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Sub. H. B. No. 303 As Reported by the Senate Health, Human Services and Aging CommitteeAs Reported by the Senate Health, Human Services and Aging Committee
129th General Assembly | Regular Session | 2011-2012 |
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Cosponsors:
Representatives Carney, Gonzales, Fende, Antonio, Barnes, Garland, Hackett, Yuko, Adams, R., Anielski, Bubp, Celeste, Damschroder, Gardner, Grossman, Hagan, R., Heard, Hill, Hottinger, Johnson, Letson, Lynch, Mallory, McClain, Milkovich, Newbold, O'Brien, Okey, Pillich, Ramos, Reece, Sears, Stebelton, Stinziano, Wachtmann Speaker Batchelder
A BILL
To amend sections 2305.113, 2305.234, 2711.22,
3701.92, 3701.923, 3701.924, 3701.925, 3701.926,
3701.927, 3701.928, 3701.929, 3793.11, 3963.01,
4503.44, 4723.01, 4723.03, 4723.06, 4723.063,
4723.07, 4723.08, 4723.09, 4723.17, 4723.171,
4723.24, 4723.271, 4723.28, 4723.32, 4723.34,
4723.35, 4723.41, 4723.42, 4723.43, 4723.431,
4723.44, 4723.48, 4723.482, 4723.485, 4723.487,
4723.50, 4723.61, 4723.64, 4723.65, 4723.651,
4723.652, 4723.66, 4723.67, 4723.68, 4723.69,
4723.71, 4723.72, 4723.73, 4723.74, 4723.75,
4723.751, 4723.76, 4723.77, 4723.79, 4723.83,
4723.84, 4723.87, 4723.88, 4723.99, 4759.01,
4759.03, 4759.05, 4759.06, 4759.10, 5111.222,
5111.231, 5111.24, 5111.242, 5111.246, 5111.25,
5111.88, 5111.981, and 5120.55; to amend, for the
purpose of adopting new section numbers as
indicated in parentheses, sections 4723.17
(4723.18) and 4723.171 (4723.181); to enact new
section 4723.17 and sections 4723.091, 4723.092,
4723.19, 4723.653, and 5111.982; to repeal
sections 4723.483, 4723.62, 4723.621, 4723.63, and
4723.78 of the Revised Code; and to amend Section
3.19 of Am. Sub. H.B. 95 of the 125th General
Assembly to revise the laws administered by the
Board of Nursing and the professionals regulated
by the Board, to update statutory references to
professional organizations of dietitians, to
extend qualified immunity from civil liability for
volunteer services provided by certain behavioral
health professionals, to modify the requirements
for licensure of methadone treatment programs, to
make changes in the laws governing certain
Medicaid payments for nursing facility services,
to authorize certain assessments of persons with
intellectual disabilities residing in intermediate
care facilities, and to declare an emergency.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 2305.113, 2305.234, 2711.22,
3701.92, 3701.923, 3701.924, 3701.925, 3701.926, 3701.927,
3701.928, 3701.929, 3793.11, 3963.01, 4503.44, 4723.01, 4723.03,
4723.06, 4723.063, 4723.07, 4723.08, 4723.09, 4723.17, 4723.171,
4723.24, 4723.271, 4723.28, 4723.32, 4723.34, 4723.35, 4723.41,
4723.42, 4723.43, 4723.431, 4723.44, 4723.48, 4723.482, 4723.485,
4723.487, 4723.50, 4723.61, 4723.64, 4723.65, 4723.651, 4723.652,
4723.66, 4723.67, 4723.68, 4723.69, 4723.71, 4723.72, 4723.73,
4723.74, 4723.75, 4723.751, 4723.76, 4723.77, 4723.79, 4723.83,
4723.84, 4723.87, 4723.88, 4723.99, 4759.01, 4759.03, 4759.05,
4759.06, 4759.10, 5111.222, 5111.231, 5111.24, 5111.242, 5111.246,
5111.25, 5111.88, 5111.981, and 5120.55 be amended; sections
4723.17 (4723.18) and 4723.171 (4723.181) be amended for the
purpose of adopting new section numbers as indicated in
parentheses; and new section 4723.17 and sections 4723.091,
4723.092, 4723.19, 4723.653, and 5111.982 of the Revised Code be
enacted to read as follows:
Sec. 2305.113. (A) Except as otherwise provided in this
section, an action upon a medical, dental, optometric, or
chiropractic claim shall be commenced within one year after the
cause of action accrued.
(B)(1) If prior to the expiration of the one-year period
specified in division (A) of this section, a claimant who
allegedly possesses a medical, dental, optometric, or chiropractic
claim gives to the person who is the subject of that claim written
notice that the claimant is considering bringing an action upon
that claim, that action may be commenced against the person
notified at any time within one hundred eighty days after the
notice is so given.
(2) An insurance company shall not consider the existence or
nonexistence of a written notice described in division (B)(1) of
this section in setting the liability insurance premium rates that
the company may charge the company's insured person who is
notified by that written notice.
(C) Except as to persons within the age of minority or of
unsound mind as provided by section 2305.16 of the Revised Code,
and except as provided in division (D) of this section, both of
the following apply:
(1) No action upon a medical, dental, optometric, or
chiropractic claim shall be commenced more than four years after
the occurrence of the act or omission constituting the alleged
basis of the medical, dental, optometric, or chiropractic claim.
(2) If an action upon a medical, dental, optometric, or
chiropractic claim is not commenced within four years after the
occurrence of the act or omission constituting the alleged basis
of the medical, dental, optometric, or chiropractic claim, then,
any action upon that claim is barred.
(D)(1) If a person making a medical claim, dental claim,
optometric claim, or chiropractic claim, in the exercise of
reasonable care and diligence, could not have discovered the
injury resulting from the act or omission constituting the alleged
basis of the claim within three years after the occurrence of the
act or omission, but, in the exercise of reasonable care and
diligence, discovers the injury resulting from that act or
omission before the expiration of the four-year period specified
in division (C)(1) of this section, the person may commence an
action upon the claim not later than one year after the person
discovers the injury resulting from that act or omission.
(2) If the alleged basis of a medical claim, dental claim,
optometric claim, or chiropractic claim is the occurrence of an
act or omission that involves a foreign object that is left in the
body of the person making the claim, the person may commence an
action upon the claim not later than one year after the person
discovered the foreign object or not later than one year after the
person, with reasonable care and diligence, should have discovered
the foreign object.
(3) A person who commences an action upon a medical claim,
dental claim, optometric claim, or chiropractic claim under the
circumstances described in division (D)(1) or (2) of this section
has the affirmative burden of proving, by clear and convincing
evidence, that the person, with reasonable care and diligence,
could not have discovered the injury resulting from the act or
omission constituting the alleged basis of the claim within the
three-year period described in division (D)(1) of this section or
within the one-year period described in division (D)(2) of this
section, whichever is applicable.
(E) As used in this section:
(1) "Hospital" includes any person, corporation, association,
board, or authority that is responsible for the operation of any
hospital licensed or registered in the state, including, but not
limited to, those that are owned or operated by the state,
political subdivisions, any person, any corporation, or any
combination of the state, political subdivisions, persons, and
corporations. "Hospital" also includes any person, corporation,
association, board, entity, or authority that is responsible for
the operation of any clinic that employs a full-time staff of
physicians practicing in more than one recognized medical
specialty and rendering advice, diagnosis, care, and treatment to
individuals. "Hospital" does not include any hospital operated by
the government of the United States or any of its branches.
(2) "Physician" means a person who is licensed to practice
medicine and surgery or osteopathic medicine and surgery by the
state medical board or a person who otherwise is authorized to
practice medicine and surgery or osteopathic medicine and surgery
in this state.
(3) "Medical claim" means any claim that is asserted in any
civil action against a physician, podiatrist, hospital, home, or
residential facility, against any employee or agent of a
physician, podiatrist, hospital, home, or residential facility, or
against a licensed practical nurse, registered nurse, advanced
practice registered nurse, physical therapist, physician
assistant, emergency medical technician-basic, emergency medical
technician-intermediate, or emergency medical
technician-paramedic, and that arises out of the medical
diagnosis, care, or treatment of any person. "Medical claim"
includes the following:
(a) Derivative claims for relief that arise from the medical
diagnosis, care, or treatment of a person;
(b) Claims that arise out of the medical diagnosis, care, or
treatment of any person and to which either of the following
applies:
(i) The claim results from acts or omissions in providing
medical care.
(ii) The claim results from the hiring, training,
supervision, retention, or termination of caregivers providing
medical diagnosis, care, or treatment.
(c) Claims that arise out of the medical diagnosis, care, or
treatment of any person and that are brought under section 3721.17
of the Revised Code.
(4) "Podiatrist" means any person who is licensed to practice
podiatric medicine and surgery by the state medical board.
(5) "Dentist" means any person who is licensed to practice
dentistry by the state dental board.
(6) "Dental claim" means any claim that is asserted in any
civil action against a dentist, or against any employee or agent
of a dentist, and that arises out of a dental operation or the
dental diagnosis, care, or treatment of any person. "Dental claim"
includes derivative claims for relief that arise from a dental
operation or the dental diagnosis, care, or treatment of a person.
(7) "Derivative claims for relief" include, but are not
limited to, claims of a parent, guardian, custodian, or spouse of
an individual who was the subject of any medical diagnosis, care,
or treatment, dental diagnosis, care, or treatment, dental
operation, optometric diagnosis, care, or treatment, or
chiropractic diagnosis, care, or treatment, that arise from that
diagnosis, care, treatment, or operation, and that seek the
recovery of damages for any of the following:
(a) Loss of society, consortium, companionship, care,
assistance, attention, protection, advice, guidance, counsel,
instruction, training, or education, or any other intangible loss
that was sustained by the parent, guardian, custodian, or spouse;
(b) Expenditures of the parent, guardian, custodian, or
spouse for medical, dental, optometric, or chiropractic care or
treatment, for rehabilitation services, or for other care,
treatment, services, products, or accommodations provided to the
individual who was the subject of the medical diagnosis, care, or
treatment, the dental diagnosis, care, or treatment, the dental
operation, the optometric diagnosis, care, or treatment, or the
chiropractic diagnosis, care, or treatment.
(8) "Registered nurse" means any person who is licensed to
practice nursing as a registered nurse by the board of nursing.
(9) "Chiropractic claim" means any claim that is asserted in
any civil action against a chiropractor, or against any employee
or agent of a chiropractor, and that arises out of the
chiropractic diagnosis, care, or treatment of any person.
"Chiropractic claim" includes derivative claims for relief that
arise from the chiropractic diagnosis, care, or treatment of a
person.
(10) "Chiropractor" means any person who is licensed to
practice chiropractic by the state chiropractic board.
(11) "Optometric claim" means any claim that is asserted in
any civil action against an optometrist, or against any employee
or agent of an optometrist, and that arises out of the optometric
diagnosis, care, or treatment of any person. "Optometric claim"
includes derivative claims for relief that arise from the
optometric diagnosis, care, or treatment of a person.
(12) "Optometrist" means any person licensed to practice
optometry by the state board of optometry.
(13) "Physical therapist" means any person who is licensed to
practice physical therapy under Chapter 4755. of the Revised Code.
(14) "Home" has the same meaning as in section 3721.10 of the
Revised Code.
(15) "Residential facility" means a facility licensed under
section 5123.19 of the Revised Code.
(16) "Advanced practice registered nurse" means any certified
nurse practitioner, clinical nurse specialist, certified
registered nurse anesthetist, or certified nurse-midwife who holds
a certificate of authority issued by the board of nursing under
Chapter 4723. of the Revised Code.
(17) "Licensed practical nurse" means any person who is
licensed to practice nursing as a licensed practical nurse by the
board of nursing pursuant to Chapter 4723. of the Revised Code.
(18) "Physician assistant" means any person who holds a valid
certificate to practice issued pursuant to Chapter 4730. of the
Revised Code.
(19) "Emergency medical technician-basic," "emergency medical
technician-intermediate," and "emergency medical
technician-paramedic" means any person who is certified under
Chapter 4765. of the Revised Code as an emergency medical
technician-basic, emergency medical technician-intermediate, or
emergency medical technician-paramedic, whichever is applicable.
Sec. 2305.234. (A) As used in this section:
(1) "Chiropractic claim," "medical claim," and "optometric
claim" have the same meanings as in section 2305.113 of the
Revised Code.
(2) "Dental claim" has the same meaning as in section
2305.113 of the Revised Code, except that it does not include any
claim arising out of a dental operation or any derivative claim
for relief that arises out of a dental operation.
(3) "Governmental health care program" has the same meaning
as in section 4731.65 of the Revised Code.
(4) "Health care facility or location" means a hospital,
clinic, ambulatory surgical facility, office of a health care
professional or associated group of health care professionals,
training institution for health care professionals, or any other
place where medical, dental, or other health-related diagnosis,
care, or treatment is provided to a person.
(5) "Health care professional" means any of the following who
provide medical, dental, or other health-related diagnosis, care,
or treatment:
(a) Physicians authorized under Chapter 4731. of the Revised
Code to practice medicine and surgery or osteopathic medicine and
surgery;
(b) Registered nurses and licensed practical nurses licensed
under Chapter 4723. of the Revised Code and individuals who hold a
certificate of authority issued under that chapter that authorizes
the practice of nursing as a certified registered nurse
anesthetist, clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner;
(c) Physician assistants authorized to practice under Chapter
4730. of the Revised Code;
(d) Dentists and dental hygienists licensed under Chapter
4715. of the Revised Code;
(e) Physical therapists, physical therapist assistants,
occupational therapists, and occupational therapy assistants
licensed under Chapter 4755. of the Revised Code;
(f) Chiropractors licensed under Chapter 4734. of the Revised
Code;
(g) Optometrists licensed under Chapter 4725. of the Revised
Code;
(h) Podiatrists authorized under Chapter 4731. of the Revised
Code to practice podiatry;
(i) Dietitians licensed under Chapter 4759. of the Revised
Code;
(j) Pharmacists licensed under Chapter 4729. of the Revised
Code;
(k) Emergency medical technicians-basic, emergency medical
technicians-intermediate, and emergency medical
technicians-paramedic, certified under Chapter 4765. of the
Revised Code;
(l) Respiratory care professionals licensed under Chapter
4761. of the Revised Code;
(m) Speech-language pathologists and audiologists licensed
under Chapter 4753. of the Revised Code;
(n) Professional clinical counselors, professional
counselors, independent social workers, social workers,
independent marriage and family therapists, and marriage and
family therapists, licensed under Chapter 4757. of the Revised
Code;
(o) Psychologists licensed under Chapter 4732. of the Revised
Code;
(p) Independent chemical dependency counselors, chemical
dependency counselors III, chemical dependency counselors II, and
chemical dependency counselors I, licensed under Chapter 4758. of
the Revised Code.
(6) "Health care worker" means a person other than a health
care professional who provides medical, dental, or other
health-related care or treatment under the direction of a health
care professional with the authority to direct that individual's
activities, including medical technicians, medical assistants,
dental assistants, orderlies, aides, and individuals acting in
similar capacities.
(7) "Indigent and uninsured person" means a person who meets
all of the following requirements:
(a) The person's income is not greater than two hundred per
cent of the current poverty line as defined by the United States
office of management and budget and revised in accordance with
section 673(2) of the "Omnibus Budget Reconciliation Act of 1981,"
95 Stat. 511, 42 U.S.C. 9902, as amended.
(b) The person is not eligible to receive medical assistance
under Chapter 5111. of the Revised Code or assistance under any
other governmental health care program.
(c) Either of the following applies:
(i) The person is not a policyholder, certificate holder,
insured, contract holder, subscriber, enrollee, member,
beneficiary, or other covered individual under a health insurance
or health care policy, contract, or plan.
(ii) The person is a policyholder, certificate holder,
insured, contract holder, subscriber, enrollee, member,
beneficiary, or other covered individual under a health insurance
or health care policy, contract, or plan, but the insurer, policy,
contract, or plan denies coverage or is the subject of insolvency
or bankruptcy proceedings in any jurisdiction.
(8) "Nonprofit health care referral organization" means an
entity that is not operated for profit and refers patients to, or
arranges for the provision of, health-related diagnosis, care, or
treatment by a health care professional or health care worker.
(9) "Operation" means any procedure that involves cutting or
otherwise infiltrating human tissue by mechanical means, including
surgery, laser surgery, ionizing radiation, therapeutic
ultrasound, or the removal of intraocular foreign bodies.
"Operation" does not include the administration of medication by
injection, unless the injection is administered in conjunction
with a procedure infiltrating human tissue by mechanical means
other than the administration of medicine by injection.
"Operation" does not include routine dental restorative
procedures, the scaling of teeth, or extractions of teeth that are
not impacted.
(10) "Tort action" means a civil action for damages for
injury, death, or loss to person or property other than a civil
action for damages for a breach of contract or another agreement
between persons or government entities.
(11) "Volunteer" means an individual who provides any
medical, dental, or other health-care related diagnosis, care, or
treatment without the expectation of receiving and without receipt
of any compensation or other form of remuneration from an indigent
and uninsured person, another person on behalf of an indigent and
uninsured person, any health care facility or location, any
nonprofit health care referral organization, or any other person
or government entity.
(12) "Community control sanction" has the same meaning as in
section 2929.01 of the Revised Code.
(13) "Deep sedation" means a drug-induced depression of
consciousness during which a patient cannot be easily aroused but
responds purposefully following repeated or painful stimulation, a
patient's ability to independently maintain ventilatory function
may be impaired, a patient may require assistance in maintaining a
patent airway and spontaneous ventilation may be inadequate, and
cardiovascular function is usually maintained.
(14) "General anesthesia" means a drug-induced loss of
consciousness during which a patient is not arousable, even by
painful stimulation, the ability to independently maintain
ventilatory function is often impaired, a patient often requires
assistance in maintaining a patent airway, positive pressure
ventilation may be required because of depressed spontaneous
ventilation or drug-induced depression of neuromuscular function,
and cardiovascular function may be impaired.
(B)(1) Subject to divisions (F) and (G)(3) of this section, a
health care professional who is a volunteer and complies with
division (B)(2) of this section is not liable in damages to any
person or government entity in a tort or other civil action,
including an action on a medical, dental, chiropractic,
optometric, or other health-related claim, for injury, death, or
loss to person or property that allegedly arises from an action or
omission of the volunteer in the provision to an indigent and
uninsured person of medical, dental, or other health-related
diagnosis, care, or treatment, including the provision of samples
of medicine and other medical products, unless the action or
omission constitutes willful or wanton misconduct.
(2) To qualify for the immunity described in division (B)(1)
of this section, a health care professional shall do all of the
following prior to providing diagnosis, care, or treatment:
(a) Determine, in good faith, that the indigent and uninsured
person is mentally capable of giving informed consent to the
provision of the diagnosis, care, or treatment and is not subject
to duress or under undue influence;
(b) Inform the person of the provisions of this section,
including notifying the person that, by giving informed consent to
the provision of the diagnosis, care, or treatment, the person
cannot hold the health care professional liable for damages in a
tort or other civil action, including an action on a medical,
dental, chiropractic, optometric, or other health-related claim,
unless the action or omission of the health care professional
constitutes willful or wanton misconduct;
(c) Obtain the informed consent of the person and a written
waiver, signed by the person or by another individual on behalf of
and in the presence of the person, that states that the person is
mentally competent to give informed consent and, without being
subject to duress or under undue influence, gives informed consent
to the provision of the diagnosis, care, or treatment subject to
the provisions of this section. A written waiver under division
(B)(2)(c) of this section shall state clearly and in conspicuous
type that the person or other individual who signs the waiver is
signing it with full knowledge that, by giving informed consent to
the provision of the diagnosis, care, or treatment, the person
cannot bring a tort or other civil action, including an action on
a medical, dental, chiropractic, optometric, or other
health-related claim, against the health care professional unless
the action or omission of the health care professional constitutes
willful or wanton misconduct.
(3) A physician or podiatrist who is not covered by medical
malpractice insurance, but complies with division (B)(2) of this
section, is not required to comply with division (A) of section
4731.143 of the Revised Code.
(C) Subject to divisions (F) and (G)(3) of this section,
health care workers who are volunteers are not liable in damages
to any person or government entity in a tort or other civil
action, including an action upon a medical, dental, chiropractic,
optometric, or other health-related claim, for injury, death, or
loss to person or property that allegedly arises from an action or
omission of the health care worker in the provision to an indigent
and uninsured person of medical, dental, or other health-related
diagnosis, care, or treatment, unless the action or omission
constitutes willful or wanton misconduct.
(D) Subject to divisions (F) and (G)(3) of this section, a
nonprofit health care referral organization is not liable in
damages to any person or government entity in a tort or other
civil action, including an action on a medical, dental,
chiropractic, optometric, or other health-related claim, for
injury, death, or loss to person or property that allegedly arises
from an action or omission of the nonprofit health care referral
organization in referring indigent and uninsured persons to, or
arranging for the provision of, medical, dental, or other
health-related diagnosis, care, or treatment by a health care
professional described in division (B)(1) of this section or a
health care worker described in division (C) of this section,
unless the action or omission constitutes willful or wanton
misconduct.
(E) Subject to divisions (F) and (G)(3) of this section and
to the extent that the registration requirements of section
3701.071 of the Revised Code apply, a health care facility or
location associated with a health care professional described in
division (B)(1) of this section, a health care worker described in
division (C) of this section, or a nonprofit health care referral
organization described in division (D) of this section is not
liable in damages to any person or government entity in a tort or
other civil action, including an action on a medical, dental,
chiropractic, optometric, or other health-related claim, for
injury, death, or loss to person or property that allegedly arises
from an action or omission of the health care professional or
worker or nonprofit health care referral organization relative to
the medical, dental, or other health-related diagnosis, care, or
treatment provided to an indigent and uninsured person on behalf
of or at the health care facility or location, unless the action
or omission constitutes willful or wanton misconduct.
(F)(1) Except as provided in division (F)(2) of this section,
the immunities provided by divisions (B), (C), (D), and (E) of
this section are not available to a health care professional,
health care worker, nonprofit health care referral organization,
or health care facility or location if, at the time of an alleged
injury, death, or loss to person or property, the health care
professionals or health care workers involved are providing one of
the following:
(a) Any medical, dental, or other health-related diagnosis,
care, or treatment pursuant to a community service work order
entered by a court under division (B) of section 2951.02 of the
Revised Code or imposed by a court as a community control
sanction;
(b) Performance of an operation to which any one of the
following applies:
(i) The operation requires the administration of deep
sedation or general anesthesia.
(ii) The operation is a procedure that is not typically
performed in an office.
(iii) The individual involved is a health care professional,
and the operation is beyond the scope of practice or the
education, training, and competence, as applicable, of the health
care professional.
(c) Delivery of a baby or any other purposeful termination of
a human pregnancy.
(2) Division (F)(1) of this section does not apply when a
health care professional or health care worker provides medical,
dental, or other health-related diagnosis, care, or treatment that
is necessary to preserve the life of a person in a medical
emergency.
(G)(1) This section does not create a new cause of action or
substantive legal right against a health care professional, health
care worker, nonprofit health care referral organization, or
health care facility or location.
(2) This section does not affect any immunities from civil
liability or defenses established by another section of the
Revised Code or available at common law to which a health care
professional, health care worker, nonprofit health care referral
organization, or health care facility or location may be entitled
in connection with the provision of emergency or other medical,
dental, or other health-related diagnosis, care, or treatment.
(3) This section does not grant an immunity from tort or
other civil liability to a health care professional, health care
worker, nonprofit health care referral organization, or health
care facility or location for actions that are outside the scope
of authority of health care professionals or health care workers.
(4) This section does not affect any legal responsibility of
a health care professional, health care worker, or nonprofit
health care referral organization to comply with any applicable
law of this state or rule of an agency of this state.
(5) This section does not affect any legal responsibility of
a health care facility or location to comply with any applicable
law of this state, rule of an agency of this state, or local code,
ordinance, or regulation that pertains to or regulates building,
housing, air pollution, water pollution, sanitation, health, fire,
zoning, or safety.
Sec. 2711.22. (A) Except as otherwise provided in this
section, a written contract between a patient and a hospital or
healthcare provider to settle by binding arbitration any dispute
or controversy arising out of the diagnosis, treatment, or care of
the patient rendered by a hospital or healthcare provider, that is
entered into prior to the diagnosis, treatment, or care of the
patient is valid, irrevocable, and enforceable once the contract
is signed by all parties. The contract remains valid, irrevocable,
and enforceable until or unless the patient or the patient's legal
representative rescinds the contract by written notice within
thirty days of the signing of the contract. A guardian or other
legal representative of the patient may give written notice of the
rescission of the contract if the patient is incapacitated or a
minor.
(B) As used in this section and in sections 2711.23 and
2711.24 of the Revised Code:
(1) "Healthcare provider" means a physician, podiatrist,
dentist, licensed practical nurse, registered nurse, advanced
practice registered nurse, chiropractor, optometrist, physician
assistant, emergency medical technician-basic, emergency medical
technician-intermediate, emergency medical technician-paramedic,
or physical therapist.
(2) "Hospital," "physician," "podiatrist," "dentist,"
"licensed practical nurse," "registered nurse," "advanced practice
registered nurse," "chiropractor," "optometrist," "physician
assistant," "emergency medical technician-basic," "emergency
medical technician-intermediate," "emergency medical
technician-paramedic," "physical therapist," "medical claim,"
"dental claim," "optometric claim," and "chiropractic claim" have
the same meanings as in section 2305.113 of the Revised Code.
Sec. 3701.92. As used in sections 3701.921 to 3701.929 of
the Revised Code:
(A) "Advanced practice registered nurse" has the same meaning
as in section 4723.01 of the Revised Code.
(B) "Patient centered medical home education advisory group"
means the entity established under section 3701.924 of the Revised
Code.
(D)(C) "Patient centered medical home education program"
means the program established under section 3701.921 of the
Revised Code and any pilot projects operated pursuant to that
section.
(E)(D) "Patient centered medical home education pilot
project" means the pilot project established under section
3701.923 of the Revised Code.
(F)(E) "Physician assistant" has the same meaning as in
section 4730.01 of the Revised Code.
Sec. 3701.923. (A) To the extent that funds are available,
the director of health shall establish the patient centered
medical home education pilot project. If the director establishes
the project, all of the following apply:
(1) The director shall select practices led by physicians and
primary care practices led by advanced practice registered nurses
to participate in the project. The director may consider the
recommendations of the advisory group made in accordance with
section 3701.925 of the Revised Code, but may not select a
practice unless the practice complies with any applicable
requirements under section 3701.926 of the Revised Code.
(2) The director shall conduct the project in a manner that
advances education in the patient centered medical home model of
care.
(3) The director shall evaluate all of the following:
(a) Learning opportunities generated by the project;
(b) Training of physicians and advanced practice registered
nurses under the project;
(c) Costs of the project;
(d) The extent to which the project met the expected outcomes
developed under division (A) of section 3701.924 of the Revised
Code.
(4) The director shall assess and review results of the
project.
(5) The director shall recommend best practices and
opportunities for improving technology, education, comprehensive
training, consultation, and technical assistance for health care
service providers in the patient centered medical home model of
care.
(B) The director may contract with an entity that has
significant experience in assisting physician-led practices led by
physicians and
advanced practice nurse-led primary care practices
led by advanced practice registered nurses in transitioning to the
patient centered medical home model of care. The contract shall
require the entity to do both of the following:
(1) Provide, to each practice that enters into a contract
with the director pursuant to section 3701.927 of the Revised
Code, comprehensive training, consultation, and technical
assistance in the operation of a patient centered medical home,
including assistance with leadership training, scheduling changes,
staff support, and care management for chronic health conditions;
(2) Assist the director in identifying necessary financial
and operational requirements and any barriers or challenges
associated with transitioning to a patient centered medical home
model of care.
(C) The project established under this section shall begin
not later than the date the first practice enters into a contract
with the director pursuant to section 3701.927 of the Revised Code
and shall cease not later than the date the final report is
submitted pursuant to division (B)(3) of section 3701.929 of the
Revised Code.
(D) The project shall not be operated in a manner that
requires a patient, unless otherwise required by the Revised Code,
to receive a referral from a physician in a practice selected for
inclusion in the pilot project under division (A)(1) of this
section as a condition of being authorized to receive specialized
health care services from an individual licensed or certified
under Title XLVII of the Revised Code to provide those services.
Sec. 3701.924. (A) The patient centered medical home
education advisory group is hereby created for the purpose of
advising the director of health on the implementation and
administration of the patient centered medical home education
program. The advisory group shall develop and provide to the
director a set of expected outcomes for the pilot project. The
advisory group shall consider and provide other recommendations to
the director and complete other duties as the director considers
appropriate.
(B) The advisory group shall consist of the following
members:
(1) The following members appointed by the director of
health:
(a) One individual with expertise in the training and
education of primary care physicians recommended by the dean of
the university of Toledo college of medicine;
(b) One individual with expertise in the training and
education of primary care physicians recommended by the dean of
the Boonshoft school of medicine at Wright state university;
(c) One individual with expertise in the training and
education of primary care physicians recommended by the president
and dean of the northeast Ohio medical university;
(d) One individual with expertise in the training and
education of primary care physicians recommended by the dean of
the Ohio university college of osteopathic medicine;
(e) Two individuals recommended by the governing board of the
Ohio academy of family physicians;
(f) One individual recommended by the governing board of the
Ohio chapter of the American college of physicians;
(g) One individual recommended by the governing board of the
Ohio chapter of the American academy of pediatrics;
(h) One individual recommended by the governing board of the
Ohio osteopathic association;
(i) One individual with expertise in the training and
education of advanced practice registered nurses, recommended by
the governing board of the Ohio council of deans and directors of
baccalaureate and higher degree programs in nursing;
(j) One individual recommended by the governing board of the
Ohio nurses association;
(k) One individual recommended by the governing board of the
Ohio association of advanced practice nurses;
(l) One individual recommended by the governing board of the
Ohio council for home care and hospice;
(m) One individual recommended by the superintendent of
insurance;
(n) An employee of the department of health;
(o) Not more than five additional members who have relevant
expertise that the director considers appropriate.
(2) The following members:
(a) The executive director of the state medical board or the
director's designee;
(b) The executive director of the board of nursing or the
director's designee;
(c) The chancellor of the Ohio board of regents or the
chancellor's designee;
(d) The medical assistance director, or the director's
designee.
(C)(1) In making the original appointments of the members
specified in divisions (B)(1)(a) to (m) of this section, the
director shall appoint the member who served in that capacity in
the patient centered medical home advisory group, as it existed
immediately prior to the effective date of this section September
10, 2012. If for any reason the member who served immediately
prior to the effective date of this section September 10, 2012, is
unable to serve on the advisory group, the director shall request
from the specified recommending authority a list of not less than
two persons qualified to serve as members of the advisory group.
The director shall appoint as a member one person from the list
submitted by the recommending authority.
(2) The advisory group members specified in divisions
(B)(1)(a) to (m) of this section shall serve at the pleasure of
the director, in consultation with their respective recommending
authorities.
(3) Vacancies shall be filled in the manner provided for
original appointments.
(D) Members shall serve without compensation, except to the
extent that serving on the advisory group is considered part of
their regular employment duties.
(E) The director may appoint from the members of the advisory
group a chairperson and vice-chairperson.
A majority of the members of the advisory group constitutes a
quorum. A majority of a quorum is necessary for the advisory group
to make any recommendations to the director.
The advisory group shall meet at the call of the director.
The director shall call the advisory group to meet not less than
annually to discuss or consider recommendations to the director on
the administration of the patient centered medical home education
program.
(F) Sections 101.82 to 101.87 of the Revised Code do not
apply to the advisory group.
Sec. 3701.925. (A) The patient centered medical home
education advisory group shall accept applications for inclusion
in the patient centered medical home education pilot project from
primary care practices with educational affiliations, as
determined by the advisory group, with one or more of the
following:
(1) The Boonshoft school of medicine at Wright state
university;
(2) The university of Toledo college of medicine;
(3) The northeast Ohio medical university;
(4) The Ohio university college of osteopathic medicine;
(5) The college of nursing at the university of Toledo;
(6) The Wright state university college of nursing and
health;
(7) The college of nursing at Kent state university;
(8) The university of Akron college of nursing;
(9) The school of nursing at Ohio university.
(B)(1) Subject to division (C)(1) of this section, the
advisory group shall recommend to the director of health for
inclusion in the pilot project not less than the following number
of primary care practices led by physicians:
(a) Ten practices affiliated with the Boonshoft school of
medicine at Wright state university;
(b) Ten practices affiliated with the university of Toledo
college of medicine;
(c) Ten practices affiliated with the northeast Ohio medical
university;
(d) Ten practices affiliated with the centers for osteopathic
research and education of the Ohio university college of
osteopathic medicine.
(2) Subject to division (C)(2) of this section, the advisory
group shall recommend to the director of health for inclusion in
the pilot project not less than the following number of primary
care practices led by advanced practice registered nurses:
(a) One practice affiliated with the college of nursing at
the university of Toledo;
(b) One practice affiliated with the Wright state university
college of nursing and health;
(c) One practice affiliated with the college of nursing at
Kent state university or the university of Akron college of
nursing;
(d) One practice affiliated with the school of nursing at
Ohio university.
(C)(1) All of the following apply with respect to the
recommendation of physician-led practices under division (B)(1) of
this section of practices led by physicians:
(a) The advisory group shall strive to recommend
physician-led practices in such a manner that the pilot project
includes a diverse range of primary care specialties, including
practices specializing in pediatrics, geriatrics, general internal
medicine, or family medicine.
(b) When evaluating an application, the advisory group shall
consider the percentage of patients in the physician-led practice
who are part of a medically underserved population, including
medicaid recipients and individuals without health insurance.
(c) The advisory group shall recommend not fewer than six
practices that serve rural areas of this state, as those areas are
determined by the advisory group.
(d) A member of the advisory group shall abstain from
participating in any vote taken regarding the recommendation of a
physician-led practice if the member would receive any financial
benefit from having the practice included in the pilot project.
(2) All of the following apply with respect to the
recommendation of advanced practice nurse-led primary care
practices under division (B)(2) of this section of practices led
by advanced practice registered nurses:
(a) When evaluating an application, the advisory group shall
consider the percentage of patients in the advanced practice
nurse-led primary care practice who are part of a medically
underserved population, including medicaid recipients and
individuals without health insurance.
(b) If the advisory group determines that it has not received
an application from a sufficiently qualified advanced practice
nurse-led primary care practice affiliated with a particular
institution specified in division (B)(2) of this section, the
advisory group shall make the recommendations required under that
division in such a manner that the greatest possible number of
those institutions are recommended to be included in the pilot
project. To be recommended in this manner, a practice remains
subject to the eligibility requirements specified in division (B)
of section 3701.926 of the Revised Code. As specified in division
(B)(2) of this section, the number of practices recommended for
inclusion in the pilot project shall be at least four.
(c) A member of the advisory group shall abstain from
participating in any vote taken regarding the recommendation of an
advanced practice nurse-led primary care a practice if the member
would receive any financial benefit from having the practice
included in the pilot project.
(D) The advisory group shall provide a copy to the director
of health copies of all applications received under this section
to the director of health after making recommendations under
division (B)(1) of this section.
Sec. 3701.926. (A) To be eligible for inclusion in the
patient centered medical home education pilot project, a
physician-led primary care practice led by physicians shall meet
all of the following requirements:
(1) Consist of physicians who are board-certified in family
medicine, general pediatrics, or internal medicine, as those
designations are issued by a medical specialty certifying board
recognized by the American board of medical specialties or
American osteopathic association;
(2) Be capable of adapting the practice during the period in
which the practice participates in the patient centered medical
home education pilot project in such a manner that the practice is
fully compliant with the minimum standards for operation of a
patient centered medical home, as those standards are established
by the director of health;
(3) Have submitted an application to participate in the
project established under former section 185.05 of the Revised
Code not later than April 15, 2011.
(4) Meet any other criteria established by the director as
part of the selection process.
(B) To be eligible for inclusion in the pilot project, an
advanced practice nurse-led a primary care practice led by
advanced practice registered nurses shall meet all of the
following requirements:
(1) Consist of advanced practice registered nurses, each of
whom meets all of the following requirements:
(a) Holds a certificate to prescribe issued under section
4723.48 of the Revised Code;
(b) Is board-certified as a family nurse practitioner or
adult nurse practitioner by the American academy of nurse
practitioners or American nurses credentialing center,
board-certified as a geriatric nurse practitioner or women's
health nurse practitioner by the American nurses credentialing
center, or is board-certified as a pediatric nurse practitioner by
the American nurses credentialing center or pediatric nursing
certification board;
(c) Collaborates under a standard care arrangement with a
physician with board certification as specified in division (A)(1)
of this section and who is an active participant on the health
care team.
(2) Be capable of adapting the primary care practice during
the period in which the practice participates in the project in
such a manner that the practice is fully compliant with the
minimum standards for operation of a patient centered medical
home, as those standards are established by the director;
(3) Have submitted an application to participate in the
project established under former section 185.05 of the Revised
Code not later than April 15, 2011.
(4) Meet any other criteria established by the director as
part of the selection process.
Sec. 3701.927. The director of health shall enter into a
contract with each primary care practice selected by the director
for inclusion in the patient centered medical home education pilot
project. The contract shall specify the terms and conditions for
inclusion in the pilot project, including a requirement that the
practice provide comprehensive, coordinated primary care services
to patients and serve as the patients' medical home. The contract
shall also require the practice to participate in the training of
medical students, advanced practice registered nursing students,
physician assistant students, and primary care medical residents.
The director may include as part of the contract any other
requirements necessary for a practice to be included in the
project, including requirements regarding the number of patients
served who are medicaid recipients and individuals without health
insurance.
Sec. 3701.928. (A) The director of health or, at the
director's request, the patient centered medical home education
advisory group may work with medical, nursing, and physician
assistant schools or programs in this state to develop appropriate
curricula designed to prepare primary care physicians, advanced
practice registered nurses, and physician assistants to practice
within the patient centered medical home model of care. In
developing the curricula, the director or advisory group and the
schools or programs shall include all of the following:
(1) Components for use at the medical student, advanced
practice registered nursing student, physician assistant student,
and primary care resident training levels;
(2) Components that reflect, as appropriate, the special
needs of patients who are part of a medically underserved
population, including medicaid recipients, individuals without
health insurance, individuals with disabilities, individuals with
chronic health conditions, and individuals within racial or ethnic
minority groups;
(3) Components that include training in interdisciplinary
cooperation between physicians, advanced practice registered
nurses, and physician assistants in the patient centered medical
home model of care, including curricula ensuring that a common
conception of a patient centered medical home model of care is
provided to medical students, advanced practice registered nurses,
physician assistants, and primary care residents.
(B) The director or advisory group may work in association
with the medical, nursing, and physician assistant schools or
programs to identify funding sources to ensure that the curricula
developed under division (A) of this section are accessible to
medical students, advanced practice registered nursing students,
physician assistant students, and primary care residents. The
director or advisory group shall consider scholarship options or
incentives provided to students in addition to those provided
under the choose Ohio first scholarship program operated under
section 3333.61 of the Revised Code.
Sec. 3701.929. (A) If the director of health establishes the
patient centered medical home education pilot project, the
director shall prepare reports of its findings and recommendations
from the pilot project. Each report shall include an evaluation of
the learning opportunities generated by the pilot project, the
physicians and advanced practice registered nurses trained in the
pilot project, the costs of the pilot project, and the extent to
which the pilot project has met the set of expected outcomes
developed under division (A) of section 3701.924 of the Revised
Code.
(B) The reports shall be completed in accordance with the
following schedule:
(1) An interim report not later than six months after the
date on which the last primary care practice selected to
participate in the project enters into a contract with the
department of health pursuant to section 3701.927 of the Revised
Code;
(2) An update of the interim report not later than one year
after the date specified under division (B)(1) of this section;
(3) A final report not later than two years after the date
specified under division (B)(1) of this section.
(C) The director shall submit each of the reports to the
governor and, in accordance with section 101.68 of the Revised
Code, to the general assembly.
Sec. 3793.11. (A) No alcohol and drug addiction program
shall employ methadone treatment or prescribe, dispense, or
administer methadone unless the program is licensed under this
section. No alcohol and drug addiction program licensed under this
section shall maintain methadone treatment in a manner
inconsistent with this section and the rules adopted under it.
(B) An alcohol and drug addiction program may apply to the
department of alcohol and drug addiction services for a license to
maintain methadone treatment. The department shall review all
applications received.
(C) The department may issue a license to maintain methadone
treatment to an alcohol and drug addiction program only if all of
the following apply:
(1) The program is operated by a private, nonprofit
organization or by a government entity;
(2) For at least two years immediately preceding the date of
application, the program has been fully certified under section
3793.06 of the Revised Code;
(3) The program has not been denied a license to maintain
methadone treatment or had its license withdrawn or revoked within
the five-year period immediately preceding the date of
application;
(4) It affirmatively appears to the department that the
program is adequately staffed and equipped to maintain methadone
treatment;
(5) It affirmatively appears to the department that the
program will conduct maintain methadone treatment in strict
compliance with section 3719.61 of the Revised Code, all other
laws relating to drug abuse, and the rules adopted by the
department;
(6) Except as provided in division (D) of this section, there
is no public or private school, licensed child day-care center, or
other child-serving agency within a radius of five hundred feet of
the location where the program is to maintain methadone treatment.
(D) The department may waive the requirement of division
(C)(6) of this section if it receives, from each public or private
school, licensed child day-care center, or other child-serving
agency that is within the applicable radius of the location where
the program is to maintain methadone treatment, a letter of
support for the location. The department shall determine whether a
letter of support is satisfactory for purposes of waiving the
requirement.
(D)(E) A license to maintain methadone treatment shall expire
one year from the date of issuance. Licenses may be renewed.
(E)(F) The department shall establish procedures and adopt
rules for licensing, inspection, and supervision of alcohol and
drug addiction programs that maintain methadone treatment. The
rules shall establish standards for the control, storage,
furnishing, use, and dispensing of methadone, prescribe minimum
standards for the operation of the methadone treatment component
of the program, and comply with federal laws and regulations.
All rules adopted under this division shall be adopted in
accordance with Chapter 119. of the Revised Code. All actions
taken by the department regarding the licensing of programs to
maintain methadone treatment shall be conducted in accordance with
Chapter 119. of the Revised Code, except as provided in division
(K)(L) of this section.
(F)(G) The department of alcohol and drug addiction services
shall inspect all alcohol and drug addiction programs licensed to
maintain methadone treatment. Inspections shall be conducted at
least annually and may be conducted more frequently. No person or
government entity shall interfere with a state or local government
official acting on behalf of the department while conducting an
inspection.
(G)(H) An alcohol and drug addiction program shall not
administer or dispense methadone in a tablet, powder, or
intravenous form. Methadone shall be administered or dispensed
only in a liquid form intended for ingestion. A program shall not
administer or dispense methadone to an individual for pain or
other medical reasons.
(H)(1)(I) As used in this division, "program sponsor" means a
person who assumes responsibility for the operation and employees
of the methadone treatment component of an alcohol and drug
addiction program.
(2) An alcohol and drug addiction program shall not employ an
individual who receives methadone treatment from that program. A
program shall not permit an individual to act as a program
sponsor, medical director, or director of the program if the
individual is receiving methadone treatment from any alcohol and
drug addiction program.
(I)(J) The department may issue orders to assure compliance
with section 3719.61 of the Revised Code, all other laws relating
to drug abuse, and the rules adopted under this section. Subject
to section 3793.13 of the Revised Code, the department may hold
hearings, require the production of relevant matter, compel
testimony, issue subpoenas, and make adjudications. Upon failure
of a person without lawful excuse to obey a subpoena or to produce
relevant matter, the department may apply to a court of common
pleas for an order compelling compliance.
(J)(K) The department may refuse to issue, or may withdraw or
revoke, a license to maintain methadone treatment. A license may
be refused if an alcohol and drug addiction program does not meet
the requirements of division (C) of this section. A license may be
withdrawn at any time the department determines that the program
no longer meets the requirements for receiving the license. A
license may be revoked in accordance with division (K)(L) of this
section.
(K) In the case of a license issued prior to the effective
date of this amendment, the department shall not consider the
requirement of division (C)(6) of this section in determining
whether to renew, withdraw, or revoke the license.
(L) If the department of alcohol and drug addiction services
finds reasonable cause to believe that an alcohol and drug
addiction program licensed under this section is in violation of
any provision of section 3719.61 of the Revised Code, or of any
other state or federal law or rule relating to drug abuse, the
department may issue an order immediately revoking the license,
subject to division (L)(M) of this section. The department shall
set a date not more than fifteen days later than the date of the
order of revocation for a hearing on the continuation or
cancellation of the revocation. For good cause, the department may
continue the hearing on application of any interested party. In
conducting hearings, the department has all the authority and
power set forth in division (I)(J) of this section. Following the
hearing, the department shall either confirm or cancel the
revocation. The hearing shall be conducted in accordance with
Chapter 119. of the Revised Code, except that the program shall
not be permitted to maintain methadone treatment pending the
hearing or pending any appeal from an adjudication made as a
result of the hearing. Notwithstanding any provision of Chapter
119. of the Revised Code to the contrary, a court shall not stay
or suspend any order of revocation issued by the director under
this division pending judicial appeal.
(L)(M) The department shall not revoke a license to maintain
methadone treatment unless all clients receiving methadone
treatment from the alcohol and drug addiction program are provided
adequate substitute treatment. For purposes of this division, the
department may transfer the clients to other programs licensed to
maintain methadone treatment or replace any or all of the
administrators and staff of the program with representatives of
the department who shall continue on a provisional basis the
methadone treatment component of the program.
(M)(N) Each time the department receives an application from
an alcohol and drug addiction program for a license to maintain
methadone treatment, issues or refuses to issue a license, or
withdraws or revokes a license, the department shall notify the
board of alcohol, drug addiction, and mental health services of
each alcohol, drug addiction, and mental health service district
in which the program is operated.
(N)(O) Whenever it appears to the department from files, upon
complaint, or otherwise, that an alcohol and drug addiction
program has engaged in any practice declared to be illegal or
prohibited by section 3719.61 of the Revised Code, or any other
state or federal laws or regulations relating to drug abuse, or
when the department believes it to be in the best interest of the
public and necessary for the protection of the citizens of the
state, the department may request criminal proceedings by laying
before the prosecuting attorney of the proper county any evidence
of criminality which may come to its knowledge.
(O)(P) The department shall maintain a current list of
alcohol and drug addiction programs licensed by the department
under division (C) of this section and shall provide a copy of the
current list to a judge of a court of common pleas who requests a
copy for the use of the judge under division (H) of section
2925.03 of the Revised Code. The list of licensed alcohol and drug
addiction programs shall identify each licensed program by its
name, its address, and the county in which it is located.
Sec. 3963.01. As used in this chapter:
(A) "Affiliate" means any person or entity that has ownership
or control of a contracting entity, is owned or controlled by a
contracting entity, or is under common ownership or control with a
contracting entity.
(B) "Basic health care services" has the same meaning as in
division (A) of section 1751.01 of the Revised Code, except that
it does not include any services listed in that division that are
provided by a pharmacist or nursing home.
(C) "Contracting entity" means any person that has a primary
business purpose of contracting with participating providers for
the delivery of health care services.
(D) "Credentialing" means the process of assessing and
validating the qualifications of a provider applying to be
approved by a contracting entity to provide basic health care
services, specialty health care services, or supplemental health
care services to enrollees.
(E) "Edit" means adjusting one or more procedure codes billed
by a participating provider on a claim for payment or a practice
that results in any of the following:
(1) Payment for some, but not all of the procedure codes
originally billed by a participating provider;
(2) Payment for a different procedure code than the procedure
code originally billed by a participating provider;
(3) A reduced payment as a result of services provided to an
enrollee that are claimed under more than one procedure code on
the same service date.
(F) "Electronic claims transport" means to accept and
digitize claims or to accept claims already digitized, to place
those claims into a format that complies with the electronic
transaction standards issued by the United States department of
health and human services pursuant to the "Health Insurance
Portability and Accountability Act of 1996," 110 Stat. 1955, 42
U.S.C. 1320d, et seq., as those electronic standards are
applicable to the parties and as those electronic standards are
updated from time to time, and to electronically transmit those
claims to the appropriate contracting entity, payer, or
third-party administrator.
(G) "Enrollee" means any person eligible for health care
benefits under a health benefit plan, including an eligible
recipient of medicaid under Chapter 5111. of the Revised Code, and
includes all of the following terms:
(1) "Enrollee" and "subscriber" as defined by section 1751.01
of the Revised Code;
(2) "Member" as defined by section 1739.01 of the Revised
Code;
(3) "Insured" and "plan member" pursuant to Chapter 3923. of
the Revised Code;
(4) "Beneficiary" as defined by section 3901.38 of the
Revised Code.
(H) "Health care contract" means a contract entered into,
materially amended, or renewed between a contracting entity and a
participating provider for the delivery of basic health care
services, specialty health care services, or supplemental health
care services to enrollees.
(I) "Health care services" means basic health care services,
specialty health care services, and supplemental health care
services.
(J) "Material amendment" means an amendment to a health care
contract that decreases the participating provider's payment or
compensation, changes the administrative procedures in a way that
may reasonably be expected to significantly increase the
provider's administrative expenses, or adds a new product. A
material amendment does not include any of the following:
(1) A decrease in payment or compensation resulting solely
from a change in a published fee schedule upon which the payment
or compensation is based and the date of applicability is clearly
identified in the contract;
(2) A decrease in payment or compensation that was
anticipated under the terms of the contract, if the amount and
date of applicability of the decrease is clearly identified in the
contract;
(3) An administrative change that may significantly increase
the provider's administrative expense, the specific applicability
of which is clearly identified in the contract;
(4) Changes to an existing prior authorization,
precertification, notification, or referral program that do not
substantially increase the provider's administrative expense;
(5) Changes to an edit program or to specific edits if the
participating provider is provided notice of the changes pursuant
to division (A)(1) of section 3963.04 of the Revised Code and the
notice includes information sufficient for the provider to
determine the effect of the change;
(6) Changes to a health care contract described in division
(B) of section 3963.04 of the Revised Code.
(K) "Participating provider" means a provider that has a
health care contract with a contracting entity and is entitled to
reimbursement for health care services rendered to an enrollee
under the health care contract.
(L) "Payer" means any person that assumes the financial risk
for the payment of claims under a health care contract or the
reimbursement for health care services provided to enrollees by
participating providers pursuant to a health care contract.
(M) "Primary enrollee" means a person who is responsible for
making payments for participation in a health care plan or an
enrollee whose employment or other status is the basis of
eligibility for enrollment in a health care plan.
(N) "Procedure codes" includes the American medical
association's current procedural terminology code, the American
dental association's current dental terminology, and the centers
for medicare and medicaid services health care common procedure
coding system.
(O) "Product" means one of the following types of categories
of coverage for which a participating provider may be obligated to
provide health care services pursuant to a health care contract:
(1) A health maintenance organization or other product
provided by a health insuring corporation;
(2) A preferred provider organization;
(5) Workers' compensation.
(P) "Provider" means a physician, podiatrist, dentist,
chiropractor, optometrist, psychologist, physician assistant,
advanced practice registered nurse, occupational therapist,
massage therapist, physical therapist, professional counselor,
professional clinical counselor, hearing aid dealer, orthotist,
prosthetist, home health agency, hospice care program, or
hospital, or a provider organization or physician-hospital
organization that is acting exclusively as an administrator on
behalf of a provider to facilitate the provider's participation in
health care contracts. "Provider" does not mean a pharmacist,
pharmacy, nursing home, or a provider organization or
physician-hospital organization that leases the provider
organization's or physician-hospital organization's network to a
third party or contracts directly with employers or health and
welfare funds.
(Q) "Specialty health care services" has the same meaning as
in section 1751.01 of the Revised Code, except that it does not
include any services listed in division (B) of section 1751.01 of
the Revised Code that are provided by a pharmacist or a nursing
home.
(R) "Supplemental health care services" has the same meaning
as in division (B) of section 1751.01 of the Revised Code, except
that it does not include any services listed in that division that
are provided by a pharmacist or nursing home.
Sec. 4503.44. (A) As used in this section and in section
4511.69 of the Revised Code:
(1) "Person with a disability that limits or impairs the
ability to walk" means any person who, as determined by a health
care provider, meets any of the following criteria:
(a) Cannot walk two hundred feet without stopping to rest;
(b) Cannot walk without the use of, or assistance from, a
brace, cane, crutch, another person, prosthetic device,
wheelchair, or other assistive device;
(c) Is restricted by a lung disease to such an extent that
the person's forced (respiratory) expiratory volume for one
second, when measured by spirometry, is less than one liter, or
the arterial oxygen tension is less than sixty millimeters of
mercury on room air at rest;
(d) Uses portable oxygen;
(e) Has a cardiac condition to the extent that the person's
functional limitations are classified in severity as class III or
class IV according to standards set by the American heart
association;
(f) Is severely limited in the ability to walk due to an
arthritic, neurological, or orthopedic condition;
(2) "Organization" means any private organization or
corporation, or any governmental board, agency, department,
division, or office, that, as part of its business or program,
transports persons with disabilities that limit or impair the
ability to walk on a regular basis in a motor vehicle that has not
been altered for the purpose of providing it with special
equipment for use by handicapped persons. This definition does not
apply to division (J) of this section.
(3) "Health care provider" means a physician, physician
assistant, advanced practice registered nurse, or chiropractor as
defined in this section.
(4) "Physician" means a person licensed to practice medicine
or surgery or osteopathic medicine and surgery under Chapter 4731.
of the Revised Code.
(5) "Chiropractor" means a person licensed to practice
chiropractic under Chapter 4734. of the Revised Code.
(6) "Advanced practice registered nurse" means any a
certified nurse practitioner, clinical nurse specialist, certified
registered nurse anesthetist, or certified nurse-midwife who holds
a certificate of authority issued by the board of nursing under
Chapter 4723. of the Revised Code.
(7) "Physician assistant" means a person who holds a
certificate to practice as a physician assistant issued under
Chapter 4730. of the Revised Code.
(B) Any organization or person with a disability that limits
or impairs the ability to walk may apply to the registrar of motor
vehicles for a removable windshield placard or, if the person owns
or leases a motor vehicle, the person may apply for the
registration of any motor vehicle the person owns or leases. In
addition to one or more sets of license plates or one placard, a
person with a disability that limits or impairs the ability to
walk is entitled to one additional placard, but only if the person
applies separately for the additional placard, states the reasons
why the additional placard is needed, and the registrar, in the
registrar's discretion, determines that good and justifiable cause
exists to approve the request for the additional placard. When a
motor vehicle has been altered for the purpose of providing it
with special equipment for a person with a disability that limits
or impairs the ability to walk, but is owned or leased by someone
other than such a person, the owner or lessee may apply to the
registrar or a deputy registrar for registration under this
section. The application for registration of a motor vehicle owned
or leased by a person with a disability that limits or impairs the
ability to walk shall be accompanied by a signed statement from
the applicant's health care provider certifying that the applicant
meets at least one of the criteria contained in division (A)(1) of
this section and that the disability is expected to continue for
more than six consecutive months. The application for a removable
windshield placard made by a person with a disability that limits
or impairs the ability to walk shall be accompanied by a
prescription from the applicant's health care provider prescribing
such a placard for the applicant, provided that the applicant
meets at least one of the criteria contained in division (A)(1) of
this section. The health care provider shall state on the
prescription the length of time the health care provider expects
the applicant to have the disability that limits or impairs the
applicant's ability to walk. The application for a removable
windshield placard made by an organization shall be accompanied by
such documentary evidence of regular transport of persons with
disabilities that limit or impair the ability to walk by the
organization as the registrar may require by rule and shall be
completed in accordance with procedures that the registrar may
require by rule. The application for registration of a motor
vehicle that has been altered for the purpose of providing it with
special equipment for a person with a disability that limits or
impairs the ability to walk but is owned by someone other than
such a person shall be accompanied by such documentary evidence of
vehicle alterations as the registrar may require by rule.
(C) When an organization, a person with a disability that
limits or impairs the ability to walk, or a person who does not
have a disability that limits or impairs the ability to walk but
owns a motor vehicle that has been altered for the purpose of
providing it with special equipment for a person with a disability
that limits or impairs the ability to walk first submits an
application for registration of a motor vehicle under this section
and every fifth year thereafter, the organization or person shall
submit a signed statement from the applicant's health care
provider, a completed application, and any required documentary
evidence of vehicle alterations as provided in division (B) of
this section, and also a power of attorney from the owner of the
motor vehicle if the applicant leases the vehicle. Upon submission
of these items, the registrar or deputy registrar shall issue to
the applicant appropriate vehicle registration and a set of
license plates and validation stickers, or validation stickers
alone when required by section 4503.191 of the Revised Code. In
addition to the letters and numbers ordinarily inscribed thereon,
the license plates shall be imprinted with the international
symbol of access. The license plates and validation stickers shall
be issued upon payment of the regular license fee as prescribed
under section 4503.04 of the Revised Code and any motor vehicle
tax levied under Chapter 4504. of the Revised Code, and the
payment of a service fee equal to the amount specified in division
(D) or (G) of section 4503.10 of the Revised Code.
(D)(1) Upon receipt of a completed and signed application for
a removable windshield placard, a prescription as described in
division (B) of this section, documentary evidence of regular
transport of persons with disabilities that limit or impair the
ability to walk, if required, and payment of a service fee equal
to the amount specified in division (D) or (G) of section 4503.10
of the Revised Code, the registrar or deputy registrar shall issue
to the applicant a removable windshield placard, which shall bear
the date of expiration on both sides of the placard and shall be
valid until expired, revoked, or surrendered. Every removable
windshield placard expires as described in division (D)(2) of this
section, but in no case shall a removable windshield placard be
valid for a period of less than sixty days. Removable windshield
placards shall be renewable upon application as provided in
division (B) of this section, and a service fee equal to the
amount specified in division (D) or (G) of section 4503.10 of the
Revised Code shall be charged for the renewal of a removable
windshield placard. The registrar shall provide the application
form and shall determine the information to be included thereon.
The registrar also shall determine the form and size of the
removable windshield placard, the material of which it is to be
made, and any other information to be included thereon, and shall
adopt rules relating to the issuance, expiration, revocation,
surrender, and proper display of such placards. Any placard issued
after October 14, 1999, shall be manufactured in a manner that
allows the expiration date of the placard to be indicated on it
through the punching, drilling, boring, or creation by any other
means of holes in the placard.
(2) At the time a removable windshield placard is issued to a
person with a disability that limits or impairs the ability to
walk, the registrar or deputy registrar shall enter into the
records of the bureau of motor vehicles the last date on which the
person will have that disability, as indicated on the accompanying
prescription. Not less than thirty days prior to that date and all
removable windshield placard renewal dates, the bureau shall send
a renewal notice to that person at the person's last known address
as shown in the records of the bureau, informing the person that
the person's removable windshield placard will expire on the
indicated date not to exceed five years from the date of issuance,
and that the person is required to renew the placard by submitting
to the registrar or a deputy registrar another prescription, as
described in division (B) of this section, and by complying with
the renewal provisions prescribed in division (D)(1) of this
section. If such a prescription is not received by the registrar
or a deputy registrar by that date, the placard issued to that
person expires and no longer is valid, and this fact shall be
recorded in the records of the bureau.
(3) At least once every year, on a date determined by the
registrar, the bureau shall examine the records of the office of
vital statistics, located within the department of health, that
pertain to deceased persons, and also the bureau's records of all
persons who have been issued removable windshield placards and
temporary removable windshield placards. If the records of the
office of vital statistics indicate that a person to whom a
removable windshield placard or temporary removable windshield
placard has been issued is deceased, the bureau shall cancel that
placard, and note the cancellation in its records.
The office of vital statistics shall make available to the
bureau all information necessary to enable the bureau to comply
with division (D)(3) of this section.
(4) Nothing in this section shall be construed to require a
person or organization to apply for a removable windshield placard
or special license plates if the parking card or special license
plates issued to the person or organization under prior law have
not expired or been surrendered or revoked.
(E)(1)(a) Any person with a disability that limits or impairs
the ability to walk may apply to the registrar or a deputy
registrar for a temporary removable windshield placard. The
application for a temporary removable windshield placard shall be
accompanied by a prescription from the applicant's health care
provider prescribing such a placard for the applicant, provided
that the applicant meets at least one of the criteria contained in
division (A)(1) of this section and that the disability is
expected to continue for six consecutive months or less. The
health care provider shall state on the prescription the length of
time the health care provider expects the applicant to have the
disability that limits or impairs the applicant's ability to walk,
which cannot exceed six months from the date of the prescription.
Upon receipt of an application for a temporary removable
windshield placard, presentation of the prescription from the
applicant's health care provider, and payment of a service fee
equal to the amount specified in division (D) or (G) of section
4503.10 of the Revised Code, the registrar or deputy registrar
shall issue to the applicant a temporary removable windshield
placard.
(b) Any active-duty member of the armed forces of the United
States, including the reserve components of the armed forces and
the national guard, who has an illness or injury that limits or
impairs the ability to walk may apply to the registrar or a deputy
registrar for a temporary removable windshield placard. With the
application, the person shall present evidence of the person's
active-duty status and the illness or injury. Evidence of the
illness or injury may include a current department of defense
convalescent leave statement, any department of defense document
indicating that the person currently has an ill or injured
casualty status or has limited duties, or a prescription from any
health care provider prescribing the placard for the applicant.
Upon receipt of the application and the necessary evidence, the
registrar or deputy registrar shall issue the applicant the
temporary removable windshield placard without the payment of any
service fee.
(2) The temporary removable windshield placard shall be of
the same size and form as the removable windshield placard, shall
be printed in white on a red-colored background, and shall bear
the word "temporary" in letters of such size as the registrar
shall prescribe. A temporary removable windshield placard also
shall bear the date of expiration on the front and back of the
placard, and shall be valid until expired, surrendered, or
revoked, but in no case shall such a placard be valid for a period
of less than sixty days. The registrar shall provide the
application form and shall determine the information to be
included on it, provided that the registrar shall not require a
health care provider's prescription or certification for a person
applying under division (E)(1)(b) of this section. The registrar
also shall determine the material of which the temporary removable
windshield placard is to be made and any other information to be
included on the placard and shall adopt rules relating to the
issuance, expiration, surrender, revocation, and proper display of
those placards. Any temporary removable windshield placard issued
after October 14, 1999, shall be manufactured in a manner that
allows for the expiration date of the placard to be indicated on
it through the punching, drilling, boring, or creation by any
other means of holes in the placard.
(F) If an applicant for a removable windshield placard is a
veteran of the armed forces of the United States whose disability,
as defined in division (A)(1) of this section, is
service-connected, the registrar or deputy registrar, upon receipt
of the application, presentation of a signed statement from the
applicant's health care provider certifying the applicant's
disability, and presentation of such documentary evidence from the
department of veterans affairs that the disability of the
applicant meets at least one of the criteria identified in
division (A)(1) of this section and is service-connected as the
registrar may require by rule, but without the payment of any
service fee, shall issue the applicant a removable windshield
placard that is valid until expired, surrendered, or revoked.
(G) Upon a conviction of a violation of division (I), (J), or
(K) of this section, the court shall report the conviction, and
send the placard or parking card, if available, to the registrar,
who thereupon shall revoke the privilege of using the placard or
parking card and send notice in writing to the placardholder or
cardholder at that holder's last known address as shown in the
records of the bureau, and the placardholder or cardholder shall
return the placard or card if not previously surrendered to the
court, to the registrar within ten days following mailing of the
notice.
Whenever a person to whom a removable windshield placard or
parking card has been issued moves to another state, the person
shall surrender the placard or card to the registrar; and whenever
an organization to which a placard or card has been issued changes
its place of operation to another state, the organization shall
surrender the placard or card to the registrar.
(H) Subject to division (F) of section 4511.69 of the Revised
Code, the operator of a motor vehicle displaying a removable
windshield placard, temporary removable windshield placard,
parking card, or the special license plates authorized by this
section is entitled to park the motor vehicle in any special
parking location reserved for persons with disabilities that limit
or impair the ability to walk, also known as handicapped parking
spaces or disability parking spaces.
(I) No person or organization that is not eligible under
division (B) or (E) of this section shall willfully and falsely
represent that the person or organization is so eligible.
No person or organization shall display license plates issued
under this section unless the license plates have been issued for
the vehicle on which they are displayed and are valid.
(J) No person or organization to which a removable windshield
placard or temporary removable windshield placard is issued shall
do either of the following:
(1) Display or permit the display of the placard on any motor
vehicle when having reasonable cause to believe the motor vehicle
is being used in connection with an activity that does not include
providing transportation for persons with disabilities that limit
or impair the ability to walk;
(2) Refuse to return or surrender the placard, when required.
(K)(1) No person or organization to which a parking card is
issued shall do either of the following:
(a) Display or permit the display of the parking card on any
motor vehicle when having reasonable cause to believe the motor
vehicle is being used in connection with an activity that does not
include providing transportation for a handicapped person;
(b) Refuse to return or surrender the parking card, when
required.
(2) As used in division (K) of this section:
(a) "Handicapped person" means any person who has lost the
use of one or both legs or one or both arms, who is blind, deaf,
or so severely handicapped as to be unable to move about without
the aid of crutches or a wheelchair, or whose mobility is
restricted by a permanent cardiovascular, pulmonary, or other
handicapping condition.
(b) "Organization" means any private organization or
corporation, or any governmental board, agency, department,
division, or office, that, as part of its business or program,
transports handicapped persons on a regular basis in a motor
vehicle that has not been altered for the purposes of providing it
with special equipment for use by handicapped persons.
(L) If a removable windshield placard, temporary removable
windshield placard, or parking card is lost, destroyed, or
mutilated, the placardholder or cardholder may obtain a duplicate
by doing both of the following:
(1) Furnishing suitable proof of the loss, destruction, or
mutilation to the registrar;
(2) Paying a service fee equal to the amount specified in
division (D) or (G) of section 4503.10 of the Revised Code.
Any placardholder or cardholder who loses a placard or card
and, after obtaining a duplicate, finds the original, immediately
shall surrender the original placard or card to the registrar.
(M) The registrar shall pay all fees received under this
section for the issuance of removable windshield placards or
temporary removable windshield placards or duplicate removable
windshield placards or cards into the state treasury to the credit
of the state bureau of motor vehicles fund created in section
4501.25 of the Revised Code.
(N) In addition to the fees collected under this section, the
registrar or deputy registrar shall ask each person applying for a
removable windshield placard or temporary removable windshield
placard or duplicate removable windshield placard or license plate
issued under this section, whether the person wishes to make a
two-dollar voluntary contribution to support rehabilitation
employment services. The registrar shall transmit the
contributions received under this division to the treasurer of
state for deposit into the rehabilitation employment fund, which
is hereby created in the state treasury. A deputy registrar shall
transmit the contributions received under this division to the
registrar in the time and manner prescribed by the registrar. The
contributions in the fund shall be used by the rehabilitation
services commission to purchase services related to vocational
evaluation, work adjustment, personal adjustment, job placement,
job coaching, and community-based assessment from accredited
community rehabilitation program facilities.
(O) For purposes of enforcing this section, every peace
officer is deemed to be an agent of the registrar. Any peace
officer or any authorized employee of the bureau of motor vehicles
who, in the performance of duties authorized by law, becomes aware
of a person whose placard or parking card has been revoked
pursuant to this section, may confiscate that placard or parking
card and return it to the registrar. The registrar shall prescribe
any forms used by law enforcement agencies in administering this
section.
No peace officer, law enforcement agency employing a peace
officer, or political subdivision or governmental agency employing
a peace officer, and no employee of the bureau is liable in a
civil action for damages or loss to persons arising out of the
performance of any duty required or authorized by this section. As
used in this division, "peace officer" has the same meaning as in
division (B) of section 2935.01 of the Revised Code.
(P) All applications for registration of motor vehicles,
removable windshield placards, and temporary removable windshield
placards issued under this section, all renewal notices for such
items, and all other publications issued by the bureau that relate
to this section shall set forth the criminal penalties that may be
imposed upon a person who violates any provision relating to
special license plates issued under this section, the parking of
vehicles displaying such license plates, and the issuance,
procurement, use, and display of removable windshield placards and
temporary removable windshield placards issued under this section.
(Q) Whoever violates this section is guilty of a misdemeanor
of the fourth degree.
Sec. 4723.01. As used in this chapter:
(A) "Registered nurse" means an individual who holds a
current, valid license issued under this chapter that authorizes
the practice of nursing as a registered nurse.
(B) "Practice of nursing as a registered nurse" means
providing to individuals and groups nursing care requiring
specialized knowledge, judgment, and skill derived from the
principles of biological, physical, behavioral, social, and
nursing sciences. Such nursing care includes:
(1) Identifying patterns of human responses to actual or
potential health problems amenable to a nursing regimen;
(2) Executing a nursing regimen through the selection,
performance, management, and evaluation of nursing actions;
(3) Assessing health status for the purpose of providing
nursing care;
(4) Providing health counseling and health teaching;
(5) Administering medications, treatments, and executing
regimens authorized by an individual who is authorized to practice
in this state and is acting within the course of the individual's
professional practice;
(6) Teaching, administering, supervising, delegating, and
evaluating nursing practice.
(C) "Nursing regimen" may include preventative, restorative,
and health-promotion activities.
(D) "Assessing health status" means the collection of data
through nursing assessment techniques, which may include
interviews, observation, and physical evaluations for the purpose
of providing nursing care.
(E) "Licensed practical nurse" means an individual who holds
a current, valid license issued under this chapter that authorizes
the practice of nursing as a licensed practical nurse.
(F) "The practice of nursing as a licensed practical nurse"
means providing to individuals and groups nursing care requiring
the application of basic knowledge of the biological, physical,
behavioral, social, and nursing sciences at the direction of a
licensed physician, dentist, podiatrist, optometrist,
chiropractor, or registered nurse. Such nursing care includes:
(1) Observation, patient teaching, and care in a diversity of
health care settings;
(2) Contributions to the planning, implementation, and
evaluation of nursing;
(3) Administration of medications and treatments authorized
by an individual who is authorized to practice in this state and
is acting within the course of the individual's professional
practice, except that administration of intravenous therapy shall
be performed only in accordance with section 4723.17 or 4723.171
of the Revised Code. Medications may be administered by a on the
condition that the licensed practical nurse upon proof of
completion of a course in medication administration approved by
the board of nursing. is authorized under section 4723.17 of the
Revised Code to administer medications;
(4) Administration to an adult of intravenous therapy
authorized by an individual who is authorized to practice in this
state and is acting within the course of the individual's
professional practice, on the condition that the licensed
practical nurse is authorized under section 4723.17 4723.18 or
4723.171 4723.181 of the Revised Code to perform intravenous
therapy and performs intravenous therapy only in accordance with
those sections;
(5) Delegation of nursing tasks as directed by a registered
nurse;
(6) Teaching nursing tasks to licensed practical nurses and
individuals to whom the licensed practical nurse is authorized to
delegate nursing tasks as directed by a registered nurse.
(G) "Certified registered nurse anesthetist" means a
registered nurse who holds a valid certificate of authority issued
under this chapter that authorizes the practice of nursing as a
certified registered nurse anesthetist in accordance with section
4723.43 of the Revised Code and rules adopted by the board of
nursing.
(H) "Clinical nurse specialist" means a registered nurse who
holds a valid certificate of authority issued under this chapter
that authorizes the practice of nursing as a clinical nurse
specialist in accordance with section 4723.43 of the Revised Code
and rules adopted by the board of nursing.
(I) "Certified nurse-midwife" means a registered nurse who
holds a valid certificate of authority issued under this chapter
that authorizes the practice of nursing as a certified
nurse-midwife in accordance with section 4723.43 of the Revised
Code and rules adopted by the board of nursing.
(J) "Certified nurse practitioner" means a registered nurse
who holds a valid certificate of authority issued under this
chapter that authorizes the practice of nursing as a certified
nurse practitioner in accordance with section 4723.43 of the
Revised Code and rules adopted by the board of nursing.
(K) "Physician" means an individual authorized under Chapter
4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery, except as used in divisions (C)
and (D) of section 4723.482 of the Revised Code.
(L) "Collaboration" or "collaborating" means the following:
(1) In the case of a clinical nurse specialist, except as
provided in division (L)(3) of this section, or a certified nurse
practitioner, that one or more podiatrists acting within the scope
of practice of podiatry in accordance with section 4731.51 of the
Revised Code and with whom the nurse has entered into a standard
care arrangement or one or more physicians with whom the nurse has
entered into a standard care arrangement are continuously
available to communicate with the clinical nurse specialist or
certified nurse practitioner either in person or by radio,
telephone, or other form of telecommunication;
(2) In the case of a certified nurse-midwife, that one or
more physicians with whom the certified nurse-midwife has entered
into a standard care arrangement are continuously available to
communicate with the certified nurse-midwife either in person or
by radio, telephone, or other form of telecommunication;
(3) In the case of a clinical nurse specialist who practices
the nursing specialty of mental health or psychiatric mental
health without being authorized to prescribe drugs and therapeutic
devices, that one or more physicians are continuously available to
communicate with the nurse either in person or by radio,
telephone, or other form of telecommunication.
(M) "Supervision," as it pertains to a certified registered
nurse anesthetist, means that the certified registered nurse
anesthetist is under the direction of a podiatrist acting within
the podiatrist's scope of practice in accordance with section
4731.51 of the Revised Code, a dentist acting within the dentist's
scope of practice in accordance with Chapter 4715. of the Revised
Code, or a physician, and, when administering anesthesia, the
certified registered nurse anesthetist is in the immediate
presence of the podiatrist, dentist, or physician.
(N) "Standard care arrangement" means a written, formal guide
for planning and evaluating a patient's health care that is
developed by one or more collaborating physicians or podiatrists
and a clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner and meets the requirements of section
4723.431 of the Revised Code.
(O) "Advanced practice registered nurse" means a certified
registered nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner.
(P) "Dialysis care" means the care and procedures that a
dialysis technician or dialysis technician intern is authorized to
provide and perform, as specified in section 4723.72 of the
Revised Code.
(Q) "Dialysis technician" means an individual who holds a
current, valid certificate or temporary certificate issued under
this chapter that authorizes the individual to practice as a
dialysis technician in accordance with issued under section
4723.72 4723.75 of the Revised Code.
(R) "Dialysis technician intern" means an individual who
holds a current, valid certificate to practice as a dialysis
technician intern issued under section 4723.75 of the Revised
Code.
(S) "Certified community health worker" means an individual
who holds a current, valid certificate as a community health
worker issued by the board of nursing under section 4723.85 of the
Revised Code.
(T) "Medication aide" means an individual who holds a
current, valid certificate issued under this chapter that
authorizes the individual to administer medication in accordance
with section 4723.67 of the Revised Code.
Sec. 4723.03. (A) No person shall engage in the practice of
nursing as a registered nurse, represent the person as being a
registered nurse, or use the title "registered nurse," the
initials "R.N.," or any other title implying that the person is a
registered nurse, for a fee, salary, or other consideration, or as
a volunteer, without holding a current, valid license as a
registered nurse under this chapter.
(B) No person shall engage in the practice of nursing as a
licensed practical nurse, represent the person as being a licensed
practical nurse, or use the title "licensed practical nurse," the
initials "L.P.N.," or any other title implying that the person is
a licensed practical nurse, for a fee, salary, or other
consideration, or as a volunteer, without holding a current, valid
license as a practical nurse under this chapter.
(C) No person shall use the titles or initials "graduate
nurse," "G.N.," "professional nurse," "P.N.," "graduate practical
nurse," "G.P.N.," "practical nurse," "P.N.," "trained nurse,"
"T.N.," or any other statement, title, or initials that would
imply or represent to the public that the person is authorized to
practice nursing in this state, except as follows:
(1) A person licensed under this chapter to practice nursing
as a registered nurse may use that title and the initials "R.N.";
(2) A person licensed under this chapter to practice nursing
as a licensed practical nurse may use that title and the initials
"L.P.N.";
(3) A person authorized under this chapter to practice
nursing as a certified registered nurse anesthetist may use that
title, the initials "C.R.N.A." or "N.A.," and any other title or
initials approved by the board of nursing;
(4) A person authorized under this chapter to practice
nursing as a clinical nurse specialist may use that title, the
initials "C.N.S.," and any other title or initials approved by the
board;
(5) A person authorized under this chapter to practice
nursing as a certified nurse-midwife may use that title, the
initials "C.N.M.," and any other title or initials approved by the
board;
(6) A person authorized under this chapter to practice
nursing as a certified nurse practitioner may use that title, the
initials "C.N.P.," and any other title or initials approved by the
board;
(7) A person authorized under this chapter to practice as a
certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner may use
the title "advanced practice registered nurse" or the initials
"A.P.R.N."
(D) No person shall employ a person not licensed as a
registered nurse under this chapter to engage in the practice of
nursing as a registered nurse. No person shall employ a person not
licensed as a practical nurse under this chapter to engage in the
practice of nursing as a licensed practical nurse.
(E) No person shall sell or fraudulently obtain or furnish
any nursing diploma, license, certificate, renewal, or record, or
aid or abet such acts.
Sec. 4723.06. (A) The board of nursing shall:
(1) Administer and enforce the provisions of this chapter,
including the taking of disciplinary action for violations of
section 4723.28 of the Revised Code, any other provisions of this
chapter, or rules adopted under this chapter;
(2) Develop criteria that an applicant must meet to be
eligible to sit for the examination for licensure to practice as a
registered nurse or as a licensed practical nurse;
(3) Issue and renew nursing licenses, dialysis technician
certificates, and community health worker certificates, as
provided in this chapter;
(4) Define the minimum curricula and standards for
educational programs of the schools of professional registered
nursing and schools of practical nursing in this state;
(5) Survey, inspect, and grant full approval to prelicensure
nursing education programs in this state that meet the standards
established by rules adopted under section 4723.07 of the Revised
Code. Prelicensure nursing education programs include, but are not
limited to, diploma, associate degree, baccalaureate degree,
diploma master's degree, and doctor of nursing programs leading to
initial licensure to practice nursing as a registered nurse and
practical nurse programs leading to initial licensure to practice
nursing as a licensed practical nurse.
(6) Grant conditional approval, by a vote of a quorum of the
board, to a new prelicensure nursing education program or a
program that is being reestablished after having ceased to
operate, if the program meets and maintains the minimum standards
of the board established by rules adopted under section 4723.07 of
the Revised Code. If the board does not grant conditional
approval, it shall hold an adjudication under Chapter 119. of the
Revised Code to consider conditional approval of the program. If
the board grants conditional approval, at its the first meeting
after the first class has completed the program following
completion of the survey process required by division (A)(5) of
this section, the board shall determine whether to grant full
approval to the program. If the board does not grant full approval
or if it appears that the program has failed to meet and maintain
standards established by rules adopted under section 4723.07 of
the Revised Code, the board shall hold an adjudication under
Chapter 119. of the Revised Code to consider the program. Based on
results of the adjudication, the board may continue or withdraw
conditional approval, or grant full approval.
(7) Place on provisional approval, for a period of time
specified by the board, a program that has ceased to meet and
maintain the minimum standards of the board established by rules
adopted under section 4723.07 of the Revised Code. At Prior to or
at the end of the period, the board shall reconsider whether the
program meets the standards and shall grant full approval if it
does. If it does not, the board may withdraw approval, pursuant to
an adjudication under Chapter 119. of the Revised Code.
(8) Approve continuing nursing education programs and courses
under standards established in rules adopted under section
sections 4723.07, 4723.69, 4723.79, and 4723.88 of the Revised
Code;
(9) Approve peer support programs, under rules adopted under
section 4723.07 of the Revised Code, for nurses, for dialysis
technicians, and for certified community health workers;
(10) Establish a program for monitoring chemical dependency
in accordance with section 4723.35 of the Revised Code;
(11)(10) Establish the practice intervention and improvement
program in accordance with section 4723.282 of the Revised Code;
(12)(11) Issue and renew certificates of authority to
practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner;
(13)(12) Approve under section 4723.46 of the Revised Code
national certifying organizations for examination and
certification of certified registered nurse anesthetists, clinical
nurse specialists, certified nurse-midwives, or certified nurse
practitioners;
(14)(13) Issue and renew certificates to prescribe in
accordance with sections 4723.48 and 4723.486 of the Revised Code;
(15)(14) Grant approval to the planned classroom and clinical
study required by section 4723.482 of the Revised Code to be
eligible for a certificate to prescribe;
(16)(15) Make an annual edition of the formulary established
in rules adopted under section 4723.50 of the Revised Code
available to the public either in printed form or by electronic
means and, as soon as possible after any revision of the formulary
becomes effective, make the revision available to the public in
printed form or by electronic means;
(17)(16) Provide guidance and make recommendations to the
general assembly, the governor, state agencies, and the federal
government with respect to the regulation of the practice of
nursing and the enforcement of this chapter;
(18)(17) Make an annual report to the governor, which shall
be open for public inspection;
(19)(18) Maintain and have open for public inspection the
following records:
(a) A record of all its meetings and proceedings;
(b) A file record of all applicants for, and holders of
nursing, licenses, registrations, and certificates granted under
this chapter; dialysis technician certificates granted under this
chapter; and community health worker certificates granted issued
by the board under this chapter. The file shall be maintained in
the form prescribed by rule of the board or in accordance with
rules adopted under this chapter. The record shall be maintained
in a format determined by the board.
(c) A list of prelicensure nursing education and training
programs approved by the board;
(d) A list of approved peer support programs for nurses,
dialysis technicians, and certified community health workers.
(19) Deny approval to a person who submits or causes to be
submitted false, misleading, or deceptive statements, information,
or documentation to the board in the process of applying for
approval of a new education or training program. If the board
proposes to deny approval of a new education or training program,
it shall do so pursuant to an adjudication conducted under Chapter
119. of the Revised Code.
(B) The board may fulfill the requirement of division (A)(8)
of this section by authorizing persons who meet the standards
established in rules adopted under section 4723.07 of the Revised
Code to approve continuing nursing education programs and courses.
Persons so authorized shall approve continuing nursing education
programs and courses in accordance with standards established in
rules adopted under section 4723.07 of the Revised Code.
Persons seeking authorization to approve continuing nursing
education programs and courses shall apply to the board and pay
the appropriate fee established under section 4723.08 of the
Revised Code. Authorizations to approve continuing nursing
education programs and courses shall expire, and may be renewed
according to the schedule established in rules adopted under
section 4723.07 of the Revised Code.
In addition to approving continuing nursing education
programs under division (A)(8) of this section, the board may
sponsor continuing education activities that are directly related
to the statutes and rules pertaining to the practice of nursing in
this state the board enforces.
Sec. 4723.063. (A) As used in this section:
(1) "Health care facility" means:
(a) A hospital registered under section 3701.07 of the
Revised Code;
(b) 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;
(c) 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. 301, as amended;
(d) A freestanding dialysis center;
(e) A freestanding inpatient rehabilitation facility;
(f) An ambulatory surgical facility;
(g) A freestanding cardiac catheterization facility;
(h) A freestanding birthing center;
(i) A freestanding or mobile diagnostic imaging center;
(j) A freestanding radiation therapy center.
(2) "Nurse education program" means a prelicensure nurse
education program approved by the board of nursing under section
4723.06 of the Revised Code or a postlicensure nurse education
program approved by the board of regents under section 3333.04 of
the Revised Code.
(B) The state board of nursing shall establish and administer
the nurse education grant program. Under the program, the board
shall award grants to nurse education programs that have
partnerships with other education programs, community health
agencies, or health care facilities, or patient centered medical
homes. Grant recipients shall use the money to fund partnerships
to increase the nurse education program's enrollment capacity.
Methods of increasing a program's enrollment capacity may include
hiring faculty and preceptors, purchasing educational equipment
and materials, and other actions acceptable to the board. Grant
money shall not be used to construct or renovate buildings.
Partnerships may be developed between one or more nurse education
programs and one or more health care facilities.
In awarding grants, the board shall give preference to
partnerships between nurse education programs and hospitals,
nursing homes, and county homes or county nursing homes, but may
also award grants to fund partnerships between nurse education
programs and other health care facilities and between nurse
education programs and patient centered medical homes.
(C) The board shall adopt rules in accordance with Chapter
119. of the Revised Code establishing the following:
(1) Eligibility requirements for receipt of a grant;
(2) Grant application forms and procedures;
(3) The amounts in which grants may be made and the total
amount that may be awarded to a nurse education program that has a
partnership with other education programs, a community health
agency, or a health care facility, or a patient centered medical
home;
(4) A method whereby the board may evaluate the effectiveness
of a partnership between joint recipients in increasing the nurse
education program's enrollment capacity;
(5) The percentage of the money in the fund that must remain
in the fund at all times to maintain a fiscally responsible fund
balance;
(6) The percentage of available grants to be awarded to
licensed practical nurse education programs, registered nurse
education programs, and graduate programs;
(7) Any other matters incidental to the operation of the
program.
(D) From January 1, 2004, until Until December 31, 2013 2023,
the ten dollars of each biennial nursing license renewal fee
collected under section 4723.08 of the Revised Code shall be
dedicated to the nurse education grant program fund, which is
hereby created in the state treasury. The board shall use money in
the fund for grants awarded under division (A) of this section and
for expenses of administering the grant program. The amount used
for administrative expenses in any year shall not exceed ten per
cent of the amount transferred to the fund in that year.
(E) Each quarter, for the purposes of transferring funds to
the nurse education grant program, the board of nursing shall
certify to the director of budget and management the number of
biennial licenses renewed under this chapter during the preceding
quarter and the amount equal to that number times ten dollars.
(F) Notwithstanding the requirements of section 4743.05 of
the Revised Code, from January 1, 2004, until December 31, 2013
2023, at the end of each quarter, the director of budget and
management shall transfer from the occupational licensing and
regulatory fund to the nurse education grant program fund the
amount certified under division (E) of this section.
Sec. 4723.07. In accordance with Chapter 119. of the Revised
Code, the board of nursing shall adopt and may amend and rescind
rules that establish all of the following:
(A) Provisions for the board's government and control of its
actions and business affairs;
(B) Minimum curricula and standards for nursing education
programs that prepare graduates to be licensed under this chapter
and procedures for granting, renewing, and withdrawing approval of
those programs;
(C) Criteria that applicants for licensure must meet to be
eligible to take examinations for licensure;
(D) Standards and procedures for renewal of the licenses and
certificates issued by the board;
(E) Standards for approval of continuing nursing education
programs and courses for registered nurses, licensed practical
nurses, certified registered nurse anesthetists, clinical nurse
specialists, certified nurse-midwives, and certified nurse
practitioners. The standards may provide for approval of
continuing nursing education programs and courses that have been
approved by other state boards of nursing or by national
accreditation systems for nursing, including, but not limited to,
the American nurses' credentialing center and the national
association for practical nurse education and service.
(F) Standards that persons must meet to be authorized by the
board to approve continuing nursing education programs and courses
and a schedule by which that authorization expires and may be
renewed;
(G) Requirements, including continuing education
requirements, for restoring reactivating inactive nursing
licenses, dialysis technician certificates, and community health
worker or certificates, and for restoring nursing
reinstating
licenses, dialysis technician certificates, and community health
worker or certificates that have lapsed through failure to renew;
(H) Conditions that may be imposed for reinstatement of a
nursing license, dialysis technician certificate, or community
health worker or certificate following action taken under section
3123.47, 4723.28, 4723.281, 4723.652, or 4723.86 of the Revised
Code resulting in a license or certificate suspension;
(I) Standards for approval of peer support programs for
persons who hold a nursing license, dialysis technician
certificate, or community health worker certificate;
(J) Requirements for board approval of courses in medication
administration by licensed practical nurses;
(K)(J) Criteria for evaluating the qualifications of an
applicant for a license to practice nursing as a registered nurse
or, a license to practice nursing as a licensed practical nurse,
or a certificate of authority issued under division (E)(B) of
section 4723.41 of the Revised Code, a dialysis technician
certificate, or a community health worker certificate for the
purpose of issuing the license or certificate by the board's
endorsement of the applicant's authority to practice issued by the
licensing agency of another state;
(L)(K) Universal blood and
body fluid standard precautions
that shall be used by each person holding a nursing license
licensee or dialysis technician certificate issued under this
chapter who performs exposure-prone invasive procedures holder.
The rules shall define and establish requirements for universal
blood and body fluid standard precautions that include the
following:
(1) Appropriate use of hand washing;
(2) Disinfection and sterilization of equipment;
(3) Handling and disposal of needles and other sharp
instruments;
(4) Wearing and disposal of gloves and other protective
garments and devices.
(M)(L) Standards and procedures for approving certificates of
authority to practice nursing as a certified registered nurse
anesthetist, clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner, and for renewal of those
certificates;
(N)(M) Quality assurance standards for certified registered
nurse anesthetists, clinical nurse specialists, certified
nurse-midwives, or certified nurse practitioners;
(O)(N) Additional criteria for the standard care arrangement
required by section 4723.431 of the Revised Code entered into by a
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner and the nurse's collaborating physician or
podiatrist;
(P)(O) Continuing education standards for clinical nurse
specialists who are exempt were issued a certificate of authority
to practice as a clinical nurse specialist under division (C) of
section 4723.41 of the Revised Code from the requirement of having
passed a certification examination as that division existed at any
time before the effective date of this amendment;
(Q)(P) For purposes of division (B)(31) of section 4723.28 of
the Revised Code, the actions, omissions, or other circumstances
that constitute failure to establish and maintain professional
boundaries with a patient.
The board may adopt other rules necessary to carry out the
provisions of this chapter. The rules shall be adopted in
accordance with Chapter 119. of the Revised Code.
Sec. 4723.08. (A) The board of nursing may impose fees not
to exceed the following limits:
(1) For application for licensure by examination to practice
nursing as a registered nurse or as a licensed practical nurse,
seventy-five dollars;
(2) For application for licensure by endorsement to practice
nursing as a registered nurse or as a licensed practical nurse,
seventy-five dollars;
(3) For application for a certificate of authority to
practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner, one hundred dollars;
(4) For application for a temporary dialysis technician
certificate, the amount specified in rules adopted under section
4723.79 of the Revised Code;
(5) For application for a full dialysis technician
certificate, the amount specified in rules adopted under section
4723.79 of the Revised Code;
(6) For application for a certificate to prescribe, fifty
dollars;
(7) For providing, pursuant to division (B) of section
4723.271 of the Revised Code, written verification of a nursing
license, certificate of authority, or certificate to prescribe,
dialysis technician certificate, medication aide certificate, or
community health worker certificate to another jurisdiction,
fifteen dollars;
(8) For providing, pursuant to division (A) of section
4723.271 of the Revised Code, a replacement copy of a nursing
license, certificate of authority, certificate to prescribe,
dialysis technician certificate, intravenous therapy card, or
frameable wall certificate suitable for framing as described in
that division, twenty-five dollars;
(9) For biennial renewal of a nursing license that expires on
or after August 31, 2003, but before January 1, 2004, forty-five
dollars;
(10) For biennial renewal of a nursing license that expires
on or after January 1, 2004, sixty-five dollars;
(11) For biennial renewal of a certificate of authority to
practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse mid-wife, or certified
nurse practitioner that expires on or before August 31, 2005, one
hundred dollars;
(12)(10) For biennial renewal of a certificate of authority
to practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner that expires on or after September 1, 2005,
eighty-five dollars;
(13)(11) For renewal of a certificate to prescribe, fifty
dollars;
(14)(12) For biennial renewal of a dialysis technician
certificate, the amount specified in rules adopted under section
4723.79 of the Revised Code;
(15)(13) For processing a late application for renewal of a
nursing license, certificate of authority, or dialysis technician
certificate, fifty dollars;
(16)(14) For application for authorization to approve
continuing nursing education programs and courses from an
applicant accredited by a national accreditation system for
nursing, five hundred dollars;
(17)(15) For application for authorization to approve
continuing nursing education programs and courses from an
applicant not accredited by a national accreditation system for
nursing, one thousand dollars;
(18)(16) For each year for which authorization to approve
continuing nursing education programs and courses is renewed, one
hundred fifty dollars;
(19)(17) For application for approval to operate a dialysis
training program, the amount specified in rules adopted under
section 4723.79 of the Revised Code;
(20)(18) For reinstatement of a lapsed
nursing license,
certificate of authority, or dialysis technician certificate
issued under this chapter, one hundred dollars except as provided
in section 5903.10 of the Revised Code;
(21)(19) For written verification of a nursing license,
certificate of authority, or dialysis technician certificate, when
the verification is performed for purposes other than providing
verification to another jurisdiction, five dollars;
(22)(20) For processing a check returned to the board by a
financial institution as noncollectible, twenty-five dollars;
(23) For issuance of an intravenous therapy card for which a
fee may be charged under section 4723.17 of the Revised Code,
twenty-five dollars;
(24) For out-of-state survey visits of nursing education
programs operating in Ohio, two thousand dollars;
(25)(21) The amounts specified in rules adopted under section
4723.88 of the Revised Code pertaining to the issuance of
certificates to community health workers, including fees for
application for a certificate, verification of a certificate to
another jurisdiction, written verification of a certificate when
the verification is performed for purposes other than verification
to another jurisdiction, providing a replacement copy of a
certificate, biennial renewal of a certificate, processing a late
application for renewal of a certificate, reinstatement of a
lapsed certificate, application for approval of a community health
worker training program for community health workers, and biennial
renewal of the approval of a training program for community health
workers.
(B) Each quarter, for purposes of transferring funds under
section 4743.05 of the Revised Code to the nurse education
assistance fund created in section 3333.28 of the Revised Code,
the board of nursing shall certify to the director of budget and
management the number of biennial licenses renewed under this
chapter during the preceding quarter and the amount equal to that
number times five dollars.
(C) The board may charge a participant in a board-sponsored
continuing education activity an amount not exceeding fifteen
dollars for each activity.
(D) The board may contract for services pertaining to the
process of providing written verification of a nursing license,
certificate of authority, dialysis technician certificate, or
community health worker certificate when the verification is
performed for purposes other than providing verification to
another jurisdiction. The contract may include provisions
pertaining to the collection of the fee charged for providing the
written verification. As part of these provisions, the board may
permit the contractor to retain a portion of the fees as
compensation, before any amounts are deposited into the state
treasury.
Sec. 4723.09. (A)(1) An application for licensure by
examination to practice as a registered nurse or as a licensed
practical nurse shall be submitted to the board of nursing in the
form prescribed by rules of the board. The application shall
include evidence that the applicant has completed requirements of
a nursing education program approved by the board or approved by
another jurisdiction's under division (A) of section 4723.06 of
the Revised Code or by a board that regulates nurse licensure of
another jurisdiction that is a member of the national council of
state boards of nursing. The application also shall include any
other information required by rules of the board. The application
shall be accompanied by the application fee required by section
4723.08 of the Revised Code.
(2) The board shall grant a license to practice nursing as a
registered nurse or as a licensed practical nurse if all of the
following apply:
(a) For all applicants, the applicant passes the examination
accepted by the board under section 4723.10 of the Revised Code.
(b) For an applicant who entered a prelicensure nursing
education program on or after June 1, 2003, the results of a
criminal records check of the applicant that is completed by the
bureau of criminal identification and investigation and includes a
check of federal bureau of investigation records and that the
bureau submits to the board indicates that the applicant has not
been convicted of, has not pleaded guilty to, and has not had a
judicial finding of guilt for violating section 2903.01, 2903.02,
2903.03, 2903.11, 2905.01, 2907.02, 2907.03, 2907.05, 2909.02,
2911.01, or 2911.11 of the Revised Code or a substantially similar
law of another state, the United States, or another country
conducted in accordance with section 4723.091 of the Revised Code
demonstrate that the applicant is not ineligible for licensure as
specified in section 4723.092 of the Revised Code.
(c) For all applicants, the board determines that the
applicant has not committed any act that is grounds for
disciplinary action under section 3123.47 or 4723.28 of the
Revised Code or determines that an applicant who has committed any
act that is grounds for disciplinary action under either section
has made restitution or has been rehabilitated, or both.
(d) For all applicants, the applicant is not required to
register under Chapter 2950. of the Revised Code or a
substantially similar law of another state, the United States, or
another country.
(3) The board is not required to afford an adjudication to an
individual to whom it has refused to grant a license because of
that individual's failure to pass the examination.
(B)(1) An application for license by endorsement to practice
nursing as a registered nurse or as a licensed practical nurse
shall be submitted to the board in the form prescribed by rules of
the board and shall be accompanied by the application fee required
by section 4723.08 of the Revised Code. The application shall
include evidence that the applicant holds a current, valid, and
unrestricted license in good standing in another jurisdiction
granted after passing an examination approved by the board of that
jurisdiction that is equivalent to the examination requirements
under this chapter for a license to practice nursing as a
registered nurse or licensed practical nurse and. The application
shall include any other information required by rules of the board
of nursing. The
application shall be accompanied by the
application fee required by section 4723.08 of the Revised Code.
(2) The
board shall grant a license by endorsement to
practice nursing as a registered nurse or as a licensed practical
nurse if the applicant is licensed or certified by another
jurisdiction and the board determines, pursuant to rules
established under section 4723.07 of the Revised Code, that all of
the following apply:
(1)(a) For all applicants, the educational preparation of the
applicant is substantially similar to the minimum curricula and
standards for provides evidence satisfactory to the board that the
applicant has successfully completed a nursing education programs
established by program approved by the board under division (A) of
section
4723.07 4723.06 of the Revised Code or by a board of
another jurisdiction that is a member of the national council of
state boards of nursing.
(2)(b) For all applicants, the examination, at the time it is
successfully completed, is equivalent to the examination
requirements in effect at that time for applicants who were
licensed by examination in this state.
(3)(c) For all applicants, the board determines there is
sufficient evidence that the applicant completed two contact hours
of continuing education directly related to this chapter or the
rules adopted under it.
(d) For all applicants, the results of a criminal records
check of the applicant that is completed by the bureau of criminal
identification and investigation and includes a check of federal
bureau of investigation records and that the bureau submits to the
board indicates that the applicant has not been convicted of, has
not pleaded guilty to, and has not had a judicial finding of guilt
for violating section 2903.01, 2903.02, 2903.03, 2903.11, 2905.01,
2907.02, 2907.03, 2907.05, 2909.02, 2911.01, or 2911.11 of the
Revised Code or a substantially similar law of another state, the
United States, or another country conducted in accordance with
section 4723.091 of the Revised Code demonstrate that the
applicant is not ineligible for licensure as specified in section
4723.092 of the Revised Code.
(4)(e) For all applicants, the applicant has not committed
any act that is grounds for disciplinary action under section
3123.47, or 4723.28, or 4723.281 of the Revised Code, or the board
determines that an applicant who has committed any act that is
grounds for disciplinary action under any either of those sections
has made restitution or has been rehabilitated, or both.
(f) For all applicants, the applicant is not required to
register under Chapter 2950. of the Revised Code, or a
substantially similar law of another state, the United States, or
another country.
(C) The board may grant a nonrenewable temporary permit to
practice nursing as a registered nurse or as a licensed practical
nurse to an applicant for license by endorsement if the board is
satisfied by the evidence that the applicant holds a current,
active valid, and unrestricted license in good standing in another
jurisdiction. Subject to earlier automatic termination as
described in this paragraph, the temporary permit shall expire at
the earlier of one hundred eighty days after issuance or upon the
issuance of a license by endorsement. The temporary permit shall
terminate automatically if the criminal records check completed by
the bureau of criminal identification and investigation as
described in this section 4723.091 of the Revised Code regarding
the applicant indicates that the applicant previously has been
convicted of, pleaded guilty to, or had a judicial finding of
guilt for a violation of section 2903.01, 2903.02, 2903.03,
2903.11, 2905.01, 2907.02, 2907.03, 2907.05, 2909.02, 2911.01, or
2911.11 of the Revised Code or a substantially similar law of
another state, the United States, or another country is ineligible
for licensure as specified in section 4723.092 of the Revised
Code. An applicant whose temporary permit is automatically
terminated is permanently prohibited from obtaining a license to
practice nursing in this state as a registered nurse or as a
licensed practical nurse.
(C) An applicant under this section shall submit a request to
the bureau of criminal identification and investigation for a
criminal records check of the applicant. The request shall be on
the form prescribed pursuant to division (C)(1) of section 109.572
of the Revised Code, accompanied by a standard impression sheet to
obtain fingerprints prescribed pursuant to division (C)(2) of that
section, and accompanied by the fee prescribed pursuant to
division (C)(3) of that section. Upon receipt of the completed
form, the completed impression sheet, and the fee, the bureau
shall conduct a criminal records check of the applicant. Upon
completion of the criminal records check, the bureau shall send
the results of the check to the board. An applicant requesting a
criminal records check under this division shall ask the
superintendent of the bureau of criminal identification and
investigation to also request the federal bureau of investigation
to provide the superintendent with any information it has with
respect to the applicant.
The results of any criminal records check conducted pursuant
to a request made under this section, and any report containing
those results, are not public records for purposes of section
149.43 of the Revised Code and shall not be made available to any
person or for any purpose other than the following:
(1) The results may be made available to any person for use
in determining under this section and division (N) of section
4723.28 of the Revised Code whether the individual who is the
subject of the check should be granted a license to practice
nursing as a registered nurse or as a licensed practical nurse or
whether any temporary permit granted to the individual under this
section has terminated automatically.
(2) The results may be made available to the individual who
is the subject of the check or that individual's representative.
Sec. 4723.091. (A) An individual who applies for licensure
under section 4723.09 of the Revised Code; issuance of a
certificate under section 4723.651, 4723.75, 4723.76, or 4723.85
of the Revised Code; reactivation of a license, under division (D)
of section 4723.24 of the Revised Code, that has been inactive for
at least five years; or reinstatement of a license, under division
(D) of section 4723.24 of the Revised Code, that has been expired
for at least five years shall submit a request to the bureau of
criminal identification and investigation for a criminal records
check of the applicant. The request shall be made in accordance
with section 109.572 of the Revised Code.
(B) An applicant requesting a criminal records check under
division (A) of this section shall also ask the superintendent of
the bureau of criminal identification and investigation to request
that the federal bureau of investigation send to the
superintendent any information the federal bureau of investigation
has with respect to the applicant.
(C) On receipt of all items required for the commencement of
a criminal records check pursuant to division (A) of this section,
the bureau of criminal identification and investigation shall
conduct a criminal records check of the applicant. On the
completion of the criminal records check, the bureau shall send
the results to the board of nursing.
(D) The results of a criminal records check conducted
pursuant to a request made under division (A) of this section, and
any report containing those results, are not public records for
purposes of section 149.43 of the Revised Code and shall not be
made available to any person or for any purpose other than the
following:
(1) The results may be made available to any person for use
in determining under section 4723.09, 4723.651, 4723.75, 4723.76,
or 4723.85 of the Revised Code whether the individual who is the
subject of the check should be granted a license or certificate
under this chapter or whether any temporary permit granted to the
individual under either of the following has terminated
automatically:
(a) Section 4723.09 of the Revised Code;
(b) Section 4723.76 of the Revised Code as that section
existed at any time before the effective date of this section.
(2) The results may be made available to any person for use
in determining under division (D) of section 4723.24 of the
Revised Code whether the individual who is the subject of the
check should have the individual's license or certificate
reactivated or reinstated.
(3) The results may be made available to any person for use
in determining under section 4723.28 of the Revised Code whether
the individual who is the subject of the check should be subject
to disciplinary action in accordance with that section.
(4) The results may be made available to the individual who
is the subject of the check or that individual's representative.
Sec. 4723.092. An individual is ineligible for licensure
under section 4723.09 of the Revised Code or issuance of a
certificate under section 4723.651, 4723.75, 4723.76, or 4723.85
of the Revised Code if a criminal records check conducted in
accordance with section 4723.091 of the Revised Code indicates
that the individual has been convicted of, pleaded guilty to, or
had a judicial finding of guilt for either of the following:
(A) Violating section 2903.01, 2903.02, 2903.03, 2903.11,
2905.01, 2907.02, 2907.03, 2907.05, 2909.02, 2911.01, or 2911.11
of the Revised Code;
(B) Violating a law of another state, the United States, or
another country that is substantially similar to a law described
in division (A) of this section.
Sec. 4723.17. The board of nursing shall authorize a licensed
practical nurse to administer medications if the nurse supplies
evidence satisfactory to the board that either of the following is
the case:
(A) The nurse successfully completed, within a practical
nurse prelicensure education program approved by the board or by
another jurisdiction's agency that regulates the practice of
nursing, a course in basic pharmacology.
(B) The nurse successfully completed a postlicensure course
in basic pharmacology that is acceptable to the board.
Sec. 4723.17 4723.18. (A) The board of nursing may shall
authorize a licensed practical nurse to administer to an adult
intravenous therapy authorized by an individual who is authorized
to practice in this state and is acting within the course of the
individual's professional practice, if the
licensed practical
nurse has a current, valid license issued under this chapter that
includes authorization to administer medications and one supplies
evidence satisfactory to the board that all of the following
is
are the case:
(1) The nurse holds a current, valid license issued under
this chapter to practice nursing as a licensed practical nurse.
(2) The nurse has been authorized under section 4723.18 of
the Revised Code to administer medications.
(3) The nurse has successfully completed, within a practical
nurse prelicensure education program a course of study in the safe
performance of intravenous therapy approved by the board or by
another jurisdiction's agency that regulates the practice of
nursing, a course of study that prepares the nurse to safely
perform the intravenous therapy procedures the board may authorize
under this section. To meet this requirement, the course of study
must include all of the following:
(a) Both didactic and clinical components;
(b) Curriculum requirements established in rules the board of
nursing shall adopt in accordance with Chapter 119. of the Revised
Code;
(c) Standards that require the nurse to perform a successful
demonstration of the intravenous procedures, including all skills
needed to perform them safely pursuant to section 4723.19 of the
Revised Code or by an agency in another jurisdiction that
regulates the practice of nursing and has requirements for
intravenous therapy course approval that are substantially similar
to the requirements in division (B) of section 4723.19 of the
Revised Code, as determined by the board.
(2)(4) The nurse has successfully completed a minimum of
forty hours of training that includes all of the following:
(a) The curriculum established by rules adopted by the board
and in effect on January 1, 1999;
(b) Training in the anatomy and physiology of the
cardiovascular system, signs and symptoms of local and systemic
complications in the administration of fluids and antibiotic
additives, and guidelines for management of these complications;
(c) Any other training or instruction the board considers
appropriate.;
(d) A testing component that requires the nurse to perform a
successful demonstration of the intravenous procedures, including
all skills needed to perform them safely.
(B) Except as provided in section 4723.171 4723.181 of the
Revised Code and subject to the restrictions in division (D) of
this section, a licensed practical nurse may perform intravenous
therapy on an adult patient only if authorized by the board
pursuant to division (A) of this section and only if it is
performed in accordance with this section.
A licensed practical nurse authorized by the board to perform
intravenous therapy may perform an intravenous therapy procedure
only at the direction of one of the following:
(1) A licensed physician, dentist, optometrist, or podiatrist
who, except as provided in division (C)(2) of this section, is
present and readily available at the facility where the
intravenous therapy procedure is performed;
(2) A registered nurse in accordance with division (C) of
this section.
(C)(1) Except as provided in division (C)(2) of this section
and section 4723.171 4723.181 of the Revised Code, when a licensed
practical nurse authorized by the board to perform intravenous
therapy performs an intravenous therapy procedure at the direction
of a registered nurse, the registered nurse or another registered
nurse shall be readily available at the site where the intravenous
therapy is performed, and before the licensed practical nurse
initiates the intravenous therapy, the registered nurse shall
personally perform an on-site assessment of the individual adult
patient who is to receive the intravenous therapy.
(2) When a licensed practical nurse authorized by the board
to perform intravenous therapy performs an intravenous therapy
procedure in a home as defined in section 3721.10 of the Revised
Code, or in an intermediate care facility for the mentally
retarded as defined in section 5111.20 of the Revised Code, at the
direction of a registered nurse or licensed physician, dentist,
optometrist, or podiatrist, a registered nurse shall be on the
premises of the home or facility or accessible by some form of
telecommunication.
(D) No licensed practical nurse shall perform any of the
following intravenous therapy procedures:
(1) Initiating or maintaining any of the following:
(a) Blood or blood components;
(b) Solutions for total parenteral nutrition;
(c) Any cancer therapeutic medication including, but not
limited to, cancer chemotherapy or an anti-neoplastic agent;
(d) Solutions administered through any central venous line or
arterial line or any other line that does not terminate in a
peripheral vein, except that a licensed practical nurse authorized
by the board to perform intravenous therapy may maintain the
solutions specified in division (D)(6)(a) of this section that are
being administered through a central venous line or peripherally
inserted central catheter;
(e) Any investigational or experimental medication.
(2) Initiating intravenous therapy in any vein, except that a
licensed practical nurse authorized by the board to perform
intravenous therapy may initiate intravenous therapy in accordance
with this section in a vein of the hand, forearm, or antecubital
fossa;
(3) Discontinuing a central venous, arterial, or any other
line that does not terminate in a peripheral vein;
(4) Initiating or discontinuing a peripherally inserted
central catheter;
(5) Mixing, preparing, or reconstituting any medication for
intravenous therapy, except that a licensed practical nurse
authorized by the board to perform intravenous therapy may prepare
or reconstitute an antibiotic additive;
(6) Administering medication via the intravenous route,
including all of the following activities:
(a) Adding medication to an intravenous solution or to an
existing infusion, except that a licensed practical nurse
authorized by the board to perform intravenous therapy may do
either any of the following:
(i) Initiate an intravenous infusion containing one or more
of the following elements: dextrose 5%;, normal saline;, lactated
ringers;, sodium chloride .45%;, sodium chloride 0.2%;, sterile
water.;
(ii) Hang subsequent containers of the intravenous solutions
specified in division (D)(6)(a)(i) of this section that contain
vitamins or electrolytes, if a registered nurse initiated the
infusion of that same intravenous solution.
(b) Initiating or maintaining an intravenous piggyback
infusion, except that a licensed practical nurse authorized by the
board to perform intravenous therapy may initiate;
(iii) Initiate or maintain an intravenous piggyback infusion
containing an antibiotic additive;.
(c)(b) Injecting medication via a direct intravenous route,
except that a licensed practical nurse authorized by the board to
perform intravenous therapy may inject heparin or normal saline to
flush an intermittent infusion device or heparin lock including,
but not limited to, bolus or push.
(7) Aspirating any intravenous line to maintain patency;
(8) Changing tubing on any line including, but not limited
to, an arterial line or a central venous line, except that a
licensed practical nurse authorized by the board to perform
intravenous therapy may change tubing on an intravenous line that
terminates in a peripheral vein;
(9)(8) Programming or setting any function of a patient
controlled infusion pump.
(E) Notwithstanding division divisions (A) and (D) of this
section, at the direction of a physician or a registered nurse, a
licensed practical nurse authorized by the board to perform
intravenous therapy may perform the following activities for the
purpose of performing dialysis:
(1) The routine administration and regulation of saline
solution for the purpose of maintaining an established fluid plan;
(2) The administration of a heparin dose intravenously;
(3) The administration of a heparin dose peripherally via a
fistula needle;
(4) The loading and activation of a constant infusion pump or
the;
(5) The intermittent injection of a dose of medication
prescribed by a licensed physician for dialysis that is
administered via the hemodialysis blood circuit and through the
patient's venous access.
(F) No person shall employ or direct a licensed practical
nurse to perform an intravenous therapy procedure without first
verifying that the licensed practical nurse is authorized by the
board to perform intravenous therapy.
(G) The board shall issue an intravenous therapy card to the
licensed practical nurses authorized pursuant to division (A) of
this section to perform intravenous therapy. A fee for issuing the
card shall not be charged under section 4723.08 of the Revised
Code if the licensed practical nurse receives the card by meeting
the requirements of division (A)(1) of this section. The board
shall maintain a registry of the names of licensed practical
nurses who hold intravenous therapy cards.
Sec. 4723.171 4723.181. (A) A licensed practical nurse may
perform on any person any of the intravenous therapy procedures
specified in division (B) of this section without receiving
authorization to perform intravenous therapy from the board of
nursing under section 4723.17 4723.18 of the Revised Code, if both
of the following apply:
(1) The licensed practical nurse acts at the direction of a
registered nurse or a licensed physician, dentist, optometrist, or
podiatrist and the registered nurse, physician, dentist,
optometrist, or podiatrist is on the premises where the procedure
is to be performed or accessible by some form of
telecommunication.
(2) The licensed practical nurse can demonstrate the
knowledge, skills, and ability to perform the procedure safely.
(B) The intravenous therapy procedures that a licensed
practical nurse may perform pursuant to division (A) of this
section are limited to the following:
(1) Verification of the type of peripheral intravenous
solution being administered;
(2) Examination of a peripheral infusion site and the
extremity for possible infiltration;
(3) Regulation of a peripheral intravenous infusion according
to the prescribed flow rate;
(4) Discontinuation of a peripheral intravenous device at the
appropriate time;
(5) Performance of routine dressing changes at the insertion
site of a peripheral venous or arterial infusion, peripherally
inserted central catheter infusion, or central venous pressure
subclavian infusion.
Sec. 4723.19. (A) A person or government entity seeking
approval to provide a course of study in the safe performance of
intravenous therapy shall apply to the board of nursing in a
manner specified by the board.
(B) The board shall approve the applicant to provide a course
of study in the safe performance of intravenous therapy if the
content of the course of study to be provided includes all of the
following:
(1) Didactic and clinical components;
(2) Curriculum requirements established in rules the board
shall adopt in accordance with Chapter 119. of the Revised Code;
(3) Standards that require the nurse to perform a successful
demonstration of the intravenous procedures, including all skills
needed to perform them safely.
Sec. 4723.24. (A) All Except as otherwise specified in this
chapter, all active licenses and certificates issued under this
chapter shall be renewed biennially according to a schedule
established by the board of nursing. The board shall provide an
application for renewal to every holder of an active license or
certificate, except when the board is aware that an individual is
ineligible for license or certificate renewal for any reason,
including pending criminal charges in this state or another
jurisdiction, failure to comply with a disciplinary order from the
board or the terms of a consent agreement entered into with the
board, failure to pay fines or fees owed to the board, or failure
to provide on the board's request documentation of having
completed the continuing nursing education requirements specified
in division (C) of this section.
If the board provides a renewal application by mail, the
application shall be addressed to the last known post-office
address of the license or certificate holder and mailed before the
date specified in the board's schedule. Failure of the license or
certificate holder to receive an application for renewal from the
board shall not excuse the holder from the requirements contained
in this section, except as provided in section 5903.10 of the
Revised Code.
The license or certificate holder shall complete the renewal
form and return it to the treasurer of state board with the
renewal fee required by section 4723.08 of the Revised Code on or
before the date specified by the board. The license or certificate
holder shall report any conviction, plea, or judicial finding
regarding a criminal offense that constitutes grounds for the
board to impose sanctions under section 4723.28 of the Revised
Code since the holder last submitted an application to the board.
The treasurer shall immediately forward the renewal
application to the board. On receipt of the renewal application,
the board shall verify that whether the applicant meets the
renewal requirements and. If the applicant meets the requirements,
the board shall renew the license or certificate for the following
two-year period.
If a renewal application that meets the renewal requirements
is submitted after the date specified in the board's schedule, but
before expiration of the license or certificate, the board shall
grant a renewal upon payment of the late renewal fee authorized
under section 4723.08 of the Revised Code.
(B) Every license or certificate holder shall give written
notice to the board of any change of name or address within thirty
days of the change. The board shall require the holder to document
a change of name in a manner acceptable to the board.
(C)(1) Except in the case of a first renewal after licensure
by examination, to be eligible for renewal of an active license to
practice nursing as a registered nurse or licensed practical
nurse, each individual who holds an active license shall, in each
two-year period specified by the board, complete continuing
nursing education as follows:
(a) For renewal of a license that was issued for a two-year
renewal period, twenty-four hours of continuing nursing education;
(b) For renewal of a license that was issued for less than a
two-year renewal period, the number of hours of continuing nursing
education specified by the board in rules adopted in accordance
with Chapter 119. of the Revised Code;
(c) Of the hours of continuing nursing education completed in
any renewal period, at least one hour of the education must be
directly related to the statutes and rules pertaining to the
practice of nursing in this state.
(2) The board shall adopt rules establishing the procedure
for a license holder to certify to the board completion of the
required continuing nursing education. The board may conduct a
random sample of license holders and require that the license
holders included in the sample submit satisfactory documentation
of having completed the requirements for continuing nursing
education. On the board's request, a license holder included in
the sample shall submit the required documentation.
(3) An educational activity may be applied toward meeting the
continuing nursing education requirement only if it is obtained
through a program or course approved by the board or a person the
board has authorized to approve continuing nursing education
programs and courses.
(4) The continuing education required of a certified
registered nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner to obtain or
maintain certification by a national certifying organization shall
be applied toward the continuing education requirements for
renewal of a license to practice nursing as a registered nurse
only if it is obtained through a program or course approved by the
board or a person the board has authorized to approve continuing
nursing education programs and courses.
(D) Except as otherwise provided in section 4723.28 of the
Revised Code, a an individual who holds an active license holder
to practice nursing as a registered nurse or licensed practical
nurse and who does not intend to practice in Ohio may send to the
board written notice to that effect on or before the renewal date,
and the board shall classify the license as inactive. During the
period that the license is classified as inactive, the holder may
not engage in the practice of nursing in Ohio and is not required
to pay the renewal fee.
The holder of an inactive license or an individual who has
failed to renew the individual's license may have the license
restored or renewed reactivated or reinstated upon meeting doing
the following, as applicable to the holder or individual:
(1) Applying to the board for license reactivation or
reinstatement on forms provided by the board;
(2) Meeting the requirements for restoring and renewing
reactivating or reinstating licenses established in rules adopted
under section 4723.07 of the Revised Code or, if the individual
did not renew because of service in the armed forces of the United
States, as provided in section 5903.10 of the Revised Code;
(3) If the license has been inactive for at least five years
from the date of application for reactivation or has lapsed for at
least five years from the date of application for reinstatement,
submitting a request to the bureau of criminal identification and
investigation for a criminal records check and check of federal
bureau of investigation records pursuant to section 4723.091 of
the Revised Code.
Sec. 4723.271. The (A) Upon request of the holder of a
nursing license, certificate of authority, dialysis technician
certificate, medication aide certificate, or community health
worker certificate issued under this chapter, the presentment of
proper identification as prescribed in rules adopted by the board
of nursing, and payment of the fee authorized under section
4723.08 of the Revised Code, the board of nursing shall provide to
the requestor a replacement copy of a
nursing license, certificate
of authority, dialysis technician wall certificate, or community
health worker certificate issued under this chapter upon request
of the holder accompanied by proper identification as prescribed
in rules adopted by the board and payment of the fee authorized
under section 4723.08 of the Revised Code suitable for framing.
(B) Upon request of the holder of a nursing license,
certificate of authority, certificate to prescribe, dialysis
technician certificate, medication aide certificate, or community
health worker certificate issued under this chapter and payment of
the fee authorized under section 4723.08 of the Revised Code, the
board shall verify to an agency of another jurisdiction or foreign
country the fact that the person holds such nursing license,
certificate of authority, certificate to prescribe, dialysis
technician certificate, medication aide certificate, or community
health worker certificate.
Sec. 4723.28. (A) The board of nursing, by a vote of a
quorum, may revoke or may refuse to grant a nursing license,
certificate of authority, or dialysis technician certificate to a
person found by the board to have impose one or more of the
following sanctions if it finds that a person committed fraud in
passing an examination required to obtain the a license,
certificate of authority, or dialysis technician certificate
issued by the board or to have committed fraud, misrepresentation,
or deception in applying for or securing any nursing license,
certificate of authority, or dialysis technician certificate
issued by the board: deny, revoke, suspend, or place restrictions
on any nursing license, certificate of authority, or dialysis
technician certificate issued by the board; reprimand or otherwise
discipline a holder of a nursing license, certificate of
authority, or dialysis technician certificate; or impose a fine of
not more than five hundred dollars per violation.
(B) Subject to division (N) of this section, the The board of
nursing, by a vote of a quorum, may impose one or more of the
following sanctions: deny, revoke, suspend, or place restrictions
on any nursing license, certificate of authority, or dialysis
technician certificate issued by the board; reprimand or otherwise
discipline a holder of a nursing license, certificate of
authority, or dialysis technician certificate; or impose a fine of
not more than five hundred dollars per violation. The sanctions
may be imposed for any of the following:
(1) Denial, revocation, suspension, or restriction of
authority to engage in a licensed profession or practice a health
care occupation, including nursing or practice as a dialysis
technician, for any reason other than a failure to renew, in Ohio
or another state or jurisdiction;
(2) Engaging in the practice of nursing or engaging in
practice as a dialysis technician, having failed to renew a
nursing license or dialysis technician certificate issued under
this chapter, or while a nursing license or dialysis technician
certificate is under suspension;
(3) Conviction of, a plea of guilty to, a judicial finding of
guilt of, a judicial finding of guilt resulting from a plea of no
contest to, or a judicial finding of eligibility for a pretrial
diversion or similar program or for intervention in lieu of
conviction for, a misdemeanor committed in the course of practice;
(4) Conviction of, a plea of guilty to, a judicial finding of
guilt of, a judicial finding of guilt resulting from a plea of no
contest to, or a judicial finding of eligibility for a pretrial
diversion or similar program or for intervention in lieu of
conviction for, any felony or of any crime involving gross
immorality or moral turpitude;
(5) Selling, giving away, or administering drugs or
therapeutic devices for other than legal and legitimate
therapeutic purposes; or conviction of, a plea of guilty to, a
judicial finding of guilt of, a judicial finding of guilt
resulting from a plea of no contest to, or a judicial finding of
eligibility for a pretrial diversion or similar program or for
intervention in lieu of conviction for, violating any municipal,
state, county, or federal drug law;
(6) Conviction of, a plea of guilty to, a judicial finding of
guilt of, a judicial finding of guilt resulting from a plea of no
contest to, or a judicial finding of eligibility for a pretrial
diversion or similar program or for intervention in lieu of
conviction for, an act in another jurisdiction that would
constitute a felony or a crime of moral turpitude in Ohio;
(7) Conviction of, a plea of guilty to, a judicial finding of
guilt of, a judicial finding of guilt resulting from a plea of no
contest to, or a judicial finding of eligibility for a pretrial
diversion or similar program or for intervention in lieu of
conviction for, an act in the course of practice in another
jurisdiction that would constitute a misdemeanor in Ohio;
(8) Self-administering or otherwise taking into the body any
dangerous drug, as defined in section 4729.01 of the Revised Code,
in any way that is not in accordance with a legal, valid
prescription issued for that individual, or self-administering or
otherwise taking into the body any drug that is a schedule I
controlled substance;
(9) Habitual indulgence in the or excessive use of controlled
substances, other habit-forming drugs, or alcohol or other
chemical substances to an extent that impairs ability to practice
the individual's ability to provide safe nursing care or safe
dialysis care;
(10) Impairment of the ability to practice according to
acceptable and prevailing standards of safe nursing care or safe
dialysis care because of habitual or excessive the use of drugs,
alcohol, or other chemical substances that impair the ability to
practice;
(11) Impairment of the ability to practice according to
acceptable and prevailing standards of safe nursing care or safe
dialysis care because of a physical or mental disability;
(12) Assaulting or causing harm to a patient or depriving a
patient of the means to summon assistance;
(13) Obtaining or attempting to obtain Misappropriation or
attempted misappropriation of money or anything of value by
intentional misrepresentation or material deception in the course
of practice;
(14) Adjudication by a probate court of being mentally ill or
mentally incompetent. The board may restore reinstate the person's
nursing license or dialysis technician certificate upon
adjudication by a probate court of the person's restoration to
competency or upon submission to the board of other proof of
competency.
(15) The suspension or termination of employment by the
department of defense or the veterans administration of the United
States for any act that violates or would violate this chapter;
(16) Violation of this chapter or any rules adopted under it;
(17) Violation of any restrictions placed by the board on a
nursing license or dialysis technician certificate by the board;
(18) Failure to use universal blood and body fluid standard
precautions established by rules adopted under section 4723.07 of
the Revised Code;
(19) Failure to practice in accordance with acceptable and
prevailing standards of safe nursing care or safe dialysis care;
(20) In the case of a registered nurse, engaging in
activities that exceed the practice of nursing as a registered
nurse;
(21) In the case of a licensed practical nurse, engaging in
activities that exceed the practice of nursing as a licensed
practical nurse;
(22) In the case of a dialysis technician, engaging in
activities that exceed those permitted under section 4723.72 of
the Revised Code;
(23) Aiding and abetting a person in that person's practice
of nursing without a license or practice as a dialysis technician
without a certificate issued under this chapter;
(24) In the case of a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner, except as provided in division (M) of this
section, either of the following:
(a) Waiving the payment of all or any part of a deductible or
copayment that a patient, pursuant to a health insurance or health
care policy, contract, or plan that covers such nursing services,
would otherwise be required to pay if the waiver is used as an
enticement to a patient or group of patients to receive health
care services from that provider;
(b) Advertising that the nurse will waive the payment of all
or any part of a deductible or copayment that a patient, pursuant
to a health insurance or health care policy, contract, or plan
that covers such nursing services, would otherwise be required to
pay.
(25) Failure to comply with the terms and conditions of
participation in the chemical dependency monitoring program
established under section 4723.35 of the Revised Code;
(26) Failure to comply with the terms and conditions required
under the practice intervention and improvement program
established under section 4723.282 of the Revised Code;
(27) In the case of a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner:
(a) Engaging in activities that exceed those permitted for
the nurse's nursing specialty under section 4723.43 of the Revised
Code;
(b) Failure to meet the quality assurance standards
established under section 4723.07 of the Revised Code.
(28) In the case of a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner, failure to
maintain a standard care arrangement in accordance with section
4723.431 of the Revised Code or to practice in accordance with the
standard care arrangement;
(29) In the case of a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner who holds a
certificate to prescribe issued under section 4723.48 of the
Revised Code, failure to prescribe drugs and therapeutic devices
in accordance with section 4723.481 of the Revised Code;
(30) Prescribing any drug or device to perform or induce an
abortion, or otherwise performing or inducing an abortion;
(31) Failure to establish and maintain professional
boundaries with a patient, as specified in rules adopted under
section 4723.07 of the Revised Code;
(32) Regardless of whether the contact or verbal behavior is
consensual, engaging with a patient other than the spouse of the
registered nurse, licensed practical nurse, or dialysis technician
in any of the following:
(a) Sexual contact, as defined in section 2907.01 of the
Revised Code;
(b) Verbal behavior that is sexually demeaning to the patient
or may be reasonably interpreted by the patient as sexually
demeaning.
(33) Assisting suicide as defined in section 3795.01 of the
Revised Code.
(C) Disciplinary actions taken by the board under divisions
(A) and (B) of this section shall be taken pursuant to an
adjudication conducted under Chapter 119. of the Revised Code,
except that in lieu of a hearing, the board may enter into a
consent agreement with an individual to resolve an allegation of a
violation of this chapter or any rule adopted under it. A consent
agreement, when ratified by a vote of a quorum, shall constitute
the findings and order of the board with respect to the matter
addressed in the agreement. If the board refuses to ratify a
consent agreement, the admissions and findings contained in the
agreement shall be of no effect.
(D) The hearings of the board shall be conducted in
accordance with Chapter 119. of the Revised Code, the board may
appoint a hearing examiner, as provided in section 119.09 of the
Revised Code, to conduct any hearing the board is authorized to
hold under Chapter 119. of the Revised Code.
In any instance in which the board is required under Chapter
119. of the Revised Code to give notice of an opportunity for a
hearing and the applicant, licensee, or license certificate holder
does not make a timely request for a hearing in accordance with
section 119.07 of the Revised Code, the board is not required to
hold a hearing, but may adopt, by a vote of a quorum, a final
order that contains the board's findings. In the final order, the
board may order any of the sanctions listed in division (A) or (B)
of this section.
(E) If a criminal action is brought against a registered
nurse, licensed practical nurse, or dialysis technician for an act
or crime described in divisions (B)(3) to (7) of this section and
the action is dismissed by the trial court other than on the
merits, the board shall conduct an adjudication to determine
whether the registered nurse, licensed practical nurse, or
dialysis technician committed the act on which the action was
based. If the board determines on the basis of the adjudication
that the registered nurse, licensed practical nurse, or dialysis
technician committed the act, or if the registered nurse, licensed
practical nurse, or dialysis technician fails to participate in
the adjudication, the board may take action as though the
registered nurse, licensed practical nurse, or dialysis technician
had been convicted of the act.
If the board takes action on the basis of a conviction, plea,
or a judicial finding as described in divisions (B)(3) to (7) of
this section that is overturned on appeal, the registered nurse,
licensed practical nurse, or dialysis technician may, on
exhaustion of the appeal process, petition the board for
reconsideration of its action. On receipt of the petition and
supporting court documents, the board shall temporarily rescind
its action. If the board determines that the decision on appeal
was a decision on the merits, it shall permanently rescind its
action. If the board determines that the decision on appeal was
not a decision on the merits, it shall conduct an adjudication to
determine whether the registered nurse, licensed practical nurse,
or dialysis technician committed the act on which the original
conviction, plea, or judicial finding was based. If the board
determines on the basis of the adjudication that the registered
nurse, licensed practical nurse, or dialysis technician committed
such act, or if the registered nurse, licensed practical nurse, or
dialysis technician does not request an adjudication, the board
shall reinstate its action; otherwise, the board shall permanently
rescind its action.
Notwithstanding the provision of division (C)(2) of section
2953.32 of the Revised Code specifying that if records pertaining
to a criminal case are sealed under that section the proceedings
in the case shall be deemed not to have occurred, sealing of the
following records of a conviction on which the board has based an
action under this section shall have no effect on the board's
action or any sanction imposed by the board under this section:
records of any conviction, guilty plea, judicial finding of guilt
resulting from a plea of no contest, or a judicial finding of
eligibility for a pretrial diversion program or intervention in
lieu of conviction.
The board shall not be required to seal, destroy, redact, or
otherwise modify its records to reflect the court's sealing of
conviction records.
(F) The board may investigate an individual's criminal
background in performing its duties under this section.
As part of
such investigation, the board may order the individual to submit,
at the individual's expense, a request to the bureau of criminal
identification and investigation for a criminal records check and
check of federal bureau of investigation records in accordance
with the procedure described in section 4723.091 of the Revised
Code.
(G) During the course of an investigation conducted under
this section, the board may compel any registered nurse, licensed
practical nurse, or dialysis technician or applicant under this
chapter to submit to a mental or physical examination, or both, as
required by the board and at the expense of the individual, if the
board finds reason to believe that the individual under
investigation may have a physical or mental impairment that may
affect the individual's ability to provide safe nursing care.
Failure of any individual to submit to a mental or physical
examination when directed constitutes an admission of the
allegations, unless the failure is due to circumstances beyond the
individual's control, and a default and final order may be entered
without the taking of testimony or presentation of evidence.
If the board finds that an individual is impaired, the board
shall require the individual to submit to care, counseling, or
treatment approved or designated by the board, as a condition for
initial, continued, reinstated, or renewed authority to practice.
The individual shall be afforded an opportunity to demonstrate to
the board that the individual can begin or resume the individual's
occupation in compliance with acceptable and prevailing standards
of care under the provisions of the individual's authority to
practice.
For purposes of this division, any registered nurse, licensed
practical nurse, or dialysis technician or applicant under this
chapter shall be deemed to have given consent to submit to a
mental or physical examination when directed to do so in writing
by the board, and to have waived all objections to the
admissibility of testimony or examination reports that constitute
a privileged communication.
(H) The board shall investigate evidence that appears to show
that any person has violated any provision of this chapter or any
rule of the board. Any person may report to the board any
information the person may have that appears to show a violation
of any provision of this chapter or rule of the board. In the
absence of bad faith, any person who reports such information or
who testifies before the board in any adjudication conducted under
Chapter 119. of the Revised Code shall not be liable for civil
damages as a result of the report or testimony.
(I) All of the following apply under this chapter with
respect to the confidentiality of information:
(1) Information received by the board pursuant to a complaint
or an investigation is confidential and not subject to discovery
in any civil action, except that the board may disclose
information to law enforcement officers and government entities
investigating for purposes of an investigation of either a
licensed health care professional, including a registered nurse,
licensed practical nurse, or dialysis technician, or a person who
may have engaged in the unauthorized practice of nursing or
dialysis care. No law enforcement officer or government entity
with knowledge of any information disclosed by the board pursuant
to this division shall divulge the information to any other person
or government entity except for the purpose of a government
investigation, a prosecution, or an adjudication by a court or
government entity.
(2) If an investigation requires a review of patient records,
the investigation and proceeding shall be conducted in such a
manner as to protect patient confidentiality.
(3) All adjudications and investigations of the board shall
be considered civil actions for the purposes of section 2305.252
of the Revised Code.
(4) Any board activity that involves continued monitoring of
an individual as part of or following any disciplinary action
taken under this section shall be conducted in a manner that
maintains the individual's confidentiality. Information received
or maintained by the board with respect to the board's monitoring
activities is confidential and not subject to discovery in any
civil action and is confidential, except that the board may
disclose information to law enforcement officers and government
entities for purposes of an investigation of a licensee or
certificate holder.
(J) Any action taken by the board under this section
resulting in a suspension from practice shall be accompanied by a
written statement of the conditions under which the person may be
reinstated to practice.
(K) When the board refuses to grant a license or certificate
to an applicant, revokes a license or certificate, or refuses to
reinstate a license or certificate, the board may specify that its
action is permanent. An individual subject to permanent action
taken by the board is forever ineligible to hold a license or
certificate of the type that was refused or revoked and the board
shall not accept from the individual an application for
reinstatement of the license or certificate or for a new license
or certificate.
(L) No unilateral surrender of a nursing license, certificate
of authority, or dialysis technician certificate issued under this
chapter shall be effective unless accepted by majority vote of the
board. No application for a nursing license, certificate of
authority, or dialysis technician certificate issued under this
chapter may be withdrawn without a majority vote of the board. The
board's jurisdiction to take disciplinary action under this
section is not removed or limited when an individual has a license
or certificate classified as inactive or fails to renew a license
or certificate.
(M) Sanctions shall not be imposed under division (B)(24) of
this section against any licensee who waives deductibles and
copayments as follows:
(1) In compliance with the health benefit plan that expressly
allows such a practice. Waiver of the deductibles or copayments
shall be made only with the full knowledge and consent of the plan
purchaser, payer, and third-party administrator. Documentation of
the consent shall be made available to the board upon request.
(2) For professional services rendered to any other person
licensed pursuant to this chapter to the extent allowed by this
chapter and the rules of the board.
(N)(1) Any person who enters a prelicensure nursing education
program on or after June 1, 2003, and who subsequently applies
under division (A) of section 4723.09 of the Revised Code for
licensure to practice as a registered nurse or as a licensed
practical nurse and any person who applies under division (B) of
that section for license by endorsement to practice nursing as a
registered nurse or as a licensed practical nurse shall submit a
request to the bureau of criminal identification and investigation
for the bureau to conduct a criminal records check of the
applicant and to send the results to the board, in accordance with
section 4723.09 of the Revised Code.
The board shall refuse to grant a license to practice nursing
as a registered nurse or as a licensed practical nurse under
section 4723.09 of the Revised Code to a person who entered a
prelicensure nursing education program on or after June 1, 2003,
and applied under division (A) of section 4723.09 of the Revised
Code for the license or a person who applied under division (B) of
that section for the license, if the criminal records check
performed in accordance with division (C) of that section
indicates that the person has pleaded guilty to, been convicted
of, or has had a judicial finding of guilt for violating section
2903.01, 2903.02, 2903.03, 2903.11, 2905.01, 2907.02, 2907.03,
2907.05, 2909.02, 2911.01, or 2911.11 of the Revised Code or a
substantially similar law of another state, the United States, or
another country.
(2) Any person who enters a dialysis training program on or
after June 1, 2003, and who subsequently applies for a certificate
to practice as a dialysis technician shall submit a request to the
bureau of criminal identification and investigation for the bureau
to conduct a criminal records check of the applicant and to send
the results to the board, in accordance with section 4723.75 of
the Revised Code.
The board shall refuse to issue a certificate to practice as
a dialysis technician under section 4723.75 of the Revised Code to
a person who entered a dialysis training program on or after June
1, 2003, and whose criminal records check performed in accordance
with division (C) of that section indicates that the person has
pleaded guilty to, been convicted of, or has had a judicial
finding of guilt for violating section 2903.01, 2903.02, 2903.03,
2903.11, 2905.01, 2907.02, 2907.03, 2907.05, 2909.02, 2911.01, or
2911.11 of the Revised Code or a substantially similar law of
another state, the United States, or another country.
Sec. 4723.32. This chapter does not prohibit any of the
following:
(A) The practice of nursing by a student currently enrolled
in and actively pursuing completion of a prelicensure nursing
education program, if all of the following are the case:
(1) The student is participating in a program located in this
state and approved by the board of nursing or participating in
this state in a component of a program located in another
jurisdiction and approved by a board that is a member of the
national council of state boards of nursing;
(2) The student's practice is under the auspices of the
program;
(3) The student acts under the supervision of a registered
nurse serving for the program as a faculty member or teaching
assistant.
(B) The rendering of medical assistance to a licensed
physician, licensed dentist, or licensed podiatrist by a person
under the direction, supervision, and control of such licensed
physician, dentist, or podiatrist;
(C) The activities of persons employed as nursing aides,
attendants, orderlies, or other auxiliary workers in patient
homes, nurseries, nursing homes, hospitals, home health agencies,
or other similar institutions;
(D) The provision of nursing services to family members or in
emergency situations;
(E) The care of the sick when done in connection with the
practice of religious tenets of any church and by or for its
members;
(F) The practice of nursing as a certified registered nurse
anesthetist, clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner by a student currently enrolled in
and actively pursuing completion of a program of study leading to
initial authorization by the board of nursing to practice nursing
in the specialty, if all of the following are the case:
(1) The program qualifies the student to sit for the
examination of 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 or the
program prepares the student to receive a master's degree in
accordance with division (A)(2) of section 4723.41 of the Revised
Code;
(2) The student's practice is under the auspices of the
program;
(3) The student acts under the supervision of a registered
nurse serving for the program as a faculty member, teaching
assistant, or preceptor.
(G) The activities of an individual who currently holds a
license to practice nursing in another jurisdiction, if the
individual's license has not been revoked, the individual is not
currently under suspension or on probation, the individual does
not represent the individual as being licensed under this chapter,
and one of the following is the case:
(1) The individual is engaging in the practice of nursing by
discharging official duties while employed by or under contract
with the United States government or any agency thereof;
(2) The individual is engaging in the practice of nursing as
an employee of an individual, agency, or corporation located in
the other jurisdiction in a position with employment
responsibilities that include transporting patients into, out of,
or through this state, as long as each trip in this state does not
exceed seventy-two hours;
(3) The individual is consulting with an individual licensed
in this state to practice any health-related profession;
(4) The individual is engaging in activities associated with
teaching in this state as a guest lecturer at or for a nursing
education program, continuing nursing education program, or
in-service presentation;
(5) The individual is conducting evaluations of nursing care
that are undertaken on behalf of an accrediting organization,
including the national league for nursing accrediting committee,
the joint commission on accreditation of healthcare organizations,
or any other nationally recognized accrediting organization;
(6) The individual is providing nursing care to an individual
who is in this state on a temporary basis, not to exceed six
months in any one calendar year, if the nurse is directly employed
by or under contract with the individual or a guardian or other
person acting on the individual's behalf;
(7) The individual is providing nursing care during any
disaster, natural or otherwise, that has been officially declared
to be a disaster by a public announcement issued by an appropriate
federal, state, county, or municipal official.
(H) The administration of medication by an individual who
holds a valid medication aide certificate issued under this
chapter, if the medication is administered to a resident of a
nursing home or residential care facility authorized by section
4723.63 or 4723.64 of the Revised Code to use a certified
medication aide and the medication is administered in accordance
with section 4723.67 of the Revised Code.
Sec. 4723.34. (A) Reports to the board of nursing shall be
made as follows:
(1) Every employer of A person or governmental entity that
employs, or contracts directly or through another person or
governmental entity for the provision of services by, registered
nurses, licensed practical nurses, or dialysis technicians,
medication aides, or certified community health workers and that
knows or has reason to believe that a current or former employee
or person providing services under a contract who holds a license
or certificate issued under this chapter engaged in conduct that
would be grounds for disciplinary action by the board of nursing
under this chapter or rules adopted under it shall report to the
board of nursing the name of any such current or former employee
who holds a nursing license or dialysis technician certificate
issued under this chapter who has engaged in conduct that would be
grounds for disciplinary action by the board under section 4723.28
of the Revised Code or person providing services under a contract.
The report shall be made on the person's or governmental entity's
behalf by an individual licensed by the board who the person or
governmental entity has designated to make such reports.
Every employer of certified community health workers shall
report to the board the name of any current or former employee who
holds a community health worker certificate issued under this
chapter who has engaged in conduct that would be grounds for
disciplinary action by the board under section 4723.86 of the
Revised Code.
Every employer of medication aides shall report to the board
the name of any current or former employee who holds a medication
aide certificate issued under this chapter who has engaged in
conduct that would be grounds for disciplinary action by the board
under section 4723.652 of the Revised Code.
(2) Nursing associations shall report to the board the name
of any registered nurse or licensed practical nurse and dialysis
technician associations shall report to the board the name of any
dialysis technician who has been investigated and found to
constitute a danger to the public health, safety, and welfare
because of conduct that would be grounds for disciplinary action
by the board under section 4723.28 of the Revised Code, except
that an association is not required to report the individual's
name if the individual is maintaining satisfactory participation
in a peer support program approved by the board under rules
adopted under section 4723.07 of the Revised Code.
Community health worker associations shall report to the
board the name of any certified community health worker who has
been investigated and found to constitute a danger to the public
health, safety, and welfare because of conduct that would be
grounds for disciplinary action by the board under section 4723.86
of the Revised Code, except that an association is not required to
report the individual's name if the individual is maintaining
satisfactory participation in a peer support program approved by
the board under rules adopted under section 4723.07 of the Revised
Code.
Medication aide associations shall report to the board the
name of any medication aide who has been investigated and found to
constitute a danger to the public health, safety, and welfare
because of conduct that would be grounds for disciplinary action
by the board under section 4723.652 of the Revised Code, except
that an association is not required to report the individual's
name if the individual is maintaining satisfactory participation
in a peer support program approved by the board under rules
adopted under section 4723.69 of the Revised Code.
(3) If the A prosecutor in a case described in divisions
(B)(3) to (5) of section 4723.28 of the Revised Code, or in a case
where the trial court issued an order of dismissal upon technical
or procedural grounds of a charge of a misdemeanor committed in
the course of practice, a felony charge, or a charge of gross
immorality or moral turpitude, who knows or has reason to believe
that the person charged is licensed under this chapter to practice
nursing as a registered nurse or as a licensed practical nurse or
holds a certificate issued under this chapter to practice as a
dialysis technician, the prosecutor shall notify the board of
nursing of the charge. With regard to certified community health
workers and medication aides, if the prosecutor in a case
involving a charge of a misdemeanor committed in the course of
employment, a felony charge, or a charge of gross immorality or
moral turpitude, including a case dismissed on technical or
procedural grounds, who knows or has reason to believe that the
person charged holds a community health worker or medication aide
certificate issued under this chapter, the prosecutor shall notify
the board of the charge.
Each notification required by this division from a prosecutor
shall be made on forms prescribed and provided by the board. The
report shall include the name and address of the license or
certificate holder, the charge, and the certified court documents
recording the action.
(B) If any person or governmental entity fails to provide a
report required by this section, the board may seek an order from
a court of competent jurisdiction compelling submission of the
report.
Sec. 4723.35. (A) As used in this section, "chemical
dependency" means either of the following:
(1) The chronic and habitual use of alcoholic beverages to
the extent that the user no longer can control the use of alcohol
or endangers the user's health, safety, or welfare or that of
others;
(2) The use of a controlled substance as defined in section
3719.01 of the Revised Code, a harmful intoxicant as defined in
section 2925.01 of the Revised Code, or a dangerous drug as
defined in section 4729.01 of the Revised Code, to the extent that
the user becomes physically or psychologically dependent on the
substance, intoxicant, or drug or endangers the user's health,
safety, or welfare or that of others.
(B) The board of nursing may abstain from taking disciplinary
action under section 4723.28 or 4723.86 of the Revised Code
against an individual with a chemical dependency if it finds that
the individual can be treated effectively and there is no
impairment of the individual's ability to practice according to
acceptable and prevailing standards of safe care. The board shall
establish a chemical dependency monitoring program to monitor the
registered nurses, licensed practical nurses, dialysis
technicians, and certified community health workers against whom
the board has abstained from taking action. The board shall
develop the program, select the program's name, and designate a
coordinator to administer the program.
(C) Determinations regarding an individual's eligibility for
admission to, continued participation in, and successful
completion of the monitoring program shall be made by the board's
supervising member for disciplinary matters in accordance with
rules adopted under division (D) of this section.
(D) The board shall adopt rules in accordance with Chapter
119. of the Revised Code that establish the following:
(1) Eligibility requirements for admission to and continued
participation in the monitoring program;
(2) Terms and conditions that must be met to participate in
and successfully complete the program;
(3) Procedures for keeping confidential records regarding
participants;
(4) Any other requirements or procedures necessary to
establish and administer the program.
(D)(E)(1) As a condition of being admitted to the monitoring
program, an individual shall surrender to the program coordinator
the license or certificate that the individual holds. While the
surrender is in effect, the individual is prohibited from engaging
in the practice of nursing, engaging in the provision of dialysis
care, or engaging in the provision of services that were being
provided as a certified community health worker.
If the program coordinator board's supervising member for
disciplinary matters determines that a participant is capable of
resuming practice according to acceptable and prevailing standards
of safe care, the program coordinator shall return the
participant's license or certificate. If the participant violates
the terms and conditions of resumed practice, the program
coordinator shall require the participant to surrender the license
or certificate as a condition of continued participation in the
program. The coordinator may require the surrender only on the
approval of the board's supervising member for disciplinary
matters.
The surrender of a license or certificate on admission to the
monitoring program or while participating in the program does not
constitute an action by the board under section 4723.28 or 4723.86
of the Revised Code. The participant may rescind the surrender at
any time and the board may proceed by taking action under section
4723.28 or 4723.86 of the Revised Code.
(2) If the program coordinator determines that a participant
is significantly out of compliance with the terms and conditions
for participation, the coordinator shall notify the board's
supervising member for disciplinary matters and the supervising
member shall determine whether to temporarily suspend the
participant's license or certificate. The program coordinator
board shall notify the participant of the suspension by certified
mail sent to the participant's last known address and shall refer
the matter to the board for formal action under section 4723.28 or
4723.86 of the Revised Code.
(E)(F) All of the following apply with respect to the
receipt, release, and maintenance of records and information by
the monitoring program:
(1) The program coordinator shall maintain all program
records in the board's office, and for each participant, shall
retain the records for a period of five two years following the
participant's date of successful completion of the program.
(2) When applying to participate in the monitoring program,
the applicant shall sign a waiver permitting the program
coordinator board to receive and release information necessary for
the coordinator to determine whether the individual is eligible
for admission. After being admitted, the participant shall sign a
waiver permitting the
program coordinator board to receive and
release information necessary to determine whether the individual
is eligible for continued participation in the program.
Information that may be necessary for the program coordinator
board's supervising member for disciplinary matters to determine
eligibility for admission or continued participation in the
monitoring program includes, but is not limited to, information
provided to and by employers, probation officers, law enforcement
agencies, peer assistance programs, health professionals, and
treatment providers. No entity with knowledge that the information
has been provided to the monitoring program shall divulge that
knowledge to any other person.
(3) Except as provided in division (E)(F)(4) of this section,
all records pertaining to an individual's application for or
participation in the monitoring program, including medical
records, treatment records, and mental health records, shall be
confidential. The records are not public records for the purposes
of section 149.43 of the Revised Code and are not subject to
discovery by subpoena or admissible as evidence in any judicial
proceeding.
(4) The program coordinator board may disclose information
regarding a participant's progress in the program to any person or
government entity that the participant authorizes in writing to be
given the information. In disclosing information under this
division, the
coordinator board shall not include any information
that is protected under section 3793.13 of the Revised Code or any
federal statute or regulation that provides for the
confidentiality of medical, mental health, or substance abuse
records.
(F)(G) In the absence of fraud or bad faith, the
program
coordinator, the board of nursing, and the board's employees and
representatives as a whole, its individual members, and its
employees and representatives are not liable for damages in any
civil action as a result of disclosing information in accordance
with division
(E)(F)(4) of this section. In the absence of fraud
or bad faith, any person reporting to the program with regard to
an individual's chemical dependence, or the progress or lack of
progress of that individual with regard to treatment, is not
liable for damages in any civil action as a result of the report.
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.
Except as provided in divisions division (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) Submit documentation satisfactory to the board that the
applicant has earned a graduate 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) 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 a
national certifying organization approved by the board under
section 4723.46 of the Revised Code to examine and certify, as
applicable, nurse-midwives, registered nurse anesthetists,
clinical nurse specialists, or 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 a graduate 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 one of the following applies:
(1) The applicant holds a graduate 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 graduate 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 a graduate degree with a
major in a nursing specialty or a related field.
(E)(B)(1) 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 division (A) of this section or division
(B)(2) of this section. The
(2) If an applicant practicing in another jurisdiction
applies for a certificate of authority under division (B)(2) of
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 division (B)(2) 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 With respect to the educational requirements and national
certification requirements that an applicant under division (B)(2)
of this section must meet, both of the following apply:
(a) 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 obtained 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 as that
division existed prior to the effective date of this amendment or
that was at that time approved by the board under section 4723.46
of the Revised Code, division (B) of this section shall apply the
applicant must have maintained the certification. The applicant is
not required to have earned a graduate degree with a major in a
nursing specialty or in a related field that qualifies the
applicant to sit for the certification examination.
(b) 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, division (C) of this section shall apply one
of the following must apply to the applicant:
(i) On or before December 31, 2000, the applicant obtained a
graduate degree with a major in a clinical area of nursing from an
educational institution accredited by a national or regional
accrediting organization. The applicant is not required to have
passed a certification examination.
(ii) On or before December 31, 2000, the applicant obtained a
graduate degree in nursing or a related field and was certified as
a clinical nurse specialist by the American nurses credentialing
center or another national certifying organization that was at
that time approved by the board under section 4723.46 of the
Revised Code.
Sec. 4723.42. (A) If the applicant for authorization to
practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner has met all the requirements of section 4723.41
of the Revised Code and has paid the fee required by section
4723.08 of the Revised Code, the board of nursing shall issue its
certificate of authority to practice nursing as a certified
registered nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner, which shall
designate the nursing specialty the nurse is authorized to
practice. The certificate entitles its holder to practice nursing
in the specialty designated on the certificate.
The board shall issue or deny its certificate not later than
sixty days after receiving all of the documents required by
section 4723.41 of the Revised Code.
If an applicant is under investigation for a violation of
this chapter, the board shall conclude the investigation not later
than ninety days after receipt of all required documents, unless
this ninety-day period is extended by written consent of the
applicant, or unless the board determines that a substantial
question of such a violation exists and the board has notified the
applicant in writing of the reasons for the continuation of the
investigation. If the board determines that the applicant has not
violated this chapter, it shall issue a certificate not later than
forty-five days after making that determination.
(B) Authorization to practice nursing as a certified
registered nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner shall be renewed
biennially according to rules and a schedule adopted by the board.
In providing renewal applications to certificate holders, the
board shall follow the procedures it follows under section 4723.24
of the Revised Code in providing renewal applications to license
holders. Failure of the certificate holder to receive an
application for renewal from the board does not excuse the holder
from the requirements of section 4723.44 of the Revised Code.
Not later than the date specified by the board, the holder
shall complete the renewal form and return it to the board with
all of the following:
(1) The renewal fee required by section 4723.08 of the
Revised Code;
(2) Except as provided in division (C) of this section,
documentation Documentation satisfactory to the board that the
holder has maintained certification in the 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;
(3) A list of the names and business addresses of the
holder's current collaborating physicians and podiatrists, if the
holder is a clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner;
(4) If the holder's certificate was issued under division (C)
of section 4723.41 of the Revised Code, as that division existed
at any time before the effective date of this amendment,
documentation satisfactory to the board that the holder has
completed continuing education for a clinical nurse specialist as
required by rule of the board;
(5) If the holder's certificate was issued under division (D)
of section 4723.41 of the Revised Code, documentation satisfactory
to the board that the holder has continued employment 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).
On receipt of the renewal application, fees, and documents,
the board shall verify that the applicant holds a current license
to practice nursing as a registered nurse in this state, and, if
it so verifies, shall renew the certificate. If an applicant
submits the completed renewal application after the date specified
in the board's schedule, but before the expiration of the
certificate, the board shall grant a renewal when the late renewal
fee required by section 4723.08 of the Revised Code is paid.
An applicant for reinstatement of an expired certificate
shall submit the reinstatement fee, renewal fee, and late renewal
fee required by section 4723.08 of the Revised Code. Any holder of
a certificate who desires inactive status shall give the board
written notice to that effect.
(C) The board shall renew a certificate of authority to
practice nursing as a clinical nurse specialist issued pursuant to
division (C) of section 4723.41 of the Revised Code, if the
certificate holder complies with all renewal requirements of this
section other than the requirement of having maintained
certification in the holder's nursing specialty.
Sec. 4723.43. A certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner may provide to individuals and groups nursing
care that requires knowledge and skill obtained from advanced
formal education and clinical experience. In this capacity as an
advanced practice registered nurse, a certified nurse-midwife is
subject to division (A) of this section, a certified registered
nurse anesthetist is subject to division (B) of this section, a
certified nurse practitioner is subject to division (C) of this
section, and a clinical nurse specialist is subject to division
(D) of this section.
(A) A nurse authorized to practice as a certified
nurse-midwife, in collaboration with one or more physicians, may
provide the management of preventive services and those primary
care services necessary to provide health care to women
antepartally, intrapartally, postpartally, and gynecologically,
consistent with the nurse's education and certification, and in
accordance with rules adopted by the board of nursing.
No certified nurse-midwife may perform version, deliver
breech or face presentation, use forceps, do any obstetric
operation, or treat any other abnormal condition, except in
emergencies. Division (A) of this section does not prohibit a
certified nurse-midwife from performing episiotomies or normal
vaginal deliveries, or repairing vaginal tears. A certified
nurse-midwife who holds a certificate to prescribe issued under
section 4723.48 of the Revised Code may, in collaboration with one
or more physicians, prescribe drugs and therapeutic devices in
accordance with section 4723.481 of the Revised Code.
(B) A nurse authorized to practice as a certified registered
nurse anesthetist, with the supervision and in the immediate
presence of a physician, podiatrist, or dentist, may administer
anesthesia and perform anesthesia induction, maintenance, and
emergence, and may perform with supervision preanesthetic
preparation and evaluation, postanesthesia care, and clinical
support functions, consistent with the nurse's education and
certification, and in accordance with rules adopted by the board.
A certified registered nurse anesthetist is not required to obtain
a certificate to prescribe in order to provide the anesthesia care
described in this division.
The physician, podiatrist, or dentist supervising a certified
registered nurse anesthetist must be actively engaged in practice
in this state. When a certified registered nurse anesthetist is
supervised by a podiatrist, the nurse's scope of practice is
limited to the anesthesia procedures that the podiatrist has the
authority under section 4731.51 of the Revised Code to perform. A
certified registered nurse anesthetist may not administer general
anesthesia under the supervision of a podiatrist in a podiatrist's
office. When a certified registered nurse anesthetist is
supervised by a dentist, the nurse's scope of practice is limited
to the anesthesia procedures that the dentist has the authority
under Chapter 4715. of the Revised Code to perform.
(C) A nurse authorized to practice as a certified nurse
practitioner, in collaboration with one or more physicians or
podiatrists, may provide preventive and primary care services,
provide services for acute illnesses, and evaluate and promote
patient wellness within the nurse's nursing specialty, consistent
with the nurse's education and certification, and in accordance
with rules adopted by the board. A certified nurse practitioner
who holds a certificate to prescribe issued under section 4723.48
of the Revised Code may, in collaboration with one or more
physicians or podiatrists, prescribe drugs and therapeutic devices
in accordance with section 4723.481 of the Revised Code.
When a certified nurse practitioner is collaborating with a
podiatrist, the nurse's scope of practice is limited to the
procedures that the podiatrist has the authority under section
4731.51 of the Revised Code to perform.
(D) A nurse authorized to practice as a clinical nurse
specialist, in collaboration with one or more physicians or
podiatrists, may provide and manage the care of individuals and
groups with complex health problems and provide health care
services that promote, improve, and manage health care within the
nurse's nursing specialty, consistent with the nurse's education
and in accordance with rules adopted by the board. A clinical
nurse specialist who holds a certificate to prescribe issued under
section 4723.48 of the Revised Code may, in collaboration with one
or more physicians or podiatrists, prescribe drugs and therapeutic
devices in accordance with section 4723.481 of the Revised Code.
When a clinical nurse specialist is collaborating with a
podiatrist, the nurse's scope of practice is limited to the
procedures that the podiatrist has the authority under section
4731.51 of the Revised Code to perform.
Sec. 4723.431. (A) Except as provided in division (D)(1) of
this section, a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner may practice only
in accordance with a standard care arrangement entered into with
each physician or podiatrist with whom the nurse collaborates. A
copy of the standard care arrangement shall be retained on file at
each site where the nurse practices. Prior approval of the
standard care arrangement by the board of nursing is not required,
but the board may periodically review it for compliance with this
section.
A clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner may enter into a standard care
arrangement with one or more collaborating physicians or
podiatrists. Each Not later than thirty days after first engaging
in the practice of nursing as a clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner, the
nurse shall submit to the board the name and business address of
each collaborating physician or podiatrist. Thereafter, the nurse
shall give to the board written notice of any additions or
deletions to the nurse's collaborating physicians or podiatrists
not later than thirty days after the change takes effect.
Each collaborating physician or podiatrist must be actively
engaged in direct clinical practice in this state and practicing
in a specialty that is the same as or similar to the nurse's
nursing specialty. If a collaborating physician or podiatrist
enters into standard care arrangements with more than three nurses
who hold certificates to prescribe issued under section 4723.48 of
the Revised Code, the physician or podiatrist shall not
collaborate at the same time with more than three of the nurses in
the prescribing component of their practices.
(B) A standard care arrangement shall be in writing and,
except as provided in division (D)(2) of this section, shall
contain all of the following:
(1) Criteria for referral of a patient by the clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner to a collaborating physician or podiatrist;
(2) A process for the clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner to obtain a
consultation with a collaborating physician or podiatrist;
(3) A plan for coverage in instances of emergency or planned
absences of either the clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner or a collaborating
physician or podiatrist that provides the means whereby a
physician or podiatrist is available for emergency care;
(4) The process for resolution of disagreements regarding
matters of patient management between the clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner and a collaborating physician or podiatrist;
(5) A procedure for a regular review of the referrals by the
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner to other health care professionals and the care
outcomes for a random sample of all patients seen by the nurse;
(6) If the clinical nurse specialist or certified nurse
practitioner regularly provides services to infants, a policy for
care of infants up to age one and recommendations for
collaborating physician visits for children from birth to age
three;
(7) Any other criteria required by rule of the board adopted
pursuant to section 4723.07 or 4723.50 of the Revised Code.
(C) A standard care arrangement entered into pursuant to this
section may permit a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner to supervise
services provided by a home health agency as defined in section
3701.881 of the Revised Code.
(D)(1) A clinical nurse specialist who does not hold a
certificate to prescribe and whose nursing specialty is mental
health or psychiatric mental health, as determined by the board,
is not required to enter into a standard care arrangement, but
shall practice in collaboration with one or more physicians.
(2) If a clinical nurse specialist practicing in either of
the specialties specified in division (D)(1) of this section holds
a certificate to prescribe, the nurse shall enter into a standard
care arrangement with one or more physicians. The standard care
arrangement must meet the requirements of division (B) of this
section, but only to the extent necessary to address the
prescribing component of the nurse's practice.
(E) Nothing in this section prohibits a hospital from hiring
a clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner as an employee and negotiating standard care
arrangements on behalf of the employee as necessary to meet the
requirements of this section. A standard care arrangement between
the hospital's employee and the employee's collaborating physician
is subject to approval by the medical staff and governing body of
the hospital prior to implementation of the arrangement at the
hospital.
Sec. 4723.44. (A) No person shall do any of the following
unless the person holds a current, valid certificate of authority
to practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner issued by the board of nursing under this
chapter:
(1) Engage in the practice of nursing as a certified
registered nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner for a fee, salary,
or other consideration, or as a volunteer;
(2) Represent the person as being a certified registered
nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner;
(3) Use any title or initials implying that the person is a
certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner;
(4) Represent the person as being an advanced practice
registered nurse;
(5) Use any title or initials implying that the person is an
advanced practice registered nurse.
(B) No person who is not certified by 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 shall use
the title "certified registered nurse anesthetist" or the initials
"C.R.N.A.," or any other title or initial implying that the person
has been certified by the council or organization.
(C) No certified registered nurse anesthetist, clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner shall do any of the following:
(1) Engage, for a fee, salary, or other consideration, or as
a volunteer, in the practice of a nursing specialty other than the
specialty designated on the nurse's current, valid certificate of
authority issued by the board under this chapter;
(2) Represent the person as being authorized to practice any
nursing specialty other than the specialty designated on the
current, valid certificate of authority;
(3) Use the title "certified registered nurse anesthetist" or
the initials "N.A." or "C.R.N.A.," the title "clinical nurse
specialist" or the initials "C.N.S.," the title "certified
nurse-midwife" or the initials "C.N.M.," the title "certified
nurse practitioner" or the initials "C.N.P.," the title "advanced
practice registered nurse" or the initials "A.P.R.N.," or any
other title or initials implying that the nurse is authorized to
practice any nursing specialty other than the specialty designated
on the nurse's current, valid certificate of authority;
(4) Enter into a standard care arrangement with a physician
or podiatrist whose practice is not the same as or similar to the
nurse's nursing specialty;
(5) Prescribe drugs or therapeutic devices unless the nurse
holds a current, valid certificate to prescribe issued under
section 4723.48 of the Revised Code;
(6) Prescribe drugs or therapeutic devices under a
certificate to prescribe in a manner that does not comply with
section 4723.481 of the Revised Code;
(7) Prescribe any drug or device to perform or induce an
abortion, or otherwise Perform perform or induce an abortion.
(D) No person shall knowingly employ a person to engage in
the practice of nursing as a certified registered nurse
anesthetist, clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner unless the person so employed
holds a current, valid certificate of authority to engage in that
nursing specialty issued by the board under this chapter.
(E) A certificate certified by the executive director of the
board, under the official seal of the board, to the effect that it
appears from the records that no certificate of authority to
practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner has been issued to any person specified
therein, or that a certificate, if issued, has been revoked or
suspended, shall be received as prima-facie evidence of the record
in any court or before any officer of the state.
Sec. 4723.48. (A) A clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner seeking authority
to prescribe drugs and therapeutic devices shall file with the
board of nursing a written application for a certificate to
prescribe. The board of nursing shall issue a certificate to
prescribe to each applicant who meets the requirements specified
in section 4723.482 or 4723.485 of the Revised Code.
Except as provided in division (B) of this section, the
initial certificate to prescribe that the board issues to an
applicant shall be issued as an externship certificate. Under an
externship certificate, the nurse may obtain experience in
prescribing drugs and therapeutic devices by participating in an
externship that evaluates the nurse's competence, knowledge, and
skill in pharmacokinetic principles and their clinical application
to the specialty being practiced. During the externship, the nurse
may prescribe drugs and therapeutic devices only when one or more
physicians are providing supervision in accordance with rules
adopted under section 4723.50 of the Revised Code.
After completing the externship, the holder of an externship
certificate may apply for a new certificate to prescribe. On
receipt of the new certificate, the nurse may prescribe drugs and
therapeutic devices in collaboration with one or more physicians
or podiatrists.
(B) In the case of an applicant who on May 17, 2000, was
approved to prescribe drugs and therapeutic devices under section
4723.56 of the Revised Code, as that section existed on that date,
the initial certificate to prescribe that the board issues to the
applicant under this section shall not be an externship
certificate. The applicant shall be issued a certificate to
prescribe that permits the recipient to prescribe drugs and
therapeutic devices in collaboration with one or more physicians
or podiatrists.
In the case of an applicant who meets the requirements of
division (C) of section 4723.482 of the Revised Code, the initial
certificate to prescribe that the board issues to the applicant
under this section shall not be an externship certificate. The
applicant shall be issued a certificate to prescribe that permits
the recipient to prescribe drugs and therapeutic devices in
collaboration with one or more physicians or podiatrists.
Sec. 4723.482. (A) Except as provided in divisions (C) and
(D) of this section, an applicant shall include with the
application submitted under section 4723.48 of the Revised Code
all of the following:
(1) Subject to section 4723.483 of the Revised Code, evidence
Evidence of holding a current, valid certificate of authority
issued under this chapter to practice as a clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner that was issued by meeting the requirements of
division (A) of section 4723.41 of the Revised Code;
(2) Evidence of successfully completing the course of study
in advanced pharmacology and related topics in accordance with the
requirements specified in division (B) of this section;
(3) The fee required by section 4723.08 of the Revised Code
for a certificate to prescribe;
(4) Any additional information the board of nursing requires
pursuant to rules adopted under section 4723.50 of the Revised
Code.
(B) With respect to the course of study in advanced
pharmacology and related topics that must be successfully
completed to obtain a certificate to prescribe, all of the
following requirements apply:
(1) The course of study shall be completed not longer than
three years before the application for the certificate to
prescribe is filed.
(2) The course of study shall consist of planned classroom
and clinical instruction for a total of not less than forty-five
contact hours.
(3) The course of study shall meet the requirements to be
approved by the board in accordance with standards established in
rules adopted under section 4723.50 of the Revised Code.
(4) The content of the course of study shall be specific to
the applicant's nursing specialty.
(5) The instruction provided in the course of study shall
include all of the following:
(a) A minimum of thirty-six contact hours of instruction in
advanced pharmacology that includes pharmacokinetic principles and
clinical application and the use of drugs and therapeutic devices
in the prevention of illness and maintenance of health;
(b) Instruction in the fiscal and ethical implications of
prescribing drugs and therapeutic devices;
(c) Instruction in the state and federal laws that apply to
the authority to prescribe;
(d) Instruction that is specific to schedule II controlled
substances, including instruction in all of the following:
(i) Indications for the use of schedule II controlled
substances in drug therapies;
(ii) The most recent guidelines for pain management
therapies, as established by state and national organizations such
as the Ohio pain initiative and the American pain society;
(iii) Fiscal and ethical implications of prescribing schedule
II controlled substances;
(iv) State and federal laws that apply to the authority to
prescribe schedule II controlled substances;
(v) Prevention of abuse and diversion of schedule II
controlled substances, including identification of the risk of
abuse and diversion, recognition of abuse and diversion, types of
assistance available for prevention of abuse and diversion, and
methods of establishing safeguards against abuse and diversion.
(e) Any additional instruction required pursuant to rules
adopted under section 4723.50 of the Revised Code.
(C) An applicant who practiced or is practicing as a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner in another jurisdiction or as an employee of the
United States government, and is not seeking authority to
prescribe drugs and therapeutic devices by meeting the
requirements of division (A) or (D) of this section, shall include
with the application submitted under section 4723.48 of the
Revised Code all of the following:
(1) Subject to section 4723.483 of the Revised Code, evidence
Evidence of holding a current, valid certificate of authority
issued under this chapter to practice as a clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner;
(2) The fee required by section 4723.08 of the Revised Code
for a certificate to prescribe;
(3) Either of the following:
(a) Evidence of having held, for a continuous period of at
least one year during the three years immediately preceding the
date of application, valid authority issued by another
jurisdiction to prescribe therapeutic devices and drugs, including
at least some controlled substances;
(b) Evidence of having been employed by the United States
government and authorized, for a continuous period of at least one
year during the three years immediately preceding the date of
application, to prescribe therapeutic devices and drugs, including
at least some controlled substances, in conjunction with that
employment.
(4) If the applicant includes the evidence described in
division (C)(3)(a) of this section, documentation from a licensed
physician in a form acceptable to the board that the prescribing
component of the nurse's practice was overseen or supervised by a
licensed physician in the other jurisdiction;
(5) If the applicant includes the evidence described in
division (C)(3)(b) of this section, documentation from a licensed
physician employed by the United States government in a form
acceptable to the board that the prescribing component of the
nurse's practice was overseen or supervised by a licensed
physician employed by the United States government;
(6) Evidence of having completed a two-hour course of
instruction approved by the board in the laws of this state that
govern drugs and prescriptive authority;
(7)(5) Any additional information the board requires pursuant
to rules adopted under section 4723.50 of the Revised Code.
(D) An applicant who practiced or is practicing as a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner in another jurisdiction or as an employee of the
United States government, and is not seeking authority to
prescribe drugs and therapeutic devices by meeting the
requirements of division (A) or (C) of this section, shall include
with the application submitted under section 4723.48 of the
Revised Code all of the following:
(1) Subject to section 4723.483 of the Revised Code, evidence
Evidence of holding a current, valid certificate of authority
issued under this chapter to practice as a clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner;
(2) The fee required by section 4723.08 of the Revised Code
for a certificate to prescribe;
(3) Either of the following:
(a) Evidence of having held, for a continuous period of at
least one year during the three years immediately preceding the
date of application, valid authority issued by another
jurisdiction to prescribe therapeutic devices and drugs, excluding
controlled substances;
(b) Evidence of having been employed by the United States
government and authorized, for a continuous period of at least one
year during the three years immediately preceding the date of
application, to prescribe therapeutic devices and drugs, excluding
controlled substances, in conjunction with that employment.
(4) If the applicant includes the evidence described in
division (D)(3)(a) of this section, documentation from a licensed
physician in a form acceptable to the board that the prescribing
component of the nurse's practice was overseen or supervised by a
licensed physician in the other jurisdiction;
(5) If the applicant includes the evidence described in
division (D)(3)(b) of this section, documentation from a licensed
physician employed by the United States government in a form
acceptable to the board that the prescribing component of the
nurse's practice was overseen or supervised by a licensed
physician employed by the United States government;
(6) Any additional information the board requires pursuant to
rules adopted under section 4723.50 of the Revised Code.
Sec. 4723.485. (A) A (1) Except as provided in division
(A)(2) of this section, a certificate to prescribe issued under
section 4723.48 of the Revised Code as an externship certificate
is valid for not more than one year, unless earlier suspended or
revoked by the board of nursing. The
(2) An externship certificate may be extended
beyond the
period for an additional year which it was issued if the holder
submits to the board evidence of continued participation in an
externship. The extension period shall not exceed two years.
(3) If an externship is terminated for any reason, the nurse
shall notify the board.
(B) To be eligible for a certificate to prescribe after
receiving an externship certificate, an applicant shall include
with the application submitted under section 4723.48 of the
Revised Code all of the following:
(1) A statement from a supervising physician attesting to the
applicant's successful completion of the externship;
(2) The fee required by section 4723.08 of the Revised Code
for a certificate to prescribe;
(3) Any additional information the board requires pursuant to
rules adopted under section 4723.50 of the Revised Code.
Sec. 4723.487. (A) As used in this section, "drug database"
means the database established and maintained by the state board
of pharmacy pursuant to section 4729.75 of the Revised Code.
(B) The board of nursing shall adopt rules in accordance with
Chapter 119. of the Revised Code that establish standards and
procedures to be followed by an advanced practice registered nurse
with a certificate to prescribe issued under section 4723.48 of
the Revised Code regarding the review of patient information
available through the drug database.
(C) This section and the rules adopted under it do not apply
if the state board of pharmacy no longer maintains the drug
database.
Sec. 4723.50. (A) In accordance with Chapter 119. of the
Revised Code, the board of nursing shall adopt rules as necessary
to implement the provisions of this chapter pertaining to the
authority of clinical nurse specialists, certified nurse-midwives,
and certified nurse practitioners to prescribe drugs and
therapeutic devices and the issuance and renewal of certificates
to prescribe.
The board shall adopt rules that are consistent with the
recommendations the board receives from the committee on
prescriptive governance pursuant to section 4723.492 of the
Revised Code. After reviewing a recommendation submitted by the
committee, the board may either adopt the recommendation as a rule
or ask the committee to reconsider and resubmit the
recommendation. The board shall not adopt any rule that does not
conform to a recommendation made by the committee.
(B) The board shall adopt rules under this section that do
all of the following:
(1) Establish a formulary listing the types of drugs and
therapeutic devices that may be prescribed by a clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner. The formulary may include controlled substances, as
defined in section 3719.01 of the Revised Code. The formulary
shall not permit the prescribing of any drug or device to perform
or induce an abortion.
(2) Establish safety standards to be followed by a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner when personally furnishing to patients complete or
partial supplies of antibiotics, antifungals, scabicides,
contraceptives, prenatal vitamins, antihypertensives, drugs and
devices used in the treatment of diabetes, drugs and devices used
in the treatment of asthma, and drugs used in the treatment of
dyslipidemia;
(3) Establish criteria for the components of the standard
care arrangements described in section 4723.431 of the Revised
Code that apply to the authority to prescribe, including the
components that apply to the authority to prescribe schedule II
controlled substances. The rules shall be consistent with that
section and include all of the following:
(a) Quality assurance standards;
(b) Standards for periodic review by a collaborating
physician or podiatrist of the records of patients treated by the
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner;
(c) Acceptable travel time between the location at which the
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner is engaging in the prescribing components of
the nurse's practice and the location of the nurse's collaborating
physician or podiatrist;
(d) Any other criteria recommended by the committee on
prescriptive governance.
(4) Establish standards and procedures for issuance and
renewal of a certificate to prescribe, including specification of
any additional information the board may require under division
(A)(4), (C)(7)(5), or (D)(6)(5) of section 4723.482 or division
(B)(3) of section 4723.485 of the Revised Code;
(5) Establish standards for board approval of the course of
study in advanced pharmacology and related topics required by
section 4723.482 of the Revised Code;
(6) Establish requirements for board approval of the two-hour
course of instruction in the laws of this state as required under
division (C)(6)(4) of section 4723.482 of the Revised Code and
division (B)(2) of section 4723.484 of the Revised Code;
(7) Establish standards and procedures for the appropriate
conduct of an externship as described in section 4723.484 of the
Revised Code, including the following:
(a) Standards and procedures to be used in evaluating an
individual's participation in an externship;
(b) Standards and procedures for the supervision that a
physician must provide during an externship, including supervision
provided by working with the participant and supervision provided
by making timely reviews of the records of patients treated by the
participant. The manner in which supervision must be provided may
vary according to the location where the participant is practicing
and with the participant's level of experience.
Sec. 4723.61. As used in this section and in sections
4723.62 4723.64 to 4723.69 of the Revised Code:
(A) "Medication" means a drug, as defined in section 4729.01
of the Revised Code.
(B) "Medication error" means a failure to follow the
prescriber's instructions when administering a prescription
medication.
(C) "Nursing home" and "residential care facility" have the
same meanings as in section 3721.01 of the Revised Code.
(D) "Prescription medication" means a medication that may be
dispensed only pursuant to a prescription.
(E) "Prescriber" and "prescription" have the same meanings as
in section 4729.01 of the Revised Code.
Sec. 4723.64. On and after the thirty-first day following
the board of nursing's submission of the report required by
division (F)(2) of section 4723.63 of the Revised Code, any A
nursing home or residential care facility may use one or more
medication aides to administer prescription medications to its
residents, subject to both of the following conditions:
(A) Each individual used as a medication aide must hold a
current, valid medication aide certificate issued by the board of
nursing under this chapter.
(B) The nursing home or residential care facility shall
ensure that the requirements of section 4723.67 of the Revised
Code are met.
Sec. 4723.65. (A) An individual seeking certification as a
medication aide shall apply to the board of nursing on a form
prescribed and provided by the board. If the The application is
submitted on or after the day any nursing home or residential care
facility may initially use medication aides as specified in
section 4723.64 of the Revised Code, the application shall be
accompanied by the certification fee established in rules adopted
under section 4723.69 of the Revised Code.
(B)(1) Except as provided in division (B)(2) of this section,
an applicant for a medication aide certificate shall submit a
request to the bureau of criminal identification and investigation
for a criminal records check. The request shall be on the form
prescribed pursuant to division (C)(1) of section 109.572 of the
Revised Code and shall be accompanied by a standard impression
sheet to obtain fingerprints prescribed pursuant to division
(C)(2) of that section. The request shall also be accompanied by
the fee prescribed pursuant to division (C)(3) of section 109.572
of the Revised Code. On receipt of the completed form, the
completed impression sheet, and the fee, the bureau shall conduct
a criminal records check of the applicant. On completion of the
criminal records check, the bureau shall send the results of the
check to the board. An applicant requesting a criminal records
check under this division who has not lived in this state for at
least five years shall ask the superintendent of the bureau of
criminal identification and investigation to also request that the
federal bureau of investigation provide the superintendent with
any information it has with respect to the applicant.
(2) If a criminal records check of an applicant was completed
pursuant to section 3721.121 of the Revised Code not more than
five years prior to the date the application is submitted, the
applicant may include a certified copy of the criminal records
check completed pursuant to that section and is not required to
comply with division (B)(1) of this section.
(3) A criminal records check provided to the board in
accordance with division (B)(1) or (B)(2) of this section shall
not be made available to any person or for any purpose other than
the following:
(a) The results may be made available to any person for use
in determining whether the individual who is the subject of the
check should be issued a medication aide certificate.
(b) The results may be made available to the person who is
the subject of the check or a representative of that person.
Sec. 4723.651. (A) To be eligible to receive a medication
aide certificate, an applicant shall meet all of the following
conditions:
(1) Be at least eighteen years of age;
(2) Have a high school diploma or a high school equivalence
diploma as defined in section 5107.40 of the Revised Code;
(3) If the applicant is to practice as a medication aide in a
nursing home, be a nurse aide who satisfies the requirements of
division (A)(1), (2), (3), (4), (5), (6), or (8) of section
3721.32 of the Revised Code;
(4) If the applicant is to practice as a medication aide in a
residential care facility, be a nurse aide who satisfies the
requirements of division (A)(1), (2), (3), (4), (5), (6), or (8)
of section 3721.32 of the Revised Code or an individual who has at
least one year of direct care experience in a residential care
facility;
(5) Successfully complete the course of instruction provided
by a training program approved by the board under section 4723.66
of the Revised Code;
(6) Have results on the criminal records check provided to
the board under division (B)(1) or (2) of section 4723.65 of the
Revised Code indicating that the applicant has not been convicted
of, has not pleaded guilty to, and has not had a judicial finding
of guilt for violating section 2903.01, 2903.02, 2903.03, 2903.11,
2905.01, 2907.02, 2907.03, 2907.05, 2909.02, 2911.01, or 2911.11
of the Revised Code or a substantially similar law of another
state, the United States, or another country Not be ineligible for
licensure or certification as specified in section 4723.092 of the
Revised Code;
(7) Have not committed any act that is grounds for
disciplinary action under section 3123.47 or 4723.28 of the
Revised Code or be determined by the board to have made
restitution, been rehabilitated, or both;
(8) Not be required to register under Chapter 2950. of the
Revised Code or a substantially similar law of another state, the
United States, or another country;
(9) Meet all other requirements for a medication aide
certificate established in rules adopted under section 4723.69 of
the Revised Code.
(B) If an applicant meets the requirement specified in
division (A) of this section, the board shall issue a medication
aide certificate to the applicant. If a medication aide
certificate is issued to an individual on the basis of having at
least one year of direct care experience working in a residential
care facility, as provided in division (A)(4) of this section, the
certificate is valid for use only in a residential care facility.
The board shall state the limitation on the certificate issued to
the individual.
(C) A medication aide certificate is valid for two years,
unless earlier suspended or revoked. The certificate may be
renewed in accordance with procedures specified by the board in
rules adopted under section 4723.69 of the Revised Code. To be
eligible for renewal, an applicant shall pay the renewal fee
established in the rules and meet all renewal qualifications
specified in the rules.
Sec. 4723.652. (A) The board of nursing, by vote of a
quorum, may impose one or more of the following sanctions against
any individual who applies for, or holds, a medication aide
certificate: deny, revoke, suspend, or place restrictions on the
certificate; reprimand or otherwise discipline the holder of a
medication aide certificate; or impose a fine of not more than
five hundred dollars per violation. The sanctions may be imposed
for any of the reasons specified in division (A) or (B) of section
4723.28 of the Revised Code, to the extent that those reasons are
applicable to medication aides or applicants as specified in rules
adopted under section 4723.69 of the Revised Code.
(B) Disciplinary actions taken by the board under this
section shall be taken pursuant to an adjudication conducted under
Chapter 119. of the Revised Code, except that in lieu of a
hearing, the board may enter into a consent agreement with an
individual to resolve an allegation of a violation of this chapter
or any rule adopted under it. A consent agreement, when ratified
by vote of a quorum, shall constitute the findings and order of
the board with respect to the matter addressed in the agreement.
If the board refuses to ratify a consent agreement, the admissions
and findings contained in the agreement shall be of no effect.
(C) In taking actions under this section, the board has the
same powers and duties that it has when taking actions under
section 4723.28 of the Revised Code. In addition, the board may
issue an order to summarily suspend or automatically suspend a
medication aide certificate in the same manner that the board is
authorized to take those actions under section 4723.281 of the
Revised Code.
Sec. 4723.653. (A) No person shall engage in the
administration of medication as a medication aide, represent the
person as being a certified medication aide, or use the title,
"medication aide," or any other title implying that the person is
a certified medication aide, for a fee, salary, or other
compensation, or as a volunteer, without holding a current, valid
certificate as a medication aide under this chapter.
(B) No person shall employ a person not certified as a
medication aide under this chapter to engage in the administration
of medication as a medication aide.
Sec. 4723.66. (A) A person or government entity seeking
approval to provide a medication aide training program shall apply
to the board of nursing on a form prescribed and provided by the
board. If the application is submitted on or after the day any
nursing home or residential care facility may initially use
medication aides as specified in section 4723.64 of the Revised
Code, the The application shall be accompanied by the fee
established in rules adopted under section 4723.69 of the Revised
Code.
(B) The board shall approve the applicant to provide a
medication aide training program if the content of the course of
instruction to be provided by the program meets the standards
specified by the board in rules adopted under section 4723.69 of
the Revised Code and includes all of the following:
(1) At least seventy clock-hours of instruction, including
both classroom instruction on medication administration and at
least twenty clock-hours of supervised clinical practice in
medication administration;
(2) A mechanism for evaluating whether an individual's
reading, writing, and mathematical skills are sufficient for the
individual to be able to administer prescription medications
safely;
(3) An examination that tests the ability to administer
prescription medications safely and that meets the requirements
established by the board in rules adopted under section 4723.69 of
the Revised Code.
(C) The board may deny, suspend, or revoke the approval
granted to the provider of a medication aide training program for
reasons specified in rules adopted under section 4723.69 of the
Revised Code. All actions taken by the board to deny, suspend, or
revoke the approval of a training program shall be taken in
accordance with Chapter 119. of the Revised Code.
Sec. 4723.67. (A) Except for the prescription medications
specified in division (C) of this section and the methods of
medication administration specified in division (D) of this
section, a medication aide who holds a current, valid medication
aide certificate issued under this chapter may administer
prescription medications to the residents of nursing homes and
residential care facilities that use medication aides pursuant to
section 4723.63 or 4723.64 of the Revised Code. A medication aide
shall administer prescription medications only pursuant to the
delegation of a registered nurse or a licensed practical nurse
acting at the direction of a registered nurse.
Delegation of medication administration to a medication aide
shall be carried out in accordance with the rules for nursing
delegation adopted under this chapter by the board of nursing. A
nurse who has delegated to a medication aide responsibility for
the administration of prescription medications to the residents of
a nursing home or residential care facility shall not withdraw the
delegation on an arbitrary basis or for any purpose other than
patient safety.
(B) In exercising the authority to administer prescription
medications pursuant to nursing delegation, a medication aide may
administer prescription medications in any of the following
categories:
(3) Medications administered as drops to the eye, ear, or
nose;
(4) Rectal and vaginal medications;
(5) Medications prescribed with a designation authorizing or
requiring administration on an as-needed basis, but only if a
nursing assessment of the patient is completed before the
medication is administered.
(C) A medication aide shall not administer prescription
medications in either of the following categories:
(1) Medications containing a schedule II controlled
substance, as defined in section 3719.01 of the Revised Code;
(2) Medications requiring dosage calculations.
(D) A medication aide shall not administer prescription
medications by any of the following methods:
(2) Intravenous therapy procedures;
(3) Splitting pills for purposes of changing the dose being
given.
(E) A nursing home or residential care facility that uses
medication aides shall ensure that medication aides do not have
access to any schedule II controlled substances within the home or
facility for use by its residents.
Sec. 4723.68. (A) A registered nurse, or licensed practical
nurse acting at the direction of a registered nurse, who delegates
medication administration to a medication aide who holds a
current, valid medication aide certificate issued under this
chapter is not liable in damages to any person or government
entity in a civil action for injury, death, or loss to person or
property that allegedly arises from an action or omission of the
medication aide in performing the medication administration, if
the delegating nurse delegates the medication administration in
accordance with this chapter and the rules adopted under this
chapter.
(B) A person employed by a nursing home or residential care
facility that uses medication aides pursuant to section 4723.63 or
4723.64 of the Revised Code who reports in good faith a medication
error at the nursing home or residential care facility is not
subject to disciplinary action by the board of nursing or any
other government entity regulating that person's professional
practice and is not liable in damages to any person or government
entity in a civil action for injury, death, or loss to person or
property that allegedly results from reporting the medication
error.
Sec. 4723.69. (A) In consultation with the medication aide
advisory council created under section 4723.62 of the Revised
Code, the The board of nursing shall adopt rules to implement
sections 4723.61 to 4723.68 of the Revised Code. Initial rules
shall be adopted not later than February 1, 2006. All rules
adopted under this section shall be adopted in accordance with
Chapter 119. of the Revised Code.
(B) The rules adopted under this section shall establish or
specify all of the following:
(1) Fees, in an amount sufficient to cover the costs the
board incurs in implementing sections 4723.61 to 4723.68 of the
Revised Code, for participation in the medication aide pilot
program, certification as a medication aide, and approval of a
medication aide training program;
(2) Requirements to obtain a medication aide certificate that
are not otherwise specified in section 4723.651 of the Revised
Code;
(3) Procedures for renewal of medication aide certificates;
(4) The extent to which the board determines that the reasons
for taking disciplinary actions under section 4723.28 of the
Revised Code are applicable reasons for taking disciplinary
actions under section 4723.652 of the Revised Code against an
applicant for or holder of a medication aide certificate;
(5) Standards for approval of peer support programs for the
holders of medication aide certificates;
(6) Standards for medication aide training programs,
including the examination to be administered by the training
program to test an individual's ability to administer prescription
medications safely;
(6) Standards for approval of continuing education programs
and courses for medication aides;
(7) Reasons for denying, revoking, or suspending approval of
a medication aide training program;
(8) Other standards and procedures the board considers
necessary to implement sections 4723.61 to 4723.68 of the Revised
Code.
Sec. 4723.71. (A) There is hereby established, under the
board of nursing, the advisory group on dialysis. The advisory
group shall advise the board of nursing regarding the
qualifications, standards for training, and competence of dialysis
technicians and dialysis technician interns and all other related
matters related to dialysis technicians. The advisory group shall
consist of the members appointed under divisions (B) and (C) of
this section. A member of the board of nursing or a representative
appointed by the board shall serve as chairperson of all meetings
of the advisory group.
(B) The board of nursing shall appoint the following as
members of the advisory group:
(1) Four dialysis technicians;
(2) A registered nurse who regularly performs dialysis and
cares for patients who receive dialysis;
(3) A physician, recommended by the state medical board, who
specializes in nephrology;
(4) An administrator of a dialysis center;
(6) A representative of the association for hospitals and
health systems (OHA) Ohio hospital association;
(7) A representative from the end-stage renal disease
network, as defined in 42 C.F.R. 405.2102.
(C) The members of the advisory group appointed under
division (B) of this section may recommend additional persons to
serve as members of the advisory group. The board of nursing may
appoint, as appropriate, any of the additional persons
recommended.
(D) The board of nursing shall specify the terms for the
advisory group members. Members shall serve at the discretion of
the board of nursing. Members shall receive their actual and
necessary expenses incurred in the performance of their official
duties.
(E) Sections 101.82 to 101.87 of the Revised Code do not
apply to the advisory group.
Sec. 4723.72. (A) A dialysis technician or dialysis
technician intern may engage in dialysis care by doing the
following:
(1) Performing and monitoring dialysis procedures, including
initiating, monitoring, and discontinuing dialysis;
(3) Administering any of the medications as specified in
division (C) of this section when the administration is essential
to the dialysis process;
(4) Responding to complications that arise during dialysis.
(B) A (1) Subject to divisions (B)(2) and (3) of this
section, a dialysis technician or dialysis technician intern may
provide the dialysis care specified in division (A) of this
section only if the care has been delegated to the technician or
intern by a physician or registered nurse and the technician or
intern is under the supervision of a physician or registered
nurse. Supervision requires that the dialysis technician or
dialysis technician intern be in the immediate presence of a
physician or registered nurse, or, in.
(2) In accordance with division (E) of section 4723.73 of the
Revised Code, a dialysis technician intern shall not provide
dialysis care in a patient's home.
(3) In the case of dialysis care provided in a patient's home
by a dialysis technician,
that the dialysis both of the following
apply:
(a) The technician shall be supervised in accordance with the
rules adopted under section 4723.79 of the Revised Code for
supervision of dialysis technicians who provide dialysis care in a
patient's home. Division (E)
(b) Division (D)(5) of section 4723.73 of the Revised Code
does not allow a dialysis technician who provides dialysis care in
a patient's home to provide dialysis care that is not authorized
under this section.
(C) A dialysis technician or dialysis technician intern may
administer medication only the following medications as ordered by
a licensed health professional authorized to prescribe drugs as
defined in section 4729.01 of the Revised Code and in accordance
with the standards for the delegation of dialysis care
established in division (B) of this section and in rules adopted
under section 4723.79 of the Revised Code. A dialysis technician
may administer only the following medications:
(1) Intradermal lidocaine or other single therapeutically
equivalent local anesthetic for the purpose of initiating dialysis
treatment;
(2) Intravenous heparin or other single therapeutically
equivalent anticoagulant for the purpose of initiating and
maintaining dialysis treatment;
(3) Intravenous normal saline;
(4) Patient-specific dialysate, to which the person
technician or intern may add electrolytes but no other additives
or medications;
(5) Oxygen, when the administration of the oxygen has been
delegated to the technician by a registered nurse.
Sec. 4723.73. (A) No person shall claim to the public to be
a dialysis technician unless the person holds who does not hold a
current, valid certificate issued under section 4723.75 or renewed
under section 4723.77 or a current, valid temporary certificate
issued under section 4723.76 of the Revised Code. shall do either
of the following:
(1) Claim to the public to be a dialysis technician;
(B) No person shall use (2) Use the title "Ohio certified
dialysis technician," the initials "OCDT," or any other title or
initials to represent that the person is authorized to perform
dialysis care as a fully certified dialysis technician, unless the
person holds a current, valid certificate issued under section
4723.75 or renewed under section 4723.77 of the Revised Code.
(C)(B) No person who does not hold a current, valid dialysis
technician intern certificate issued under section 4723.76 of the
Revised Code shall use any do either of the following:
(1) Claim to the public to be a dialysis technician intern;
(2) Use the title or "dialysis technician intern," the
initials "DTI," or any other title or initials to represent that
the person is authorized to perform dialysis care as a
temporarily
certified dialysis technician, unless the person holds a current,
valid temporary certificate issued under section 4723.76 of the
Revised Code intern.
(D)(C) No dialysis technician or dialysis technician intern
shall engage in dialysis care in a manner that is inconsistent
with section 4723.72 of the Revised Code.
(E)(D) No person other than a dialysis technician or dialysis
technician intern shall engage in the dialysis care that is
authorized by section 4723.72 of the Revised Code, unless the
person is one or more of the following applies:
(1) The person is a A registered nurse or licensed practical
nurse.;
(2) The person is a A physician.;
(3) The person is a A student performing dialysis care under
the supervision of an instructor as an integral part of a dialysis
training program approved by the board of nursing under section
4723.74 of the Revised Code.;
(4) The person is a A dialysis patient who has been trained
to engage in the dialysis care with little or no professional
assistance by completing a medicare-approved self-dialysis or home
dialysis training program.;
(5) The person is a A family member or friend of a dialysis
patient who engages in self-dialysis or home dialysis, and the
person engages in the dialysis care by assisting the patient in
performing the self-dialysis or home dialysis, after the person
providing the assistance has completed a medicare-approved
self-dialysis or home dialysis training program for the particular
dialysis patient being assisted.
(E) No dialysis technician intern shall do either of the
following:
(1) Serve as a trainer or preceptor in a dialysis training
program;
(2) Provide dialysis care in a patient's home.
(F) No person shall operate a dialysis training program,
unless the program is approved by the board of nursing under
section 4723.74 of the Revised Code.
Sec. 4723.74. (A) A person who seeks to operate a dialysis
training program shall apply to the board of nursing for approval
of the program. Applications shall be submitted in accordance with
rules adopted under section 4723.79 of the Revised Code. The
person shall include with the application the fee prescribed in
those rules. If the program meets the requirements for approval as
specified in the rules, the board shall approve the program. A
program shall apply for reapproval and may be reapproved in
accordance with rules adopted under section 4723.79 of the Revised
Code.
(B) The board may place on provisional approval, for a period
of time it specifies, a dialysis training program that has ceased
to meet and maintain the minimum standards of the board
established by rules adopted under section 4723.79 of the Revised
Code. Prior to or at the end of the period, the board shall
reconsider whether the program meets the standards. The board
shall grant full approval if the program meets the standards. If
the program does not meet the standards, the board may withdraw
approval in accordance with division (C) of this section.
(C) The board may withdraw the approval of a program that
ceases to meet the requirements for approval. Any action to
withdraw the approval shall be taken in accordance with Chapter
119. of the Revised Code.
(B) A person (D) An individual shall not be permitted to
enroll, and shall not enroll, in a dialysis training program
approved by the board under
division (A) of this section unless
the person individual is eighteen years of age or older and
possesses a high school diploma or high school equivalence
diploma.
Sec. 4723.75. (A) The board of nursing shall issue a
certificate to practice as a dialysis technician to a person an
applicant who meets all of the following applicable requirements:
(1) For all persons applicants, the person applies
application is submitted to the board in accordance with rules
adopted under section 4723.79 of the Revised Code and includes
with the application the both of the following:
(a) The fee established in
those rules adopted under section
4723.79 of the Revised Code;
(b) The name and address of each approved dialysis training
program in which the applicant has enrolled and the dates during
which the applicant was enrolled in each program.
(2) For all persons applicants, the person applicant meets
the requirements established by the board's rules.
(3) For all persons applicants, the person applicant
demonstrates competency to practice as a dialysis technician, as
specified
under in division (B) of this section.
(4) For persons applicants who entered a dialysis training
program on or after June 1, 2003, the results of a criminal
records check of the person that is completed by the bureau of
criminal identification and investigation and includes a check of
federal bureau of investigation records and that the bureau
submits to the board indicates that the person has not been
convicted of, has not pleaded guilty to, and has not had a
judicial finding of guilt for violating section 2903.01, 2903.02,
2903.03, 2903.11, 2905.01, 2907.02, 2907.03, 2907.05, 2909.02,
2911.01, or 2911.11 of the Revised Code or a substantially similar
law of another state, the United States, or another country
conducted in accordance with section 4723.091 of the Revised Code
demonstrate that the applicant is not ineligible for certification
as specified in section 4723.092 of the Revised Code.
(B) For a person an applicant to demonstrate competence to
practice as a dialysis technician, one of the following must
apply:
(1) The person meets all of the following requirements:
(a) The person applicant has successfully completed a
dialysis training program approved by the board under section
4723.74 of the Revised Code.
(b) The person has been employed to perform and meets both of
the following requirements:
(a) Has performed dialysis care by for a dialysis provider
for not less than twelve months immediately prior to the date of
application.
(b) Has passed a certification examination demonstrating
competence to perform dialysis care. The person must pass the
examination not later than eighteen months after entering
successfully completing a dialysis training program approved by
the board under section 4723.74 of the Revised Code. A person who
does not pass the examination within eighteen months after
entering a dialysis training program must repeat and successfully
complete the training program, or successfully complete another
dialysis training program approved by the board, and pass the
examination not less than six months after entering the new or
repeated program. A person who does not pass the examination
within six months after entering the new or repeated program must
wait at least one year before entering or reentering any dialysis
training program approved by the board, after which the person
must successfully complete a dialysis training program approved by
the board and pass the examination not later than six months after
entering the program.
(2) The person meets both of the following requirements:
(a) The person holds, on December 24, 2000, a current, valid
certificate from a qualifying testing organization specified by
the board under division (B) of section 4723.751 of the Revised
Code or provides evidence satisfactory to the board of having
passed the examination of a qualifying testing organization not
longer than five years prior to December 24, 2000.
(b) The dialysis provider who employs the person provides the
board with the information specified in rules adopted under
section 4723.79 of the Revised Code attesting to the person's
competence to perform dialysis care.
(3) The person submits evidence satisfactory to the board
that the person holds a current, valid license, certificate, or
other authorization to perform dialysis care issued by another
state that has standards for dialysis technicians that the board
considers substantially similar to those established under
sections 4723.71 to 4723.79 of the Revised Code applicant does
all of the following:
(a) Has a testing organization approved by the board submit
evidence satisfactory to the board that the applicant passed an
examination, in another jurisdiction, that demonstrates the
applicant's competence to provide dialysis care;
(b) Submits evidence satisfactory to the board that the
applicant has been employed to perform dialysis care in another
jurisdiction for not less than twelve months immediately prior to
the date of application for certification under this section;
(c) Submits evidence satisfactory to the board that the
applicant completed at least two hours of education directly
related to this chapter and the rules adopted under it.
(C) A person who applies under this section to be certified
to practice as a dialysis technician shall submit a request to the
bureau of criminal identification and investigation for a criminal
records check of the applicant. The request shall be on the form
prescribed pursuant to division (C)(1) of section 109.572,
accompanied by a standard impression sheet to obtain fingerprints
prescribed pursuant to division (C)(2) of that section, and
accompanied by the fee prescribed pursuant to division (C)(3) of
that section. Upon receipt of the completed form, the completed
impression sheet, and the fee, the bureau shall conduct a criminal
records check of the applicant. Upon completion of the criminal
records check, the bureau shall send the results of the check to
the board. A person requesting a criminal records check under this
division shall ask the superintendent of the bureau of criminal
identification and investigation to also request the federal
bureau of investigation to provide the superintendent with any
information it has with respect to the person.
The results of any criminal records check conducted pursuant
to a request made under this section, and any report containing
those results, are not public records for purposes of section
149.43 of the Revised Code and shall not be made available to any
person or for any purpose other than the following:
(1) The results may be made available to any person for use
in determining under this section and division (N) of section
4723.28 of the Revised Code whether the individual who is the
subject of the check should be issued a certificate to practice as
a dialysis technician.
(2) The results may be made available to the individual who
is the subject of the check or that individual's representative.
An applicant who does not pass the certification examination
described in division (B)(1)(b) of this section within the time
period prescribed in that division may continue to pursue
certification by repeating the entire training and application
process, including doing all of the following:
(1) Enrolling in and successfully completing a dialysis
training program approved by the board;
(2) Submitting a request to the bureau of criminal
identification and investigation for a criminal records check and
check of federal bureau of investigation records pursuant to
section 4723.091 of the Revised Code;
(3) Submitting an application for a dialysis technician
intern certificate in accordance with section 4723.76 of the
Revised Code;
(4) Demonstrating competence to perform dialysis care in
accordance with division (B) of this section.
Sec. 4723.751. (A) The board of nursing shall either conduct
dialysis technician certification examinations itself or, in
accordance with rules adopted under section 4723.79 of the Revised
Code, approve testing organizations to conduct the examinations.
If it conducts the examinations, the board may use all or part of
a standard examination created by a testing organization approved
by the board. Regardless of who conducts it, the examination shall
cover all of the subjects specified in rules adopted under section
4723.79 of the Revised Code.
(B) The board shall specify the testing organizations that
qualify a person to demonstrate competence to practice as a
dialysis technician pursuant to division (B)(2) of section 4723.75
of the Revised Code.
Sec. 4723.76. (A) The board of nursing shall issue a
temporary certificate to practice as a dialysis technician intern
to a person an applicant who has not passed the dialysis
technician certification examination required by section 4723.751
of the Revised Code, but who
meets satisfies all of the following
requirements:
(1) The person applies Applies to the board in accordance
with rules adopted under section 4723.79 of the Revised Code and
includes with the application the both of the following:
(a) The fee established in those rules adopted under section
4723.79 of the Revised Code;
(b) The name and address of all dialysis training programs
approved by the board in which the applicant has been enrolled and
the dates of enrollment in each program.
(2) The person provides Provides documentation from the
person's applicant's employer
that demonstrates attesting that the
person applicant is competent to perform dialysis care.;
(3) One of the following applies:
(a) The person has Has successfully completed a dialysis
training program approved by the board of nursing under section
4723.74 of the Revised Code.
(b) The person is, on December 24, 2000, employed as a
dialysis technician but has been so employed for less than twelve
months.
(c) The person has experience as a dialysis technician in a
jurisdiction that does not license or certify dialysis technicians
and has successfully completed a training program that is
substantially similar to a program approved by the board.
(B) A temporary dialysis technician intern certificate issued
to a person an applicant who meets the
requirement requirements in
division (A)(3)(a) of this section is valid for a period of time
that is eighteen months from the date on which the
holder entered
applicant successfully completed a dialysis training program
approved by the board under section 4723.74 of the Revised Code,
minus the time the applicant was enrolled in one or more dialysis
training programs approved by the board.
A temporary certificate issued to a person who meets the
requirement in division (A)(3)(b) of this section is valid for the
number of months equal to eighteen months minus the number of
months the person has been employed as a dialysis technician.
A temporary certificate issued to a person who meets the
requirement in division (A)(3)(c) of this section and has been
working as a dialysis technician for twelve months or longer is
valid for six months. A temporary certificate issued to a person
who meets the requirement in division (A)(3)(c) of this section
and has been employed as a dialysis technician for less than
twelve months is valid for the number of months equal to eighteen
months minus the number of months the person has been employed as
a dialysis technician.
(C) A temporary dialysis technician intern certificate issued
under this section may not be renewed once if the holder enrolls
or re-enrolls in a dialysis training program approved by the
board. A temporary certificate that has been renewed is not
renewable. A person holding a temporary certificate shall provide
a copy of the temporary certificate to the dialysis provider who
employs the person. The person shall not act as a trainer or
preceptor in any dialysis training program.
Sec. 4723.77. A dialysis technician certificate issued under
section 4723.75 of the Revised Code expires biennially and shall
be renewed according to a schedule established by the board of
nursing in rules adopted under section 4723.79 of the Revised
Code. An application for renewal of a dialysis technician
certificate shall be accompanied by the renewal fee established in
rules adopted by the board under section 4723.79 of the Revised
Code. A certificate may be renewed only if, during the period for
which the certificate was issued, the certificate holder satisfied
the continuing education requirements established by the board's
rules. Of the hours of continuing education completed during the
period for which the dialysis technician certificate was issued,
at least one hour of the education must be directly related to the
statutes and rules pertaining to the practice of nursing in this
state or the practice as a dialysis technician in this state.
Sec. 4723.79. The board of nursing shall adopt rules to
administer and enforce sections 4723.71 to 4723.79 of the Revised
Code. The board shall adopt the rules in accordance with Chapter
119. of the Revised Code. The rules shall establish or specify all
of the following:
(A) The application process, fee, and requirements for
approval, reapproval, and withdrawing the approval of a dialysis
training program under section 4723.74 of the Revised Code. The
requirements shall include standards that must be satisfied
regarding curriculum, length of training, and instructions in
patient care.
(B) The application process, fee, and requirements for
issuance of a dialysis technician certificate under section
4723.75 of the Revised Code, except that the amount of the fee
shall be no greater than the fee charged under division (A)(1) of
section 4723.08 of the Revised Code;
(C) The application process, fee, and requirements for
issuance of a temporary dialysis technician intern certificate
under section 4723.76 of the Revised Code;
(D) The process for approval of testing organizations under
section 4723.751 of the Revised Code;
(E) Subjects to be included in a certification examination
provided for in division (B)(1) of pursuant to section 4723.75
4723.751 of the Revised Code;
(F) The schedule, fees, and continuing education requirements
for renewal of a dialysis technician certificate under section
4723.77 of the Revised Code, except that the amount of the fee for
the renewal of a certificate shall be no greater than the fee
charged under division (A)(9)(10) of section 4723.08 of the
Revised Code
or, effective September 1, 2003, division (A)(10) of
that section;
(G) Standards and procedures for establishing and maintaining
the dialysis registry required by section 4723.78 of the Revised
Code, including standards and procedures that persons must follow
in providing the information to be included in the registry for
approval of continuing education programs and courses for dialysis
technicians;
(H) Standards for the administration of medication by
dialysis technicians and dialysis technician interns under section
4723.72 of the Revised Code;
(I) The information a dialysis provider is to provide to the
board when attesting to a person's competence to perform dialysis;
(J) Standards and procedures for the supervision of dialysis
technicians who provide dialysis care in a patient's home,
including monthly home visits by a registered nurse to monitor the
quality of the dialysis care;
(K)(J) Any other procedures or requirements necessary for the
administration and enforcement of sections 4723.71 to 4723.79 of
the Revised Code.
Sec. 4723.83. (A) An individual seeking a community health
worker certificate shall submit an application to the board of
nursing on forms the board shall prescribe and furnish. The
applicant shall include all information the board requires to
process the application. The application shall be accompanied by
the fee established in rules adopted under section 4723.88 of the
Revised Code.
(B) An applicant for a community health worker certificate
shall submit a request to the bureau of criminal identification
and investigation for a criminal records check of the applicant.
The request shall be on the form prescribed pursuant to division
(C)(1) of section 109.572 of the Revised Code, accompanied by a
standard impression sheet to obtain fingerprints prescribed
pursuant to division (C)(2) of that section, and accompanied by
the fee prescribed pursuant to division (C)(3) of that section. On
receipt of the completed form, the completed impression sheet, and
the fee, the bureau shall conduct a criminal records check of the
applicant. On completion of the criminal records check, the bureau
shall send the results of the check to the board. The applicant
shall ask the superintendent of the bureau of criminal
identification and investigation to request that the federal
bureau of investigation provide the superintendent with any
information it has with respect to the applicant.
The results of any criminal records check conducted pursuant
to a request made under this section, and any report containing
those results, are not public records for purposes of section
149.43 of the Revised Code and shall not be made available to any
person or for any purpose other than the following:
(1) The results may be made available to any person for use
in determining whether the individual who is the subject of the
check should be issued a community health worker certificate.
(2) The results may be made available to the individual who
is the subject of the check or that individual's representative.
Sec. 4723.84. (A) To be eligible to receive a community
health worker certificate, an applicant shall meet all of the
following conditions:
(1) Be eighteen years of age or older;
(2) Possess a high school diploma or the equivalent of a high
school diploma, as determined by the board;
(3) Except as provided in division (B) of this section,
successfully complete a community health worker training program
approved by the board under section 4723.87 of the Revised Code;
(4) Have results on the criminal records check requested
under section 4723.83 of the Revised Code indicating that the
individual has not been convicted of, has not pleaded guilty to,
and has not had a judicial finding of guilt for violating section
2903.01, 2903.02, 2903.03, 2903.11, 2905.01, 2907.02, 2907.03,
2907.05, 2909.02, 2911.01, or 2911.11 of the Revised Code or a
substantially similar law of another state, the United States, or
another country Not be ineligible for certification as specified
in section 4723.092 of the Revised Code;
(5) Not have committed any act that is grounds for
disciplinary action under section 3123.47 of the Revised Code or
rules adopted under division (F) of section 4723.88 of the Revised
Code or, if such an act has been committed, be determined by the
board to have made restitution, been rehabilitated, or both;
(6) Not be required to register under Chapter 2950. of the
Revised Code or a substantially similar law of another state, the
United States, or another country;
(7) Meet all other requirements the board specifies in rules
adopted under section 4723.88 of the Revised Code.
(B) In lieu of meeting the condition of completing a
community health worker training program, an applicant may be
issued a community health worker certificate if the individual was
employed in a capacity substantially the same as a community
health worker before the board implemented the certification
program prior to February 1, 2005. To be eligible under this
division, an applicant must meet the requirements specified in
rules adopted by the board under section 4723.88 of the Revised
Code and provide documentation from the employer attesting to the
employer's belief that the applicant is competent to perform
activities as a certified community health worker.
Sec. 4723.87. (A) A person or government entity seeking to
operate a training program that prepares individuals to become
certified community health workers shall submit an application to
the board of nursing on forms the board shall prescribe and
furnish. The applicant shall include all information the board
requires to process the application. The application shall be
accompanied by the fee established in rules adopted under section
4723.87 of the Revised Code.
The board shall review all applications received. If an
applicant meets the standards for approval established in the
board's rules adopted under section 4723.88 of the Revised Code,
the board shall approve the program.
(B) The board's approval of a training program expires
biennially and may be renewed in accordance with the schedule and
procedures established by the board in rules adopted under section
4723.88 of the Revised Code.
(C) If an approved community health worker training program
ceases to meet the standards for approval, the board shall
withdraw its approval of the program, refuse to renew its approval
of the program, or place the program on provisional approval. In
withdrawing or refusing to renew its approval, the board shall act
in accordance with Chapter 119. of the Revised Code. In placing a
program on provisional approval, the board shall specify the
period of time during which the provisional approval is valid. At
Prior to or at the end of the period, the board shall reconsider
whether the program meets the standards for approval. If the
program meets the standards for approval, the board shall
reinstate its full approval of the program or renew its approval
of the program. If the program does not meet the standards for
approval, the board shall proceed by withdrawing or refusing to
renew its approval of the program.
Sec. 4723.88. The board of nursing, in accordance with
Chapter 119. of the Revised Code, shall adopt rules to administer
and enforce sections 4723.81 to 4723.87 of the Revised Code. The
rules shall establish all of the following:
(A) Standards and procedures for issuance of community health
worker certificates;
(B) Standards for evaluating the competency of an individual
who applies to receive a certificate on the basis of having been
employed in a capacity substantially the same as a community
health worker before the board implemented the certification
program;
(C) Standards and procedures for renewal of community health
worker certificates, including the continuing education
requirements that must be met for renewal;
(D) Standards governing the performance of activities related
to nursing care that are delegated by a registered nurse to
certified community health workers. In establishing the standards,
the board shall specify limits on the number of certified
community health workers a registered nurse may supervise at any
one time.
(E) Standards and procedures for assessing the quality of the
services that are provided by certified community health workers;
(F) Standards and procedures for denying, suspending, and
revoking a community health worker certificate, including reasons
for imposing the sanctions that are substantially similar to the
reasons that sanctions are imposed under section 4723.28 of the
Revised Code;
(G) Standards and procedures for approving and renewing the
board's approval of training programs that prepare individuals to
become certified community health workers. In establishing the
standards, the board shall specify the minimum components that
must be included in a training program, shall require that all
approved training programs offer the standardized curriculum, and
shall ensure that the curriculum enables individuals to use the
training as a basis for entering programs leading to other
careers, including nursing education programs.
(H) Standards for approval of continuing education programs
and courses for certified community health workers;
(I) Standards and procedures for withdrawing the board's
approval of a training program, refusing to renew the approval of
a training program, and placing a training program on provisional
approval;
(I)(J) Amounts for each fee that may be imposed under
division (A)(25)(21) of section 4723.08 of the Revised Code;
(J)(K) Any other standards or procedures the board considers
necessary and appropriate for the administration and enforcement
of sections 4723.81 to 4723.87 of the Revised Code.
Sec. 4723.99. (A) Except as provided in division (B) of this
section, whoever violates section 4723.03, 4723.44, 4723.653, or
4723.73 of the Revised Code is guilty of a felony of the fifth
degree on a first offense and a felony of the fourth degree on
each subsequent offense.
(B)
A Each of the following is guilty of a minor misdemeanor:
(1) A registered nurse or licensed practical nurse who
violates division (A) or (B) of section 4723.03 of the Revised
Code by reason of a license to practice nursing that has lapsed
for failure to renew or by practicing nursing after a license has
been classified as inactive is guilty of a minor misdemeanor;
(2) A medication aide who violates section 4723.653 of the
Revised Code by reason of a medication aide certificate that has
lapsed for failure to renew or by administering medication as a
medication aide after a certificate has been classified as
inactive.
Sec. 4759.01. As used in this chapter:
(A) "The practice Practice of dietetics" means any of the
following:
(1) Nutritional assessment to determine nutritional needs and
to recommend appropriate nutritional intake, including enteral and
parenteral nutrition;
(2) Nutritional counseling or education as components of
preventive, curative, and restorative health care;
(3) Development, administration, evaluation, and consultation
regarding nutritional care standards.
(B) "The American dietetic association Academy of nutrition
and dietetics" means the national professional organization of
dietitians that provides direction and leadership for quality
dietetic practice, education, and research known by that name or a
successor organization that serves in an equivalent capacity.
(C) "Commission on dietetic registration" means the
commission on dietetic registration that is a member of the
national commission on health certifying agencies entity that
serves as the credentialing agency for the academy of nutrition
and dietetics.
(D) "Ohio academy of nutrition and dietetics" means the state
professional organization known by that name or a successor
organization that serves in an equivalent capacity.
Sec. 4759.03. There is hereby created the Ohio board of
dietetics consisting of five members appointed by the governor
with the advice and consent of the senate. The Ohio dietetic
association academy of nutrition and dietetics may submit a list
of five names for each position or vacancy on the board to be
filled by a dietitian, and the governor may make his appointment
appointments from the persons so recommended or from other
persons. Within
Within thirty days of
the effective date of this section July
1, 1987, the governor shall make initial appointments to the
board. Of the initial appointments, one shall be for a term ending
one year after
the effective date of this section July 1, 1987,
one shall be for a term ending two years after
the effective date
of this section July 1, 1987, one shall be for a term ending three
years after
the effective date of this section July 1, 1987, one
shall be for a term ending four years after
the effective date of
this section July 1, 1987, and one shall be for a term ending five
years after
the effective date of this section July 1, 1987.
Thereafter, terms of office shall be for five years, each term
ending on the same day of the same month as did the term which it
succeeds. Each member shall hold office from the date of his
appointment until the end of the term for which he the member was
appointed. The governor shall appoint a member to fill a vacancy
in the manner prescribed for filling the position in which the
vacancy occurs. Any member appointed to fill a vacancy occurring
prior to the expiration of the term for which his the member's
predecessor was appointed shall hold office for the remainder of
the term. Any member shall continue in office subsequent to the
expiration date of his the member's term until
his a successor
takes office, or until a period of sixty days has elapsed,
whichever occurs first.
Members of the board may be removed by the governor for
malfeasance, misfeasance, or nonfeasance after an adjudication
hearing pursuant to Chapter 119. of the Revised Code. Members may
not be appointed to a second term unless a period of five years
has passed since the expiration of the first term, except that
members appointed for less than a five-year term or appointed to
fill an unexpired term may be appointed for one full term of five
years immediately following the end of the term for which he the
member was first appointed.
Three members of the board shall be dietitians who have been
actively engaged in the practice of dietetics in the state for at
least five years immediately preceding their appointment; one
member shall be an educator with a doctoral degree who holds a
regular faculty appointment in a program that prepares students to
meet the requirements of division (A)(5) of section 4759.06 of the
Revised Code; and one member shall be a member of the general
public who is not and never has been a dietitian, is not a member
of the immediate family of a dietitian, does not have a financial
interest in the provision of goods or services to dietitians, and
is not engaged in any activity related to the practice of
dietetics.
Each member of the board shall receive an amount fixed
pursuant to division (J) of section 124.15 of the Revised Code for
each day, or portion thereof, he is actually engaged in the
discharge of his official duties, and shall be reimbursed for
actual and necessary expenses incurred in the performance of those
duties.
Sec. 4759.05. The Ohio board of dietetics shall:
(A) Adopt, amend, or rescind rules pursuant to Chapter 119.
of the Revised Code to carry out the provisions of this chapter,
including rules governing the following:
(1) Selection and approval of a dietitian licensure
examination offered by the commission on dietetic registration or
any other examination;
(2) The examination of applicants for licensure as a
dietitian, to be held at least twice annually, as required under
division (A) of section 4759.06 of the Revised Code;
(3) Requirements for pre-professional dietetic experience of
applicants for licensure as a dietitian that are at least
equivalent to the requirements adopted by the commission on
dietetic registration;
(4) Requirements for a person holding a limited permit under
division (F) of section 4759.06 of the Revised Code, including the
duration of validity of a limited permit;
(5) Requirements for a licensed dietitian who places a
license in inactive status under division (G) of section 4759.06
of the Revised Code, including a procedure for changing inactive
status to active status;
(6) Continuing education requirements for renewal of a
license, except that the board may adopt rules to waive the
requirements for a person who is unable to meet the requirements
due to illness or other reasons. Rules adopted under this division
shall be consistent with the continuing education requirements
adopted by the commission on dietetic registration.
(7) Any additional education requirements the board considers
necessary, for applicants who have not practiced dietetics within
five years of the initial date of application for licensure;
(8) Standards of professional responsibility and practice for
persons licensed under this chapter that are consistent with those
standards of professional responsibility and practice adopted by
the American dietetic association academy of nutrition and
dietetics;
(9) Formulation of a written application form for licensure
or license renewal that includes the statement that any applicant
who knowingly makes a false statement on the application is guilty
of a misdemeanor of the first degree under section 2921.13 of the
Revised Code;
(10) Procedures for license renewal;
(11) Establishing a time period after the notification of a
violation of section 4759.02 of the Revised Code, by which the
person notified must request a hearing by the board under section
4759.09 of the Revised Code;
(12) Requirements for criminal records checks of applicants
under section 4776.03 of the Revised Code.
(B) Investigate alleged violations of sections 4759.02 to
4759.10 of the Revised Code. In making its investigations, the
board may issue subpoenas, examine witnesses, and administer
oaths.
(D) Conduct meetings and keep records as are necessary to
carry out the provisions of this chapter;
(E) Publish, and make available to the public, upon request
and for a fee not to exceed the actual cost of printing and
mailing, the board's rules and requirements for licensure adopted
under division (A) of this section and a record of all persons
licensed under section 4759.06 of the Revised Code.
Sec. 4759.06. (A) The Ohio board of dietetics shall issue or
renew a license to practice dietetics to an applicant who:
(1) Has satisfactorily completed an application for licensure
in accordance with division (A) of section 4759.05 of the Revised
Code;
(2) Has paid the fee required under division (A) of section
4759.08 of the Revised Code;
(3) Is a resident of the state or performs or plans to
perform dietetic services within the state;
(4) Is of good moral character;
(5) Has received a baccalaureate or higher degree from an
institution of higher education that is approved by the board or a
regional accreditation agency that is recognized by the council on
postsecondary accreditation, and has completed a program
consistent with the academic standards for dietitians established
by the American dietetic association academy of nutrition and
dietetics;
(6) Has successfully completed a pre-professional dietetic
experience approved by the American dietetic association academy
of nutrition and dietetics, or experience approved by the board
under division (A)(3) of section 4759.05 of the Revised Code;
(7) Has passed the examination approved by the board under
division (A)(1) of section 4759.05 of the Revised Code;
(8) Is an applicant for renewal of a license, and has
fulfilled the continuing education requirements adopted under
division (A)(6) of section 4759.05 of the Revised Code.
(B) The board shall waive the requirements of divisions
(A)(5), (6), and (7) of this section and any rules adopted under
division (A)(7) of section 4759.05 of the Revised Code if the
applicant presents satisfactory evidence to the board of current
registration as a registered dietitian with the commission on
dietetic registration.
(C) The board shall waive the requirements of division (A)(7)
of this section if the application for renewal is made within two
years after the date of license expiration.
(D) The board may waive the requirements of division (A)(5),
(6), or (7) of this section or any rules adopted under division
(A)(7) of section 4759.05 of the Revised Code, if the applicant
presents satisfactory evidence of education, experience, or
passing an examination in another state or a foreign country, that
the board considers the equivalent of the requirements stated in
those divisions or rules.
(E) The board shall issue an initial license to practice
dietetics to an applicant who meets the requirements of division
(A) of this section. An initial license shall be valid from the
date of issuance through the thirtieth day of June following
issuance of the license. Each subsequent license shall be valid
from the first day of July through the thirtieth day of June. The
board shall renew the license of an applicant who is licensed to
practice dietetics and who meets the continuing education
requirements of division (A)(6) of section 4759.05 of the Revised
Code. The renewal shall be pursuant to the standard renewal
procedure of sections 4745.01 to 4745.03 of the Revised Code.
(F) The board may grant a limited permit to a person who has
completed the education and pre-professional requirements of
divisions (A)(5) and (6) of this section and who presents evidence
to the board of having applied to take the examination approved by
the board under division (A)(1) of section 4759.05 of the Revised
Code. A person holding a limited permit who has failed the
examination shall practice only under the direct supervision of a
licensed dietitian.
(G) A licensed dietitian may place the license in inactive
status.
Sec. 4759.10. Sections 4759.01 to 4759.09 of the Revised
Code do not apply to any of the following:
(A) A person licensed under Chapters 4701. to 4755. of the
Revised Code who is acting within the scope of the person's
profession, provided that the person complies with division (B) of
section 4759.02 of the Revised Code;
(B) A person who is a graduate of an associate degree program
approved by the American dietetic association academy of nutrition
and dietetics or the Ohio board of dietetics who is working as a
dietetic technician under the supervision of a dietitian licensed
under section 4759.06 of the Revised Code or registered by the
commission on dietetic registration, except that the person is
subject to division (B) of section 4759.02 of the Revised Code if
the person uses a title other than "dietetic technician";
(C) A person who practices dietetics related to employment in
the armed forces, veteran's administration, or the public health
service of the United States;
(D) Persons employed by a nonprofit agency approved by the
board or by a federal, state, municipal or county government, or
by any other political subdivision, elementary or secondary
school, or an institution of higher education approved by the
board or by a regional agency recognized by the council on
postsecondary accreditation, who performs only nutritional
education activities and such other nutritional activities as the
board of dietetics, by rule, permits, provided the person does not
violate division (B) of section 4759.02 of the Revised Code;
(E) A person who has completed a program meeting the academic
standards set by the American dietetic association for dietitians
by the academy of nutrition and dietetics, received a
baccalaureate or higher degree from a school, college, or
university approved by a regional accreditation agency recognized
by the council on postsecondary accreditation, works under the
supervision of a licensed dietitian or registered dietitian, and
does not violate division (B) of section 4759.02 of the Revised
Code;
(F) A person when acting, under the direction and supervision
of a person licensed under Chapters 4701. to 4755. of the Revised
Code, in the execution of a plan of treatment authorized by the
licensed person, provided the person complies with division (B) of
section 4759.02 of the Revised Code;
(G) The free dissemination of literature in the state;
(H) Provided that the persons involved in the sale,
promotion, or explanation of the sale of food, food materials, or
dietary supplements do not violate division (B) of section 4759.02
of the Revised Code, the sale of food, food materials, or dietary
supplements and the marketing and distribution of food, food
materials, or dietary supplements and the promotion or explanation
of the use of food, food materials, or dietary supplements
provided that the promotion or explanation does not violate
Chapter 1345. of the Revised Code;
(I) A person who offers dietary supplements for sale and who
makes the following statements about the product if the statements
are consistent with the dietary supplement's label or labeling:
(1) Claim a benefit related to a classical nutrient
deficiency disease and disclose the prevalence of the disease in
the United States;
(2) Describe the role of a nutrient or dietary ingredient
intended to affect the structure or function of the human body;
(3) Characterize the documented mechanism by which a nutrient
or dietary ingredient acts to maintain the structure or function
of the human body;
(4) Describe general well-being from the consumption of a
nutrient or dietary ingredient.
(J) Provided that the persons involved in presenting a
general program of instruction for weight control do not violate
division (B) of section 4759.02 of the Revised Code, a general
program of instruction for weight control approved in writing by a
licensed dietitian, a physician licensed under Chapter 4731. of
the Revised Code to practice medicine or surgery or osteopathic
medicine or surgery, a person licensed in another state that the
board considers to have substantially equivalent licensure
requirements as this state, or a registered dietitian;
(K) The continued practice of dietetics at a hospital by a
person employed at that same hospital to practice dietetics for
the twenty years immediately prior to July 1, 1987, so long as the
person works under the supervision of a dietitian licensed under
section 4759.06 of the Revised Code and does not violate division
(B) of section 4759.02 of the Revised Code. This division does not
apply to any person who has held a license issued under this
chapter to practice dietetics. As used in this division,
"hospital" has the same meaning as in section 3727.01 of the
Revised Code.
Sec. 5111.222. (A) As used in this section, "low resource
utilization resident" means a medicaid recipient residing in a
nursing facility who, for purposes of calculating the nursing
facility's medicaid reimbursement rate for direct care costs, is
placed in either of the two lowest resource utilization groups,
excluding any resource utilization group that is a default group
used for residents with incomplete assessment data.
(B) Except as otherwise provided by sections 5111.20 to
5111.331 of the Revised Code and by division (B)(C) of this
section, the total rate that the department of job and family
services shall agree to pay for a fiscal year to the provider of a
nursing facility pursuant to a provider agreement shall equal the
sum of all of the following:
(1) The rate for direct care costs determined for the nursing
facility under section 5111.231 of the Revised Code;
(2) The rate for ancillary and support costs determined for
the nursing facility's ancillary and support cost peer group under
section 5111.24 of the Revised Code;
(3) The rate for tax costs determined for the nursing
facility under section 5111.242 of the Revised Code;
(4) The quality incentive payment paid to the nursing
facility under section 5111.244 of the Revised Code;
(5) If the nursing facility qualifies as a critical access
nursing facility, the critical access incentive payment paid to
the nursing facility under section 5111.246 of the Revised Code;
(6) The rate for capital costs determined for the nursing
facility's capital costs peer group under section 5111.25 of the
Revised Code.
(B) The department shall adjust the rates otherwise
determined under division (A) of this section as directed by the
general assembly through the enactment of law governing medicaid
payments to providers of nursing facilities, including any law
that establishes factors by which the rates are to be adjusted.
(C) The total rate determined under division (B) of this
section shall not be paid for nursing facility services provided
to low resource utilization residents. Instead, the total rate for
nursing facility services that a nursing facility provides to low
resource utilization residents shall be one hundred thirty dollars
per medicaid day.
(D) In addition to paying a nursing facility provider the
nursing facility's total rate determined for the nursing facility
under division
(A)(B) or (C) of this section for a fiscal year,
the department shall pay the provider a quality bonus under
section 5111.245 of the Revised Code for that fiscal year if the
provider's nursing facility is a qualifying nursing facility, as
defined in that section, for that fiscal year. The quality bonus
shall not be part of the total rate.
Sec. 5111.231. (A) As used in this section:
(1) "Applicable calendar year" means the following:
(a) For the purpose of the department of job and family
services' initial determination under division (D) of this section
of each peer group's cost per case-mix unit, calendar year 2003;
(b) For the purpose of the department's rebasings, the
calendar year the department selects.
(2) "Rebasing" means a redetermination under division (D) of
this section of each peer groups' cost per case-mix unit using
information from cost reports for an applicable calendar year that
is later than the applicable calendar year used for the previous
determination of such costs.
(B) The department of job and family services shall pay a
provider for each of the provider's eligible nursing facilities a
per resident per day rate for direct care costs determined
semiannually by multiplying the cost per case-mix unit determined
under division (D) of this section for the facility's peer group
by the facility's semiannual case-mix score determined under
section 5111.232 of the Revised Code.
(C) For the purpose of determining nursing facilities' rate
for direct care costs, the department shall establish three peer
groups.
Each nursing facility located in any of the following
counties shall be placed in peer group one: Brown, Butler,
Clermont, Clinton, Hamilton, and Warren.
Each nursing facility located in any of the following
counties shall be placed in peer group two: Ashtabula, Champaign,
Clark, Cuyahoga, Darke, Delaware, Fairfield, Fayette, Franklin,
Fulton, Geauga, Greene, Hancock, Knox, Lake, Licking, Lorain,
Lucas, Madison, Marion, Medina, Miami, Montgomery, Morrow, Ottawa,
Pickaway, Portage, Preble, Ross, Sandusky, Seneca, Summit, Union,
and Wood.
Each nursing facility located in any of the following
counties shall be placed in peer group three: Adams, Allen,
Ashland, Athens, Auglaize, Belmont, Carroll, Columbiana,
Coshocton, Crawford, Defiance, Erie, Gallia, Guernsey, Hardin,
Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson,
Jefferson, Lawrence, Logan, Mahoning, Meigs, Mercer, Monroe,
Morgan, Muskingum, Noble, Paulding, Perry, Pike, Putnam, Richland,
Scioto, Shelby, Stark, Trumbull, Tuscarawas, Van Wert, Vinton,
Washington, Wayne, Williams, and Wyandot.
(D)(1) The department shall determine a cost per case-mix
unit for each peer group established under division (C) of this
section. The department is not required to conduct a rebasing more
than once every ten years. Except as necessary to implement the
amendments made by this act to this section by Am. Sub. H.B. 153
and Sub. H.B. 303, both of the 129th general assembly, the cost
per case-mix unit determined under this division for a peer group
shall be used for subsequent years until the department conducts a
rebasing. To determine a peer group's cost per case-mix unit, the
department shall do all of the following:
(a) Determine the cost per case-mix unit for each nursing
facility in the peer group for the applicable calendar year by
dividing each facility's desk-reviewed, actual, allowable, per
diem direct care costs for the applicable calendar year by the
facility's annual average case-mix score determined under section
5111.232 of the Revised Code for the applicable calendar year;
(b) Subject to division (D)(2) of this section, identify
which nursing facility in the peer group is at the twenty-fifth
percentile of the cost per case-mix units determined under
division (D)(1)(a) of this section;
(c) Calculate the amount that is two per cent above the cost
per case-mix unit determined under division (D)(1)(a) of this
section for the nursing facility identified under division
(D)(1)(b) of this section;
(d) Using the index specified in division (D)(3) of this
section, multiply the rate of inflation for the eighteen-month
period beginning on the first day of July of the applicable
calendar year and ending the last day of December of the calendar
year immediately following the applicable calendar year by the
amount calculated under division (D)(1)(c) of this section;
(e) Until the first rebasing occurs, add one dollar and
eighty-eight cents to the amount calculated under division
(D)(1)(d) of this section;
(f) Until the first rebasing occurs, increase the amount
calculated under division (D)(1)(e) of this section by five and
eight hundredths per cent.
(2) In making the identification under division (D)(1)(b) of
this section, the department shall exclude both of the following:
(a) Nursing facilities that participated in the medicaid
program under the same provider for less than twelve months in the
applicable calendar year;
(b) Nursing facilities whose cost per case-mix unit is more
than one standard deviation from the mean cost per case-mix unit
for all nursing facilities in the nursing facility's peer group
for the applicable calendar year.
(3) The following index shall be used for the purpose of the
calculation made under division (D)(1)(d) of this section:
(a) Until the first rebasing occurs, the employment cost
index for total compensation, health services component, published
by the United States bureau of labor statistics, as the index
existed on July 1, 2005;
(b) Effective with the first rebasing and except as provided
in division (D)(3)(c) of this section, the employment cost index
for total compensation, nursing and residential care facilities
occupational group, published by the United States bureau of labor
statistics;
(c) If the United States bureau of labor statistics ceases to
publish the index specified in division (D)(3)(b) of this section,
the index the bureau subsequently publishes that covers nursing
facilities' staff costs.
(4) The department shall not redetermine a peer group's cost
per case-mix unit under this division based on additional
information that it receives after the peer group's per case-mix
unit is determined. The department shall redetermine a peer
group's cost per case-mix unit only if it made an error in
determining the peer group's cost per case-mix unit based on
information available to the department at the time of the
original determination.
Sec. 5111.24. (A) As used in this section:
(1) "Applicable calendar year" means the following:
(a) For the purpose of the department of job and family
services' initial determination under division (D) of this section
of each peer group's rate for ancillary and support costs,
calendar year 2003;
(b) For the purpose of the department's rebasings, the
calendar year the department selects.
(2) "Rebasing" means a redetermination under division (D) of
this section of each peer groups' rate for ancillary and support
costs using information from cost reports for an applicable
calendar year that is later than the applicable calendar year used
for the previous determination of such rates.
(B) The department of job and family services shall pay a
provider for each of the provider's eligible nursing facilities a
per resident per day rate for ancillary and support costs
determined for the nursing facility's peer group under division
(D) of this section.
(C) For the purpose of determining nursing facilities' rate
for ancillary and support costs, the department shall establish
six peer groups.
Each nursing facility located in any of the following
counties shall be placed in peer group one or two: Brown, Butler,
Clermont, Clinton, Hamilton, and Warren. Each nursing facility
located in any of those counties that has fewer than one hundred
beds shall be placed in peer group one. Each nursing facility
located in any of those counties that has one hundred or more beds
shall be placed in peer group two.
Each nursing facility located in any of the following
counties shall be placed in peer group three or four: Ashtabula,
Champaign, Clark, Cuyahoga, Darke, Delaware, Fairfield, Fayette,
Franklin, Fulton, Geauga, Greene, Hancock, Knox, Lake, Licking,
Lorain, Lucas, Madison, Marion, Medina, Miami, Montgomery, Morrow,
Ottawa, Pickaway, Portage, Preble, Ross, Sandusky, Seneca, Summit,
Union, and Wood. Each nursing facility located in any of those
counties that has fewer than one hundred beds shall be placed in
peer group three. Each nursing facility located in any of those
counties that has one hundred or more beds shall be placed in peer
group four.
Each nursing facility located in any of the following
counties shall be placed in peer group five or six: Adams, Allen,
Ashland, Athens, Auglaize, Belmont, Carroll, Columbiana,
Coshocton, Crawford, Defiance, Erie, Gallia, Guernsey, Hardin,
Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson,
Jefferson, Lawrence, Logan, Mahoning, Meigs, Mercer, Monroe,
Morgan, Muskingum, Noble, Paulding, Perry, Pike, Putnam, Richland,
Scioto, Shelby, Stark, Trumbull, Tuscarawas, Van Wert, Vinton,
Washington, Wayne, Williams, and Wyandot. Each nursing facility
located in any of those counties that has fewer than one hundred
beds shall be placed in peer group five. Each nursing facility
located in any of those counties that has one hundred or more beds
shall be placed in peer group six.
(D)(1) The department shall determine the rate for ancillary
and support costs for each peer group established under division
(C) of this section. The department is not required to conduct a
rebasing more than once every ten years. Except as necessary to
implement the amendments made by this act to this section by Am.
Sub. H.B. 153 and Sub. H.B. 303, both of the 129th general
assembly, the rate for ancillary and support costs determined
under this division for a peer group shall be used for subsequent
years until the department conducts a rebasing. To determine a
peer group's rate for ancillary and support costs, the department
shall do all of the following:
(a) Subject to division (D)(2) of this section, determine the
rate for ancillary and support costs for each nursing facility in
the peer group for the applicable calendar year by using the
greater of the nursing facility's actual inpatient days for the
applicable calendar year or the inpatient days the nursing
facility would have had for the applicable calendar year if its
occupancy rate had been ninety per cent;
(b) Subject to division (D)(3) of this section, identify
which nursing facility in the peer group is at the twenty-fifth
percentile of the rate for ancillary and support costs for the
applicable calendar year determined under division (D)(1)(a) of
this section;
(c) Multiply the rate for ancillary and support costs
determined under division (D)(1)(a) of this section for the
nursing facility identified under division (D)(1)(b) of this
section by the rate of inflation for the eighteen-month period
beginning on the first day of July of the applicable calendar year
and ending the last day of December of the calendar year
immediately following the applicable calendar year using the
following:
(i) Until the first rebasing occurs, the consumer price index
for all items for all urban consumers for the north central
region, published by the United States bureau of labor statistics,
as that index existed on July 1, 2005;
(ii) Effective with the first rebasing and except as provided
in division (D)(1)(c)(iii) of this section, the consumer price
index for all items for all urban consumers for the midwest
region, published by the United States bureau of labor statistics;
(iii) If the United States bureau of labor statistics ceases
to publish the index specified in division (D)(1)(c)(ii) of this
section, the index the bureau subsequently publishes that covers
urban consumers' prices for items for the region that includes
this state.
(d) Until the first rebasing occurs, increase the amount
calculated under division (D)(1)(c) of this section by five and
eight hundredths per cent.
(2) For the purpose of determining a nursing facility's
occupancy rate under division (D)(1)(a) of this section, the
department shall include any beds that the nursing facility
removes from its medicaid-certified capacity unless the nursing
facility also removes the beds from its licensed bed capacity.
(3) In making the identification under division (D)(1)(b) of
this section, the department shall exclude both of the following:
(a) Nursing facilities that participated in the medicaid
program under the same provider for less than twelve months in the
applicable calendar year;
(b) Nursing facilities whose ancillary and support costs are
more than one standard deviation from the mean desk-reviewed,
actual, allowable, per diem ancillary and support cost for all
nursing facilities in the nursing facility's peer group for the
applicable calendar year.
(4) The department shall not redetermine a peer group's rate
for ancillary and support costs under this division based on
additional information that it receives after the rate is
determined. The department shall redetermine a peer group's rate
for ancillary and support costs only if the department made an
error in determining the rate based on information available to
the department at the time of the original determination.
Sec. 5111.242. (A) As used in this section, "applicable:
(1) "Applicable calendar year" means the following:
(1)(a) For the purpose of the department of job and family
services' initial determination under this section of nursing
facilities' rate for tax costs, calendar year 2003;
(2)(b) For the purpose of the department's subsequent
determinations under division (C) of this section of nursing
facilities' rate for tax costs rebasings, the calendar year the
department selects.
(2) "Rebasing" means a redetermination under division (C) of
this section of each nursing facility's rate for tax costs using
information from cost reports for an applicable calendar year that
is later than the applicable calendar year used for the previous
determination of such rates.
(B) The department of job and family services shall pay a
provider for each of the provider's eligible nursing facilities a
per resident per day rate for tax costs determined under division
(C) of this section.
(C) At least once every ten years, the The department shall
determine the rate for tax costs for each nursing facility. The
department is not required to conduct a rebasing more than once
every ten years. Except as necessary to implement the amendments
made to this section by Sub. H.B. 303 of the 129th general
assembly, the rate for tax costs determined under this division
for a nursing facility shall be used for subsequent years until
the department
redetermines it conducts a rebasing. To determine
a nursing facility's rate for tax costs and except as provided in
division (D) of this section, the department shall divide do both
of the following:
(1) Divide the nursing facility's desk-reviewed, actual,
allowable tax costs paid for the applicable calendar year by the
number of inpatient days the nursing facility would have had if
its occupancy rate had been one hundred per cent during the
applicable calendar year;
(2) Until the first rebasing occurs, increase the amount
calculated under division (C)(1) of this section by five and eight
hundredths per cent.
(D) If a nursing facility had a credit regarding its real
estate taxes reflected on its cost report for calendar year 2003,
the department shall determine, as follows, its rate for tax costs
for the period beginning on July 1, 2010, and ending on the first
day of the fiscal year for which the department first redetermines
all nursing facilities' rate for tax costs under division (C) of
this section by dividing conducts a rebasing:
(1) Divide the nursing facility's desk-reviewed, actual,
allowable tax costs paid for calendar year 2004 by the number of
inpatient days the nursing facility would have had if its
occupancy rate had been one hundred per cent during calendar year
2004;
(2) Until the first rebasing occurs, increase the amount
calculated under division (D)(1) of this section by five and eight
hundredths per cent.
Sec. 5111.246. (A) Each fiscal year, the department of job
and family services shall pay a critical access incentive payment
to the provider of each nursing facility that qualifies as a
critical access nursing facility. To qualify as a critical access
nursing facility for a fiscal year, a nursing facility must meet
all of the following requirements:
(1) The nursing facility must be located in an area that, on
December 31, 2011, was designated an empowerment zone under
section 1391 of the "Internal Revenue Code of 1986," 107 Stat.
543, 26 U.S.C. 1391, as amended.
(2) The nursing facility must have an occupancy rate of at
least eighty-five per cent as of the last day of the calendar year
preceding the fiscal year.
(3) The nursing facility must have a medicaid utilization
rate of at least sixty-five per cent as of the last day of the
calendar year preceding the fiscal year.
(B) A critical access nursing facility's critical access
incentive payment for a fiscal year shall equal five per cent of
the portion of the nursing facility's total rate for the fiscal
year that is the sum of the rates and payment identified in
divisions (A)(B)(1) to (4) and (6) of section 5111.222 of the
Revised Code.
Sec. 5111.25. (A) As used in this section:
(1) "Applicable calendar year" means the following:
(a) For the purpose of the department of job and family
services' initial determination under division (D) of this section
of each peer group's rate for capital costs, calendar year 2003;
(b) For the purpose of the department's rebasings, the
calendar year the department selects.
(2) "Rebasing" means a redetermination under division (D) of
this section of each peer groups' rate for capital costs using
information from cost reports for an applicable calendar year that
is later than the applicable calendar year used for the previous
determination of such rates.
(B) The department of job and family services shall pay a
provider for each of the provider's eligible nursing facilities a
per resident per day rate for capital costs determined for the
nursing facility's peer group under division (D) of this section.
(C) For the purpose of determining nursing facilities' rate
for capital costs, the department shall establish six peer groups.
Each nursing facility located in any of the following
counties shall be placed in peer group one or two: Brown, Butler,
Clermont, Clinton, Hamilton, and Warren. Each nursing facility
located in any of those counties that has fewer than one hundred
beds shall be placed in peer group one. Each nursing facility
located in any of those counties that has one hundred or more beds
shall be placed in peer group two.
Each nursing facility located in any of the following
counties shall be placed in peer group three or four: Ashtabula,
Champaign, Clark, Cuyahoga, Darke, Delaware, Fairfield, Fayette,
Franklin, Fulton, Geauga, Greene, Hancock, Knox, Lake, Licking,
Lorain, Lucas, Madison, Marion, Medina, Miami, Montgomery, Morrow,
Ottawa, Pickaway, Portage, Preble, Ross, Sandusky, Seneca, Summit,
Union, and Wood. Each nursing facility located in any of those
counties that has fewer than one hundred beds shall be placed in
peer group three. Each nursing facility located in any of those
counties that has one hundred or more beds shall be placed in peer
group four.
Each nursing facility located in any of the following
counties shall be placed in peer group five or six: Adams, Allen,
Ashland, Athens, Auglaize, Belmont, Carroll, Columbiana,
Coshocton, Crawford, Defiance, Erie, Gallia, Guernsey, Hardin,
Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson,
Jefferson, Lawrence, Logan, Mahoning, Meigs, Mercer, Monroe,
Morgan, Muskingum, Noble, Paulding, Perry, Pike, Putnam, Richland,
Scioto, Shelby, Stark, Trumbull, Tuscarawas, Van Wert, Vinton,
Washington, Wayne, Williams, and Wyandot. Each nursing facility
located in any of those counties that has fewer than one hundred
beds shall be placed in peer group five. Each nursing facility
located in any of those counties that has one hundred or more beds
shall be placed in peer group six.
(D)(1) The department shall determine the rate for capital
costs for each peer group established under division (C) of this
section. The department is not required to conduct a rebasing more
than once every ten years. Except as necessary to implement the
amendments made by this act to this section by Am. Sub. H.B. 153
and Sub. H.B. 303, both of the 129th general assembly, the rate
for capital costs determined under this division for a peer group
shall be used for subsequent years until the department conducts a
rebasing. A To determine a peer group's rate for capital costs
shall be, the department shall do both of the following:
(a) Determine the rate for capital costs determined for the
nursing facility in the peer group that is at the twenty-fifth
percentile of the rate for capital costs for the applicable
calendar year;
(b) Until the first rebasing occurs, increase the amount
calculated under division (D)(1)(a) of this section by five and
eight hundredths per cent. In identifying that
(2) To identify the nursing facility in a peer group that is
at the twenty-fifth percentile of the rate for capital costs for
the applicable calendar year, the department shall do both of the
following:
(a) Subject to division (D)(2)(3) of this section, use the
greater of each nursing facility's actual inpatient days for the
applicable calendar year or the inpatient days the nursing
facility would have had for the applicable calendar year if its
occupancy rate had been one hundred per cent;
(b) Exclude both of the following:
(i) Nursing facilities that participated in the medicaid
program under the same provider for less than twelve months in the
applicable calendar year;
(ii) Nursing facilities whose capital costs are more than one
standard deviation from the mean desk-reviewed, actual, allowable,
per diem capital cost for all nursing facilities in the nursing
facility's peer group for the applicable calendar year.
(2)(3) For the purpose of determining a nursing facility's
occupancy rate under division (D)(1)(2)(a) of this section, the
department shall include any beds that the nursing facility
removes from its medicaid-certified capacity after June 30, 2005,
unless the nursing facility also removes the beds from its
licensed bed capacity.
(3)(4) The department shall not redetermine a peer group's
rate for capital costs under this division based on additional
information that it receives after the rate is determined. The
department shall redetermine a peer group's rate for capital costs
only if the department made an error in determining the rate based
on information available to the department at the time of the
original determination.
(E) Buildings shall be depreciated using the straight line
method over forty years or over a different period approved by the
department. Components and equipment shall be depreciated using
the straight-line method over a period designated in rules adopted
under section 5111.02 of the Revised Code, consistent with the
guidelines of the American hospital association, or over a
different period approved by the department. Any rules authorized
by this division that specify useful lives of buildings,
components, or equipment apply only to assets acquired on or after
July 1, 1993. Depreciation for costs paid or reimbursed by any
government agency shall not be included in capital costs unless
that part of the payment under sections 5111.20 to 5111.331 of the
Revised Code is used to reimburse the government agency.
(F) The capital cost basis of nursing facility assets shall
be determined in the following manner:
(1) Except as provided in division (F)(3) of this section,
for purposes of calculating the rates to be paid for facilities
with dates of licensure on or before June 30, 1993, the capital
cost basis of each asset shall be equal to the desk-reviewed,
actual, allowable, capital cost basis that is listed on the
facility's cost report for the calendar year preceding the fiscal
year during which the rate will be paid.
(2) For facilities with dates of licensure after June 30,
1993, the capital cost basis shall be determined in accordance
with the principles of the medicare program established under
Title XVIII, except as otherwise provided in sections 5111.20 to
5111.331 of the Revised Code.
(3) Except as provided in division (F)(4) of this section, if
a provider transfers an interest in a facility to another provider
after June 30, 1993, there shall be no increase in the capital
cost basis of the asset if the providers are related parties or
the provider to which the interest is transferred authorizes the
provider that transferred the interest to continue to operate the
facility under a lease, management agreement, or other
arrangement. If the previous sentence does not prohibit the
adjustment of the capital cost basis under this division, the
basis of the asset shall be adjusted by one-half of the change in
the consumer price index for all items for all urban consumers, as
published by the United States bureau of labor statistics, during
the time that the transferor held the asset.
(4) If a provider transfers an interest in a facility to
another provider who is a related party, the capital cost basis of
the asset shall be adjusted as specified in division (F)(3) of
this section if all of the following conditions are met:
(a) The related party is a relative of owner;
(b) Except as provided in division (F)(4)(c)(ii) of this
section, the provider making the transfer retains no ownership
interest in the facility;
(c) The department of job and family services determines that
the transfer is an arm's length transaction pursuant to rules
adopted under section 5111.02 of the Revised Code. The rules shall
provide that a transfer is an arm's length transaction if all of
the following apply:
(i) Once the transfer goes into effect, the provider that
made the transfer has no direct or indirect interest in the
provider that acquires the facility or the facility itself,
including interest as an owner, officer, director, employee,
independent contractor, or consultant, but excluding interest as a
creditor.
(ii) The provider that made the transfer does not reacquire
an interest in the facility except through the exercise of a
creditor's rights in the event of a default. If the provider
reacquires an interest in the facility in this manner, the
department shall treat the facility as if the transfer never
occurred when the department calculates its reimbursement rates
for capital costs.
(iii) The transfer satisfies any other criteria specified in
the rules.
(d) Except in the case of hardship caused by a catastrophic
event, as determined by the department, or in the case of a
provider making the transfer who is at least sixty-five years of
age, not less than twenty years have elapsed since, for the same
facility, the capital cost basis was adjusted most recently under
division (F)(4) of this section or actual, allowable cost of
ownership was determined most recently under division (G)(9) of
this section.
(G) As used in this division:
"Imputed interest" means the lesser of the prime rate plus
two per cent or ten per cent.
"Lease expense" means lease payments in the case of an
operating lease and depreciation expense and interest expense in
the case of a capital lease.
"New lease" means a lease, to a different lessee, of a
nursing facility that previously was operated under a lease.
(1) Subject to division (B) of this section, for a lease of a
facility that was effective on May 27, 1992, the entire lease
expense is an actual, allowable capital cost during the term of
the existing lease. The entire lease expense also is an actual,
allowable capital cost if a lease in existence on May 27, 1992, is
renewed under either of the following circumstances:
(a) The renewal is pursuant to a renewal option that was in
existence on May 27, 1992;
(b) The renewal is for the same lease payment amount and
between the same parties as the lease in existence on May 27,
1992.
(2) Subject to division (B) of this section, for a lease of a
facility that was in existence but not operated under a lease on
May 27, 1992, actual, allowable capital costs shall include the
lesser of the annual lease expense or the annual depreciation
expense and imputed interest expense that would be calculated at
the inception of the lease using the lessor's entire historical
capital asset cost basis, adjusted by one-half of the change in
the consumer price index for all items for all urban consumers, as
published by the United States bureau of labor statistics, during
the time the lessor held each asset until the beginning of the
lease.
(3) Subject to division (B) of this section, for a lease of a
facility with a date of licensure on or after May 27, 1992, that
is initially operated under a lease, actual, allowable capital
costs shall include the annual lease expense if there was a
substantial commitment of money for construction of the facility
after December 22, 1992, and before July 1, 1993. If there was not
a substantial commitment of money after December 22, 1992, and
before July 1, 1993, actual, allowable capital costs shall include
the lesser of the annual lease expense or the sum of the
following:
(a) The annual depreciation expense that would be calculated
at the inception of the lease using the lessor's entire historical
capital asset cost basis;
(b) The greater of the lessor's actual annual amortization of
financing costs and interest expense at the inception of the lease
or the imputed interest expense calculated at the inception of the
lease using seventy per cent of the lessor's historical capital
asset cost basis.
(4) Subject to division (B) of this section, for a lease of a
facility with a date of licensure on or after May 27, 1992, that
was not initially operated under a lease and has been in existence
for ten years, actual, allowable capital costs shall include the
lesser of the annual lease expense or the annual depreciation
expense and imputed interest expense that would be calculated at
the inception of the lease using the entire historical capital
asset cost basis of one-half of the change in the consumer price
index for all items for all urban consumers, as published by the
United States bureau of labor statistics, during the time the
lessor held each asset until the beginning of the lease.
(5) Subject to division (B) of this section, for a new lease
of a facility that was operated under a lease on May 27, 1992,
actual, allowable capital costs shall include the lesser of the
annual new lease expense or the annual old lease payment. If the
old lease was in effect for ten years or longer, the old lease
payment from the beginning of the old lease shall be adjusted by
one-half of the change in the consumer price index for all items
for all urban consumers, as published by the United States bureau
of labor statistics, from the beginning of the old lease to the
beginning of the new lease.
(6) Subject to division (B) of this section, for a new lease
of a facility that was not in existence or that was in existence
but not operated under a lease on May 27, 1992, actual, allowable
capital costs shall include the lesser of annual new lease expense
or the annual amount calculated for the old lease under division
(G)(2), (3), (4), or (6) of this section, as applicable. If the
old lease was in effect for ten years or longer, the lessor's
historical capital asset cost basis shall be, for purposes of
calculating the annual amount under division (G)(2), (3), (4), or
(6) of this section, adjusted by one-half of the change in the
consumer price index for all items for all urban consumers, as
published by the United States bureau of labor statistics, from
the beginning of the old lease to the beginning of the new lease.
In the case of a lease under division (G)(3) of this section
of a facility for which a substantial commitment of money was made
after December 22, 1992, and before July 1, 1993, the old lease
payment shall be adjusted for the purpose of determining the
annual amount.
(7) For any revision of a lease described in division (G)(1),
(2), (3), (4), (5), or (6) of this section, or for any subsequent
lease of a facility operated under such a lease, other than
execution of a new lease, the portion of actual, allowable capital
costs attributable to the lease shall be the same as before the
revision or subsequent lease.
(8) Except as provided in division (G)(9) of this section, if
a provider leases an interest in a facility to another provider
who is a related party or previously operated the facility, the
related party's or previous operator's actual, allowable capital
costs shall include the lesser of the annual lease expense or the
reasonable cost to the lessor.
(9) If a provider leases an interest in a facility to another
provider who is a related party, regardless of the date of the
lease, the related party's actual, allowable capital costs shall
include the annual lease expense, subject to the limitations
specified in divisions (G)(1) to (7) of this section, if all of
the following conditions are met:
(a) The related party is a relative of owner;
(b) If the lessor retains an ownership interest, it is,
except as provided in division (G)(9)(c)(ii) of this section, in
only the real property and any improvements on the real property;
(c) The department of job and family services determines that
the lease is an arm's length transaction pursuant to rules adopted
under section 5111.02 of the Revised Code. The rules shall provide
that a lease is an arm's length transaction if all of the
following apply:
(i) Once the lease goes into effect, the lessor has no direct
or indirect interest in the lessee or, except as provided in
division (G)(9)(b) of this section, the facility itself, including
interest as an owner, officer, director, employee, independent
contractor, or consultant, but excluding interest as a lessor.
(ii) The lessor does not reacquire an interest in the
facility except through the exercise of a lessor's rights in the
event of a default. If the lessor reacquires an interest in the
facility in this manner, the department shall treat the facility
as if the lease never occurred when the department calculates its
reimbursement rates for capital costs.
(iii) The lease satisfies any other criteria specified in the
rules.
(d) Except in the case of hardship caused by a catastrophic
event, as determined by the department, or in the case of a lessor
who is at least sixty-five years of age, not less than twenty
years have elapsed since, for the same facility, the capital cost
basis was adjusted most recently under division (F)(4) of this
section or actual, allowable capital costs were determined most
recently under division (G)(9) of this section.
(10) This division does not apply to leases of specific items
of equipment.
Sec. 5111.88. (A) As used in sections 5111.88 to 5111.8811
of the Revised Code:
(1) "Adult" means an individual at least eighteen years of
age.
(2) "Authorized representative" means the following:
(a) In the case of a consumer who is a minor, the consumer's
parent, custodian, or guardian;
(b) In the case of a consumer who is an adult, an individual
selected by the consumer pursuant to section 5111.8810 of the
Revised Code to act on the consumer's behalf for purposes
regarding home care attendant services.
(3) "Authorizing health care professional" means a health
care professional who, pursuant to section 5111.887 of the Revised
Code, authorizes a home care attendant to assist a consumer with
self-administration of medication, nursing tasks, or both.
(4) "Consumer" means an individual to whom all of the
following apply:
(a) The individual is enrolled in a participating medicaid
waiver component.
(b) The individual has a medically determinable physical
impairment to which both of the following apply:
(i) It is expected to last for a continuous period of not
less than twelve months.
(ii) It causes the individual to require assistance with
activities of daily living, self-care, and mobility, including
either assistance with self-administration of medication or the
performance of nursing tasks, or both.
(c) In the case of an individual who is an adult, the
individual is mentally alert and is, or has an authorized
representative who is, capable of selecting, directing the actions
of, and dismissing a home care attendant.
(d) In the case of an individual who is a minor, the
individual has an authorized representative who is capable of
selecting, directing the actions of, and dismissing a home care
attendant.
(5) "Controlled substance" has the same meaning as in section
3719.01 of the Revised Code.
(6) "Custodian" has the same meaning as in section 2151.011
of the Revised Code.
(7) "Gastrostomy tube" means a percutaneously inserted
catheter that terminates in the stomach.
(8) "Guardian" has the same meaning as in section 2111.01 of
the Revised Code.
(9) "Health care professional" means a physician or
registered nurse.
(10) "Home care attendant" means an individual holding a
valid medicaid provider agreement in accordance with section
5111.881 of the Revised Code that authorizes the individual to
provide home care attendant services to consumers.
(11) "Home care attendant services" means all of the
following as provided by a home care attendant:
(a) Personal care aide services;
(b) Assistance with the self-administration of medication;
(c) Assistance with nursing tasks.
(12) "Jejunostomy tube" means a percutaneously inserted
catheter that terminates in the jejunum.
(13) "Medicaid waiver component" has the same meaning as in
section 5111.85 of the Revised Code.
(14) "Medication" means a drug as defined in section 4729.01
of the Revised Code.
(15) "Minor" means an individual under eighteen years of age.
(16) "Participating medicaid waiver component" means both of
the following:
(a) The Ohio home care program created under section 5111.861
of the Revised Code;
(b) The Ohio transitions II aging carve-out program created
under section 5111.863 of the Revised Code.
(17) "Physician" means an individual authorized under Chapter
4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery.
(18) "Practice of nursing as a registered nurse," "practice
of nursing as a licensed practical nurse," and "registered nurse"
have the same meanings as in section 4723.01 of the Revised Code.
"Registered nurse" includes an advanced practice registered nurse,
as defined in section 4723.01 of the Revised Code.
(19) "Schedule II," "schedule III," "schedule IV," and
"schedule V" have the same meanings as in section 3719.01 of the
Revised Code.
(B) The director of job and family services may submit
requests to the United States secretary of health and human
services to amend the federal medicaid waivers authorizing the
participating medicaid waiver components to have those components
cover home care attendant services in accordance with sections
5111.88 to 5111.8810 of the Revised Code and rules adopted under
section 5111.8811 of the Revised Code. Notwithstanding sections
5111.881 to 5111.8811 of the Revised Code, those sections shall be
implemented regarding a participating medicaid waiver component
only if the secretary approves a waiver amendment for the
component.
Sec. 5111.981. (A) As used in this section and section
5111.982 of the Revised Code:
"Dual eligible individual" has the same meaning as in section
1915(h)(2)(B) of the "Social Security Act," 124 Stat. 315 (2010)
section 1915(h)(2)(B), 42 U.S.C. 1396n(h)(2)(B).
"Medicare program" means the program created under Title
XVIII of in the "Social Security Act," 79 Stat. 286 (1965) Title
XVIII, 42 U.S.C. 1395 et seq., as amended.
(B) Subject to division (C) of this section, the medical
assistance director of job and family services may implement a
demonstration project called the integrated care delivery system
to test and evaluate the integration of the care that dual
eligible individuals receive under the medicare and medicaid
programs. No provision of Title LI of the Revised Code applies to
the
demonstration project integrated care delivery system if that
provision implements or incorporates a provision of federal law
governing the medicaid program and that provision of federal law
does not apply to the demonstration project system.
(C) Before implementing the demonstration project integrated
care delivery system under division (B) of this section, the
director shall obtain the approval of the United States secretary
of health and human services in the form of a federal medicaid
waiver, medicaid state plan amendment, or demonstration grant. The
director is required to seek the federal approval only if the
director seeks to implement the demonstration project integrated
care delivery system. The director shall implement the
demonstration project integrated care delivery system in
accordance with the terms of the federal approval, including the
terms regarding the duration of the demonstration project system.
Sec. 5111.982. (A) As used in this section:
"Covered skilled nursing facility services" has the same
meaning as in the "Social Security Act," section 1888(e)(2)(A), 42
U.S.C. 1395yy(e)(2)(A).
"Current medicare fee-for-service rate" means the
fee-for-service rate in effect for a covered skilled nursing
facility service under medicare at the time the service is
provided.
"Skilled nursing facility" has the same meaning as in the
"Social Security Act," section 1819(a), 42 U.S.C. 1395i-3(a).
(B) Except as provided in division (C) of this section, a
managed care organization shall pay a skilled nursing facility at
least the current medicare fee-for-service rate, without deduction
for any coinsurance, for covered skilled nursing facility services
that the skilled nursing facility provides to a dual eligible
individual if the managed care organization is responsible for the
payment under the terms of a contract that the managed care
organization, medical assistance director, and United States
secretary of health and human services jointly enter into under
the integrated care delivery system authorized by section 5111.981
of the Revised Code.
(C) A managed care organization is required to pay the rate
specified in division (B) of this section for covered skilled
nursing facility services only if all of the following apply:
(1) The United States secretary agrees to the payment rate as
part of the contract that the managed care organization, medical
assistance director, and United States secretary jointly enter
into under the integrated care delivery system;
(2) The managed care organization receives a federal
capitation payment that is an actuarially sufficient amount for
the costs that the managed care organization incurs in paying the
rate;
(3) No state funds are used for any part of the costs that
the managed care organization incurs in paying the rate;
(4) The integrated care delivery system provides for dual
eligible individuals to receive the covered skilled nursing
facility services as part of the system.
Sec. 5120.55. (A) As used in this section, "licensed health
professional" means any or all of the following:
(1) A dentist who holds a current, valid license issued under
Chapter 4715. of the Revised Code to practice dentistry;
(2) A licensed practical nurse who holds a current, valid
license issued under Chapter 4723. of the Revised Code that
authorizes the practice of nursing as a licensed practical nurse;
(3) An optometrist who holds a current, valid certificate of
licensure issued under Chapter 4725. of the Revised Code that
authorizes the holder to engage in the practice of optometry;
(4) A physician who is authorized under Chapter 4731. of the
Revised Code to practice medicine and surgery, osteopathic
medicine and surgery, or podiatry podiatric medicine and surgery;
(5) A psychologist who holds a current, valid license issued
under Chapter 4732. of the Revised Code that authorizes the
practice of psychology as a licensed psychologist;
(6) A registered nurse who holds a current, valid license
issued under Chapter 4723. of the Revised Code that authorizes the
practice of nursing as a registered nurse regardless of whether
the, including such a nurse who is also authorized to practice as
an advanced practice registered nurse as defined in section
4723.01 of the Revised Code.
(B)(1) The department of rehabilitation and correction may
establish a recruitment program under which the department, by
means of a contract entered into under division (C) of this
section, agrees to repay all or part of the principal and interest
of a government or other educational loan incurred by a licensed
health professional who agrees to provide services to inmates of
correctional institutions under the department's administration.
(2)(a) For a physician to be eligible to participate in the
program, the physician must have attended a school that was,
during the time of attendance, a medical school or osteopathic
medical school in this country accredited by the liaison committee
on medical education or the American osteopathic association, a
college of podiatry in this country recognized as being in good
standing under section 4731.53 of the Revised Code, or a medical
school, osteopathic medical school, or college of podiatry located
outside this country that was acknowledged by the world health
organization and verified by a member state of that organization
as operating within that state's jurisdiction.
(b) For a nurse to be eligible to participate in the program,
the nurse must have attended a school that was, during the time of
attendance, a nursing school in this country accredited by the
commission on collegiate nursing education or the national league
for nursing accrediting commission or a nursing school located
outside this country that was acknowledged by the world health
organization and verified by a member state of that organization
as operating within that state's jurisdiction.
(c) For a dentist to be eligible to participate in the
program, the dentist must have attended a school that was, during
the time of attendance, a dental college that enabled the dentist
to meet the requirements specified in section 4715.10 of the
Revised Code to be granted a license to practice dentistry.
(d) For an optometrist to be eligible to participate in the
program, the optometrist must have attended a school of optometry
that was, during the time of attendance, approved by the state
board of optometry.
(e) For a psychologist to be eligible to participate in the
program, the psychologist must have attended an educational
institution that, during the time of attendance, maintained a
specific degree program recognized by the state board of
psychology as acceptable for fulfilling the requirement of
division (B)(4) of section 4732.10 of the Revised Code.
(C) The department shall enter into a contract with each
licensed health professional it recruits under this section. Each
contract shall include at least the following terms:
(1) The licensed health professional agrees to provide a
specified scope of medical, osteopathic medical, podiatric,
optometric, psychological, nursing, or dental services to inmates
of one or more specified state correctional institutions for a
specified number of hours per week for a specified number of
years.
(2) The department agrees to repay all or a specified portion
of the principal and interest of a government or other educational
loan taken by the licensed health professional for the following
expenses to attend, for up to a maximum of four years, a school
that qualifies the licensed health professional to participate in
the program:
(b) Other educational expenses for specific purposes,
including fees, books, and laboratory expenses, in amounts
determined to be reasonable in accordance with rules adopted under
division (D) of this section;
(c) Room and board, in an amount determined to be reasonable
in accordance with rules adopted under division (D) of this
section.
(3) The licensed health professional agrees to pay the
department a specified amount, which shall be no less than the
amount already paid by the department pursuant to its agreement,
as damages if the licensed health professional fails to complete
the service obligation agreed to or fails to comply with other
specified terms of the contract. The contract may vary the amount
of damages based on the portion of the service obligation that
remains uncompleted.
(4) Other terms agreed upon by the parties.
The licensed health professional's lending institution or the
Ohio board of regents, may be a party to the contract. The
contract may include an assignment to the department of the
licensed health professional's duty to repay the principal and
interest of the loan.
(D) If the department elects to implement the recruitment
program, it shall adopt rules in accordance with Chapter 119. of
the Revised Code that establish all of the following:
(1) Criteria for designating institutions for which licensed
health professionals will be recruited;
(2) Criteria for selecting licensed health professionals for
participation in the program;
(3) Criteria for determining the portion of a loan which the
department will agree to repay;
(4) Criteria for determining reasonable amounts of the
expenses described in divisions (C)(2)(b) and (c) of this section;
(5) Procedures for monitoring compliance by a licensed health
professional with the terms of the contract the licensed health
professional enters into under this section;
(6) Any other criteria or procedures necessary to implement
the program.
Section 2. That existing sections 2305.113, 2305.234,
2711.22, 3701.92, 3701.923, 3701.924, 3701.925, 3701.926,
3701.927, 3701.928, 3701.929, 3793.11, 3963.01, 4503.44, 4723.01,
4723.03, 4723.06, 4723.063, 4723.07, 4723.08, 4723.09, 4723.17,
4723.171, 4723.24, 4723.271, 4723.28, 4723.32, 4723.34, 4723.35,
4723.41, 4723.42, 4723.43, 4723.431, 4723.44, 4723.48, 4723.482,
4723.485, 4723.487, 4723.50, 4723.61, 4723.64, 4723.65, 4723.651,
4723.652, 4723.66, 4723.67, 4723.68, 4723.69, 4723.71, 4723.72,
4723.73, 4723.74, 4723.75, 4723.751, 4723.76, 4723.77, 4723.79,
4723.83, 4723.84, 4723.87, 4723.88, 4723.99, 4759.01, 4759.03,
4759.05, 4759.06, 4759.10, 5111.222, 5111.231, 5111.24, 5111.242,
5111.246, 5111.25, 5111.88, 5111.981, and 5120.55 and sections
4723.483,
4723.62, 4723.621,
4723.63, and
4723.78 of the
Revised Code are hereby repealed.
Section 3. That Section 3.19 of Am. Sub. H.B. 95 of the 125th
General Assembly be amended to read as follows:
Sec. 3.19. Section 4723.063 of the Revised Code is hereby
repealed, effective December 31, 2013 2023.
Section 4. That existing Section 3.19 of Am. Sub. H.B. 95 of
the 125th General Assembly is hereby repealed.
Section 5. Sections 1 to 4 of this act take effect ninety
days after the effective date of this act, except as follows:
(A) Section 3793.11 of the Revised Code, as amended by this
act, takes effect at the earliest time permitted by law;
(B) Sections 5111.22, 5111.231, 5111.24, 5111.242, 5111.246,
and 5111.25 of the Revised Code, as amended by this act, take
effect July 1, 2013.
Section 6. In the case of an application pending on the
effective date of this section for a license to maintain methadone
treatment, the requirement of division (C)(6) of section 3793.11
of the Revised Code, as amended by this act, shall be applied by
the Department of Alcohol and Drug Addiction Services in
determining whether to issue the license. The Department may waive
the requirement pursuant to division (D) of section 3793.11 of the
Revised Code, as amended by this act.
Section 7. (A) Notwithstanding the provisions of section
4723.482 of the Revised Code specifying that the course of study
in advanced pharmacology and related topics that must be completed
as a condition of eligibility to receive a certificate to
prescribe from the Board of Nursing is to consist of planned
classroom and clinical instruction, the Board may accept
instruction completed in another form, including instruction
obtained through an internet-based program, as fulfillment of all
or part of the requirement of division (B)(5)(d) of that section
to complete instruction specific to schedule II controlled
substances. To be accepted by the Board, the instruction obtained
in another form shall meet all other standards established in
rules adopted under section 4723.50 of the Revised Code regarding
the required instruction specific to schedule II controlled
substances.
(B) Division (A) of this section applies only in the case of
an applicant who completed the required course of study prior to
the effective date of this section and does not alter the
requirement of division (B)(1) of section 4723.482 of the Revised
Code that the course of study be completed not longer than three
years before an application for a certificate to prescribe is
filed.
Section 8. (A) As used in this section, "intermediate care
facility for individuals with intellectual disabilities" and
"ICF/IID" mean an intermediate care facility for the mentally
retarded as defined in the "Social Security Act," section 1905(d),
42 U.S.C. 1396d(d).
(B) The Department of Developmental Disabilities may conduct
or contract with another entity to conduct, for the first quarter
of calendar year 2013, assessments of all residents of each
ICF/IID, regardless of payment source, who are in the ICF/IID, or
on hospital or therapeutic leave from the ICF/IID, on the day or
days that the assessments are conducted at the ICF/IID.
(C) If assessments are conducted under division (B) of this
section, the Department shall do all of the following:
(1) In conducting the assessments, provide for both of the
following:
(a) The resident assessment instrument prescribed in rules
authorized by division (B) of section 5111.232 of the Revised Code
to be used in accordance with an inter-rater reliable process;
(b) The assessments to be performed by individuals who meet
the requirements to be qualified intellectual disability
professionals, as specified in 42 C.F.R. 483.430(a).
(2) Use the data obtained from the assessments to determine
each ICF/IID's case-mix score for the first quarter of calendar
year 2013;
(3) For the purpose of determining each ICF/IID's fiscal year
2014 Medicaid rates for direct care costs and subject to divisions
(C)(8) and (E) of this section, do both of the following:
(a) In determining costs per case-mix units and maximum costs
per case-mix units for the purpose of division (B) of section
5111.23 of the Revised Code, use each ICF/IID's case-mix score
determined under division (C)(2) of this section in place of the
ICF/IID's average case-mix score for calendar year 2012;
(b) Instead of determining quarterly Medicaid rates for the
direct care costs of each ICF/IID pursuant to division (D) of
section 5111.23 of the Revised Code, determine, as follows, one
Medicaid rate for the direct care costs of each ICF/IID to be paid
for all of fiscal year 2014:
(i) Multiply the ICF/IID's case-mix score determined under
division (C)(2) of this section by the lesser of the cost per
case-mix unit determined for the ICF/IID pursuant to division
(C)(3)(a) of this section or the maximum cost per case-mix unit
determined for the ICF/IID's peer group pursuant to division
(C)(3)(a) of this section;
(ii) Adjust the product determined under division
(C)(3)(b)(i) of this section by the inflation rate estimated in
accordance with division (B)(3) of section 5111.23 of the Revised
Code.
(4) For the purpose of determining each ICF/IID's fiscal year
2015 Medicaid rates for direct care costs and subject to division
(C)(8) of this section, use the following when determining,
pursuant to the second paragraph of division (C) of section
5111.232 of the Revised Code, each ICF/IID's annual average
case-mix score for calendar year 2013:
(a) For the first quarter of calendar year 2013, the
ICF/IID's case-mix score determined under division (C)(2) of this
section;
(b) For the last three quarters of calendar year 2013 and
except as provided in division (D) of section 5111.232 of the
Revised Code, the ICF/IID's case-mix scores determined by using
the data the ICF/IID provider compiles in accordance with the
first paragraph of division (C) of section 5111.232 of the Revised
Code.
(5) Notify each ICF/IID provider that the provider is
permitted but not required to compile assessment data for the
first quarter of calendar year 2013 pursuant to the first
paragraph of division (C) of section 5111.232 of the Revised Code;
(6) After the assessments of all of an ICF/IID's residents
are completed but not later than April 30, 2013, provide, or have
the entity (if any) with which the Department contracts pursuant
to division (B) of this section provide, the results of the
assessments to the ICF/IID provider;
(7) Conduct, in accordance with division (C)(8) of this
section, a reconsideration for any ICF/IID provider who does both
of the following:
(a) Submits a written request for the reconsideration to the
Department not later than fifteen days after the provider receives
the assessments' results pursuant to division (C)(6) of this
section;
(b) Includes in the request all of the following:
(i) A detailed explanation of the items in the assessments'
results that the provider disputes;
(ii) Copies of relevant supporting documentation from
specific resident records;
(iii) The provider's proposed resolution of the disputes.
(8) When conducting a reconsideration required by division
(C)(7) of this section, do both of the following:
(a) Consider all of the following:
(i) The historic results of the resident assessments
performed pursuant to the first paragraph of division (C) of
section 5111.232 of the Revised Code by the ICF/IID provider who
requested the reconsideration;
(ii) All of the materials the provider includes in the
reconsideration request;
(iii) All other matters the Department determines necessary
for consideration.
(b) Issue a written decision regarding the reconsideration
not later than the sooner of the following:
(i) Thirty days after the Department receives the
reconsideration request;
(D) The Department's decision regarding a reconsideration
required by division (C)(7) of this section is final and not
subject to further appeal.
(E) Regardless of what an ICF/IID's case-mix score is
determined to be under division (C)(2) of this section or pursuant
to a reconsideration required by division (C)(7) of this section,
no such case-mix score shall cause an ICF/IID's fiscal year 2014
Medicaid rate for direct care costs to be less than ninety per
cent of its June 30, 2013, Medicaid rate for direct care costs.
(F) No ICF/IID provider shall be treated as having failed,
for the first quarter of calendar year 2013, to timely submit data
necessary to determine the ICF/IID's case-mix score for that
quarter if the assessment is to be conducted under division (B) of
this section.
(G) The Department may provide for assessments to be
conducted under division (B) of this section and, if it so
provides, shall comply with the other divisions of this section
notwithstanding anything to the contrary in sections 5111.20,
5111.23, and 5111.232 of the Revised Code.
Section 9. This act is hereby declared to be an emergency
measure necessary for the immediate preservation of the public
peace, health, and safety. The reason for such necessity is that
the certain reforms included in the provisions of this act are
immediately needed to ensure the efficient regulation of nursing
services in this state, to create a safe environment for the youth
of this state while also fulfilling the need to deliver effective
addiction services to others, and to establish appropriate systems
for conducting assessments of residents of facilities providing
needed care to individuals in this state with intellectual
disabilities. Therefore, this act shall go into immediate effect.
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