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H. B. No. 205 As IntroducedAs Introduced
128th General Assembly | Regular Session | 2009-2010 |
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Cosponsors:
Representatives Ujvagi, Hagan, Luckie, Murray, Mallory, Lehner, Winburn
A BILL
To amend sections 3702.30 and 3702.31 and
to enact
sections 3702.40 and 3727.60
of the Revised Code
to
require hospitals and
ambulatory surgical
facilities to assign a
circulating nurse to each
procedure
performed in an operating room or
invasive procedure room and to require surgical
technologists to
work under the direct
supervision of circulating
nurses.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3702.30 and 3702.31 be
amended and
sections 3702.40 and 3727.60 of the Revised
Code be enacted to
read as follows:
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
centers for medicare and medicaid services 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," 79 Stat. 286 (1965),
42 U.S.C.A. 1395, as amended.
(d) The facility applies to be certified by a
national
accrediting body approved by the centers for medicare and medicaid
services 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) "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.
(C)
Every ambulatory surgical facility shall require
that
each physician who practices at the facility comply with all
relevant provisions in the Revised Code that relate to the
obtaining of informed consent
from a patient.
(D) 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
by
the rules adopted under division (B) of
this section
and satisfies
the informed consent
compliance
requirements specified in division
(C) of this section.
(E)(1) Except as provided in section 3702.301 of the Revised
Code, no
health
care facility shall operate without a
license
issued under this section.
(2) If the department of health finds that a physician who
practices at a health care facility is not complying with any
provision of the Revised Code related to the obtaining of informed
consent from a patient, the department shall report its finding to
the state medical board, the physician, and the health care
facility.
(3) This division does not create, and shall not be
construed
as creating, a new cause of action or substantive legal
right
against a health care facility and in favor of a patient who
allegedly sustains harm as a result of the failure of the
patient's physician to obtain informed consent from the patient
prior to performing a procedure on or otherwise caring for the
patient in the health care facility.
(F) The rules adopted under division
(B) of this section
shall include
all of the following:
(1) Provisions governing
application for, renewal,
suspension, and revocation of
a license under this
section;
(2) Provisions governing orders issued pursuant to section
3702.32 of the Revised Code for a health care facility to cease
its operations or to prohibit certain types of services provided
by a health care facility;
(3) Provisions governing the orders issued pursuant to
section 3702.40 of the Revised Code for an ambulatory surgical
facility to cease its operations or to prohibit specified types of
services provided by an ambulatory surgical facility;
(4) Provisions governing the imposition under section
sections
3702.32 and 3702.40
of the Revised Code of civil
penalties for violations of
this
section or the rules adopted
under this section, including a
scale
for determining the amount
of the penalties;
(5) The tasks that are intraoperative tasks for purposes of
division (B)(4) of section 3702.40 of the Revised Code.
(G) An ambulatory surgical facility that performs or induces
abortions shall comply with section 3701.791 of the Revised Code.
Sec. 3702.31. (A) The quality monitoring and
inspection
fund
is hereby created in the state treasury. The
director of
health
shall use the fund to
administer and enforce this section
and
sections
3702.11 to 3702.20, 3702.30, 3702.301, and 3702.32, and
3702.40 of the
Revised
Code and rules adopted pursuant to those
sections.
The
director shall deposit in the fund any moneys
collected pursuant
to this section
or section 3702.32 or 3702.40
of the Revised Code. All
investment earnings of
the fund shall be
credited to the fund.
(B) The director of health shall adopt rules pursuant to
Chapter 119. of the Revised Code establishing fees
for both of the
following:
(1) Initial and renewal license applications submitted under
section
3702.30 of the Revised Code. The fees established under
division (B)(1) of this section shall not
exceed the actual and
necessary costs of performing the
activities described in division
(A) of this section.
(2) Inspections conducted
under section 3702.15 or 3702.30
of
the
Revised
Code. The fees established
under division (B)(2)
of
this
section shall not exceed the actual and necessary costs
incurred
during an inspection, including any indirect costs
incurred by
the department for staff, salary, or other
administrative
costs.
The director of health shall provide to
each health
care facility or provider inspected pursuant to
section 3702.15
or 3702.30 of the Revised
Code a written statement
of the
fee.
The statement shall itemize and total the costs
incurred.
Within fifteen days after receiving a
statement from
the director, the facility or provider shall
forward the total
amount of the fee to the director.
(3) The fees described in divisions
(B)(1) and (2) of this
section
shall meet both of the following requirements:
(a) For each service described in
section 3702.11 of the
Revised
Code, the fee shall not exceed
one thousand
seven hundred
fifty
dollars annually, except that the total fees
charged
to a
health care provider under this section shall not exceed five
thousand dollars
annually.
(b) The fee shall exclude any costs
reimbursable by the
United
States centers for medicare and medicaid services as part
of the
certification process for the
medicare program established
under
Title
XVIII of the
"Social
Security
Act," 79
Stat. 286
(1935), 42
U.S.C.A.
1395, as amended, and the medicaid program
established
under
Title
XIX of the "Social Security Act," 79 Stat.
286 (1965), 42 U.S.C. 1396.
(4) The director shall not establish a fee for any
service
for which a licensure or inspection fee is paid by the
health care
provider to a state agency for the same or similar
licensure or
inspection.
Sec. 3702.40. (A) As used in this section:
(1) "Circulating nurse" means a registered nurse who
is
educated, trained, or experienced in perioperative nursing and who
is responsible for coordinating the nursing care and safety needs
of a patient in an operating room or invasive procedure room.
(2) "Physician" means a person who holds a valid certificate
issued under Chapter 4731. of the Revised Code authorizing the
person to practice medicine and surgery, osteopathic medicine and
surgery, or podiatric medicine and surgery.
(3) "Registered nurse" means a person who is licensed as a
registered nurse under Chapter 4723. of the Revised Code.
(B) An ambulatory surgical facility shall do all of the
following:
(1) Assign a circulating nurse to each procedure
performed
in an operating room or invasive procedure room of the facility;
(2) Ensure that the circulating nurse assigned to a procedure
described in division (B)(1) of this section is present in the
operating room or invasive procedure room for the entire duration
of the procedure unless it
becomes necessary for the nurse to
leave the room as required by
the procedure or the nurse is
relieved by another circulating
nurse;
(3) Ensure that a circulating nurse assigned to a procedure
described in division (B)(1) of this section is not assigned to
another procedure that is scheduled to occur concurrently or that
may overlap in time with the procedure to which the nurse was
originally assigned;
(4) Ensure that any person the ambulatory surgical facility
has employed or contracted with to work as a surgical technologist
for a procedure, or has assigned to assist with the
performance
of one or more intraoperative tasks as specified by the director
of health in rules adopted under divisions (B) and (F)(5) of
section 3702.30 of the Revised Code for a procedure, works under
the direct supervision of the circulating nurse assigned to the
same procedure
or the circulating nurse who relieves the
circulating nurse
assigned to the procedure as described in
division (B)(2) of this
section.
(C) If the director of health determines that an ambulatory
surgical facility has violated this section, the director may do
one or both of the following:
(1) Provide an opportunity for the ambulatory surgical
facility to correct the violation within a period of
time
specified by the director;
(2) Prior to or during the pendency of an administrative
hearing under Chapter 119. of the Revised Code, issue an order
that requires the ambulatory surgical facility to cease operation
or prohibits the facility from performing
the types of
services
specified by the director.
(D) If an ambulatory surgical facility subject to an order
issued under division (C)(2) of this section continues to operate
or to perform
the types of services prohibited by the order, the
director of
health may file a petition in the court of common
pleas of the
county in which the facility is located for an order
enjoining the facility from continuing to operate or continuing to
perform those types of services.
The court shall grant the
injunction on a showing that the
respondent named in the petition
is continuing to operate or perform the types of
services
prohibited by the director's order.
Sec. 3727.60. (A) As used in this section:
(1) "Circulating nurse" means a registered nurse who
is
educated, trained, or experienced in perioperative nursing and who
is responsible for coordinating the nursing care and safety needs
of a patient in an operating room or invasive procedure room.
(2) "Physician" means a person who holds a valid certificate
issued under Chapter 4731. of the Revised Code authorizing the
person to practice medicine and surgery, osteopathic medicine and
surgery, or podiatric medicine and surgery.
(3) "Registered nurse" means a person who is licensed as a
registered nurse under Chapter 4723. of the Revised Code.
(B) A hospital shall do all of the following:
(1) Assign a circulating nurse to each procedure
performed
in an operating room or invasive procedure room or invasive
procedure room of the hospital;
(2) Ensure that the circulating nurse assigned to a procedure
described in division (B)(1) of this section is present in the
operating room or invasive procedure room for the entire duration
of the procedure unless it
becomes necessary for the nurse to
leave the room as required by
the procedure or the nurse is
relieved by another circulating
nurse;
(3) Ensure that a circulating nurse assigned to a procedure
described in division (B)(1) of this section is not assigned to
another procedure that is scheduled to occur concurrently or that
may overlap in time with the procedure to which the nurse was
originally assigned;
(4) Ensure that any person the hospital has employed or
contracted with to work as a surgical technologist for a surgical
procedure, or has assigned to assist with the performance of one
or more intraoperative tasks as specified by the director of
health in rules adopted under division (E) of this section for a
procedure, works under
the direct supervision of the
circulating
nurse assigned to the same procedure or the
circulating nurse who
relieves the circulating nurse assigned to
the procedure as
described in division (B)(2) of this section.
(C) If the director of health determines that a hospital has
violated this section, the director may provide an opportunity for
the hospital to correct the
violation within a period of time
specified by the director.
(D) If a hospital fails to correct a violation determined by
the director under division (C) of this section within the amount
of time specified by the director, the director may file a
petition in the court of common pleas of the county in
which the
hospital is located for an order enjoining the hospital
from
continuing to operate or continuing to perform the types of
services that are associated with the violation. The court shall
grant the injunction on a showing that
the respondent named in
the petition is continuing to operate or
perform the types of
services associated with the violation.
(E)
The director of health shall adopt rules to specify the
tasks that are intraoperative tasks for purposes of division
(B)(4) of this section.
Section 2. That existing sections 3702.30 and 3702.31 of the
Revised Code are hereby repealed.
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