certify nurse-midwives;
(b) If the applicant is applying to practice nursing as a
certified registered nurse anesthetist, the national council on
certification of nurse anesthetists of the American
association of nurse anesthetists, the national council on
recertification of nurse anesthetists of the American
association of nurse anesthetists, or another national certifying
organization approved by the board under section 4723.46 of the
Revised Code to examine and certify registered nurse
anesthetists;
(c) If the applicant is applying to practice nursing as a
clinical nurse specialist, the American nurses
credentialing center or another national certifying organization
approved by the board under section 4723.46 of the
Revised Code to examine and certify clinical
nurse specialists;
(d) If the applicant is applying to practice nursing as a
certified nurse practitioner, the American nurses credentialing
center, the national certification corporation, the national
board of pediatric nurse practitioners and associates, or another
national certifying organization approved by the board under
section 4723.46 of the Revised Code to examine
and certify nurse practitioners.
(4) Submit an affidavit with the application that
states all of the following:
(a) That the applicant is the person named in
the documents submitted under divisions (A)(2) and (3)
of
this section and is the lawful possessor thereof;
(b) The applicant's age, residence, the school at which
the applicant
obtained education in the applicant's
nursing
specialty, and any other facts that the
board requires;
(c) If the applicant is already engaged in the
practice of nursing as a certified
registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner, the period during
which and the place where the applicant is engaged;
(d) If the applicant is already engaged in the
practice of nursing as a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner, the names and business addresses of the
applicant's current collaborating physicians and podiatrists. If the
applicant
is not yet engaged in the practice of nursing as a clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner, the applicant shall
submit the names and business addresses of the applicant's collaborating
physicians or podiatrists not later than thirty days after first engaging in
the practice. The applicant shall give written notice to the board of any
additions or deletions to the affidavit of collaborating physicians or
podiatrists not later than thirty days after the change takes effect.
(B) On or before December 31, 2000, the
board shall issue to an applicant a certificate of authority to
practice nursing as a certified registered nurse anesthetist,
certified nurse-midwife, or certified nurse practitioner if the applicant
complies with all
requirements of this section, other than the requirement that the applicant
has earned at least a master's degree with a major in a nursing
specialty or in a related field that qualifies the applicant to sit
for the
certification examination of a national certifying organization
listed in division (A)(3) of this section or approved by
the board under section 4723.46 of the Revised
Code.
(C) On or before December 31, 2000, the
board shall issue to an applicant a certificate of authority to
practice nursing as a clinical nurse specialist if the applicant ONE
OF THE FOLLOWING APPLIES:
(1) THE APPLICANT HOLDS A MASTER'S OR HIGHER DEGREE WITH A MAJOR IN A
CLINICAL AREA OF NURSING FROM AN EDUCATIONAL INSTITUTION ACCREDITED BY A
NATIONAL OR REGIONAL ACCREDITING ORGANIZATION
AND complies
with all requirements of this section, other than the requirement
of having passed a certification examination.
(2) THE APPLICANT HOLDS A MASTER'S OR HIGHER DEGREE IN NURSING OR
A RELATED
FIELD AND
IS CERTIFIED AS A CLINICAL NURSE SPECIALIST BY THE AMERICAN NURSES
CREDENTIALING CENTER OR ANOTHER NATIONAL CERTIFYING ORGANIZATION APPROVED BY
THE BOARD UNDER SECTION 4723.46 of the Revised Code.
(D) On or before December 31, 2008, the
board shall issue to an applicant a certificate of authority to
practice nursing as a certified nurse practitioner if the applicant has
successfully
completed a nurse practitioner certificate program that receives
funding under and is employed by a public agency or a private,
nonprofit entity that receives funding under Title
X of the "Public Health
Service Act," 42
U.S.C. 300 and 300a-1
(1991), and complies with all requirements of this section,
other than the requirement that the applicant has earned at least a
master's degree with a major in a nursing specialty or in a
related field that qualifies the applicant to sit for the certification
examination of a national certifying organization listed in
division (A)(3) of this section or approved by the board
under section 4723.46 of the Revised Code.
(E) A certified registered nurse
anesthetist, clinical nurse specialist, certified nurse-midwife, or certified
nurse
practitioner who is practicing as such in another jurisdiction may apply for a
certificate of authority to practice nursing as a certified registered nurse
anesthetist, clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner in this state if the nurse meets the requirements for a
certificate of authority set forth in this section. The application shall be
submitted to the
board in the form
prescribed by rules of the board and be accompanied by the
application fee required by section 4723.08 of the
Revised Code. The application shall include
evidence that the applicant meets the requirements of this
section, holds a license or certificate to practice nursing as a
certified registered nurse anesthetist, clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner in good
standing
in another jurisdiction granted after meeting requirements
approved by the entity of that jurisdiction that licenses nurses,
and other information required by rules of the board of
nursing.
If the applicant is a certified registered nurse
anesthetist, certified nurse-midwife, or certified nurse
practitioner who, on or before
December 31, 2000, met the
requirements of this section to practice as such and has
maintained certification in the applicant's nursing specialty
with a national certifying organization listed in division
(A)(3) of section 4723.41 of
the Revised
Code or approved by the board
under section 4723.46 of the
Revised
Code, division
(B) of this section shall
apply.
If the applicant is a clinical nurse specialist who, on or
before December 31, 2000, met
the requirements of this section to practice as such and has
earned at least a master's degree with a major in a
nursing
specialty or in a related field that qualifies the applicant
to
sit for the certification examination of a national certifying
organization listed in division
(A)(3) of this section or
approved by the board under section 4723.46 of the
Revised
Code, division
(C) of this section shall apply.
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 3702.30, 3702.51, 3727.01, 4723.41,
and 4751.05 of
the Revised
Code are hereby repealed.
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