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.

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 general anesthesia, deep sedation, moderate sedation, or minimal sedation and from monitoring a patient who has been placed under such anesthesia or sedation.

(C) An ambulatory surgical facility is not required to comply with division (B) of this section with respect to a procedure described in division (B)(1) of this section if any of the following is the case:

(1) The patient is not placed under general anesthesia, deep sedation, moderate sedation, or minimal sedation.

(2) The procedure involves the use of endoscopy.

(3) The procedure is performed for the primary purpose of relieving pain.

(4) The procedure is the surgery known as LASIK or laser-assisted in situ keratomileusis.

(5) The procedure uses extracorporeal shock wave therapy.

(6) The director of health or governor has declared a natural disaster or emergency that affects the public health.

(D) If the director of health determines that an ambulatory surgical facility has violated this section, the director may do either 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 adjudication 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 general anesthesia, deep sedation, moderate sedation, or minimal sedation and from monitoring a patient who has been placed under such anesthesia or sedation.

(C) A hospital is not required to comply with division (B) of this section with respect to a procedure described in division (B)(1) of this section if any of the following is the case:

(1) The patient is not placed under general anesthesia, deep sedation, moderate sedation, or minimal sedation.

(2) The procedure involves the use of endoscopy.

(3) The procedure is performed for the primary purpose of relieving pain.

(4) The procedure is the surgery known as LASIK or laser-assisted in situ keratomileusis.

(5) The procedure uses extracorporeal shock wave therapy.

(6) The director of health or governor has declared a natural disaster or emergency that affects the public health.

(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 period 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 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.