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S. B. No. 294 As IntroducedAs Introduced
128th General Assembly | Regular Session | 2009-2010 |
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Cosponsors:
Senators Miller, D., Miller, R., Turner, Fedor
A BILL
To amend sections 3702.30 and 3702.31 and to enact
sections 3702.40, 3727.60, and 3727.601 of the
Revised Code regarding the assignment of
circulating nurses in hospitals and ambulatory
surgical facilities.
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, 3727.60, and 3727.601 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 division (H) of this section and
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.
(G) An ambulatory surgical facility that performs or induces
abortions shall comply with section 3701.791 of the Revised Code.
(H) The following entities are not required to obtain a
license as a freestanding diagnostic imaging center issued under
this section:
(1) A hospital registered under section 3701.07 of the
Revised Code that provides diagnostic imaging;
(2) An entity that is reviewed as part of a hospital
accreditation or certification program and that provides
diagnostic imaging;
(3) An ambulatory surgical facility that provides diagnostic
imaging in conjunction with or during any portion of a surgical
procedure.
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) "General anesthesia," "deep sedation," "moderate
sedation," and "minimal sedation" have the same meanings as in
rules the state medical board adopts under section 4731.05 of the
Revised Code for purposes of regulating office-based surgeries.
(3) "Registered nurse" means a person who is licensed as a
registered nurse under Chapter 4723. of the Revised Code.
(B) Except as provided in division (C) of this section, 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) Prohibit a circulating nurse from administering
anesthesia or sedation and monitoring a patient to whom such drugs
have been administered.
(C) An ambulatory surgical facility is not required to comply
with division (B) of this section with respect to a surgical
procedure if either of the following is the case:
(1) The patient is not placed under general anesthesia, deep
sedation, moderate sedation, or minimal sedation and any one of
the following applies:
(a) The procedure involves the use of endoscopy;
(b) The procedure is performed for the primary purpose of
relieving pain;
(c) The procedure is a laser assisted in situ keratomileusis
(LASIK) surgery;
(d) The procedure uses extracorporeal shock wave therapy
(ESWT).
(2) The director of health or governor has declared a natural
disaster or public health emergency.
(D) 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.
(E) If an ambulatory surgical facility subject to an order
issued under division (D)(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) "General anesthesia," "deep sedation," "moderate
sedation," and "minimal sedation" have the same meanings as in
rules the state medical board adopts under section 4731.05 of the
Revised Code for purposes of regulating office-based surgeries.
(3) "Registered nurse" means a person who is licensed as a
registered nurse under Chapter 4723. of the Revised Code.
(B) Except as provided in division (C) of this section, 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 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) Prohibit a circulating nurse from administering
anesthesia or sedation and monitoring a patient to whom such drugs
have been administered.
(C) A hospital is not required to comply with division (B) of
this section with respect to a surgical procedure if either of the
following is the case:
(1) The patient is not placed under general anesthesia, deep
sedation, moderate sedation, or minimal sedation and any one of
the following applies:
(a) The procedure involves the use of endoscopy;
(b) The procedure is performed for the primary purpose of
relieving pain;
(c) The procedure is a laser assisted in situ keratomileusis
(LASIK) surgery;
(d) The procedure uses extracorporeal shock wave therapy
(ESWT).
(2) The director of health or governor has declared a natural
disaster or public health emergency.
(D) 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.
(E) If a hospital fails to correct a violation determined by
the director under division (D) 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.
(F) The director of health shall adopt rules regarding the
establishment and collection of fees from hospitals to cover the
costs of administering and enforcing this section. The rules shall
be adopted in accordance with Chapter 119. of the Revised Code.
Each hospital subject to the fees established in the rules
adopted under this division shall pay the fees in a manner that
complies with those rules.
Sec. 3727.601. Fees collected under section 3727.60 of the
Revised Code shall be deposited into the state treasury to the
credit of the hospital circulating nurse requirement fund, which
is hereby created. The fund shall be used by the department of
health for administering and enforcing section 3727.60 of the
Revised Code and rules adopted pursuant to that section. All
investment earnings from the fund shall be credited to the fund.
Section 2. That existing sections 3702.30 and 3702.31 of the
Revised Code are hereby repealed.
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