SB 258

As Introduced
136th General Assembly
   Regular Session  S. B. No. 258
       2025-2026
  Senators Lang, Romanchuk
  To amend sections 1751.67, 2133.211, 3313.539,  1
  3707.511, 3727.06, 3923.233, 3923.301, 3923.63,  2
  3923.64, 4723.01, 4723.02, 4723.06, 4723.07,  3
  4723.24, 4723.28, 4723.36, 4723.41, 4723.42,  4
  4723.43, 4723.431, 4723.44, 4723.46, 4723.481,  5
  4723.482, 4723.483, 4723.493, 4723.50, 4731.27,  6
  4761.17, and 5164.07; to enact section 4723.439;        7
  and to repeal sections 4723.45 and 5164.73 of  8
  the Revised Code to modify the laws governing  9
  the practice of advanced practice registered  10
  nurses and to name this act the Better Access to        11
  Health Care Act.  12
 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
     Section 1. That sections 1751.67, 2133.211, 3313.539,  13
3707.511, 3727.06, 3923.233, 3923.301, 3923.63, 3923.64,  14
4723.01, 4723.02, 4723.06, 4723.07, 4723.24, 4723.28, 4723.36,  15
4723.41, 4723.42, 4723.43, 4723.431, 4723.44, 4723.46, 4723.481,       16
4723.482, 4723.483, 4723.493, 4723.50, 4731.27, 4761.17, and  17
5164.07 be amended and section 4723.439 of the Revised Code be  18
enacted to read as follows:  19
     Sec. 1751.67. (A) Each individual or group health insuring        20
corporation policy, contract, or agreement delivered, issued for       21
S. B. No. 258  Page 2
As Introduced
delivery, or renewed in this state that provides maternity  22
benefits shall provide coverage of inpatient care and follow-up  23
care for a mother and her newborn as follows:  24
       (1) The policy, contract, or agreement shall cover a  25
minimum of forty-eight hours of inpatient care following a  26
normal vaginal delivery and a minimum of ninety-six hours of  27
inpatient care following a cesarean delivery. Services covered  28
as inpatient care shall include medical, educational, and any  29
other services that are consistent with the inpatient care  30
recommended in the protocols and guidelines developed by  31
national organizations that represent pediatric, obstetric, and  32
nursing professionals.  33
       (2) The policy, contract, or agreement shall cover a  34
physician-directed source of follow-up care or a source of  35
follow-up care directed by an advanced practice registered  36
nurse. Services covered as follow-up care shall include physical  37
assessment of the mother and newborn, parent education,  38
assistance and training in breast or bottle feeding, assessment  39
of the home support system, performance of any medically  40
necessary and appropriate clinical tests, and any other services  41
that are consistent with the follow-up care recommended in the  42
protocols and guidelines developed by national organizations  43
that represent pediatric, obstetric, and nursing professionals.  44
The coverage shall apply to services provided in a medical  45
setting or through home health care visits. The coverage shall  46
apply to a home health care visit only if the provider who  47
conducts the visit is knowledgeable and experienced in maternity  48
and newborn care.  49
       When a decision is made in accordance with division (B) of  50
this section to discharge a mother or newborn prior to the  51
S. B. No. 258  Page 3
As Introduced
expiration of the applicable number of hours of inpatient care  52
required to be covered, the coverage of follow-up care shall  53
apply to all follow-up care that is provided within seventy-two  54
hours after discharge. When a mother or newborn receives at  55
least the number of hours of inpatient care required to be  56
covered, the coverage of follow-up care shall apply to follow-up  57
care that is determined to be medically necessary by the  58
provider responsible for discharging the mother or newborn.  59
       (B) Any decision to shorten the length of inpatient stay  60
to less than that specified under division (A)(1) of this  61
section shall be made by the physician attending the mother or  62
newborn, except that if a certified nurse-midwife is attending  63
the mother in collaboration with a physician, the decision may  64
be made by the certified nurse-midwife. Decisions If the  65
certified nurse-midwife is practicing under a standard care  66
arrangement with one or more collaborating practitioners, as  67
provided in Chapter 4723. of the Revised Code, the nurse's  68
decision shall be made in collaboration with a collaborating  69
practitioner.  70
       Decisions regarding early discharge shall be made only  71
after conferring with the mother or a person responsible for the  72
mother or newborn. For purposes of this division, a person  73
responsible for the mother or newborn may include a parent,  74
guardian, or any other person with authority to make medical  75
decisions for the mother or newborn.  76
       (C)(1) No health insuring corporation may do either of the  77
following:  78
       (a) Terminate the participation of a provider or health  79
care facility in an individual or group health care plan solely  80
for making recommendations for inpatient or follow-up care for a  81
S. B. No. 258  Page 4
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particular mother or newborn that are consistent with the care  82
required to be covered by this section;  83
       (b) Establish or offer monetary or other financial  84
incentives for the purpose of encouraging a person to decline  85
the inpatient or follow-up care required to be covered by this  86
section.  87
       (2) Whoever violates division (C)(1)(a) or (b) of this  88
section has engaged in an unfair and deceptive act or practice  89
in the business of insurance under sections 3901.19 to 3901.26  90
of the Revised Code.  91
       (D) This section does not do any of the following:  92
       (1) Require a policy, contract, or agreement to cover  93
inpatient or follow-up care that is not received in accordance  94
with the policy's, contract's, or agreement's terms pertaining  95
to the providers and facilities from which an individual is  96
authorized to receive health care services;  97
       (2) Require a mother or newborn to stay in a hospital or  98
other inpatient setting for a fixed period of time following  99
delivery;  100
       (3) Require a child to be delivered in a hospital or other  101
inpatient setting;  102
       (4) Authorize a certified nurse-midwife to practice beyond  103
the authority to practice nurse-midwifery in accordance with  104
Chapter 4723. of the Revised Code;  105
       (5) Establish minimum standards of medical diagnosis,  106
care, or treatment for inpatient or follow-up care for a mother  107
or newborn. A deviation from the care required to be covered  108
under this section shall not, solely on the basis of this  109
S. B. No. 258  Page 5
As Introduced
section, give rise to a medical claim or to derivative claims  110
for relief, as those terms are defined in section 2305.113 of  111
the Revised Code.  112
       Sec. 2133.211. A person who holds a current, valid license  113
issued under Chapter 4723. of the Revised Code to practice as an  114
advanced practice registered nurse may take any action that may  115
be taken by an attending physician under sections 2133.21 to  116
2133.26 of the Revised Code and has the immunity provided by  117
section 2133.22 of the Revised Code, except that if the nurse is  118
practicing under a standard care arrangement with one or more  119
collaborating practitioners, the immunity applies only if the  120
action is taken pursuant to a standard care arrangement in  121
collaboration with a collaborating physician.  122
       A person who holds a license to practice as a physician  123
assistant issued under Chapter 4730. of the Revised Code may  124
take any action that may be taken by an attending physician  125
under sections 2133.21 to 2133.26 of the Revised Code and has  126
the immunity provided by section 2133.22 of the Revised Code if  127
the action is taken pursuant to a supervision agreement entered  128
into under section 4730.19 of the Revised Code, including, if  129
applicable, the policies of a health care facility in which the  130
physician assistant is practicing.  131
       Sec. 3313.539. (A) As used in this section:  132
       (1) "Licensing agency" has the same meaning as in section  133
4745.01 of the Revised Code.  134
       (2) "Licensed health care professional" means an  135
individual, other than a physician, who is authorized under  136
Title XLVII of the Revised Code to practice a health care  137
profession.  138
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As Introduced
       (3) "Physician" means a person authorized under Chapter  139
4731. of the Revised Code to practice medicine and surgery or  140
osteopathic medicine and surgery.  141
       (B) No school district board of education or governing  142
authority of a chartered or nonchartered nonpublic school shall  143
permit a student to practice for or compete in interscholastic  144
athletics until the student has submitted, to a school official  145
designated by the board or governing authority, a form signed by  146
the parent, guardian, or other person having care or charge of  147
the student stating that the student and the parent, guardian,  148
or other person having care or charge of the student have  149
received the concussion and head injury information sheet  150
required by section 3707.52 of the Revised Code. A completed  151
form shall be submitted each school year, as defined in section  152
3313.62 of the Revised Code, for each sport or other category of  153
interscholastic athletics for or in which the student practices  154
or competes.  155
       (C)(1) No school district board of education or governing  156
authority of a chartered or nonchartered nonpublic school shall  157
permit an individual to coach interscholastic athletics unless  158
the individual holds a pupil-activity program permit issued  159
under section 3319.303 of the Revised Code for coaching  160
interscholastic athletics.  161
       (2) No school district board of education or governing  162
authority of a chartered or nonchartered nonpublic school shall  163
permit an individual to referee interscholastic athletics unless  164
the individual holds a pupil-activity program permit issued  165
under section 3319.303 of the Revised Code for coaching  166
interscholastic athletics or presents evidence that the  167
individual has successfully completed, within the previous three  168
S. B. No. 258  Page 7
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years, a training program in recognizing the symptoms of  169
concussions and head injuries to which the department of health  170
has provided a link on its internet web site under section  171
3707.52 of the Revised Code or a training program authorized and  172
required by an organization that regulates interscholastic  173
athletic competition and conducts interscholastic athletic  174
events.  175
       (D) If a student practicing for or competing in an  176
interscholastic athletic event exhibits signs, symptoms, or  177
behaviors consistent with having sustained a concussion or head  178
injury while participating in the practice or competition, the  179
student shall be removed from the practice or competition by  180
either of the following:  181
       (1) The individual who is serving as the student's coach  182
during that practice or competition;  183
       (2) An individual who is serving as a referee during that  184
practice or competition.  185
       (E)(1) If a student is removed from practice or  186
competition under division (D) of this section, the coach or  187
referee who removed the student shall not allow the student, on  188
the same day the student is removed, to return to that practice  189
or competition or to participate in any other practice or  190
competition for which the coach or referee is responsible.  191
Thereafter, the coach or referee shall not allow the student to  192
return to that practice or competition or to participate in any  193
other practice or competition for which the coach or referee is  194
responsible until both of the following conditions are  195
satisfied:  196
       (a) The student's condition is assessed by any of the  197
S. B. No. 258  Page 8
As Introduced
following who has complied with the requirements in division (E)  198
(4) of this section:  199
       (i) A physician;  200
       (ii) A licensed health care professional the school  201
district board of education or governing authority of the  202
chartered or nonchartered nonpublic school, pursuant to division  203
(E)(2) of this section, authorizes to assess a student who has  204
been removed from practice or competition under division (D) of  205
this section;  206
       (iii) A licensed health care professional who meets the  207
minimum education requirements established by rules adopted  208
under section 3707.521 of the Revised Code by the professional's  209
licensing agency.  210
       (b) The student receives written clearance that it is safe  211
for the student to return to practice or competition from the  212
physician or licensed health care professional who assessed the  213
student's condition.  214
       (2) A (2)(a) Except as provided in division (E)(2)(b) of  215
this section, a school district board of education or governing  216
authority of a chartered or nonchartered nonpublic school may  217
authorize a licensed health care professional to make an  218
assessment or grant a clearance for purposes of division (E)(1)  219
of this section only if the professional is acting in accordance  220
with one of the following, as applicable to the professional's  221
authority to practice in this state:  222
       (a) (i) In consultation with a physician;  223
       (b) (ii) Pursuant to the referral of a physician;  224
       (c) (iii) In collaboration with a physician;  225
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As Introduced
       (d) (iv) Under the supervision of a physician.  226
       (b) The requirement of division (E)(2)(a)(iii) of this  227
section does not apply to a clinical nurse specialist or  228
certified nurse practitioner who, in accordance with section  229
4723.439 of the Revised Code, is practicing without a standard  230
care arrangement or is eligible to practice without a standard  231
care arrangement.  232
       (3) A physician or licensed health care professional who  233
makes an assessment or grants a clearance for purposes of  234
division (E)(1) of this section may be a volunteer.  235
       (4) Beginning one year after the effective date of this  236
amendment, all All physicians and licensed health care  237
professionals who conduct assessments and clearances under  238
division (E)(1) of this section must meet the minimum education  239
requirements established by rules adopted under section 3707.521  240
of the Revised Code by their respective licensing agencies.  241
       (F) A school district board of education or governing  242
authority of a chartered or nonchartered nonpublic school that  243
is subject to the rules of an interscholastic conference or an  244
organization that regulates interscholastic athletic competition  245
and conducts interscholastic athletic events shall be considered  246
to be in compliance with divisions (B), (D), and (E) of this  247
section, as long as the requirements of those rules are  248
substantially similar to the requirements of divisions (B), (D),  249
and (E) of this section.  250
       (G)(1) A school district, member of a school district  251
board of education, or school district employee or volunteer,  252
including a coach or referee, is not liable in damages in a  253
civil action for injury, death, or loss to person or property  254
S. B. No. 258  Page 10
As Introduced
allegedly arising from providing services or performing duties  255
under this section, unless the act or omission constitutes  256
willful or wanton misconduct.  257
       This section does not eliminate, limit, or reduce any  258
other immunity or defense that a school district, member of a  259
school district board of education, or school district employee  260
or volunteer, including a coach or referee, may be entitled to  261
under Chapter 2744. or any other provision of the Revised Code  262
or under the common law of this state.  263
       (2) A chartered or nonchartered nonpublic school or any  264
officer, director, employee, or volunteer of the school,  265
including a coach or referee, is not liable in damages in a  266
civil action for injury, death, or loss to person or property  267
allegedly arising from providing services or performing duties  268
under this section, unless the act or omission constitutes  269
willful or wanton misconduct.  270
       Sec. 3707.511. (A) As used in this section:  271
       (1) "Licensing agency" has the same meaning as in section  272
4745.01 of the Revised Code.  273
       (2) "Licensed health care professional" means an  274
individual, other than a physician, who is authorized under  275
Title XLVII of the Revised Code to practice a health care  276
profession.  277
       (3) "Physician" means a person authorized under Chapter  278
4731. of the Revised Code to practice medicine and surgery or  279
osteopathic medicine and surgery.  280
       (B) A youth sports organization shall provide to the  281
parent, guardian, or other person having care or charge of an  282
individual who wishes to practice for or compete in an athletic  283
S. B. No. 258  Page 11
As Introduced
activity organized by a youth sports organization the concussion  284
and head injury information sheet required by section 3707.52 of  285
the Revised Code. The organization shall provide the information  286
sheet annually for each sport or other category of athletic  287
activity for or in which the individual practices or competes.  288
       (C)(1) No individual shall act as a coach or referee for a  289
youth sports organization unless the individual holds a pupil-  290
activity program permit issued under section 3319.303 of the  291
Revised Code for coaching interscholastic athletics or presents  292
evidence that the individual has successfully completed, within  293
the previous three years, a training program in recognizing the  294
symptoms of concussions and head injuries to which the  295
department of health has provided a link on its internet web  296
site under section 3707.52 of the Revised Code.  297
       (2) The youth sports organization for which the individual  298
intends to act as a coach or referee shall inform the individual  299
of the requirement described in division (C)(1) of this section.  300
       (D) If an individual practicing for or competing in an  301
athletic event organized by a youth sports organization exhibits  302
signs, symptoms, or behaviors consistent with having sustained a  303
concussion or head injury while participating in the practice or  304
competition, the individual shall be removed from the practice  305
or competition by one of the following:  306
       (1) The individual who is serving as the individual's  307
coach during that practice or competition;  308
       (2) An individual who is serving as a referee during that  309
practice or competition;  310
       (3) An official of the youth sports organization who is  311
supervising that practice or competition.  312
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As Introduced
       (E)(1) If an individual is removed from practice or  313
competition under division (D) of this section, the coach,  314
referee, or official who removed the individual shall not allow  315
the individual, on the same day the individual is removed, to  316
return to that practice or competition or to participate in any  317
other practice or competition for which the coach, referee, or  318
official is responsible. Thereafter, the coach, referee, or  319
official shall not allow the student to return to that practice  320
or competition or to participate in any other practice or  321
competition for which the coach, referee, or official is  322
responsible until both of the following conditions are  323
satisfied:  324
       (a) The individual's condition is assessed by any of the  325
following who has complied with the requirements in division (E)  326
(4) of this section:  327
       (i) A physician;  328
       (ii) A licensed health care professional the youth sports  329
organization, pursuant to division (E)(2) of this section,  330
authorizes to assess an individual who has been removed from  331
practice or competition under division (D) of this section;  332
       (iii) A licensed health care professional who meets the  333
minimum education requirements established by rules adopted  334
under section 3707.521 of the Revised Code by the professional's  335
licensing agency.  336
       (b) The individual receives written clearance that it is  337
safe for the individual to return to practice or competition  338
from the physician or licensed health care professional who  339
assessed the individual's condition.  340
       (2) A (2)(a) Except as provided in division (E)(2)(b) of  341
S. B. No. 258  Page 13
As Introduced
this section, a youth sports organization may authorize a  342
licensed health care professional to make an assessment or grant  343
a clearance for purposes of division (E)(1) of this section only  344
if the professional is acting in accordance with one of the  345
following, as applicable to the professional's authority to  346
practice in this state:  347
       (a) (i) In consultation with a physician;  348
       (b) (ii) Pursuant to the referral of a physician;  349
       (c) (iii) In collaboration with a physician;  350
       (d) (iv) Under the supervision of a physician.  351
       (b) The requirement of division (E)(2)(a)(iii) of this  352
section does not apply to a clinical nurse specialist or  353
certified nurse practitioner who, in accordance with section  354
4723.439 of the Revised Code, is practicing without a standard  355
care arrangement or is eligible to practice without a standard  356
care arrangement.  357
       (3) A physician or licensed health care professional who  358
makes an assessment or grants a clearance for purposes of  359
division (E)(1) of this section may be a volunteer.  360
       (4) Beginning one year after the effective date of this  361
amendment, all All physicians and licensed health care  362
professionals who conduct assessments and clearances under  363
division (E)(1) of this section must meet the minimum education  364
requirements established by rules adopted under section 3707.521  365
of the Revised Code by their respective licensing agencies.  366
       (F)(1) A youth sports organization or official, employee,  367
or volunteer of a youth sports organization, including a coach  368
or referee, is not liable in damages in a civil action for  369
S. B. No. 258  Page 14
As Introduced
injury, death, or loss to person or property allegedly arising  370
from providing services or performing duties under this section,  371
unless the act or omission constitutes willful or wanton  372
misconduct.  373
       (2) This section does not eliminate, limit, or reduce any  374
other immunity or defense that a public entity, public official,  375
or public employee may be entitled to under Chapter 2744. or any  376
other provision of the Revised Code or under the common law of  377
this state.  378
       Sec. 3727.06. (A) As used in this section:  379
       (1) "Doctor" means an individual authorized under Chapter  380
4731. of the Revised Code to practice medicine and surgery or  381
osteopathic medicine and surgery.  382
       (2) "Podiatrist" means an individual authorized under  383
Chapter 4731. of the Revised Code to practice podiatric medicine  384
and surgery.  385
       (B)(1) Only the following may admit a patient to a  386
hospital:  387
       (a) A doctor who is a member of the hospital's medical  388
staff;  389
       (b) A dentist who is a member of the hospital's medical  390
staff;  391
       (c) A podiatrist who is a member of the hospital's medical  392
staff;  393
       (d) A clinical nurse specialist, certified nurse-midwife,  394
or certified nurse practitioner if all of the following  395
conditions are met:  396
S. B. No. 258  Page 15
As Introduced
       (i) The clinical nurse specialist, certified nurse-  397
midwife, or certified nurse practitioner has a standard care  398
arrangement entered into pursuant to section 4723.431 of the  399
Revised Code with a collaborating doctor or podiatrist who is a  400
member of the medical staff;  401
       (ii) The patient will be under the medical supervision of  402
the collaborating doctor or podiatrist;  403
       (iii) The the hospital has granted the clinical nurse  404
specialist, certified nurse-midwife, or certified nurse  405
practitioner admitting privileges and appropriate credentials.  406
       (e) A physician assistant if all of the following  407
conditions are met:  408
       (i) The physician assistant is listed on a supervision  409
agreement entered into under section 4730.19 of the Revised Code  410
for a doctor or podiatrist who is a member of the hospital's  411
medical staff.  412
       (ii) The patient will be under the medical supervision of  413
the supervising doctor or podiatrist.  414
       (iii) The hospital has granted the physician assistant  415
admitting privileges and appropriate credentials.  416
       (2) Prior to admitting a patient, a clinical nurse  417
specialist, certified nurse-midwife, or certified nurse  418
practitioner, or   who is practicing under a standard care  419
arrangement with one or more collaborating practitioners, as  420
provided in Chapter 4723. of the Revised Code, shall notify the  421
collaborating practitioner of the planned admission.  422
       Prior to admitting a patient, a physician assistant shall  423
notify the collaborating or supervising doctor or podiatrist of  424
S. B. No. 258  Page 16
As Introduced
the planned admission.  425
       (C) All hospital patients shall be under the medical  426
supervision of a doctor, except that services that may be  427
rendered by a licensed dentist pursuant to Chapter 4715. of the  428
Revised Code provided to patients admitted solely for the  429
purpose of receiving such services shall be under the  430
supervision of the admitting dentist and that services that may  431
be rendered by a podiatrist pursuant to section 4731.51 of the  432
Revised Code provided to patients admitted solely for the  433
purpose of receiving such services shall be under the  434
supervision of the admitting podiatrist. If treatment not within  435
the scope of Chapter 4715. or section 4731.51 of the Revised  436
Code is required at the time of admission by a dentist or  437
podiatrist, or becomes necessary during the course of hospital  438
treatment by a dentist or podiatrist, such treatment shall be  439
under the supervision of a doctor who is a member of the medical  440
staff. It shall be the responsibility of the admitting dentist  441
or podiatrist to make arrangements with a doctor who is a member  442
of the medical staff to be responsible for the patient's  443
treatment outside the scope of Chapter 4715. or section 4731.51  444
of the Revised Code when necessary during the patient's stay in  445
the hospital.  446
       Sec. 3923.233. (A) Notwithstanding any provision of any  447
certificate furnished by an insurer in connection with or  448
pursuant to any group sickness and accident insurance policy  449
delivered, issued, renewed, or used, in or outside this state,  450
on or after January 1, 1985, and notwithstanding any provision  451
of any policy of insurance delivered, issued for delivery,  452
renewed, or used, in or outside this state, on or after January  453
1, 1985, whenever the policy or certificate is subject to the  454
jurisdiction of this state and provides for reimbursement for  455
S. B. No. 258  Page 17
As Introduced
any service that may be legally performed by an advanced  456
practice registered nurse who holds a current, valid license  457
issued under Chapter 4723. of the Revised Code and is designated  458
as a certified nurse-midwife in accordance with section 4723.42  459
of the Revised Code, reimbursement under the policy or  460
certificate shall not be denied to a certified nurse-midwife  461
performing the service in collaboration with a licensed  462
physician. The collaborating physician shall be identified on an  463
insurance claim form.  464
        The cost of collaboration with a certified nurse-midwife  465
by a licensed physician as required under section 4723.43 of the  466
Revised Code is a reimbursable expense.  467
        The division of any reimbursement payment for services  468
performed by a certified nurse-midwife between the certified  469
nurse-midwife and the certified nurse-midwife's collaborating  470
physician shall be determined and mutually agreed upon by the  471
certified nurse-midwife and the physician. The division of fees  472
shall not be considered a violation of division (B)(17) of  473
section 4731.22 of the Revised Code. In no case shall the total  474
fees charged exceed the fee the physician would have charged had  475
the physician provided the entire service.  476
        (B) Division (A) of this section applies to any certified  477
nurse-midwife who is practicing in accordance with Chapter 4723.  478
of the Revised Code, regardless of whether the nurse is required  479
or chooses to practice under a standard care arrangement, as  480
provided in section 4723.43 of the Revised Code, or the nurse  481
exercises the authority to practice without a standard care  482
arrangement, as provided in section 4723.439 of the Revised  483
Code.  484
        Sec. 3923.301. (A) Every person, the state and any of its  485
S. B. No. 258  Page 18
As Introduced
instrumentalities, any county, township, school district, or  486
other political subdivision and any of its instrumentalities,  487
and any municipal corporation and any of its instrumentalities  488
that provides payment for health care benefits for any of its  489
employees resident in this state, which benefits are not  490
provided by contract with an insurer qualified to provide  491
sickness and accident insurance or a health insuring  492
corporation, and that includes reimbursement for any service  493
that may be legally performed by an advanced practice registered  494
nurse who holds a current, valid license issued under Chapter  495
4723. of the Revised Code and is designated as a certified  496
nurse-midwife in accordance with section 4723.42 of the Revised  497
Code, shall not deny reimbursement to a certified nurse-midwife  498
performing the service if the service is performed in  499
collaboration with a licensed physician. The collaborating  500
physician shall be identified on the claim form.  501
       The cost of collaboration with a certified nurse-midwife  502
by a licensed physician as required under section 4723.43 of the  503
Revised Code is a reimbursable expense.  504
       The division of any reimbursement payment for services  505
performed by a certified nurse-midwife between the certified  506
nurse-midwife and the certified nurse-midwife's collaborating  507
physician shall be determined and mutually agreed upon by the  508
certified nurse-midwife and the physician. The division of fees  509
shall not be considered a violation of division (B)(17) of  510
section 4731.22 of the Revised Code. In no case shall the total  511
fees charged exceed the fee the physician would have charged had  512
the physician provided the entire service.  513
       (B) Division (A) of this section applies to any certified  514
nurse-midwife who is practicing in accordance with Chapter 4723.  515
S. B. No. 258  Page 19
As Introduced
of the Revised Code, regardless of whether the nurse is required  516
or chooses to practice under a standard care arrangement, as  517
provided in section 4723.43 of the Revised Code, or the nurse  518
exercises the authority to practice without a standard care  519
arrangement, as provided in section 4723.439 of the Revised  520
Code.  521
        Sec. 3923.63. (A) Notwithstanding section 3901.71 of the  522
Revised Code, each individual or group policy of sickness and  523
accident insurance delivered, issued for delivery, or renewed in  524
this state that provides maternity benefits shall provide  525
coverage of inpatient care and follow-up care for a mother and  526
her newborn as follows:  527
        (1) The policy shall cover a minimum of forty-eight hours  528
of inpatient care following a normal vaginal delivery and a  529
minimum of ninety-six hours of inpatient care following a  530
cesarean delivery. Services covered as inpatient care shall  531
include medical, educational, and any other services that are  532
consistent with the inpatient care recommended in the protocols  533
and guidelines developed by national organizations that  534
represent pediatric, obstetric, and nursing professionals.  535
        (2) The policy shall cover a physician-directed source of  536
follow-up care or a source of follow-up care directed by an  537
advanced practice registered nurse. Services covered as follow-  538
up care shall include physical assessment of the mother and  539
newborn, parent education, assistance and training in breast or  540
bottle feeding, assessment of the home support system,  541
performance of any medically necessary and appropriate clinical  542
tests, and any other services that are consistent with the  543
follow-up care recommended in the protocols and guidelines  544
developed by national organizations that represent pediatric,  545
S. B. No. 258  Page 20
As Introduced
obstetric, and nursing professionals. The coverage shall apply  546
to services provided in a medical setting or through home health  547
care visits. The coverage shall apply to a home health care  548
visit only if the health care professional who conducts the  549
visit is knowledgeable and experienced in maternity and newborn  550
care.  551
        When a decision is made in accordance with division (B) of  552
this section to discharge a mother or newborn prior to the  553
expiration of the applicable number of hours of inpatient care  554
required to be covered, the coverage of follow-up care shall  555
apply to all follow-up care that is provided within seventy-two  556
hours after discharge. When a mother or newborn receives at  557
least the number of hours of inpatient care required to be  558
covered, the coverage of follow-up care shall apply to follow-up  559
care that is determined to be medically necessary by the health  560
care professionals responsible for discharging the mother or  561
newborn.  562
        (B) Any decision to shorten the length of inpatient stay  563
to less than that specified under division (A)(1) of this  564
section shall be made by the physician attending the mother or  565
newborn, except that if a certified nurse-midwife is attending  566
the mother in collaboration with a physician, the decision may  567
be made by the certified nurse-midwife. Decisions  568
        If the certified nurse-midwife is practicing under a  569
standard care arrangement with one or more collaborating  570
practitioners, as provided in Chapter 4723. of the Revised Code,  571
the nurse's decision shall be made in collaboration with a  572
collaborating practitioner. Decisions regarding early discharge  573
shall be made only after conferring with the mother or a person  574
responsible for the mother or newborn. For purposes of this  575
S. B. No. 258  Page 21
As Introduced
division, a person responsible for the mother or newborn may  576
include a parent, guardian, or any other person with authority  577
to make medical decisions for the mother or newborn.  578
       (C)(1) No sickness and accident insurer may do either of  579
the following:  580
       (a) Terminate the participation of a health care  581
professional or health care facility as a provider under a  582
sickness and accident insurance policy solely for making  583
recommendations for inpatient or follow-up care for a particular  584
mother or newborn that are consistent with the care required to  585
be covered by this section;  586
       (b) Establish or offer monetary or other financial  587
incentives for the purpose of encouraging a person to decline  588
the inpatient or follow-up care required to be covered by this  589
section.  590
       (2) Whoever violates division (C)(1)(a) or (b) of this  591
section has engaged in an unfair and deceptive act or practice  592
in the business of insurance under sections 3901.19 to 3901.26  593
of the Revised Code.  594
       (D) This section does not do any of the following:  595
       (1) Require a policy to cover inpatient or follow-up care  596
that is not received in accordance with the policy's terms  597
pertaining to the health care professionals and facilities from  598
which an individual is authorized to receive health care  599
services;  600
       (2) Require a mother or newborn to stay in a hospital or  601
other inpatient setting for a fixed period of time following  602
delivery;  603
S. B. No. 258  Page 22
As Introduced
       (3) Require a child to be delivered in a hospital or other  604
inpatient setting;  605
       (4) Authorize a certified nurse-midwife to practice beyond  606
the authority to practice nurse-midwifery in accordance with  607
Chapter 4723. of the Revised Code;  608
       (5) Establish minimum standards of medical diagnosis, care  609
or treatment for inpatient or follow-up care for a mother or  610
newborn. A deviation from the care required to be covered under  611
this section shall not, solely on the basis of this section,  612
give rise to a medical claim or derivative medical claim, as  613
those terms are defined in section 2305.113 of the Revised Code.  614
       Sec. 3923.64. (A) Notwithstanding section 3901.71 of the  615
Revised Code, each public employee benefit plan established or  616
modified in this state that provides maternity benefits shall  617
provide coverage of inpatient care and follow-up care for a  618
mother and her newborn as follows:  619
       (1) The plan shall cover a minimum of forty-eight hours of  620
inpatient care following a normal vaginal delivery and a minimum  621
of ninety-six hours of inpatient care following a cesarean  622
delivery. Services covered as inpatient care shall include  623
medical, educational, and any other services that are consistent  624
with the inpatient care recommended in the protocols and  625
guidelines developed by national organizations that represent  626
pediatric, obstetric, and nursing professionals.  627
       (2) The plan shall cover a physician-directed source of  628
follow-up care or a source of follow-up care directed by an  629
advanced practice registered nurse. Services covered as follow-  630
up care shall include physical assessment of the mother and  631
newborn, parent education, assistance and training in breast or  632
S. B. No. 258  Page 23
As Introduced
bottle feeding, assessment of the home support system,  633
performance of any medically necessary and appropriate clinical  634
tests, and any other services that are consistent with the  635
follow-up care recommended in the protocols and guidelines  636
developed by national organizations that represent pediatric,  637
obstetric, and nursing professionals. The coverage shall apply  638
to services provided in a medical setting or through home health  639
care visits. The coverage shall apply to a home health care  640
visit only if the health care professional who conducts the  641
visit is knowledgeable and experienced in maternity and newborn  642
care.  643
        When a decision is made in accordance with division (B) of  644
this section to discharge a mother or newborn prior to the  645
expiration of the applicable number of hours of inpatient care  646
required to be covered, the coverage of follow-up care shall  647
apply to all follow-up care that is provided within seventy-two  648
hours after discharge. When a mother or newborn receives at  649
least the number of hours of inpatient care required to be  650
covered, the coverage of follow-up care shall apply to follow-up  651
care that is determined to be medically necessary by the health  652
care professionals responsible for discharging the mother or  653
newborn.  654
        (B) Any decision to shorten the length of inpatient stay  655
to less than that specified under division (A)(1) of this  656
section shall be made by the physician attending the mother or  657
newborn, except that if a certified nurse-midwife is attending  658
the mother in collaboration with a physician, the decision may  659
be made by the certified nurse-midwife. Decisions  660
        If the certified nurse-midwife is practicing under a  661
standard care arrangement with one or more collaborating  662
S. B. No. 258  Page 24
As Introduced
practitioners, as provided in Chapter 4723. of the Revised Code,  663
the nurse's decision shall be made in collaboration with a  664
collaborating practitioner. Decisions regarding early discharge  665
shall be made only after conferring with the mother or a person  666
responsible for the mother or newborn. For purposes of this  667
division, a person responsible for the mother or newborn may  668
include a parent, guardian, or any other person with authority  669
to make medical decisions for the mother or newborn.  670
       (C)(1) No public employer who offers an employee benefit  671
plan may do either of the following:  672
       (a) Terminate the participation of a health care  673
professional or health care facility as a provider under the  674
plan solely for making recommendations for inpatient or follow-  675
up care for a particular mother or newborn that are consistent  676
with the care required to be covered by this section;  677
       (b) Establish or offer monetary or other financial  678
incentives for the purpose of encouraging a person to decline  679
the inpatient or follow-up care required to be covered by this  680
section.  681
       (2) Whoever violates division (C)(1)(a) or (b) of this  682
section has engaged in an unfair and deceptive act or practice  683
in the business of insurance under sections 3901.19 to 3901.26  684
of the Revised Code.  685
       (D) This section does not do any of the following:  686
       (1) Require a plan to cover inpatient or follow-up care  687
that is not received in accordance with the plan's terms  688
pertaining to the health care professionals and facilities from  689
which an individual is authorized to receive health care  690
services;  691
S. B. No. 258  Page 25
As Introduced
       (2) Require a mother or newborn to stay in a hospital or  692
other inpatient setting for a fixed period of time following  693
delivery;  694
       (3) Require a child to be delivered in a hospital or other  695
inpatient setting;  696
       (4) Authorize a certified nurse-midwife to practice beyond  697
the authority to practice nurse-midwifery in accordance with  698
Chapter 4723. of the Revised Code;  699
       (5) Establish minimum standards of medical diagnosis,  700
care, or treatment for inpatient or follow-up care for a mother  701
or newborn. A deviation from the care required to be covered  702
under this section shall not, solely on the basis of this  703
section, give rise to a medical claim or derivative medical  704
claim, as those terms are defined in section 2305.113 of the  705
Revised Code.  706
       Sec. 4723.01. As used in this chapter:  707
       (A) "Registered nurse" means an individual who holds a  708
current, valid license issued under this chapter that authorizes  709
the practice of nursing as a registered nurse.  710
       (B) "Practice of nursing as a registered nurse" means  711
providing to individuals and groups nursing care requiring  712
specialized knowledge, judgment, and skill derived from the  713
principles of biological, physical, behavioral, social, and  714
nursing sciences. Such nursing care includes:  715
       (1) Identifying patterns of human responses to actual or  716
potential health problems amenable to a nursing regimen;  717
       (2) Executing a nursing regimen through the selection,  718
performance, management, and evaluation of nursing actions;  719
S. B. No. 258  Page 26
As Introduced
       (3) Assessing health status for the purpose of providing  720
nursing care;  721
       (4) Providing health counseling and health teaching;  722
       (5) Administering medications, treatments, and executing  723
regimens authorized by an individual who is authorized to  724
practice in this state and is acting within the course of the  725
individual's professional practice;  726
       (6) Teaching, administering, supervising, delegating, and  727
evaluating nursing practice.  728
       (C) "Nursing regimen" may include preventative,  729
restorative, and health-promotion activities.  730
       (D) "Assessing health status" means the collection of data  731
through nursing assessment techniques, which may include  732
interviews, observation, and physical evaluations for the  733
purpose of providing nursing care.  734
       (E) "Licensed practical nurse" means an individual who  735
holds a current, valid license issued under this chapter that  736
authorizes the practice of nursing as a licensed practical  737
nurse.  738
       (F) "The practice of nursing as a licensed practical  739
nurse" means providing to individuals and groups nursing care  740
requiring the application of basic knowledge of the biological,  741
physical, behavioral, social, and nursing sciences at the  742
direction of a registered nurse or any of the following who is  743
authorized to practice in this state: a physician, physician  744
assistant, dentist, podiatrist, optometrist, or chiropractor.  745
Such nursing care includes:  746
       (1) Observation, patient teaching, and care in a diversity  747
S. B. No. 258  Page 27
As Introduced
of health care settings;  748
       (2) Contributions to the planning, implementation, and  749
evaluation of nursing;  750
       (3) Administration of medications and treatments  751
authorized by an individual who is authorized to practice in  752
this state and is acting within the course of the individual's  753
professional practice;  754
       (4) Administration to an adult of intravenous therapy  755
authorized by an individual who is authorized to practice in  756
this state and is acting within the course of the individual's  757
professional practice, on the condition that the licensed  758
practical nurse is authorized under section 4723.18 or 4723.181  759
of the Revised Code to perform intravenous therapy and performs  760
intravenous therapy only in accordance with those sections;  761
       (5) Delegation of nursing tasks as directed by a  762
registered nurse;  763
       (6) Teaching nursing tasks to licensed practical nurses  764
and individuals to whom the licensed practical nurse is  765
authorized to delegate nursing tasks as directed by a registered  766
nurse.  767
       (G) "Certified registered nurse anesthetist" means an  768
advanced practice registered nurse who holds a current, valid  769
license issued under this chapter and is designated as a  770
certified registered nurse anesthetist in accordance with  771
section 4723.42 of the Revised Code and rules adopted by the  772
board of nursing.  773
       (H) "Clinical nurse specialist" means an advanced practice  774
registered nurse who holds a current, valid license issued under  775
this chapter and is designated as a clinical nurse specialist in  776
S. B. No. 258  Page 28
As Introduced
accordance with section 4723.42 of the Revised Code and rules  777
adopted by the board of nursing.  778
       (I) "Certified nurse-midwife" means an advanced practice  779
registered nurse who holds a current, valid license issued under  780
this chapter and is designated as a certified nurse-midwife in  781
accordance with section 4723.42 of the Revised Code and rules  782
adopted by the board of nursing.  783
       (J) "Certified nurse practitioner" means an advanced  784
practice registered nurse who holds a current, valid license  785
issued under this chapter and is designated as a certified nurse  786
practitioner in accordance with section 4723.42 of the Revised  787
Code and rules adopted by the board of nursing.  788
       (K) "Physician" means an individual authorized under  789
Chapter 4731. of the Revised Code to practice medicine and  790
surgery or osteopathic medicine and surgery.  791
       (L) "Collaboration" or "collaborating" means the  792
following:  793
       (1) In the case of a clinical nurse specialist or a  794
certified nurse practitioner, that one or more podiatrists  795
acting within the scope of practice of podiatry in accordance  796
with section 4731.51 of the Revised Code and with whom the nurse  797
has entered into a standard care arrangement or one or more  798
physicians with whom the nurse has entered into a standard care  799
arrangement collaborating practitioners are continuously  800
available to communicate with the clinical nurse specialist,  801
certified nurse-midwife, or certified nurse practitioner either  802
in person or by electronic communication;  803
       (2) In the case of a certified nurse-midwife, that one or  804
more physicians with whom the certified nurse-midwife has  805
S. B. No. 258  Page 29
As Introduced
entered into a standard care arrangement are continuously  806
available to communicate with the certified nurse-midwife either  807
in person or by electronic communication.  808
       (M) "Collaborating practitioner" means any of the  809
following who is collaborating under a standard care arrangement  810
with a clinical nurse specialist, certified nurse-midwife, or  811
certified nurse practitioner:  812
       (1) A physician;  813
       (2) A podiatrist;  814
       (3) A clinical nurse specialist, certified nurse-midwife,  815
or certified nurse practitioner who is not practicing under a  816
standard care arrangement with another collaborating  817
practitioner.  818
       (N) "Supervision," as it pertains to a certified  819
registered nurse anesthetist, means that the certified  820
registered nurse anesthetist is under the direction of a  821
podiatrist acting within the podiatrist's scope of practice in  822
accordance with section 4731.51 of the Revised Code, a dentist  823
acting within the dentist's scope of practice in accordance with  824
Chapter 4715. of the Revised Code, or a physician, and, when  825
administering anesthesia, the certified registered nurse  826
anesthetist is in the immediate presence of the podiatrist,  827
dentist, or physician.  828
       (N)(O) "Standard care arrangement" means a written, formal  829
guide for planning and evaluating a patient's health care that  830
meets the requirements of section 4723.431 of the Revised Code  831
and is developed by one or more collaborating physicians or  832
podiatrists practitioners and a the clinical nurse specialist,  833
certified nurse-midwife, or certified nurse practitioner and  834
S. B. No. 258  Page 30
As Introduced
meets the requirements of section 4723.431 of the Revised  835
Codewho will practice under the arrangement.  836
       (O)(P) "Advanced practice registered nurse" means an  837
individual who holds a current, valid license issued under this  838
chapter that authorizes the practice of nursing as an advanced  839
practice registered nurse and is designated as any of the  840
following:  841
       (1) A certified registered nurse anesthetist;  842
       (2) A clinical nurse specialist;  843
       (3) A certified nurse-midwife;  844
       (4) A certified nurse practitioner.  845
       (P)(Q) "Practice of nursing as an advanced practice  846
registered nurse" means providing to individuals and groups  847
nursing care that requires knowledge and skill obtained from  848
advanced formal education, continuing education, training, and  849
clinical experience. Such nursing care includes the care  850
described in section 4723.43 of the Revised Code.  851
       (Q)(R) "Dialysis care" means the care and procedures that  852
a dialysis technician or dialysis technician intern is  853
authorized to provide and perform, as specified in section  854
4723.72 of the Revised Code.  855
       (R)(S) "Dialysis technician" means an individual who holds  856
a current, valid certificate to practice as a dialysis  857
technician issued under section 4723.75 of the Revised Code.  858
       (S)(T) "Dialysis technician intern" means an individual  859
who has not passed the dialysis technician certification  860
examination required by section 4723.751 of the Revised Code,  861
but who has successfully completed a dialysis training program  862
S. B. No. 258  Page 31
As Introduced
approved by the board of nursing under section 4723.74 of the  863
Revised Code within the previous eighteen months.  864
       (T)(U) "Certified community health worker" means an  865
individual who holds a current, valid certificate as a community  866
health worker issued under section 4723.85 of the Revised Code.  867
       (U)(V) "Medication aide" means an individual who holds a  868
current, valid certificate issued under this chapter that  869
authorizes the individual to administer medication in accordance  870
with section 4723.67 of the Revised Code;  871
       (V)(W) "Nursing specialtyDesignation" means a specialty in  872
practice designation as a certified registered nurse  873
anesthetist, clinical nurse specialist, certified nurse-midwife,  874
or certified nurse practitioner.  875
       (W)(X) "Physician assistant" means an individual who is  876
licensed to practice as a physician assistant under Chapter  877
4730. of the Revised Code.  878
       Sec. 4723.02. The board of nursing shall assume and  879
exercise all the powers and perform all the duties conferred and  880
imposed on it by this chapter.  881
       The board shall consist of thirteen members who shall be  882
citizens of the United States and residents of Ohio. Eight  883
members shall be registered nurses, each of whom shall be a  884
graduate of an approved program of nursing education that  885
prepares persons for licensure as a registered nurse, shall hold  886
a currently active license issued under this chapter to practice  887
nursing as a registered nurse, and shall have been actively  888
engaged in the practice of nursing as a registered nurse for the  889
five years immediately preceding the member's initial  890
appointment to the board. Of the eight members who are  891
S. B. No. 258  Page 32
As Introduced
registered nurses, at least two shall hold a current, valid  892
license issued under this chapter that authorizes the practice  893
of nursing as an advanced practice registered nurse. Four  894
members shall be licensed practical nurses, each of whom shall  895
be a graduate of an approved program of nursing education that  896
prepares persons for licensure as a practical nurse, shall hold  897
a currently active license issued under this chapter to practice  898
nursing as a licensed practical nurse, and shall have been  899
actively engaged in the practice of nursing as a licensed  900
practical nurse for the five years immediately preceding the  901
member's initial appointment to the board. One member shall  902
represent the interests of consumers of health care. Neither  903
this member nor any person in the member's immediate family  904
shall be a member of or associated with a health care provider  905
or profession or shall have a financial interest in the delivery  906
or financing of health care. Representation of nursing service  907
and nursing education and of the various geographical areas of  908
the state shall be considered in making appointments.  909
        As the term of any member of the board expires, a  910
successor shall be appointed who has the qualifications the  911
vacancy requires. Terms of office shall be for four years,  912
commencing on the first day of January and ending on the thirty-  913
first day of December.  914
        A current or former board member who has served not more  915
than one full term or one full term and not more than thirty  916
months of another term may be reappointed for one additional  917
term.  918
        Each member shall hold office from the date of appointment  919
until the end of the term for which the member was appointed.  920
The term of a member shall expire if the member ceases to meet  921
S. B. No. 258  Page 33
As Introduced
any requirement of this section for the member's position on the  922
board. Any member appointed to fill a vacancy occurring prior to  923
the expiration of the term for which the member's predecessor  924
was appointed shall hold office for the remainder of such term.  925
Any member shall continue in office subsequent to the expiration  926
date of the member's term until the member's successor takes  927
office, or until a period of sixty days has elapsed, whichever  928
occurs first.  929
       Nursing organizations of this state may each submit to the  930
governor the names of not more than five nominees for each  931
position to be filled on the board. From the names so submitted  932
or from others, at the governor's discretion, the governor with  933
the advice and consent of the senate shall make such  934
appointments.  935
       Any member of the board may be removed by the governor for  936
neglect of any duty required by law or for incompetency or  937
unprofessional or dishonorable conduct, after a hearing as  938
provided in Chapter 119. of the Revised Code.  939
       Seven members of the board including constitute a quorum,  940
which shall include at least four registered nurses, one of whom  941
is an advanced practice registered nurse, and at least one  942
licensed practical nurse shall at all times constitute a quorum.  943
       Each member of the board shall receive an amount fixed  944
pursuant to division (J) of section 124.15 of the Revised Code  945
for each day in attendance at board meetings and in discharge of  946
official duties, and in addition thereto, necessary expense  947
incurred in the performance of such duties.  948
       The board shall elect one of its nurse members as  949
president and one as vice-president. The board shall elect one  950
S. B. No. 258  Page 34
As Introduced
of its registered nurse members to serve as the supervising  951
member for disciplinary matters.  952
       The board may establish advisory groups to serve in  953
consultation with the board or the executive director. Each  954
advisory group shall be given a specific charge in writing and  955
shall report to the board. Members of advisory groups shall  956
serve without compensation but shall receive their actual and  957
necessary expenses incurred in the performance of their official  958
duties.  959
       Sec. 4723.06. (A) The board of nursing shall:  960
       (1) Administer and enforce the provisions of this chapter,  961
including the taking of disciplinary action for violations of  962
section 4723.28 of the Revised Code, any other provisions of  963
this chapter, or rules adopted under this chapter;  964
       (2) Develop criteria that an applicant must meet to be  965
eligible to sit for the examination for licensure to practice as  966
a registered nurse or as a licensed practical nurse;  967
       (3) Issue and renew nursing licenses, dialysis technician  968
certificates, and community health worker certificates, as  969
provided in this chapter;  970
       (4) Define the minimum educational standards for the  971
schools and programs of registered nursing and practical nursing  972
in this state;  973
       (5) Survey, inspect, and grant full approval to  974
prelicensure nursing education programs in this state that meet  975
the standards established by rules adopted under section 4723.07  976
of the Revised Code. Prelicensure nursing education programs  977
include, but are not limited to, diploma, associate degree,  978
baccalaureate degree, master's degree, and doctor of nursing  979
S. B. No. 258  Page 35
As Introduced
programs leading to initial licensure to practice nursing as a  980
registered nurse and practical nurse programs leading to initial  981
licensure to practice nursing as a licensed practical nurse.  982
       (6) Grant conditional approval, by a vote of a quorum of  983
the board, to a new prelicensure nursing education program or a  984
program that is being reestablished after having ceased to  985
operate, if the program meets and maintains the minimum  986
standards of the board established by rules adopted under  987
section 4723.07 of the Revised Code. If the board does not grant  988
conditional approval, it shall hold an adjudication under  989
Chapter 119. of the Revised Code to consider conditional  990
approval of the program. If the board grants conditional  991
approval, at the first meeting following completion of the  992
survey process required by division (A)(5) of this section, the  993
board shall determine whether to grant full approval to the  994
program. If the board does not grant full approval or if it  995
appears that the program has failed to meet and maintain  996
standards established by rules adopted under section 4723.07 of  997
the Revised Code, the board shall hold an adjudication under  998
Chapter 119. of the Revised Code to consider the program. Based  999
on results of the adjudication, the board may continue or  1000
withdraw conditional approval, or grant full approval.  1001
       (7) Place on provisional approval, for a period of time  1002
specified by the board, a prelicensure nursing education program  1003
that has ceased to meet and maintain the minimum standards of  1004
the board established by rules adopted under section 4723.07 of  1005
the Revised Code. Prior to or at the end of the period, the  1006
board shall reconsider whether the program meets the standards  1007
and shall grant full approval if it does. If it does not, the  1008
board may withdraw approval, pursuant to an adjudication under  1009
Chapter 119. of the Revised Code.  1010
S. B. No. 258  Page 36
As Introduced
       (8) Approve continuing education programs and courses  1011
under standards established in rules adopted under sections  1012
4723.07, 4723.69, 4723.79, and 4723.88 of the Revised Code;  1013
       (9) Establish the safe haven program in accordance with  1014
sections 4723.35 and 4723.351 of the Revised Code;  1015
       (10) Establish the practice intervention and improvement  1016
program in accordance with section 4723.282 of the Revised Code;  1017
       (11) Grant approval to the course of study in advanced  1018
pharmacology and related topics described in section 4723.482 of  1019
the Revised Code;  1020
       (12) Make an annual edition of the exclusionary formulary  1021
established in rules adopted under section 4723.50 of the  1022
Revised Code available to the public by electronic means and, as  1023
soon as possible after any revision of the formulary becomes  1024
effective, make the revision available to the public by  1025
electronic means;  1026
       (13) Approve under section 4723.46 of the Revised Code  1027
national certifying organizations for examination and licensure  1028
of advanced practice registered nurses, which may include  1029
separate organizations for each nursing specialtydesignation;  1030
       (14) Provide guidance and make recommendations to the  1031
general assembly, the governor, state agencies, and the federal  1032
government with respect to the regulation of the practice of  1033
nursing and the enforcement of this chapter;  1034
       (15) Make an annual report to the governor, which shall be  1035
open for public inspection;  1036
       (16) Maintain and have open for public inspection the  1037
following records:  1038
S. B. No. 258  Page 37
As Introduced
       (a) A record of all its meetings and proceedings;  1039
       (b) A record of all applicants for, and holders of,  1040
licenses and certificates issued by the board under this chapter  1041
or in accordance with rules adopted under this chapter. The  1042
record shall be maintained in a format determined by the board.  1043
       (c) A list of education and training programs approved by  1044
the board.  1045
       (17) Deny conditional approval to a new prelicensure  1046
nursing education program or a program that is being  1047
reestablished after having ceased to operate if the program or a  1048
person acting on behalf of the program submits or causes to be  1049
submitted to the board false, misleading, or deceptive  1050
statements, information, or documentation in the process of  1051
applying for approval of the program. If the board proposes to  1052
deny approval of the program, it shall do so pursuant to an  1053
adjudication conducted under Chapter 119. of the Revised Code.  1054
       (B) The board may fulfill the requirement of division (A)  1055
(8) of this section by authorizing persons who meet the  1056
standards established in rules adopted under section 4723.07 of  1057
the Revised Code to approve continuing education programs and  1058
courses. Persons so authorized shall approve continuing  1059
education programs and courses in accordance with standards  1060
established in rules adopted under section 4723.07 of the  1061
Revised Code.  1062
       Persons seeking authorization to approve continuing  1063
education programs and courses shall apply to the board and pay  1064
the appropriate fee established under section 4723.08 of the  1065
Revised Code. Authorizations to approve continuing education  1066
programs and courses shall expire and may be renewed according  1067
S. B. No. 258  Page 38
As Introduced
to the schedule established in rules adopted under section  1068
4723.07 of the Revised Code.  1069
        In addition to approving continuing education programs  1070
under division (A)(8) of this section, the board may sponsor  1071
continuing education activities that are directly related to the  1072
statutes and rules the board enforces.  1073
        (C)(1) The board may deny conditional approval to a new  1074
prelicensure nursing education program or program that is being  1075
reestablished after having ceased to operate if the program is  1076
controlled by a person who controls or has controlled a program  1077
that had its approval withdrawn, revoked, suspended, or  1078
restricted by the board or a board of another jurisdiction that  1079
is a member of the national council of state boards of nursing.  1080
If the board proposes to deny approval, it shall do so pursuant  1081
to an adjudication conducted under Chapter 119. of the Revised  1082
Code.  1083
        (2) As used in this division, "control" means any of the  1084
following:  1085
        (a) Holding fifty per cent or more of the outstanding  1086
voting securities or membership interest of a prelicensure  1087
nursing education program;  1088
        (b) In the case of an unincorporated prelicensure nursing  1089
education program, having the right to fifty per cent or more of  1090
the program's profits or in the event of a dissolution, fifty  1091
per cent or more of the program's assets;  1092
        (c) In the case of a prelicensure nursing education  1093
program that is a for-profit or not-for-profit corporation,  1094
having the contractual authority presently to designate fifty  1095
per cent or more of its directors;  1096
S. B. No. 258  Page 39
As Introduced
       (d) In the case of a prelicensure nursing education  1097
program that is a trust, having the contractual authority  1098
presently to designate fifty per cent or more of its trustees;  1099
       (e) Having the authority to direct the management,  1100
policies, or investments of a prelicensure nursing education  1101
program.  1102
       (D)(1) When an action taken by the board under division  1103
(A)(6), (7), or (17) or (C)(1) of this section is required to be  1104
taken pursuant to an adjudication conducted under Chapter 119.  1105
of the Revised Code, the board may, in lieu of an adjudication  1106
hearing, enter into a consent agreement to resolve the matter. A  1107
consent agreement, when ratified by a vote of a quorum of the  1108
board, constitutes the findings and order of the board with  1109
respect to the matter addressed in the agreement. If the board  1110
refuses to ratify a consent agreement, the admissions and  1111
findings contained in the agreement are of no effect.  1112
       (2) In any instance in which the board is required under  1113
Chapter 119. of the Revised Code to give notice to a person  1114
seeking approval of a prelicensure nursing education program of  1115
an opportunity for a hearing and the person does not make a  1116
timely request for a hearing in accordance with section 119.07  1117
of the Revised Code, the board is not required to hold a  1118
hearing, but may adopt, by a vote of a quorum, a final order  1119
that contains the board's findings.  1120
       (3) When the board denies or withdraws approval of a  1121
prelicensure nursing education program, the board may specify  1122
that its action is permanent. A program subject to a permanent  1123
action taken by the board is forever ineligible for approval and  1124
the board shall not accept an application for the program's  1125
reinstatement or approval.  1126
S. B. No. 258  Page 40
As Introduced
       Sec. 4723.07. In accordance with Chapter 119. of the  1127
Revised Code, the board of nursing shall adopt and may amend and  1128
rescind rules that establish all of the following:  1129
       (A) Provisions for the board's government and control of  1130
its actions and business affairs;  1131
       (B) Subject to section 4723.072 of the Revised Code,  1132
minimum standards for nursing education programs that prepare  1133
graduates to be licensed under this chapter and procedures for  1134
granting, renewing, and withdrawing approval of those programs;  1135
       (C) Criteria that applicants for licensure must meet to be  1136
eligible to take examinations for licensure;  1137
       (D) Standards and procedures for renewal of the licenses  1138
and certificates issued by the board;  1139
       (E) Standards for approval of continuing nursing education  1140
programs and courses for registered nurses, advanced practice  1141
registered nurses, and licensed practical nurses. The standards  1142
may provide for approval of continuing nursing education  1143
programs and courses that have been approved by other state  1144
boards of nursing or by national accreditation systems for  1145
nursing, including, but not limited to, the American nurses'  1146
credentialing center and the national association for practical  1147
nurse education and service.  1148
       (F) Standards that persons must meet to be authorized by  1149
the board to approve continuing education programs and courses  1150
and a schedule by which that authorization expires and may be  1151
renewed;  1152
       (G) Requirements, including continuing education  1153
requirements, for reactivating inactive licenses or  1154
certificates, and for reinstating licenses or certificates that  1155
S. B. No. 258  Page 41
As Introduced
have lapsed;  1156
       (H) Conditions that may be imposed for reinstatement of a  1157
license or certificate following action taken under section  1158
3123.47, 4723.28, 4723.281, 4723.652, or 4723.86 of the Revised  1159
Code resulting in a license or certificate suspension;  1160
       (I) Criteria for evaluating the qualifications of an  1161
applicant for a license to practice nursing as a registered  1162
nurse, a license to practice nursing as an advanced practice  1163
registered nurse, or a license to practice nursing as a licensed  1164
practical nurse for the purpose of issuing the license by the  1165
board's endorsement of the applicant's authority to practice  1166
issued by the licensing agency of another state;  1167
       (J) Universal and standard precautions that shall be used  1168
by each licensee or certificate holder. The rules shall define  1169
and establish requirements for universal and standard  1170
precautions that include the following:  1171
       (1) Appropriate use of hand washing;  1172
       (2) Disinfection and sterilization of equipment;  1173
       (3) Handling and disposal of needles and other sharp  1174
instruments;  1175
       (4) Wearing and disposal of gloves and other protective  1176
garments and devices.  1177
       (K) Quality assurance standards for advanced practice  1178
registered nurses who have practiced in a clinical setting for  1179
less than two thousand hours and are clinical nurse specialists,  1180
certified nurse-midwives, or certified nurse practitioners;  1181
       (L) Additional For purposes of division (B)(5) of section  1182
4723.431 of the Revised Code, any other criteria for the  1183
S. B. No. 258  Page 42
As Introduced
standard care arrangement required by section 4723.431 of the  1184
Revised Code entered into by a clinical nurse specialist,  1185
certified nurse-midwife, or certified nurse practitioner and the  1186
nurse's collaborating physician or podiatristarrangements;  1187
       (M) For purposes of division (B)(31) of section 4723.28 of  1188
the Revised Code, the actions, omissions, or other circumstances  1189
that constitute failure to establish and maintain professional  1190
boundaries with a patient;  1191
       (N) Standards and procedures for delegation under section  1192
4723.48 of the Revised Code of the authority to administer  1193
drugs.  1194
       The board may adopt other rules necessary to carry out the  1195
provisions of this chapter. The rules shall be adopted in  1196
accordance with Chapter 119. of the Revised Code.  1197
       Sec. 4723.24. (A)(1) Except as otherwise provided in this  1198
chapter, all of the following apply with respect to the  1199
schedules for renewal of licenses and certificates issued by the  1200
board of nursing:  1201
       (a) An active license to practice nursing as a registered  1202
nurse is subject to renewal in odd-numbered years. An  1203
application for renewal of the license is due on the fifteenth  1204
day of September of the renewal year. A late application may be  1205
submitted before the license lapses. If a license is not renewed  1206
or classified as inactive, the license lapses on the first day  1207
of November of the renewal year.  1208
       (b) An active license to practice nursing as a licensed  1209
practical nurse is subject to renewal in even-numbered years. An  1210
application for renewal of the license is due on the fifteenth  1211
day of September of the renewal year. A late application may be  1212
S. B. No. 258  Page 43
As Introduced
submitted before the license lapses. If a license is not renewed  1213
or classified as inactive, the license lapses on the first day  1214
of November of the renewal year.  1215
       (c) An active license to practice nursing as an advanced  1216
practice registered nurse is subject to renewal in odd-numbered  1217
years. An application for renewal of the license is due on the  1218
fifteenth day of September of the renewal year. A late  1219
application may be submitted before the license lapses. If a  1220
license is not renewed or classified as inactive, the license  1221
lapses on the first day of November of the renewal year.  1222
       (d) All other active licenses and certificates issued  1223
under this chapter are subject to renewal according to a  1224
schedule established by the board in rules adopted under section  1225
4723.07 of the Revised Code.  1226
       (2) The board shall provide an application for renewal to  1227
every holder of an active license or certificate, except when  1228
the board is aware that an individual is ineligible for license  1229
or certificate renewal for any reason, including pending  1230
criminal charges in this state or another jurisdiction, failure  1231
to comply with a disciplinary order from the board or the terms  1232
of a consent agreement entered into with the board, failure to  1233
pay fines or fees owed to the board, or failure to provide on  1234
the board's request documentation of having completed the  1235
continuing nursing education requirements specified in division  1236
(C) of this section.  1237
       If the board provides a renewal application by mail, the  1238
application shall be addressed to the last known post-office  1239
address of the license or certificate holder and mailed before  1240
the date the application is due. Failure of the license or  1241
certificate holder to receive an application for renewal from  1242
S. B. No. 258  Page 44
As Introduced
the board shall not excuse the holder from the requirements  1243
contained in this section, except as provided in section 5903.10  1244
of the Revised Code.  1245
       (3) A license or certificate holder seeking renewal of the  1246
license or certificate shall complete the renewal application  1247
and submit it to the board with the renewal fee established  1248
under section 4723.08 of the Revised Code. If a renewal  1249
application is submitted after the date the application is due,  1250
but before the date the license or certificate lapses, the  1251
applicant shall include with the application the fee established  1252
under section 4723.08 of the Revised Code for processing a late  1253
application for renewal.  1254
       With the renewal application, the applicant shall report  1255
any conviction, plea, or judicial finding regarding a criminal  1256
offense that constitutes grounds for the board to impose  1257
sanctions under section 4723.28 of the Revised Code since the  1258
applicant last submitted an application to the board.  1259
       (4) On receipt of the renewal application, the board shall  1260
verify whether the applicant meets the renewal requirements. If  1261
the applicant meets the requirements, the board shall renew the  1262
license or certificate.  1263
       (B) Every license or certificate holder shall give written  1264
or electronic notice to the board of any change of name or  1265
address within thirty days of the change. The board shall  1266
require the holder to document a change of name in a manner  1267
acceptable to the board.  1268
       (C)(1) Except in the case of a first renewal after  1269
licensure by examination, to be eligible for renewal of an  1270
active license to practice nursing as a registered nurse or  1271
S. B. No. 258  Page 45
As Introduced
licensed practical nurse, each individual who holds an active  1272
license shall, in each two-year period specified by the board,  1273
complete continuing nursing education as follows:  1274
       (a) For renewal of a license that was issued for a two-  1275
year renewal period, twenty-four hours of continuing nursing  1276
education;  1277
       (b) For renewal of a license that was issued for less than  1278
a two-year renewal period, the number of hours of continuing  1279
nursing education specified by the board in rules adopted in  1280
accordance with Chapter 119. of the Revised Code;  1281
       (c) Of the hours of continuing nursing education completed  1282
in any renewal period, at least one hour of the education must  1283
be directly related to the statutes and rules pertaining to the  1284
practice of nursing in this state.  1285
       (2) To be eligible for renewal of an active license to  1286
practice nursing as an advanced practice registered nurse, each  1287
individual who holds an active license shall, in each two-year  1288
period specified by the board, complete continuing education as  1289
follows:  1290
       (a) For renewal of a license that was issued for a two-  1291
year renewal period, twenty-four hours of continuing nursing  1292
education;  1293
       (b) For renewal of a license that was issued for less than  1294
a two-year renewal period, the number of hours of continuing  1295
nursing education specified by the board in rules adopted in  1296
accordance with Chapter 119. of the Revised Code, including the  1297
number of hours of continuing education in advanced  1298
pharmacology;  1299
       (c) In the case of an advanced practice registered nurse  1300
S. B. No. 258  Page 46
As Introduced
who is designated as a clinical nurse specialist, certified  1301
nurse-midwife, or certified nurse practitioner, of the hours of  1302
continuing nursing education completed in any renewal period, at  1303
least twelve hours of the education must be in advanced  1304
pharmacology and be received from an accredited institution  1305
recognized by the board.  1306
       (d) The continuing education required by division (C)(2)  1307
(a) or (b) of this section is in addition to the continuing  1308
education required by division (C)(1)(a) or (b) of this section.  1309
       (3) The board shall adopt rules establishing the procedure  1310
for a license holder to certify to the board completion of the  1311
required continuing nursing education. The board may conduct a  1312
random sample of license holders and require that the license  1313
holders included in the sample submit satisfactory documentation  1314
of having completed the requirements for continuing nursing  1315
education. On the board's request, a license holder included in  1316
the sample shall submit the required documentation.  1317
       (4) An educational activity may be applied toward meeting  1318
the continuing nursing education requirement only if it is  1319
obtained through a program or course approved by the board or a  1320
person the board has authorized to approve continuing nursing  1321
education programs and courses.  1322
       (5) The continuing education required of a certified  1323
registered nurse anesthetist, clinical nurse specialist,  1324
certified nurse-midwife, or certified nurse practitioner to  1325
maintain certification by a national certifying organization  1326
shall be applied toward the continuing education requirements  1327
for renewal of the following if the continuing education is  1328
obtained through a program or course approved by the board or a  1329
person the board has authorized to approve continuing nursing  1330
S. B. No. 258  Page 47
As Introduced
education programs and courses:  1331
       (a) A license to practice nursing as a registered nurse;  1332
       (b) A license to practice nursing as an advanced practice  1333
registered nurse.  1334
       (D) Except as otherwise provided in section 4723.28 of the  1335
Revised Code, an individual who holds an active license to  1336
practice nursing as a registered nurse or licensed practical  1337
nurse and who does not intend to practice in Ohio may send to  1338
the board written or electronic notice to that effect on or  1339
before the date the license lapses, and the board shall classify  1340
the license as inactive. During the period that the license is  1341
classified as inactive, the holder may not engage in the  1342
practice of nursing as a registered nurse or licensed practical  1343
nurse in Ohio and is not required to pay the renewal fee.  1344
       The holder of an inactive license to practice nursing as a  1345
registered nurse or licensed practical nurse or an individual  1346
who has failed to renew the individual's license to practice  1347
nursing as a registered nurse or licensed practical nurse may  1348
have the license reactivated or reinstated upon doing the  1349
following, as applicable to the holder or individual:  1350
       (1) Applying to the board for license reactivation or  1351
reinstatement on forms provided by the board;  1352
       (2) Meeting the requirements for reactivating or  1353
reinstating licenses established in rules adopted under section  1354
4723.07 of the Revised Code or, if the individual did not renew  1355
because of service in the armed forces of the United States or a  1356
reserve component of the armed forces of the United States,  1357
including the Ohio national guard or the national guard of any  1358
other state, as provided in section 5903.10 of the Revised Code;  1359
S. B. No. 258  Page 48
As Introduced
       (3) If the license has been inactive for at least five  1360
years from the date of application for reactivation or has  1361
lapsed for at least five years from the date of application for  1362
reinstatement, submitting a request to the bureau of criminal  1363
identification and investigation for a criminal records check  1364
and check of federal bureau of investigation records pursuant to  1365
section 4723.091 of the Revised Code.  1366
       (E) Except as otherwise provided in section 4723.28 of the  1367
Revised Code, an individual who holds an active license to  1368
practice nursing as an advanced practice registered nurse and  1369
does not intend to practice in Ohio as an advanced practice  1370
registered nurse may send to the board written or electronic  1371
notice to that effect on or before the renewal date, and the  1372
board shall classify the license as inactive. During the period  1373
that the license is classified as inactive, the holder may not  1374
engage in the practice of nursing as an advanced practice  1375
registered nurse in Ohio and is not required to pay the renewal  1376
fee.  1377
       The holder of an inactive license to practice nursing as  1378
an advanced practice registered nurse or an individual who has  1379
failed to renew the individual's license to practice nursing as  1380
an advanced practice registered nurse may have the license  1381
reactivated or reinstated upon doing the following, as  1382
applicable to the holder or individual:  1383
       (1) Applying to the board for license reactivation or  1384
reinstatement on forms provided by the board;  1385
       (2) Meeting the requirements for reactivating or  1386
reinstating licenses established in rules adopted under section  1387
4723.07 of the Revised Code or, if the individual did not renew  1388
because of service in the armed forces of the United States or a  1389
S. B. No. 258  Page 49
As Introduced
reserve component of the armed forces of the United States,  1390
including the Ohio national guard or the national guard of any  1391
other state, as provided in section 5903.10 of the Revised Code.  1392
       Sec. 4723.28. (A) The board of nursing, by a vote of a  1393
quorum, may impose one or more of the following sanctions if it  1394
finds that a person committed fraud in passing an examination  1395
required to obtain a license or dialysis technician certificate  1396
issued by the board or to have committed fraud,  1397
misrepresentation, or deception in applying for or securing any  1398
nursing license or dialysis technician certificate issued by the  1399
board: deny, revoke, suspend, or place restrictions on any  1400
nursing license or dialysis technician certificate issued by the  1401
board; reprimand or otherwise discipline a holder of a nursing  1402
license or dialysis technician certificate; or impose a fine of  1403
not more than five hundred dollars per violation.  1404
       (B) Except as provided in section 4723.092 of the Revised  1405
Code, the board of nursing, by a vote of a quorum, may impose  1406
one or more of the following sanctions: deny, revoke, suspend,  1407
or place restrictions on any nursing license or dialysis  1408
technician certificate issued by the board; reprimand or  1409
otherwise discipline a holder of a nursing license or dialysis  1410
technician certificate; or impose a fine of not more than five  1411
hundred dollars per violation. The sanctions may be imposed for  1412
any of the following:  1413
       (1) Denial, revocation, suspension, or restriction of  1414
authority to engage in a licensed profession or practice a  1415
health care occupation, including nursing or practice as a  1416
dialysis technician, for any reason other than a failure to  1417
renew, in Ohio or another state or jurisdiction;  1418
       (2) Engaging in the practice of nursing or engaging in  1419
S. B. No. 258  Page 50
As Introduced
practice as a dialysis technician, having failed to renew a  1420
nursing license or dialysis technician certificate issued under  1421
this chapter, or while a nursing license or dialysis technician  1422
certificate is under suspension;  1423
       (3) Conviction of, a plea of guilty to, a judicial finding  1424
of guilt of, a judicial finding of guilt resulting from a plea  1425
of no contest to, or a judicial finding of eligibility for a  1426
pretrial diversion or similar program or for intervention in  1427
lieu of conviction for, a misdemeanor committed in the course of  1428
practice;  1429
       (4) Conviction of, a plea of guilty to, a judicial finding  1430
of guilt of, a judicial finding of guilt resulting from a plea  1431
of no contest to, or a judicial finding of eligibility for a  1432
pretrial diversion or similar program or for intervention in  1433
lieu of conviction for, any felony or of any crime involving  1434
gross immorality or moral turpitude;  1435
       (5) Selling, giving away, or administering drugs or  1436
therapeutic devices for other than legal and legitimate  1437
therapeutic purposes; or conviction of, a plea of guilty to, a  1438
judicial finding of guilt of, a judicial finding of guilt  1439
resulting from a plea of no contest to, or a judicial finding of  1440
eligibility for a pretrial diversion or similar program or for  1441
intervention in lieu of conviction for, violating any municipal,  1442
state, county, or federal drug law;  1443
       (6) Conviction of, a plea of guilty to, a judicial finding  1444
of guilt of, a judicial finding of guilt resulting from a plea  1445
of no contest to, or a judicial finding of eligibility for a  1446
pretrial diversion or similar program or for intervention in  1447
lieu of conviction for, an act in another jurisdiction that  1448
would constitute a felony or a crime of moral turpitude in Ohio;  1449
S. B. No. 258  Page 51
As Introduced
        (7) Conviction of, a plea of guilty to, a judicial finding  1450
of guilt of, a judicial finding of guilt resulting from a plea  1451
of no contest to, or a judicial finding of eligibility for a  1452
pretrial diversion or similar program or for intervention in  1453
lieu of conviction for, an act in the course of practice in  1454
another jurisdiction that would constitute a misdemeanor in  1455
Ohio;  1456
        (8) Self-administering or otherwise taking into the body  1457
any dangerous drug, as defined in section 4729.01 of the Revised  1458
Code, in any way that is not in accordance with a legal, valid  1459
prescription issued for that individual, or self-administering  1460
or otherwise taking into the body any drug that is a schedule I  1461
controlled substance;  1462
        (9) Habitual or excessive use of controlled substances,  1463
other habit-forming drugs, or alcohol or other chemical  1464
substances to an extent that impairs the individual's ability to  1465
provide safe nursing care or safe dialysis care;  1466
        (10) Impairment of the ability to practice according to  1467
acceptable and prevailing standards of safe nursing care or safe  1468
dialysis care because of the use of drugs, alcohol, or other  1469
chemical substances;  1470
        (11) Impairment of the ability to practice according to  1471
acceptable and prevailing standards of safe nursing care or safe  1472
dialysis care because of a physical or mental disability;  1473
        (12) Assaulting or causing harm to a patient or depriving  1474
a patient of the means to summon assistance;  1475
        (13) Misappropriation or attempted misappropriation of  1476
money or anything of value in the course of practice;  1477
        (14) Adjudication by a probate court of being mentally ill  1478
S. B. No. 258  Page 52
As Introduced
or mentally incompetent. The board may reinstate the person's  1479
nursing license or dialysis technician certificate upon  1480
adjudication by a probate court of the person's restoration to  1481
competency or upon submission to the board of other proof of  1482
competency.  1483
       (15) The suspension or termination of employment by the  1484
United States department of defense or department of veterans  1485
affairs for any act that violates or would violate this chapter;  1486
       (16) Violation of this chapter or any rules adopted under  1487
it;  1488
       (17) Violation of any restrictions placed by the board on  1489
a nursing license or dialysis technician certificate;  1490
       (18) Failure to use universal and standard precautions  1491
established by rules adopted under section 4723.07 of the  1492
Revised Code;  1493
       (19) Failure to practice in accordance with acceptable and  1494
prevailing standards of safe nursing care or safe dialysis care;  1495
       (20) In the case of a registered nurse, engaging in  1496
activities that exceed the practice of nursing as a registered  1497
nurse;  1498
       (21) In the case of a licensed practical nurse, engaging  1499
in activities that exceed the practice of nursing as a licensed  1500
practical nurse;  1501
       (22) In the case of a dialysis technician, engaging in  1502
activities that exceed those permitted under section 4723.72 of  1503
the Revised Code;  1504
       (23) Aiding and abetting a person in that person's  1505
practice of nursing without a license or practice as a dialysis  1506
S. B. No. 258  Page 53
As Introduced
technician without a certificate issued under this chapter;  1507
       (24) In the case of an advanced practice registered nurse,  1508
except as provided in division (M) of this section, either of  1509
the following:  1510
       (a) Waiving the payment of all or any part of a deductible  1511
or copayment that a patient, pursuant to a health insurance or  1512
health care policy, contract, or plan that covers such nursing  1513
services, would otherwise be required to pay if the waiver is  1514
used as an enticement to a patient or group of patients to  1515
receive health care services from that provider;  1516
       (b) Advertising that the nurse will waive the payment of  1517
all or any part of a deductible or copayment that a patient,  1518
pursuant to a health insurance or health care policy, contract,  1519
or plan that covers such nursing services, would otherwise be  1520
required to pay.  1521
       (25) Failure to comply with the terms and conditions of  1522
participation in the safe haven program conducted under sections  1523
4723.35 and 4723.351 of the Revised Code;  1524
       (26) Failure to comply with the terms and conditions  1525
required under the practice intervention and improvement program  1526
established under section 4723.282 of the Revised Code;  1527
       (27) In the case of an advanced practice registered nurse:  1528
       (a) Engaging in activities that exceed those permitted for  1529
the nurse's nursing specialty under section 4723.43 of the  1530
Revised Code for the nurse's designation;  1531
       (b) Failure to meet the quality assurance standards  1532
established under section 4723.07 of the Revised Code that apply  1533
to the nurse as a clinical nurse specialist, certified nurse-  1534
S. B. No. 258  Page 54
As Introduced
midwife, or certified nurse practitioner who has practiced in a  1535
clinical setting for less than two thousand hours.  1536
       (28) In the case of an advanced practice registered nurse  1537
other than a certified registered nurse anesthetistwho is  1538
required or chooses to practice under a standard care  1539
arrangement, as provided in section 4723.43 of the Revised Code,  1540
failure to maintain a standard care arrangement in accordance  1541
with section 4723.431 of the Revised Code or to practice in  1542
accordance with the standard care arrangement;  1543
       (29) In the case of an advanced practice registered nurse  1544
who is designated as a clinical nurse specialist, certified  1545
nurse-midwife, or certified nurse practitioner, failure to  1546
prescribe drugs and therapeutic devices in accordance with  1547
section 4723.481 of the Revised Code;  1548
       (30) Prescribing any drug or device to perform or induce  1549
an abortion, or otherwise performing or inducing an abortion;  1550
       (31) Failure to establish and maintain professional  1551
boundaries with a patient, as specified in rules adopted under  1552
section 4723.07 of the Revised Code;  1553
       (32) Regardless of whether the contact or verbal behavior  1554
is consensual, engaging with a patient other than the spouse of  1555
the registered nurse, licensed practical nurse, or dialysis  1556
technician in any of the following:  1557
       (a) Sexual contact, as defined in section 2907.01 of the  1558
Revised Code;  1559
       (b) Verbal behavior that is sexually demeaning to the  1560
patient or may be reasonably interpreted by the patient as  1561
sexually demeaning.  1562
S. B. No. 258  Page 55
As Introduced
       (33) Assisting suicide, as defined in section 3795.01 of  1563
the Revised Code;  1564
       (34) Failure to comply with the requirements in section  1565
3719.061 of the Revised Code before issuing for a minor a  1566
prescription for an opioid analgesic, as defined in section  1567
3719.01 of the Revised Code;  1568
       (35) Failure to comply with section 4723.487 of the  1569
Revised Code, unless the state board of pharmacy no longer  1570
maintains a drug database pursuant to section 4729.75 of the  1571
Revised Code;  1572
       (36) The revocation, suspension, restriction, reduction,  1573
or termination of clinical privileges by the United States  1574
department of defense or department of veterans affairs or the  1575
termination or suspension of a certificate of registration to  1576
prescribe drugs by the drug enforcement administration of the  1577
United States department of justice;  1578
       (37) In the case of an advanced practice registered nurse  1579
who is designated as a clinical nurse specialist, certified  1580
nurse-midwife, or certified nurse practitioner, failure to  1581
comply with the terms of a consult agreement entered into with a  1582
pharmacist pursuant to section 4729.39 of the Revised Code;  1583
       (38) Violation of section 4723.93 of the Revised Code;  1584
       (39) In the case of a collaborating practitioner who is a  1585
clinical nurse specialist, certified nurse-midwife, or certified  1586
nurse practitioner, failure to enter into a standard care  1587
arrangement with the clinical nurse specialist, certified nurse-  1588
midwife, or certified nurse practitioner with whom the nurse  1589
will collaborate or failure to fulfill the responsibilities of  1590
collaboration after entering into the standard care arrangement.  1591
S. B. No. 258  Page 56
As Introduced
       (C) Disciplinary actions taken by the board under  1592
divisions (A) and (B) of this section shall be taken pursuant to  1593
an adjudication conducted under Chapter 119. of the Revised  1594
Code, except that in lieu of a hearing, the board may enter into  1595
a consent agreement with an individual to resolve an allegation  1596
of a violation of this chapter or any rule adopted under it. A  1597
consent agreement, when ratified by a vote of a quorum, shall  1598
constitute the findings and order of the board with respect to  1599
the matter addressed in the agreement. If the board refuses to  1600
ratify a consent agreement, the admissions and findings  1601
contained in the agreement shall be of no effect.  1602
       (D) The hearings of the board shall be conducted in  1603
accordance with Chapter 119. of the Revised Code, the board may  1604
appoint a hearing examiner, as provided in section 119.09 of the  1605
Revised Code, to conduct any hearing the board is authorized to  1606
hold under Chapter 119. of the Revised Code.  1607
       In any instance in which the board is required under  1608
Chapter 119. of the Revised Code to give notice of an  1609
opportunity for a hearing and the applicant, licensee, or  1610
certificate holder does not make a timely request for a hearing  1611
in accordance with section 119.07 of the Revised Code, the board  1612
is not required to hold a hearing, but may adopt, by a vote of a  1613
quorum, a final order that contains the board's findings. In the  1614
final order, the board may order any of the sanctions listed in  1615
division (A) or (B) of this section.  1616
       (E) If a criminal action is brought against a registered  1617
nurse, licensed practical nurse, or dialysis technician for an  1618
act or crime described in divisions (B)(3) to (7) of this  1619
section and the action is dismissed by the trial court other  1620
than on the merits, the board shall conduct an adjudication to  1621
S. B. No. 258  Page 57
As Introduced
determine whether the registered nurse, licensed practical  1622
nurse, or dialysis technician committed the act on which the  1623
action was based. If the board determines on the basis of the  1624
adjudication that the registered nurse, licensed practical  1625
nurse, or dialysis technician committed the act, or if the  1626
registered nurse, licensed practical nurse, or dialysis  1627
technician fails to participate in the adjudication, the board  1628
may take action as though the registered nurse, licensed  1629
practical nurse, or dialysis technician had been convicted of  1630
the act.  1631
       If the board takes action on the basis of a conviction,  1632
plea, or a judicial finding as described in divisions (B)(3) to  1633
(7) of this section that is overturned on appeal, the registered  1634
nurse, licensed practical nurse, or dialysis technician may, on  1635
exhaustion of the appeal process, petition the board for  1636
reconsideration of its action. On receipt of the petition and  1637
supporting court documents, the board shall temporarily rescind  1638
its action. If the board determines that the decision on appeal  1639
was a decision on the merits, it shall permanently rescind its  1640
action. If the board determines that the decision on appeal was  1641
not a decision on the merits, it shall conduct an adjudication  1642
to determine whether the registered nurse, licensed practical  1643
nurse, or dialysis technician committed the act on which the  1644
original conviction, plea, or judicial finding was based. If the  1645
board determines on the basis of the adjudication that the  1646
registered nurse, licensed practical nurse, or dialysis  1647
technician committed such act, or if the registered nurse,  1648
licensed practical nurse, or dialysis technician does not  1649
request an adjudication, the board shall reinstate its action;  1650
otherwise, the board shall permanently rescind its action.  1651
       Notwithstanding the provision of division (D)(2) of  1652
S. B. No. 258  Page 58
As Introduced
section 2953.32 or division (F)(1) of section 2953.39 of the  1653
Revised Code specifying that if records pertaining to a criminal  1654
case are sealed or expunged under that section the proceedings  1655
in the case shall be deemed not to have occurred, sealing or  1656
expungement of the following records on which the board has  1657
based an action under this section shall have no effect on the  1658
board's action or any sanction imposed by the board under this  1659
section: records of any conviction, guilty plea, judicial  1660
finding of guilt resulting from a plea of no contest, or a  1661
judicial finding of eligibility for a pretrial diversion program  1662
or intervention in lieu of conviction.  1663
       The board shall not be required to seal, destroy, redact,  1664
or otherwise modify its records to reflect the court's sealing  1665
or expungement of conviction records.  1666
       (F) The board may investigate an individual's criminal  1667
background in performing its duties under this section. As part  1668
of such investigation, the board may order the individual to  1669
submit, at the individual's expense, a request to the bureau of  1670
criminal identification and investigation for a criminal records  1671
check and check of federal bureau of investigation records in  1672
accordance with the procedure described in section 4723.091 of  1673
the Revised Code.  1674
       (G) During the course of an investigation conducted under  1675
this section, the board may compel any registered nurse,  1676
licensed practical nurse, or dialysis technician or applicant  1677
under this chapter to submit to a mental or physical  1678
examination, or both, as required by the board and at the  1679
expense of the individual, if the board finds reason to believe  1680
that the individual under investigation may have a physical or  1681
mental impairment that may affect the individual's ability to  1682
S. B. No. 258  Page 59
As Introduced
provide safe nursing care.  1683
       The board shall not compel an individual who has been  1684
referred to the safe haven program as described in sections  1685
4723.35 and 4723.351 of the Revised Code to submit to a mental  1686
or physical examination.  1687
       Failure of any individual to submit to a mental or  1688
physical examination when directed constitutes an admission of  1689
the allegations, unless the failure is due to circumstances  1690
beyond the individual's control, and a default and final order  1691
may be entered without the taking of testimony or presentation  1692
of evidence.  1693
       If the board finds that an individual is impaired, the  1694
board shall require the individual to submit to care,  1695
counseling, or treatment approved or designated by the board, as  1696
a condition for initial, continued, reinstated, or renewed  1697
authority to practice. The individual shall be afforded an  1698
opportunity to demonstrate to the board that the individual can  1699
begin or resume the individual's occupation in compliance with  1700
acceptable and prevailing standards of care under the provisions  1701
of the individual's authority to practice.  1702
       For purposes of this division, any registered nurse,  1703
licensed practical nurse, or dialysis technician or applicant  1704
under this chapter shall be deemed to have given consent to  1705
submit to a mental or physical examination when directed to do  1706
so in writing by the board, and to have waived all objections to  1707
the admissibility of testimony or examination reports that  1708
constitute a privileged communication.  1709
       (H) The board shall investigate evidence that appears to  1710
show that any person has violated any provision of this chapter  1711
S. B. No. 258  Page 60
As Introduced
or any rule of the board. Any person may report to the board any  1712
information the person may have that appears to show a violation  1713
of any provision of this chapter or rule of the board. In the  1714
absence of bad faith, any person who reports such information or  1715
who testifies before the board in any adjudication conducted  1716
under Chapter 119. of the Revised Code shall not be liable for  1717
civil damages as a result of the report or testimony.  1718
       (I) All of the following apply under this chapter with  1719
respect to the confidentiality of information:  1720
       (1) Information received by the board pursuant to a  1721
complaint or an investigation is confidential and not subject to  1722
discovery in any civil action, except that the board may  1723
disclose information to law enforcement officers and government  1724
entities for purposes of an investigation of either a licensed  1725
health care professional, including a registered nurse, licensed  1726
practical nurse, or dialysis technician, or a person who may  1727
have engaged in the unauthorized practice of nursing or dialysis  1728
care. No law enforcement officer or government entity with  1729
knowledge of any information disclosed by the board pursuant to  1730
this division shall divulge the information to any other person  1731
or government entity except for the purpose of a government  1732
investigation, a prosecution, or an adjudication by a court or  1733
government entity.  1734
       (2) If an investigation requires a review of patient  1735
records, the investigation and proceeding shall be conducted in  1736
such a manner as to protect patient confidentiality.  1737
       (3) All adjudications and investigations of the board  1738
shall be considered civil actions for the purposes of section  1739
2305.252 of the Revised Code.  1740
S. B. No. 258  Page 61
As Introduced
       (4) Any board activity that involves continued monitoring  1741
of an individual as part of or following any disciplinary action  1742
taken under this section shall be conducted in a manner that  1743
maintains the individual's confidentiality. Information received  1744
or maintained by the board with respect to the board's  1745
monitoring activities is not subject to discovery in any civil  1746
action and is confidential, except that the board may disclose  1747
information to law enforcement officers and government entities  1748
for purposes of an investigation of a licensee or certificate  1749
holder.  1750
       (J) Any action taken by the board under this section  1751
resulting in a suspension from practice shall be accompanied by  1752
a written statement of the conditions under which the person may  1753
be reinstated to practice.  1754
       (K) When the board refuses to grant a license or  1755
certificate to an applicant, revokes a license or certificate,  1756
or refuses to reinstate a license or certificate, the board may  1757
specify that its action is permanent. An individual subject to  1758
permanent action taken by the board is forever ineligible to  1759
hold a license or certificate of the type that was refused or  1760
revoked and the board shall not accept from the individual an  1761
application for reinstatement of the license or certificate or  1762
for a new license or certificate.  1763
       (L) No unilateral surrender of a nursing license or  1764
dialysis technician certificate issued under this chapter shall  1765
be effective unless accepted by majority vote of the board. No  1766
application for a nursing license or dialysis technician  1767
certificate issued under this chapter may be withdrawn without a  1768
majority vote of the board. The board's jurisdiction to take  1769
disciplinary action under this section is not removed or limited  1770
S. B. No. 258  Page 62
As Introduced
when an individual has a license or certificate classified as  1771
inactive or fails to renew a license or certificate.  1772
       (M) Sanctions shall not be imposed under division (B)(24)  1773
of this section against any licensee who waives deductibles and  1774
copayments as follows:  1775
       (1) In compliance with the health benefit plan that  1776
expressly allows such a practice. Waiver of the deductibles or  1777
copayments shall be made only with the full knowledge and  1778
consent of the plan purchaser, payer, and third-party  1779
administrator. Documentation of the consent shall be made  1780
available to the board upon request.  1781
       (2) For professional services rendered to any other person  1782
licensed pursuant to this chapter to the extent allowed by this  1783
chapter and the rules of the board.  1784
       Sec. 4723.36. (A) A certified nurse-midwife, certified  1785
nurse practitioner, or clinical nurse specialist may determine  1786
and pronounce an individual's death.  1787
       (B)(1)(B) A registered nurse who is not described in  1788
division (A) of this section may determine and pronounce an  1789
individual's death, but only if the individual's respiratory and  1790
circulatory functions are not being artificially sustained and,  1791
at the time the determination and pronouncement of death is  1792
made, the registered nurse is providing or supervising the  1793
individual's care through a hospice care program licensed under  1794
Chapter 3712. of the Revised Code or any other entity that  1795
provides palliative care.  1796
       (2) A registered (C) A nurse who determines and pronounces  1797
an individual's death under division (B)(1)(A) or (B) of this  1798
section shall comply with both of the following:  1799
S. B. No. 258  Page 63
As Introduced
       (a) The nurse shall not complete any portion of the  1800
individual's death certificate.  1801
       (b) The nurse shall notify the individual's attending  1802
physician, certified nurse-midwife, certified nurse  1803
practitioner, or clinical nurse specialist of the determination  1804
and pronouncement of death in order for the physician, certified  1805
nurse-midwife, certified nurse practitioner, or clinical nurse  1806
specialist to fulfill the physician's, certified nurse-  1807
midwife's, certified nurse practitioner's, or clinical nurse  1808
specialist's duties under section 3705.16 of the Revised Code.  1809
The nurse shall provide the notification within a period of time  1810
that is reasonable but not later than twenty-four hours  1811
following the determination and pronouncement of the  1812
individual's death.  1813
       (D) A nurse described in division (A) or (B) of this  1814
section, whether acting under this section or any other  1815
provision of this chapter, shall not complete the medical  1816
certification portion or any other portion of a death  1817
certificate.  1818
       Sec. 4723.41. (A) Each person who desires is seeking to  1819
practice nursing as a certified nurse-midwife and has not been  1820
authorized to practice midwifery prior to December 1, 1967, and  1821
each person who desires is seeking to practice nursing as a  1822
certified registered nurse anesthetist, clinical nurse  1823
specialist, or certified nurse practitioner, shall file with the  1824
board of nursing a written or electronic application for a  1825
license to practice nursing as an advanced practice registered  1826
nurse and that specifies the designation in the desired  1827
specialtybeing sought. The application must be filed, under  1828
oath, on a form prescribed by the board accompanied by the  1829
S. B. No. 258  Page 64
As Introduced
application fee required by section 4723.08 of the Revised Code.  1830
       Except as provided in division (B), (C), or (D) of this  1831
section, at the time of making application, the applicant shall  1832
meet all of the following requirements:  1833
       (1) Be a registered nurse;  1834
       (2) Submit documentation satisfactory to the board that  1835
the applicant has earned a master's or doctoral degree with a  1836
major in a nursing specialty or in a related field that  1837
qualifies the applicant to sit for the certification examination  1838
of a national certifying organization approved by the board  1839
under section 4723.46 of the Revised Code;  1840
       (3) Submit documentation satisfactory to the board of  1841
having passed the certification examination of a national  1842
certifying organization approved by the board under section  1843
4723.46 of the Revised Code to examine and certify, as  1844
applicable, nurse-midwives, registered nurse anesthetists,  1845
clinical nurse specialists, or nurse practitioners;  1846
       (4) Submit an affidavit with the application that states  1847
all of the following:  1848
       (a) That the applicant is the person named in the  1849
documents submitted under this section and is the lawful  1850
possessor thereof;  1851
       (b) The applicant's age, residence, the school at which  1852
the applicant obtained education in the applicant's nursing  1853
specialtythe required master's or doctoral degree, and any other  1854
facts that the board requires;  1855
       (c) The specialty in which designation being sought by the  1856
applicant seeks designation.  1857
S. B. No. 258  Page 65
As Introduced
       (B)(1) A certified registered nurse anesthetist, clinical  1858
nurse specialist, certified nurse-midwife, or certified nurse  1859
practitioner who is practicing or has practiced as such in  1860
another jurisdiction other than another state may apply for a  1861
license by endorsement to practice nursing as an advanced  1862
practice registered nurse and designation as a certified  1863
registered nurse anesthetist, clinical nurse specialist,  1864
certified nurse-midwife, or certified nurse practitioner in this  1865
state if the nurse meets the requirements set forth in division  1866
(A) of this section or division (B)(2) of this section.  1867
       (2) If an applicant who is practicing or has practiced in  1868
another jurisdiction other than another state applies for  1869
designation licensure under division (B)(2) of this section, the  1870
application shall be submitted to the board in the form  1871
prescribed by rules of the board and be accompanied by the  1872
application fee required by section 4723.08 of the Revised Code.  1873
The application shall include evidence that the applicant meets  1874
the requirements of division (B)(2) of this section, holds  1875
authority to practice nursing and is in good standing in another  1876
jurisdiction other than another state granted after meeting  1877
requirements approved by the entity of that jurisdiction that  1878
regulates nurses, and other information required by rules of the  1879
board of nursing.  1880
       With respect to the educational requirements and national  1881
certification requirements that an applicant under division (B)  1882
(2) of this section must meet, both of the following apply:  1883
       (a) If the applicant is a certified registered nurse  1884
anesthetist, certified nurse-midwife, or certified nurse  1885
practitioner who, on or before December 31, 2000, obtained  1886
certification in the applicant's nursing specialty with from a  1887
S. B. No. 258  Page 66
As Introduced
national certifying organization listed in division (A)(3) of  1888
section 4723.41 of the Revised Code as that division existed  1889
prior to March 20, 2013, or that was at that time approved by  1890
the board under section 4723.46 of the Revised Code, the  1891
applicant must have maintained the certification. The applicant  1892
is not required to have earned a master's or doctoral degree  1893
with a major in a nursing specialty or in a related field that  1894
qualifies the applicant to sit for the certification  1895
examination.  1896
       (b) If the applicant is a clinical nurse specialist, one  1897
of the following must apply to the applicant:  1898
       (i) On or before December 31, 2000, the applicant obtained  1899
a master's or doctoral degree with a major in a clinical area of  1900
nursing from an educational institution accredited by a national  1901
or regional accrediting organization. The applicant is not  1902
required to have passed a certification examination.  1903
       (ii) On or before December 31, 2000, the applicant  1904
obtained a master's or doctoral degree in nursing or a related  1905
field and was certified as a clinical nurse specialist by the  1906
American nurses credentialing center or another national  1907
certifying organization that was at that time approved by the  1908
board under section 4723.46 of the Revised Code.  1909
       (3) The board shall grant a license to practice nursing as  1910
an advanced practice registered nurse in accordance with Chapter  1911
4796. of the Revised Code to an applicant if either of the  1912
following applies:  1913
       (a) The applicant holds a license in another state.  1914
       (b) The applicant has satisfactory work experience, a  1915
government certification, or a private certification as  1916
S. B. No. 258  Page 67
As Introduced
described in that chapter as an advanced practice registered  1917
nurse in a state that does not issue that license.  1918
       (4) The board may grant a nonrenewable temporary permit to  1919
practice nursing as an advanced practice registered nurse to an  1920
applicant for licensure under division (B)(2) or (3) of this  1921
section if the board is satisfied by the evidence that the  1922
applicant holds a valid, unrestricted license in or equivalent  1923
authorization from another jurisdiction. Chapter 4796. of the  1924
Revised Code does not apply to a temporary permit issued under  1925
this division. The temporary permit shall expire at the earlier  1926
of one hundred eighty days after issuance or upon the issuance  1927
of a license under division (B)(2) or (3) of this section.  1928
       (C) An applicant who desires seeking to practice nursing  1929
as a certified registered nurse anesthetist, certified nurse-  1930
midwife, or certified nurse practitioner is exempt from the  1931
educational requirements in division (A)(2) of this section if  1932
all of the following are the case:  1933
       (1) Before January 1, 2001, the board issued to the  1934
applicant a certificate of authority to practice as a certified  1935
registered nurse anesthetist, certified nurse-midwife, or  1936
certified nurse practitioner;  1937
       (2) The applicant submits documentation satisfactory to  1938
the board that the applicant obtained certification in the  1939
applicant's nursing specialty with from a national certifying  1940
organization listed in division (A)(3) of section 4723.41 of the  1941
Revised Code as that division existed prior to March 20, 2013,  1942
or that was at that time approved by the board under section  1943
4723.46 of the Revised Code;  1944
       (3) The applicant submits documentation satisfactory to  1945
S. B. No. 258  Page 68
As Introduced
the board that the applicant has maintained the certification  1946
described in division (C)(2) of this section.  1947
       (D) An applicant who desires seeking to practice as a  1948
clinical nurse specialist is exempt from the examination  1949
requirement in division (A)(3) of this section if both of the  1950
following are the case:  1951
       (1) Before January 1, 2001, the board issued to the  1952
applicant a certificate of authority to practice as a clinical  1953
nurse specialist;  1954
       (2) The applicant submits documentation satisfactory to  1955
the board that the applicant earned either of the following:  1956
       (a) A master's or doctoral degree with a major in a  1957
clinical area of nursing from an educational institution  1958
accredited by a national or regional accrediting organization;  1959
       (b) A master's or doctoral degree in nursing or a related  1960
field and was certified as a clinical nurse specialist by the  1961
American nurses credentialing center or another national  1962
certifying organization that was at that time approved by the  1963
board under section 4723.46 of the Revised Code.  1964
       Sec. 4723.42. (A) If the applicant for a license to  1965
practice nursing as an advanced practice registered nurse has  1966
met all the requirements of section 4723.41 of the Revised Code  1967
and has paid the fee required by section 4723.08 of the Revised  1968
Code, the board of nursing shall issue the license and designate  1969
the license holder as a certified registered nurse anesthetist,  1970
clinical nurse specialist, certified nurse-midwife, or certified  1971
nurse practitioner. The license and designation authorize the  1972
holder to practice as an advanced practice registered nurse in  1973
the specialty as indicated by the designation.  1974
S. B. No. 258  Page 69
As Introduced
       The board shall issue or deny the license not later than  1975
thirty days after receiving all of the documents required by  1976
section 4723.41 of the Revised Code.  1977
       If an applicant is under investigation for a violation of  1978
this chapter, the board shall conclude the investigation not  1979
later than ninety days after receipt of all required documents,  1980
unless this ninety-day period is extended by written consent of  1981
the applicant, or unless the board determines that a substantial  1982
question of such a violation exists and the board has notified  1983
the applicant in writing of the reasons for the continuation of  1984
the investigation. If the board determines that the applicant  1985
has not violated this chapter, it shall issue a certificate not  1986
later than forty-five days after making that determination.  1987
       (B) A license to practice nursing as an advanced practice  1988
registered nurse is subject to the renewal schedule that applies  1989
under section 4723.24 of the Revised Code. In providing renewal  1990
applications, the board shall follow the procedures that apply  1991
under section 4723.24 of the Revised Code for providing renewal  1992
applications to license holders. Failure of the license holder  1993
to receive an application for renewal from the board does not  1994
excuse the holder from the requirements of section 4723.44 of  1995
the Revised Code.  1996
       A license holder seeking renewal of the license shall  1997
complete the renewal application and submit it to the board with  1998
all of the following:  1999
       (1) The renewal fee established under section 4723.08 of  2000
the Revised Code and, if the application is submitted after it  2001
is due but before the license lapses, the fee established under  2002
that section for processing a late application for renewal;  2003
S. B. No. 258  Page 70
As Introduced
       (2) Documentation satisfactory to the board that the  2004
holder has maintained certification in the nursing specialty  2005
with from a national certifying organization approved by the  2006
board under section 4723.46 of the Revised Code;  2007
       (3) A list of the names and business addresses of the  2008
holder's current collaborating physicians and  2009
podiatristspractitioners, if the holder is a clinical nurse  2010
specialist, certified nurse-midwife, or certified nurse  2011
practitioner and is practicing under a standard care  2012
arrangement;  2013
       (4) If the license holder is a clinical nurse specialist,  2014
documentation satisfactory to the board that the holder has  2015
completed continuing education for that specialty designation as  2016
required by rule of the board.  2017
       On receipt of the renewal application, fees, and  2018
documents, the board shall verify that the applicant holds a  2019
current, valid license to practice nursing as a registered nurse  2020
in this state and a current, valid license to practice nursing  2021
as an advanced practice registered nurse in this state, and, if  2022
it so verifies, shall renew the license to practice nursing as  2023
an advanced practice registered nurse.  2024
       (C) An applicant for reinstatement of a license that has  2025
lapsed shall submit the reinstatement fee established under  2026
section 4723.08 of the Revised Code.  2027
       (D) An individual who holds an active license and does not  2028
intend to practice in this state as an advanced practice  2029
registered nurse may send to the board written or electronic  2030
notice to that effect on or before the date the license lapses,  2031
and the board shall classify the license as inactive.  2032
S. B. No. 258  Page 71
As Introduced
       Sec. 4723.43. A certified registered nurse anesthetist,  2033
clinical nurse specialist, certified nurse-midwife, or certified  2034
nurse practitioner may provide to individuals and groups nursing  2035
care that requires knowledge and skill obtained from advanced  2036
formal education, continuing education, training, and clinical  2037
experience. In this capacity as an advanced practice registered  2038
nurse, a certified nurse-midwife is subject to division (A) of  2039
this section, a certified registered nurse anesthetist is  2040
subject to division (B) of this section, a certified nurse  2041
practitioner is subject to division (C) of this section, and a  2042
clinical nurse specialist is subject to division (D) of this  2043
section.  2044
       Each advanced practice registered nurse shall practice in  2045
accordance with rules adopted by the board of nursing and in a  2046
manner that is consistent with the nurse's certification from a  2047
national certifying organization approved by the board under  2048
section 4723.46 of the Revised Code. An advanced practice  2049
registered nurse who is a clinical nurse specialist, certified  2050
nurse-midwife, or certified nurse practitioner may prescribe  2051
drugs and therapeutic devices in accordance with section  2052
4723.481 of the Revised Code.  2053
       In the case of an advanced practice registered nurse who  2054
has practiced in a clinical setting for less than two thousand  2055
hours and is a clinical nurse specialist, certified nurse-  2056
midwife, or certified nurse practitioner, the nurse may practice  2057
only under a standard care arrangement that meets the  2058
requirements of section 4723.431 of the Revised Code.  2059
Thereafter, the nurse may practice without a standard care  2060
arrangement if the requirements of section 4723.439 of the  2061
Revised Code are met or may choose to continue practicing under  2062
a standard care arrangement. When a nurse is required or chooses  2063
S. B. No. 258  Page 72
As Introduced
to practice under a standard care arrangement, the nurse shall  2064
practice only in accordance with the terms of the arrangement.  2065
       (A) A nurse authorized to practice as a certified nurse-  2066
midwife, in collaboration with one or more physicians, may  2067
provide the management of preventive services and those primary  2068
care services necessary to provide health care to women  2069
antepartally, intrapartally, postpartally, and gynecologically,  2070
consistent with the nurse's education and certification, and in  2071
accordance with rules adopted by the board of nursing.  2072
       No certified nurse-midwife may perform version, deliver  2073
breech or face presentation, use forceps, or do any obstetric  2074
operation, or treat any other abnormal condition, except in  2075
emergencies. Division (A) of this section does not prohibit a  2076
certified nurse-midwife from performing episiotomies or normal  2077
vaginal deliveries, or repairing vaginal tears. A certified  2078
nurse-midwife may, in collaboration with one or more physicians,  2079
prescribe drugs and therapeutic devices in accordance with  2080
section 4723.481 of the Revised Code.  2081
       (B) A nurse authorized to practice as a certified  2082
registered nurse anesthetist, consistent with the nurse's  2083
education and certification and in accordance with rules adopted  2084
by the board, may do the following:  2085
       (1) With supervision and in the immediate presence of a  2086
physician, podiatrist, or dentist, administer anesthesia and  2087
perform anesthesia induction, maintenance, and emergence;  2088
       (2) With supervision, obtain informed consent for  2089
anesthesia care and perform preanesthetic preparation and  2090
evaluation, postanesthetic preparation and evaluation,  2091
postanesthesia care, and, subject to section 4723.433 of the  2092
S. B. No. 258  Page 73
As Introduced
Revised Code, clinical support functions;  2093
       (3) With supervision and in accordance with section  2094
4723.434 of the Revised Code, engage in the activities described  2095
in division (A) of that section.  2096
       The physician, podiatrist, or dentist supervising a  2097
certified registered nurse anesthetist must be actively engaged  2098
in practice in this state. When a certified registered nurse  2099
anesthetist is supervised by a podiatrist, the nurse's scope of  2100
practice is limited to the anesthesia procedures that the  2101
podiatrist has the authority under section 4731.51 of the  2102
Revised Code to perform. A certified registered nurse  2103
anesthetist may not administer general anesthesia under the  2104
supervision of a podiatrist in a podiatrist's office. When a  2105
certified registered nurse anesthetist is supervised by a  2106
dentist, the nurse's scope of practice is limited to the  2107
anesthesia procedures that the dentist has the authority under  2108
Chapter 4715. of the Revised Code to perform.  2109
       (C) A nurse authorized to practice as a certified nurse  2110
practitioner, in collaboration with one or more physicians or  2111
podiatrists, may provide preventive and, primary care, and acute  2112
care services, provide services for acute illnesses, and  2113
evaluate and promote patient wellness within the nurse's nursing  2114
specialty, consistent with the nurse's education and  2115
certification, and in accordance with rules adopted by the  2116
board. A certified nurse practitioner may, in collaboration with  2117
one or more physicians or podiatrists, prescribe drugs and  2118
therapeutic devices in accordance with section 4723.481 of the  2119
Revised Code.  2120
       When a certified nurse practitioner is collaborating  2121
practices under a standard care arrangement entered into with a  2122
S. B. No. 258  Page 74
As Introduced
collaborating practitioner who is a podiatrist, the nurse's  2123
scope of practice is limited to the procedures that the  2124
podiatrist has the authority under section 4731.51 of the  2125
Revised Code to perform.  2126
       (D) A nurse authorized to practice as a clinical nurse  2127
specialist, in collaboration with one or more physicians or  2128
podiatrists, may provide and manage the care of individuals and  2129
groups with complex health problems and provide health care  2130
services that promote, improve, and manage health care within  2131
the nurse's nursing specialty, consistent with the nurse's  2132
education and in accordance with rules adopted by the board. A  2133
clinical nurse specialist may, in collaboration with one or more  2134
physicians or podiatrists, prescribe drugs and therapeutic  2135
devices in accordance with section 4723.481 of the Revised Code.  2136
       When a clinical nurse specialist is collaborating  2137
practices under a standard care arrangement entered into with a  2138
collaborating practitioner who is a podiatrist, the nurse's  2139
scope of practice is limited to the procedures that the  2140
podiatrist has the authority under section 4731.51 of the  2141
Revised Code to perform.  2142
       Sec. 4723.431. (A)(1) An This section establishes  2143
standards and conditions regarding the standard care  2144
arrangements that are required or permitted by section 4723.43  2145
of the Revised Code to be maintained between an advanced  2146
practice registered nurse who is designated as a clinical nurse  2147
specialist, certified nurse-midwife, or certified nurse  2148
practitioner may practice only in accordance with a standard  2149
care arrangement entered into with and each physician or  2150
podiatrist collaborating practitioner with whom the nurse  2151
collaborates. A  2152
S. B. No. 258  Page 75
As Introduced
       (A)(1) A copy of the nurse's standard care arrangement  2153
shall be retained on file by the nurse's employer. Prior  2154
approval of the standard care arrangement by the board of  2155
nursing is not required, but the board may periodically review  2156
it for compliance with this section.  2157
       A clinical nurse specialist, certified nurse-midwife, or  2158
certified nurse practitioner (2) The nurse may enter into a  2159
standard care arrangement with one or more collaborating  2160
physicians or podiatristspractitioners. If a collaborating  2161
physician or podiatrist enters into standard care arrangements  2162
with more than five nurses, the physician or podiatrist shall  2163
not collaborate at the same time with more than five nurses in  2164
the prescribing component of their practices.  2165
       Not later than thirty days after first engaging in the  2166
practice of advanced practice registered nursing as a clinical  2167
nurse specialist, certified nurse-midwife, or certified nurse  2168
practitioner, the nurse shall submit to the board the name and  2169
business address of each collaborating physician or  2170
podiatristpractitioner. Thereafter, the nurse shall notify the  2171
board of any additions or deletions to the nurse's collaborating  2172
physicians or podiatristspractitioners. Except as provided in  2173
division (D) of this section, the The notice must be provided  2174
not later than thirty days after the change takes effect.  2175
       (2) All (3) All of the following conditions apply with  2176
respect to the practice of a collaborating physician or  2177
podiatrist with whom a clinical nurse specialist, certified  2178
nurse-midwife, or certified nurse practitioner may enter into a  2179
standard care arrangementpractitioner:  2180
       (a) The In the case of a collaborating practitioner who is  2181
a physician or podiatrist, the collaborating physician or  2182
S. B. No. 258  Page 76
As Introduced
podiatrist must be authorized both of the following:  2183
       (i) Authorized to practice in this state.  2184
       (b) Except as provided in division (A)(2)(c) of this  2185
section, the physician or podiatrist must be practicing;  2186
       (ii) Practicing in an area of health care, including a  2187
specialty, that is the same as or similar to that in which the  2188
nurse's nursing specialtynurse is or will be practicing.  2189
       (b) In the case of a collaborating practitioner who is a  2190
clinical nurse specialist, certified nurse-midwife, or certified  2191
nurse practitioner, the collaborating nurse must satisfy all of  2192
the following:  2193
       (i) Be authorized to practice in this state;  2194
       (ii) Be practicing under a designation that is the same  2195
designation as the nurse with whom the collaborating nurse has  2196
entered into a standard care arrangement;  2197
       (iii) Have met the requirements of section 4723.439 of the  2198
Revised Code;  2199
       (iv) Not practice under a standard care arrangement  2200
entered into with another collaborating practitioner.  2201
       (c) If the nurse is a clinical nurse specialist who is  2202
certified as a psychiatric-mental health CNS or the equivalent  2203
of such title by the American nurses credentialing center or a  2204
certified nurse practitioner who is certified as a psychiatric-  2205
mental health NP or the equivalent of such title by the American  2206
nurses credentialing center or American academy of nurse  2207
practitioners certification board, the nurse may enter into a  2208
standard care arrangement with a physician but not a podiatrist  2209
and the collaborating physician must be practitioner practicing  2210
S. B. No. 258  Page 77
As Introduced
in one of the following specialties:  2211
       (i) Psychiatry;  2212
       (ii) Pediatrics;  2213
       (iii) Primary care or family practice.  2214
       (B) A standard care arrangement shall be in writing and  2215
shall contain all of the following:  2216
       (1) Criteria for referral of a patient by the clinical  2217
nurse specialist, certified nurse-midwife, or certified nurse  2218
practitioner nurse practicing under the standard care  2219
arrangement to a collaborating physician or podiatrist  2220
practitioner or to another physician or podiatrist or a clinical  2221
nurse specialist, certified nurse-midwife, or certified nurse  2222
practitioner who meets the requirements of section 4723.439 of  2223
the Revised Code;  2224
       (2) A process for the clinical nurse specialist, certified  2225
nurse-midwife, or certified nurse practitioner nurse practicing  2226
under the standard care arrangement to obtain a consultation  2227
with a collaborating physician or podiatrist practitioner or  2228
with another physician or podiatrist or a clinical nurse  2229
specialist, certified nurse-midwife, or certified nurse  2230
practitioner who meets the requirements of section 4723.439 of  2231
the Revised Code;  2232
       (3) A plan for coverage in instances of emergency or  2233
planned absences of either the clinical nurse specialist,  2234
certified nurse-midwife, or certified nurse practitioner or a  2235
collaborating physician or podiatrist that provides the means  2236
whereby a physician or podiatrist or a clinical nurse  2237
specialist, certified nurse-midwife, or certified nurse  2238
practitioner that meets the requirements of section 4723.439 of  2239
S. B. No. 258  Page 78
As Introduced
the Revised Code is available for emergency care in instances of  2240
emergency or planned absences of either the nurse who is  2241
practicing under the standard care arrangement or the  2242
collaborating practitioner who entered into the arrangement;  2243
        (4) The process for resolution of disagreements regarding  2244
matters of patient management between the clinical nurse  2245
specialist, certified nurse-midwife, or certified nurse  2246
practitioner nurse practicing under the standard care  2247
arrangement and a collaborating physician or  2248
podiatristpractitioner;  2249
        (5) An agreement that the collaborating physician shall  2250
complete and sign the medical certificate of death pursuant to  2251
section 3705.16 of the Revised Code;  2252
        (6) Any other criteria required by rule of the board  2253
adopted pursuant to section 4723.07 or 4723.50 of the Revised  2254
Code.  2255
        (C) A standard care arrangement entered into pursuant to  2256
this section may permit a clinical nurse specialist, certified  2257
nurse-midwife, or certified nurse practitioner to do any of the  2258
following:  2259
        (1) Supervise services provided by a home health agency as  2260
defined in section 3740.01 of the Revised Code;  2261
        (2) Admit a patient to a hospital in accordance with  2262
section 3727.06 of the Revised Code;  2263
        (3) Sign any document relating to the admission,  2264
treatment, or discharge of an inpatient receiving psychiatric or  2265
other behavioral health care services, but only if the  2266
conditions of section 4723.436 of the Revised Code have been  2267
met.  2268
S. B. No. 258  Page 79
As Introduced
       (D)(1) Except as provided in division (D)(2) of this  2269
section, if a physician or podiatrist collaborating practitioner  2270
terminates the collaboration between the physician or podiatrist  2271
collaborating practitioner and a certified nurse-midwife,  2272
certified nurse practitioner, or clinical nurse specialist  2273
before their standard care arrangement expires, all of the  2274
following apply:  2275
       (a) The physician or podiatrist collaborating practitioner  2276
must give the nurse written or electronic notice of the  2277
termination.  2278
       (b) Once the nurse receives the termination notice, the  2279
nurse must notify the board of nursing of the termination as  2280
soon as practicable by submitting to the board a copy of the  2281
physician's or podiatrist's collaborating practitioner's  2282
termination notice.  2283
       (c) Notwithstanding the requirement of section 4723.43 of  2284
the Revised Code that the nurse practice in collaboration with a  2285
physician or podiatrist, the The nurse may continue to practice  2286
under the existing standard care arrangement without a  2287
collaborating physician or podiatrist practitioner for not more  2288
than one hundred twenty days after submitting to the board a  2289
copy of the termination notice.  2290
       (2) In the event that the collaboration between a  2291
physician or podiatrist collaborating practitioner and a  2292
certified nurse-midwife, certified nurse practitioner, or  2293
clinical nurse specialist terminates because of the physician's  2294
or podiatrist's collaborating practitioner's death, the nurse  2295
must notify the board of the death as soon as practicable. The  2296
nurse may continue to practice under the existing standard care  2297
arrangement without a collaborating physician or podiatrist  2298
S. B. No. 258  Page 80
As Introduced
practitioner for not more than one hundred twenty days after  2299
notifying the board of the physician's or podiatrist's  2300
collaborating practitioner's death.  2301
       (E)(1) Nothing in this section prohibits a hospital from  2302
hiring a clinical nurse specialist, certified nurse-midwife, or  2303
certified nurse practitioner as an employee and negotiating  2304
standard care arrangements on behalf of the employee as  2305
necessary to meet the requirements of this section or section  2306
4723.43 of the Revised Code. A standard care arrangement between  2307
the hospital's employee and the employee's collaborating  2308
physician practitioner is subject to approval by the medical  2309
staff and governing body of the hospital prior to implementation  2310
of the arrangement at the hospital.  2311
       (2) Nothing in this section prohibits a standard care  2312
arrangement from specifying actions that a clinical nurse  2313
specialist, certified nurse-midwife, or certified nurse  2314
practitioner is authorized to take, or is prohibited from  2315
taking, as part of the nurse's practice in collaboration with a  2316
physician or podiatrist or a clinical nurse specialist,  2317
certified nurse-midwife, or certified nurse practitioner that  2318
meets the requirements of section 4723.439 of the Revised Code.  2319
In specifying such actions, the standard care arrangement shall  2320
not authorize the nurse practicing under the standard care  2321
arrangement to take any action that is otherwise prohibited by  2322
the Revised Code or rule of the board.  2323
       Sec. 4723.439. (A) An advanced practice registered nurse  2324
who is a clinical nurse specialist, certified nurse-midwife, or  2325
certified nurse practitioner may practice without a standard  2326
care arrangement, and therefore without a collaborating  2327
practitioner, if the requirements of division (B) of this  2328
S. B. No. 258  Page 81
As Introduced
section are met.  2329
       (B)(1) To be eligible to practice without a standard care  2330
arrangement, a nurse must have both collaborated with one or  2331
more collaborating practitioners under a standard care  2332
arrangement and practiced in a clinical setting for two thousand  2333
hours.  2334
       (2) A nurse who seeks to practice without a standard care  2335
arrangement shall submit to the board of nursing documentation  2336
demonstrating that the requirements described in division (B)(1)  2337
of this section have been met.  2338
       (3) In the case of a nurse who obtained a license by  2339
endorsement as described in division (B) of section 4723.41 of  2340
the Revised Code, the board of nursing shall accept practice in  2341
a clinical setting completed in another jurisdiction if the  2342
board determines that the nurse practiced in that jurisdiction  2343
in a manner equivalent to practicing in this state.  2344
       (C) The board of nursing shall adopt rules as necessary to  2345
implement this section, including rules specifying the  2346
documentation that a nurse must submit in order to demonstrate  2347
that the nurse has met the requirements described in division  2348
(B)(1) of this section. The rules shall be adopted in accordance  2349
with Chapter 119. of the Revised Code.  2350
       Sec. 4723.44. (A) No person shall knowingly do any of the  2351
following unless the person holds a current, valid license  2352
issued by the board of nursing under this chapter to practice  2353
nursing as an advanced practice registered nurse in the  2354
specialty indicated by the designation:  2355
       (1) Engage in the practice of nursing as an advanced  2356
practice registered nurse for a fee, salary, or other  2357
S. B. No. 258  Page 82
As Introduced
consideration, or as a volunteer;  2358
       (2) Represent the person as being an advanced practice  2359
registered nurse, including representing the person as being a  2360
certified registered nurse anesthetist, clinical nurse  2361
specialist, certified nurse-midwife, or certified nurse  2362
practitioner;  2363
       (3) Use any title or initials implying that the person is  2364
an advanced practice registered nurse, including using any title  2365
or initials implying the person is a certified registered nurse  2366
anesthetist, clinical nurse specialist, certified nurse-midwife,  2367
or certified nurse practitioner.  2368
       (B) No advanced practice registered nurse shall knowingly  2369
do any of the following:  2370
       (1) Engage, for a fee, salary, or other consideration, or  2371
as a volunteer, in the practice of a nursing specialty nursing  2372
as an advanced practice registered nurse in a manner other than  2373
the specialty designated that which is indicated by the  2374
designation on the nurse's current, valid license issued by the  2375
board under this chapter to practice nursing as an advanced  2376
practice registered nurse;  2377
       (2) Represent the person nurse as being authorized to  2378
practice any nursing specialty nursing as an advanced practice  2379
registered nurse in a manner other than the specialty designated  2380
that which is indicated by the designation on the nurse's  2381
current, valid license to practice nursing as an advanced  2382
practice registered nurse;  2383
       (3) Use the title "certified registered nurse anesthetist"  2384
or the initials "N.A." or "C.R.N.A.," the title "clinical nurse  2385
specialist" or the initials "C.N.S.," the title "certified  2386
S. B. No. 258  Page 83
As Introduced
nurse-midwife" or the initials "C.N.M.," the title "certified  2387
nurse practitioner" or the initials "C.N.P.," the title  2388
"advanced practice registered nurse" or the initials "A.P.R.N.,"  2389
or any other title or initials implying that the nurse is  2390
authorized to practice any nursing specialty nursing as an  2391
advanced practice registered nurse in a manner other than the  2392
specialty designated that which is indicated by the designation  2393
on the nurse's current, valid license to practice nursing as an  2394
advanced practice registered nurse;  2395
       (4) Except as provided in division (A)(2)(c) of section  2396
4723.431 of the Revised Code, enter Enter into a standard care  2397
arrangement with a physician or podiatrist collaborating  2398
practitioner who is practicing in a specialty an area of health  2399
care, including a specialty, that is not the same as or similar  2400
to that in which the nurse's nursing specialtynurse is or will  2401
be practicing;  2402
       (5) Prescribe drugs or therapeutic devices in a manner  2403
that does not comply with section 4723.481 of the Revised Code;  2404
       (6) Prescribe any drug or device to perform or induce an  2405
abortion, or otherwise perform or induce an abortion.  2406
       (C) No person shall knowingly employ a person to engage in  2407
the practice of nursing as an advanced practice registered nurse  2408
unless the person so employed holds a current, valid license and  2409
designation issued by the board under this chapter to practice  2410
as an advanced practice registered nurse in the specialty as  2411
indicated by the designation.  2412
       (D) A document certified by the executive director of the  2413
board, under the official seal of the board, to the effect that  2414
it appears from the records of the board that no license to  2415
S. B. No. 258  Page 84
As Introduced
practice nursing as an advanced practice registered nurse has  2416
been issued to the person specified in the document, or that a  2417
license to practice nursing as an advanced practice registered  2418
nurse, if issued, has been revoked or suspended, shall be  2419
received as prima-facie evidence of the record of the board in  2420
any court or before any officer of the state.  2421
       Sec. 4723.46. (A) The board of nursing shall establish a  2422
list of national certifying organizations approved by the board  2423
to examine and certify advanced practice registered nurses to  2424
practice nursing specialties. To be approved by the board, a  2425
national certifying organization must meet all of the following  2426
requirements:  2427
       (1) Be national in the scope of its credentialing;  2428
       (2) Have an educational requirement beyond that required  2429
for registered nurse licensure;  2430
       (3) Have practice requirements beyond those required for  2431
registered nurse licensure;  2432
       (4) Have testing requirements beyond those required for  2433
registered nurse licensure that measure the theoretical and  2434
clinical content of a nursing specialtypractice as an advanced  2435
practice registered nurse, are developed in accordance with  2436
accepted standards of validity and reliability, and are open to  2437
registered nurses who have successfully completed the  2438
educational program required by the organization;  2439
       (5) Issue certificates to advanced practice registered  2440
nurses, including certified registered nurse anesthetists,  2441
clinical nurse specialists, certified nurse-midwives, or  2442
certified nurse practitioners;  2443
       (6) Periodically review the qualifications of advanced  2444
S. B. No. 258  Page 85
As Introduced
practice registered nurses, including certified registered nurse  2445
anesthetists, clinical nurse specialists, certified nurse-  2446
midwives, or certified nurse practitioners.  2447
       (B) Not later than the thirtieth day of January of each  2448
year, the board shall publish the list of national certifying  2449
organizations that have met the requirements of division (A) of  2450
this section within the previous year and remove from the list  2451
organizations that no longer meet the requirements.  2452
       Sec. 4723.481. This section establishes standards and  2453
conditions regarding the authority of an advanced practice  2454
registered nurse who is designated as a clinical nurse  2455
specialist, certified nurse-midwife, or certified nurse  2456
practitioner to prescribe and personally furnish drugs and  2457
therapeutic devices under a license issued under section 4723.42  2458
of the Revised Code.  2459
       (A) A clinical nurse specialist, certified nurse-midwife,  2460
or certified nurse practitioner shall not prescribe or furnish  2461
any drug or therapeutic device that is listed on the  2462
exclusionary formulary established in rules adopted under  2463
section 4723.50 of the Revised Code.  2464
       (B) The prescriptive authority of a clinical nurse  2465
specialist, certified nurse-midwife, or certified nurse  2466
practitioner practicing under a standard care arrangement shall  2467
not exceed the prescriptive authority of the collaborating  2468
physician or podiatristpractitioner, including, in the case of a  2469
collaborating practitioner who is a physician, the physician's  2470
authority to treat chronic pain with controlled substances and  2471
products containing tramadol as described in section 4731.052 of  2472
the Revised Code.  2473
S. B. No. 258  Page 86
As Introduced
       (C)(1) Except as provided in division (C)(2) or (3) of  2474
this section, a clinical nurse specialist, certified nurse-  2475
midwife, or certified nurse practitioner may prescribe to a  2476
patient a schedule II controlled substance only if all of the  2477
following are the case:  2478
       (a) The patient has a terminal condition, as defined in  2479
section 2133.01 of the Revised Code.  2480
       (b) A physician initially prescribed the substance for the  2481
patient.  2482
       (c) The prescription is for an amount that does not exceed  2483
the amount necessary for the patient's use in a single, seventy-  2484
two-hour period.  2485
       (2) The restrictions on prescriptive authority described  2486
in division (C)(1) of this section do not apply if a clinical  2487
nurse specialist, certified nurse-midwife, or certified nurse  2488
practitioner issues the prescription to the patient from any of  2489
the following entities:  2490
       (a) A hospital as defined in section 3722.01 of the  2491
Revised Code;  2492
       (b) An entity owned or controlled, in whole or in part, by  2493
a hospital or by an entity that owns or controls, in whole or in  2494
part, one or more hospitals;  2495
       (c) A health care facility operated by the department of  2496
mental health and addiction services or the department of  2497
developmental disabilities;  2498
       (d) A nursing home licensed under section 3721.02 of the  2499
Revised Code or by a political subdivision certified under  2500
section 3721.09 of the Revised Code;  2501
S. B. No. 258  Page 87
As Introduced
       (e) A county home or district home operated under Chapter  2502
5155. of the Revised Code that is certified under the medicare  2503
or medicaid program;  2504
       (f) A hospice care program, as defined in section 3712.01  2505
of the Revised Code;  2506
       (g) A community mental health services provider, as  2507
defined in section 5122.01 of the Revised Code;  2508
       (h) An ambulatory surgical facility, as defined in section  2509
3702.30 of the Revised Code;  2510
       (i) A freestanding birthing center, as defined in section  2511
3701.503 of the Revised Code;  2512
       (j) A federally qualified health center, as defined in  2513
section 3701.047 of the Revised Code;  2514
       (k) A federally qualified health center look-alike, as  2515
defined in section 3701.047 of the Revised Code;  2516
       (l) A health care office or facility operated by the board  2517
of health of a city or general health district or the authority  2518
having the duties of a board of health under section 3709.05 of  2519
the Revised Code;  2520
       (m) A site where a medical practice is operated, but only  2521
if the practice is comprised of one or more physicians who also  2522
are owners of the practice; the practice is organized to provide  2523
direct patient care; and the clinical nurse specialist,  2524
certified nurse-midwife, or certified nurse practitioner  2525
providing provides services at the site has a standard care  2526
arrangement and collaborates with at least one of the physician  2527
owners who practices primarily at that site;  2528
       (n) A site where a behavioral health practice is operated  2529
S. B. No. 258  Page 88
As Introduced
that does not qualify as a location otherwise described in  2530
division (C)(2) of this section, but only if the practice is  2531
organized to provide outpatient services for the treatment of  2532
mental health conditions, substance use disorders, or both, and  2533
the clinical nurse specialist, certified nurse-midwife, or  2534
certified nurse practitioner providing services at the site of  2535
the practice has a standard care arrangement and collaborates  2536
with at least one physician who is employed by that practice;  2537
       (o) A residential care facility, as defined in section  2538
3721.01 of the Revised Code.  2539
       (3) A clinical nurse specialist, certified nurse-midwife,  2540
or certified nurse practitioner shall not issue to a patient a  2541
prescription for a schedule II controlled substance from a  2542
convenience care clinic even if the clinic is owned or operated  2543
by an entity specified in division (C)(2) of this section.  2544
       (D) A pharmacist who acts in good faith reliance on a  2545
prescription issued by a clinical nurse specialist, certified  2546
nurse-midwife, or certified nurse practitioner under division  2547
(C)(2) of this section is not liable for or subject to any of  2548
the following for relying on the prescription: damages in any  2549
civil action, prosecution in any criminal proceeding, or  2550
professional disciplinary action by the state board of pharmacy  2551
under Chapter 4729. of the Revised Code.  2552
       (E) A clinical nurse specialist, certified nurse-midwife,  2553
or certified nurse practitioner shall comply with section  2554
3719.061 of the Revised Code if the nurse prescribes for a  2555
minor, as defined in that section, an opioid analgesic, as  2556
defined in section 3719.01 of the Revised Code.  2557
       Sec. 4723.482. (A) Except as provided in divisions (C) and  2558
S. B. No. 258  Page 89
As Introduced
(D) of this section, an applicant for a license to practice  2559
nursing as an advanced practice registered nurse who seeks  2560
designation as a clinical nurse specialist, certified nurse-  2561
midwife, or certified nurse practitioner shall include with the  2562
application submitted under section 4723.41 of the Revised Code  2563
evidence of successfully completing the course of study in  2564
advanced pharmacology and related topics in accordance with the  2565
requirements specified in division (B) of this section.  2566
       (B) With respect to the course of study in advanced  2567
pharmacology and related topics, all of the following  2568
requirements apply:  2569
       (1) The course of study shall be completed not longer than  2570
five years before the application is filed.  2571
       (2) The course of study shall be not less than forty-five  2572
contact hours.  2573
       (3) The course of study shall meet the requirements to be  2574
approved by the board of nursing in accordance with standards  2575
established in rules adopted under section 4723.50 of the  2576
Revised Code.  2577
       (4) The content of the course of study shall be specific  2578
to the applicant's nursing specialty designation being sought by  2579
the applicant.  2580
       (5) The instruction provided in the course of study shall  2581
include all of the following:  2582
       (a) A minimum of thirty-six contact hours of instruction  2583
in advanced pharmacology that includes pharmacokinetic  2584
principles and clinical application and the use of drugs and  2585
therapeutic devices in the prevention of illness and maintenance  2586
of health;  2587
S. B. No. 258  Page 90
As Introduced
       (b) Instruction in the fiscal and ethical implications of  2588
prescribing drugs and therapeutic devices;  2589
       (c) Instruction in the state and federal laws that apply  2590
to the authority to prescribe;  2591
       (d) Instruction that is specific to schedule II controlled  2592
substances, including instruction in all of the following:  2593
       (i) Indications for the use of schedule II controlled  2594
substances in drug therapies;  2595
       (ii) The most recent Pain management therapy guidelines  2596
for pain management therapies, as established by state and  2597
national organizations such as the Ohio pain initiative and the  2598
American pain society;  2599
       (iii) Fiscal and ethical implications of prescribing  2600
schedule II controlled substances;  2601
       (iv) State and federal laws that apply to the authority to  2602
prescribe schedule II controlled substances;  2603
       (v) Prevention of abuse and diversion of schedule II  2604
controlled substances, including identification of the risk of  2605
abuse and diversion, recognition of abuse and diversion, types  2606
of assistance available for prevention of abuse and diversion,  2607
and methods of establishing safeguards against abuse and  2608
diversion.  2609
       (C) An applicant who practiced or is practicing as a  2610
clinical nurse specialist, certified nurse-midwife, or certified  2611
nurse practitioner in another jurisdiction or as an employee of  2612
the United States government shall include with the application  2613
submitted under section 4723.41 of the Revised Code all of the  2614
following:  2615
S. B. No. 258  Page 91
As Introduced
       (1) Evidence of having completed a two-hour course of  2616
instruction approved by the board in the laws of this state that  2617
govern drugs and prescriptive authority;  2618
       (2) Either of the following:  2619
       (a) Evidence of having held, for a continuous period of at  2620
least one year during the three years immediately preceding the  2621
date of application, valid authority issued by another  2622
jurisdiction to prescribe therapeutic devices and drugs,  2623
including at least some controlled substances;  2624
       (b) Evidence of having been employed by the United States  2625
government and authorized, for a continuous period of at least  2626
one year during the three years immediately preceding the date  2627
of application, to prescribe therapeutic devices and drugs,  2628
including at least some controlled substances, in conjunction  2629
with that employment.  2630
       (D) In lieu of including with an application submitted  2631
under section 4723.41 of the Revised Code the evidence described  2632
in division (A) of this section, an applicant described in  2633
division (C) or (D) of section 4723.41 of the Revised Code may  2634
include evidence of all of the following:  2635
       (1) Successfully completing the course of study in  2636
advanced pharmacology and related topics more than five years  2637
before the date the application is filed;  2638
       (2) Holding, for a continuous period of at least one year  2639
during the three years immediately preceding the date of  2640
application, valid authority in any jurisdiction to prescribe  2641
therapeutic devices and drugs, including at least some  2642
controlled substances;  2643
       (3) Exercising the prescriptive authority described in  2644
S. B. No. 258  Page 92
As Introduced
division (D)(2) of this section for the minimum one-year period.  2645
        Sec. 4723.483. (A)(1) Subject to division (A)(2) of this  2646
section, and notwithstanding any provision of this chapter or  2647
rule adopted by the board of nursing, a clinical nurse  2648
specialist, certified nurse-midwife, or certified nurse  2649
practitioner who holds a certificate to prescribe issued under  2650
section 4723.48 of the Revised Code may do either of the  2651
following without having examined an individual to whom  2652
epinephrine may be administered:  2653
        (a) Personally furnish a supply of epinephrine  2654
autoinjectors for use in accordance with sections 3313.7110,  2655
3313.7111, 3314.143, 3326.28, 3328.29, 3728.03 to 3728.05, and  2656
5101.76 of the Revised Code;  2657
        (b) Issue a prescription for epinephrine autoinjectors for  2658
use in accordance with sections 3313.7110, 3313.7111, 3314.143,  2659
3326.28, 3328.29, 3728.03 to 3728.05, and 5101.76 of the Revised  2660
Code.  2661
        (2) An epinephrine autoinjector personally furnished or  2662
prescribed under division (A)(1) of this section must be  2663
furnished or prescribed in such a manner that it may be  2664
administered only in a manufactured dosage form.  2665
        (B) A nurse who acts in good faith in accordance with this  2666
section is not liable for or subject to any of the following for  2667
any action or omission of an entity to which an epinephrine  2668
autoinjector is furnished or a prescription is issued: damages  2669
in any civil action, prosecution in any criminal proceeding, or  2670
professional disciplinary action.  2671
        Sec. 4723.493. (A) There is hereby created within the  2672
board of nursing the advisory committee on advanced practice  2673
S. B. No. 258  Page 93
As Introduced
registered nursing. The committee shall consist of the following  2674
members and any other members the board appoints under division  2675
(B) of this section:  2676
       (1) Four advanced practice registered nurses, each  2677
actively engaged in the practice of advanced practice registered  2678
nursing in a clinical setting in this state, at least one of  2679
whom is actively engaged in providing primary care, at least one  2680
of whom is actively engaged in practice as a certified  2681
registered nurse anesthetist, and at least one of whom is  2682
actively engaged in practice as a certified nurse-midwife;  2683
       (2) Two advanced practice registered nurses, each serving  2684
as a faculty member of an approved program of nursing education  2685
that prepares students for licensure as advanced practice  2686
registered nurses;  2687
       (3) A member of the board of nursing who is an advanced  2688
practice registered nurse;  2689
       (4) A representative of an entity employing ten or more  2690
advanced practice registered nurses actively engaged in practice  2691
in this state.  2692
       (B) The board of nursing shall appoint the members  2693
described in division (A) of this section and may appoint  2694
additional members as described in division (D) of this section.  2695
Recommendations for For purposes of initial appointments and for  2696
filling any vacancies may be submitted to, the board by shall  2697
accept recommendations, if any, from organizations representing  2698
advanced practice registered nurses practicing in this state and  2699
by from schools of advanced practice registered nursing. The  2700
board shall appoint initial members and fill vacancies according  2701
to the recommendations it receives. If it does not receive any  2702
S. B. No. 258  Page 94
As Introduced
recommendations or receives an insufficient number of  2703
recommendations, the board shall appoint members and fill  2704
vacancies on its own advice.  2705
       Initial appointments to the committee shall be made not  2706
later than sixty days after April 6, 2017. Of the initial  2707
appointments described in division (A)(1) of this section, two  2708
shall be for terms of one year and two shall be for terms of two  2709
years. Of the initial appointments described in division (A)(2)  2710
of this section, one shall be for a term of one year and one  2711
shall be for a term of two years. Of the initial appointments  2712
described in divisions (A)(3) and (4) of this section, each  2713
shall be for a term of two years. Thereafter, terms shall be for  2714
two years, with each term ending on the same day of the same  2715
month as did the term that it succeeds. Vacancies shall be  2716
filled in the same manner as appointments.  2717
       When the term of any member expires, a successor shall be  2718
appointed in the same manner as the initial appointment. Any  2719
member appointed to fill a vacancy occurring prior to the  2720
expiration of the term for which the member's predecessor was  2721
appointed shall hold office for the remainder of that term. A  2722
member shall continue in office subsequent to the expiration  2723
date of the member's term until the member's successor takes  2724
office or until a period of sixty days has elapsed, whichever  2725
occurs first. A member may be reappointed for one additional  2726
term only.  2727
       (C) The committee shall organize by selecting a  2728
chairperson from among its members. The committee may select a  2729
new chairperson at any time. Five members constitute a quorum  2730
for the transaction of official business. Members shall serve  2731
without compensation but receive payment for their actual and  2732
S. B. No. 258  Page 95
As Introduced
necessary expenses incurred in the performance of their official  2733
duties. The expenses shall be paid by the board of nursing.  2734
       (D) The committee shall advise the board regarding the  2735
practice and regulation of advanced practice registered nurses.  2736
The committee may also recommend to the board that an individual  2737
with expertise in an advanced practice registered nursing  2738
specialty nurse who practices in a specialized area of nursing  2739
be appointed under division (B) of this section as an additional  2740
member of the committee.  2741
       Sec. 4723.50. (A) As used in this section:  2742
       (1) "Controlled substance" has the same meaning as in  2743
section 3719.01 of the Revised Code.  2744
       (2) "Medication-assisted treatment" has the same meaning  2745
as in section 340.01 of the Revised Code.  2746
       (B) In accordance with Chapter 119. of the Revised Code,  2747
the The board of nursing shall adopt rules as necessary to  2748
implement the provisions of this chapter pertaining to the  2749
authority of advanced practice registered nurses who are  2750
designated as clinical nurse specialists, certified nurse-  2751
midwives, and certified nurse practitioners to prescribe and  2752
furnish drugs and therapeutic devices.  2753
       The board shall adopt, including rules establishing an  2754
exclusionary formulary. The exclusionary formulary shall permit,  2755
in a manner consistent with section 4723.481 of the Revised  2756
Code, the prescribing of controlled substances, including drugs  2757
that contain buprenorphine used in medication-assisted treatment  2758
and both oral and long-acting opioid antagonists. The  2759
       The formulary shall not permit the prescribing or  2760
furnishing of any of the following:  2761
S. B. No. 258  Page 96
As Introduced
       (1) A drug or device to perform or induce an abortion;  2762
       (2) A drug or device prohibited by federal or state law.  2763
       (C) In addition to the rules described in division (B) of  2764
this section, the board shall adopt rules under this section  2765
that do the following:  2766
       (1) Establish standards for board approval of the course  2767
of study in advanced pharmacology and related topics required by  2768
section 4723.482 of the Revised Code;  2769
       (2) Establish requirements for board approval of the two-  2770
hour course of instruction in the laws of this state as required  2771
under division (C)(1) of section 4723.482 of the Revised Code;  2772
       (3) Establish For purposes of division (B)(5) of section  2773
4723.431 of the Revised Code, establish criteria for the  2774
components of the any standard care arrangements described in  2775
section 4723.431 of the Revised Code arrangement that apply to  2776
the authority to prescribe, including the components that apply  2777
to the authority to prescribe schedule II controlled substances.  2778
The rules shall be consistent with that section and include all  2779
of the following:  2780
       (a) Quality assurance standards;  2781
       (b) Standards for periodic review by a collaborating  2782
physician or podiatrist practitioner of the records of patients  2783
treated by the a clinical nurse specialist, certified nurse-  2784
midwife, or certified nurse practitioner who is practicing under  2785
a standard care arrangement with the collaborating practitioner;  2786
       (c) Acceptable travel time between the location at which  2787
the clinical nurse specialist, certified nurse-midwife, or  2788
certified nurse practitioner is engaging in the prescribing  2789
S. B. No. 258  Page 97
As Introduced
components of the nurse's practice and the location of the  2790
nurse's collaborating physician or podiatristAny other criteria  2791
the board considers appropriate.  2792
       (D) All rules adopted under this section shall be adopted  2793
in accordance with Chapter 119. of the Revised Code.  2794
       Sec. 4731.27. (A) As used in this section,  2795
"collaboration," "physician," "standard care arrangement," and  2796
"supervision" have the same meanings as in section 4723.01 of  2797
the Revised Code.  2798
       (B) A physician or podiatrist shall enter into a standard  2799
care arrangement with each clinical nurse specialist, certified  2800
nurse-midwife, or certified nurse practitioner with whom the  2801
physician or podiatrist is in collaboration.  2802
       The collaborating physician or podiatrist shall fulfill  2803
the responsibilities of collaboration, as specified in the  2804
arrangement and in accordance with division (A) of section  2805
4723.431 of the Revised Code. A copy of the standard care  2806
arrangement shall be retained on file by the nurse's employer.  2807
Prior approval of the standard care arrangement by the state  2808
medical board is not required, but the board may periodically  2809
review it.  2810
       A physician or podiatrist who terminates collaboration  2811
with a certified nurse-midwife, certified nurse practitioner, or  2812
clinical nurse specialist before their standard care arrangement  2813
expires shall give the nurse the written or electronic notice of  2814
termination required by division (D)(1) of section 4723.431 of  2815
the Revised Code.  2816
       Nothing in this division prohibits a hospital from hiring  2817
a clinical nurse specialist, certified nurse-midwife, or  2818
S. B. No. 258  Page 98
As Introduced
certified nurse practitioner as an employee and negotiating  2819
standard care arrangements on behalf of the employee as  2820
necessary to meet the requirements of this section. A standard  2821
care arrangement between the hospital's employee and the  2822
employee's collaborating physician practitioner is subject to  2823
approval by the medical staff and governing body of the hospital  2824
prior to implementation of the arrangement at the hospital.  2825
       (C) A physician or podiatrist shall cooperate with the  2826
board of nursing in any investigation the board conducts with  2827
respect to a clinical nurse specialist, certified nurse-midwife,  2828
or certified nurse practitioner who collaborates with the  2829
physician or podiatrist or with respect to a certified  2830
registered nurse anesthetist who practices with the supervision  2831
of the physician or podiatrist.  2832
       Sec. 4761.17. All of the following apply to the practice  2833
of respiratory care by a person who holds a license or limited  2834
permit issued under this chapter:  2835
       (A) The person shall practice only pursuant to a  2836
prescription or other order for respiratory care issued by any  2837
of the following:  2838
       (1) A physician;  2839
       (2) A clinical nurse specialist, certified nurse-midwife,  2840
or certified nurse practitioner, certified nurse-midwife, or  2841
clinical nurse specialist who holds a current, valid license  2842
issued under Chapter 4723. of the Revised Code to practice  2843
nursing as an advanced practice registered nurse and has entered  2844
into a standard care arrangement with a physician;  2845
       (3) A certified registered nurse anesthetist who holds a  2846
current, valid license issued under Chapter 4723. of the Revised  2847
S. B. No. 258  Page 99
As Introduced
Code to practice nursing as an advanced practice registered  2848
nurse and acts in compliance with sections 4723.43, 4723.433,  2849
and 4723.434 of the Revised Code;  2850
       (4) A physician assistant who holds a valid prescriber  2851
number issued by the state medical board, has been granted  2852
physician-delegated prescriptive authority, and has entered into  2853
a supervision agreement that allows the physician assistant to  2854
prescribe or order respiratory care services.  2855
       (B) The person shall practice only under the supervision  2856
of any of the following:  2857
       (1) A physician;  2858
       (2) A certified nurse practitioner, certified nurse-  2859
midwife, or clinical nurse specialist;  2860
       (3) A physician assistant who is authorized to prescribe  2861
or order respiratory care services as provided in division (A)  2862
(4) of this section.  2863
       (C)(1) When practicing under the prescription or order of  2864
a certified nurse practitioner, certified nurse midwife, or  2865
clinical nurse specialist or under the supervision of such a  2866
nurse, the person's administration of medication that requires a  2867
prescription is limited to the drugs that the nurse is  2868
authorized to prescribe pursuant to section 4723.481 of the  2869
Revised Code.  2870
       (2) When practicing under the order of a certified  2871
registered nurse anesthetist, the person's administration of  2872
medication is limited to the drugs that the nurse is authorized  2873
to order or direct the person to administer, as provided in  2874
sections 4723.43, 4723.433, and 4723.434 of the Revised Code.  2875
S. B. No. 258  Page 100
As Introduced
       (3) When practicing under the prescription or order of a  2876
physician assistant or under the supervision of a physician  2877
assistant, the person's administration of medication that  2878
requires a prescription is limited to the drugs that the  2879
physician assistant is authorized to prescribe pursuant to the  2880
physician assistant's physician-delegated prescriptive  2881
authority.  2882
       Sec. 5164.07. (A) The medicaid program shall include  2883
coverage of inpatient care and follow-up care for a mother and  2884
her newborn as follows:  2885
       (1) The medicaid program shall cover a minimum of forty-  2886
eight hours of inpatient care following a normal vaginal  2887
delivery and a minimum of ninety-six hours of inpatient care  2888
following a cesarean delivery. Services covered as inpatient  2889
care shall include medical, educational, and any other services  2890
that are consistent with the inpatient care recommended in the  2891
protocols and guidelines developed by national organizations  2892
that represent pediatric, obstetric, and nursing professionals.  2893
       (2) The medicaid program shall cover a physician-directed  2894
source of follow-up care or a source of follow-up care directed  2895
by an advanced practice registered nurse. Services covered as  2896
follow-up care shall include physical assessment of the mother  2897
and newborn, parent education, assistance and training in breast  2898
or bottle feeding, assessment of the home support system,  2899
performance of any medically necessary and appropriate clinical  2900
tests, and any other services that are consistent with the  2901
follow-up care recommended in the protocols and guidelines  2902
developed by national organizations that represent pediatric,  2903
obstetric, and nursing professionals. The coverage shall apply  2904
to services provided in a medical setting or through home health  2905
S. B. No. 258  Page 101
As Introduced
care visits. The coverage shall apply to a home health care  2906
visit only if the health care professional who conducts the  2907
visit is knowledgeable and experienced in maternity and newborn  2908
care.  2909
        When a decision is made in accordance with division (B) of  2910
this section to discharge a mother or newborn prior to the  2911
expiration of the applicable number of hours of inpatient care  2912
required to be covered, the coverage of follow-up care shall  2913
apply to all follow-up care that is provided within forty-eight  2914
hours after discharge. When a mother or newborn receives at  2915
least the number of hours of inpatient care required to be  2916
covered, the coverage of follow-up care shall apply to follow-up  2917
care that is determined to be medically necessary by the health  2918
care professionals responsible for discharging the mother or  2919
newborn.  2920
        (B) Any decision to shorten the length of inpatient stay  2921
to less than that specified under division (A)(1) of this  2922
section shall be made by the physician attending the mother or  2923
newborn, except that if a certified nurse-midwife is attending  2924
the mother in collaboration with a physician, the decision may  2925
be made by the certified nurse-midwife. Decisions If the  2926
certified nurse-midwife is practicing under a standard care  2927
arrangement with one or more collaborating practitioners, as  2928
provided in Chapter 4723. of the Revised Code, the nurse's  2929
decision shall be made in collaboration with a collaborating  2930
practitioner.  2931
        Decisions regarding early discharge shall be made only  2932
after conferring with the mother or a person responsible for the  2933
mother or newborn. For purposes of this division, a person  2934
responsible for the mother or newborn may include a parent,  2935
S. B. No. 258  Page 102
As Introduced
guardian, or any other person with authority to make medical  2936
decisions for the mother or newborn.  2937
       (C) The department of medicaid, in administering the  2938
medicaid program, may not do either of the following:  2939
       (1) Terminate the provider agreement of a health care  2940
professional or health care facility solely for making  2941
recommendations for inpatient or follow-up care for a particular  2942
mother or newborn that are consistent with the care required to  2943
be covered by this section;  2944
       (2) Establish or offer monetary or other financial  2945
incentives for the purpose of encouraging a person to decline  2946
the inpatient or follow-up care required to be covered by this  2947
section.  2948
       (D) This section does not do any of the following:  2949
       (1) Require the medicaid program to cover inpatient or  2950
follow-up care that is not received in accordance with the  2951
program's terms pertaining to the health care professionals and  2952
facilities from which a medicaid recipient is authorized to  2953
receive health care services.  2954
       (2) Require a mother or newborn to stay in a hospital or  2955
other inpatient setting for a fixed period of time following  2956
delivery;  2957
       (3) Require a child to be delivered in a hospital or other  2958
inpatient setting;  2959
       (4) Authorize a certified nurse-midwife to practice beyond  2960
the authority to practice nurse-midwifery in accordance with  2961
Chapter 4723. of the Revised Code;  2962
       (5) Establish minimum standards of medical diagnosis,  2963
S. B. No. 258  Page 103
As Introduced
care, or treatment for inpatient or follow-up care for a mother  2964
or newborn. A deviation from the care required to be covered  2965
under this section shall not, on the basis of this section, give  2966
rise to a medical claim or derivative medical claim, as those  2967
terms are defined in section 2305.113 of the Revised Code.  2968
       Section 2. That existing sections 1751.67, 2133.211,  2969
3313.539, 3707.511, 3727.06, 3923.233, 3923.301, 3923.63,  2970
3923.64, 4723.01, 4723.02, 4723.06, 4723.07, 4723.24, 4723.28,  2971
4723.36, 4723.41, 4723.42, 4723.43, 4723.431, 4723.44, 4723.46,  2972
4723.481, 4723.482, 4723.483, 4723.493, 4723.50, 4731.27,  2973
4761.17, and 5164.07 of the Revised Code are hereby repealed.  2974
       Section 3. That sections 4723.45 and 5164.73 of the  2975
Revised Code are hereby repealed.  2976
       Section 4. (A) Subject to division (B) of this section,  2977
the Board of Nursing shall consider a clinical nurse specialist,  2978
certified nurse practitioner, or certified nurse-midwife to have  2979
satisfied the requirements of section 4723.439 of the Revised  2980
Code, as enacted by this act, if the nurse, immediately prior to  2981
the effective date of this section, both collaborated with one  2982
or more physicians or podiatrists under a standard care  2983
arrangement and practiced in a clinical setting for two thousand  2984
hours.  2985
       (B) Not later than the date that occurs six months after  2986
the effective date of this section, a clinical nurse specialist,  2987
certified nurse practitioner, or certified nurse-midwife seeking  2988
authority to practice without a standard care arrangement shall  2989
submit to the Board documentation, acceptable to the Board,  2990
demonstrating that the nurse, immediately prior to the effective  2991
date of this section, both collaborated with one or more  2992
physicians or podiatrists under a standard care arrangement and  2993
S. B. No. 258  Page 104
As Introduced
practiced in a clinical setting for two thousand hours.  2994
       In the case of a nurse who obtained a license by  2995
endorsement as described in division (B) of section 4723.41 of  2996
the Revised Code, the Board shall accept practice in a clinical  2997
setting completed in another jurisdiction if the Board  2998
determines that the nurse practiced in that jurisdiction in a  2999
manner equivalent to practicing in this state.  3000
       (C) If the nurse fails to submit documentation by the date  3001
that occurs six months after the effective date of this section,  3002
the nurse shall cease practicing without a standard care  3003
arrangement until the nurse meets the requirements of section  3004
4723.439 of the Revised Code, as enacted by this act.  3005
       Section 5. This act shall be known as the Better Access to  3006
Health Care Act.  3007
       Section 6. The General Assembly, applying the principle  3008
stated in division (B) of section 1.52 of the Revised Code that  3009
amendments are to be harmonized if reasonably capable of  3010
simultaneous operation, finds that the following sections,  3011
presented in this act as composites of the sections as amended  3012
by the acts indicated, are the resulting versions of the  3013
sections in effect prior to the effective date of the sections  3014
as presented in this act:  3015
       Section 4723.431 of the Revised Code as amended by both  3016
H.B. 497 and S.B. 196 of the 135th General Assembly.  3017
       Section 4723.481 of the Revised Code as amended by H.B. 33  3018
of the 135th General Assembly and by H.B. 110 and H.B. 509 of  3019
the 134th General Assembly.  3020