HB 535

As Introduced
136th General Assembly
   Regular Session  H. B. No. 535
       2025-2026
  Representative Lorenz
  To amend sections 3727.50, 3727.51, 3727.52,  1
  3727.54, 3727.55, and 3727.56; to enact new  2
  section 3727.53 and section 4123.293; and to  3
  repeal section 3727.53 of the Revised Code to  4
  revise the law governing hospital-wide nursing  5
  care committees and hospital nursing services  6
  staffing plans.  7
 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
     Section 1. That sections 3727.50, 3727.51, 3727.52,  8
3727.54, 3727.55, and 3727.56 be amended and new section 3727.53       9
and section 4123.293 of the Revised Code be enacted to read as  10
follows:  11
     Sec. 3727.50. As used in this section and sections 3727.51        12
to 3727.57 of the Revised Code:  13
     (A) "Direct patient care" means care provided by a nurse  14
with direct responsibility to carry out medical regimens or  15
nursing care for one or more patients.  16
     (B) "Hospital" means a facility or institution licensed  17
under Chapter 3722. of the Revised Code.  18
     (B) "Hospital administrator" means an individual who is  19
both of the following:  20
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       (1) Employed by or under contract with a hospital in an  21
executive, managerial, or supervisory capacity;  22
       (2) Authorized by the hospital to direct, discipline,  23
evaluate, fire, or hire nursing staff or to establish one or  24
more hospital-wide policies affecting nursing practice, staffing  25
levels, or patient care operations.  26
       "Hospital administrator" includes a hospital's chief  27
executive officer, chief nursing officer, or chief operating  28
officer, the director of a hospital department, or the manager  29
of a hospital unit.  30
       (C) "Inpatient care unit" means a hospital unit, including  31
an operating room or other inpatient care area, in which nursing  32
care is provided to patients who have been admitted to the  33
hospital.  34
       (C) "Nurse" means a person who is licensed to practice as  35
a registered nurse under Chapter 4723. of the Revised Code or,  36
if the hospital employs licensed practical nurses, a person who  37
is licensed to practice as a licensed practical nurse under that  38
chapter.  39
       (D) "Licensed practical nurse" and "registered nurse" have  40
the same meanings as in section 4723.01 of the Revised Code.  41
       (E) "Unit-specific minimum staffing level" means the  42
minimum number of registered nurses and licensed practical  43
nurses assigned to provide direct patient care in a specific  44
inpatient care unit of a hospital during an employment shift.  45
       Sec. 3727.51. (A) Each hospital shall convene a hospital-  46
wide nursing care committee not Not later than ninety days after  47
the effective date of this section or, if the hospital is not  48
treating patients on the effective date of this section, ninety  49
H. B. No. 535  Page 3
As Introduced
days after the hospital begins to treat patientsamendment, each  50
hospital shall convene a hospital-wide nursing care committee.  51
The In the case of a hospital that begins operation after the  52
effective date of this amendment, the hospital shall convene  53
such a committee not later than ninety days after the hospital  54
begins operation.  55
       The hospital shall select the members of the committee,  56
subject to all of the following:  57
       (1) The hospital's chief nursing officer shall be included  58
as a member of the committee and other hospital administrators  59
also may be included as members, but only if the total number of  60
hospital administrator members does not exceed thirty per cent  61
of the committee's membership.  62
       (2) At Subject to division (B) of this section, at least  63
fifty fifty-one per cent of the committee's membership shall  64
consist of registered nurses who provide direct patient care in  65
the hospital.  66
       (3) The number of registered nurses included as members of  67
the committee shall be sufficient to provide adequate  68
representation of all types of nursing care services provided in  69
the hospital.  70
       (B) The committee member who is the hospital's chief  71
nursing officer shall establish a mechanism for obtaining input  72
from nurses in all inpatient care units who provide direct  73
patient care regarding what the nursing services staffing plan  74
recommendations described in division (B) of section 3727.52 of  75
the Revised Code should includeIn the case of a hospital that  76
has bargained collectively with the registered nurses who are  77
employed by or under contract with the hospital, the hospital  78
H. B. No. 535  Page 4
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shall not select all of the members of the committee described  79
in division (A)(2) of this section. In such a case, the  80
collective bargaining representative for the hospital's  81
registered nurses shall select a majority of the members  82
described in division (A)(2) of this section, with the hospital  83
being responsible for selecting the remainder of those members.  84
       Sec. 3727.52. A (A) Not later than ninety days after a  85
hospital-wide nursing care committee is convened pursuant to  86
section 3727.51 of the Revised Code, and then every two years  87
thereafter, the hospital-wide nursing care committee shall do  88
both all of the following:  89
       (A) If one exists, evaluate the hospital's current (1)  90
Review the hospital's nursing services staffing plan in effect  91
at the time of the review;  92
       (B) Recommend a nursing services staffing plan that is, at  93
a minimum, consistent with current standards established by  94
private accreditation organizations or governmental entities and  95
addresses (2) Consider all of the following factors related to  96
nursing services staffing:  97
       (1)(a) The selection, implementation, and evaluation of  98
minimum staffing levels that ensure, for all inpatient care  99
units that ensure, that the hospital has a staff of competent  100
nurses with the specialized skills needed to meet patient needs  101
in accordance with evidence-based safe nurse staffing standards;  102
       (2)(b) The complexity of complete care,; the requirements  103
for assessment of patients on patient admission,; the volume of  104
patient admissions, discharges, and transfers,; the evaluation  105
of the progress of a patient's problems,; and the amount of time  106
needed for patient education, ongoing physical patient  107
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assessments, planning for a patient's discharge, assessment  108
after a change in patient condition, and assessment of the need  109
for patient referrals;  110
       (3)(c) Patient acuity and the number of patients for whom  111
care is being provided;  112
       (4)(d) The need for ongoing assessments of a unit's  113
patients and its nursing staff levels relative to its patients;  114
       (5)(e) The hospital's policy for identifying additional  115
nurses who can provide direct patient care when patients'  116
unexpected needs exceed the planned workload for direct care  117
staff.  118
       (3) Following the review of a nursing services staffing  119
plan under division (A)(1) of this section, develop a  120
replacement plan that establishes for a two-year period unit-  121
specific minimum staffing levels for each inpatient care unit,  122
ensuring that the hospital has a staff of competent nurses with  123
the specialized skills needed to meet patient needs in  124
accordance with evidence-based safe nurse staffing standards.  125
       (B) In developing one or more nursing services staffing  126
plans under this section, in particular such a plan's unit-  127
specific minimum staffing levels, the hospital-wide nursing care  128
committee shall express those minimum staffing levels in either  129
of the following terms:  130
       (1) A fixed nurse-to-patient ratio;  131
       (2) A ratio range that specifies a permissible minimum and  132
maximum number of patients per nurse, provided that such a range  133
ensures safe patient care and meets evidence-based safe nurse  134
staffing standards.  135
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       (C) As soon as practicable after the development of a  136
nursing services staffing plan, the hospital-wide nursing care  137
committee shall hold a vote to determine if the committee should  138
approve the plan. Such a plan may be approved only by a majority  139
vote of the committee.  140
       Sec. 3727.53. (A) Except as provided in division (B) of  141
this section, as soon as practicable after a hospital-wide  142
nursing care committee develops and approves a nursing services  143
staffing plan under section 3727.52 of the Revised Code, the  144
hospital shall adopt and implement the staffing plan for the  145
two-year period that begins on the date of the plan's adoption.  146
       (B) Subject to division (C) of this section, during the  147
two-year period in which a nursing services staffing plan is in  148
effect, a hospital may adjust the plan's unit-specific minimum  149
staffing levels, but only in either the following circumstances:  150
       (1) When patient care needs exceed the plan's unit-  151
specific minimum staffing levels, but only if staffing levels  152
are adjusted with the assistance of the model identified in  153
section 3727.55 of the Revised Code and the patient acuity  154
assessment tool adopted under that section;  155
       (2) When a public health emergency has been declared for a  156
time period not exceeding ninety days, for the geographic area  157
in which the hospital is located, and in response to a health  158
threat that poses a significant risk to the area's population.  159
       (C) Any adjustment to the nursing staffing services plan  160
as described in division (B) of this section takes effect only  161
on approval by a majority vote of the hospital-wide nursing care  162
committee.  163
       (D) A hospital shall file with the department of health a  164
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nursing services staffing plan in accordance with the following  165
schedule:  166
       (1) Not later than thirty days after any such plan is  167
adopted under division (A) of this section;  168
       (2) Not later than thirty days after an adjusted plan is  169
approved under division (C) of this section.  170
       (E) Each calendar quarter, a hospital shall make a prompt  171
and diligent effort to adhere to its nursing services staffing  172
plan at least eighty per cent of the time in each inpatient  173
unit, except that during a public health emergency as described  174
in division (B)(2) of this section, a hospital shall make a  175
prompt and diligent effort to adhere to its nursing services  176
staffing plan at least sixty per cent of the time in each  177
hospital unit.  178
       (F)(1) A hospital shall submit to the department of health  179
on a quarterly basis compliance reports for the hospital. Each  180
report shall include the following information: compliance rates  181
organized by unit-level; approved variances; and a summary of  182
corrective actions taken when the percentages described in  183
division (E) of this section were not met.  184
       (2) Before a report is submitted under division (F)(1) of  185
this section, the report shall be certified by the hospital's  186
chief nursing officer and a direct care nurse who serves as a  187
co-chairperson for the hospital's hospital-wide nursing care  188
committee.  189
       (3) Not later than thirty days after receiving a  190
compliance report submitted under division (F)(1) of this  191
section, the department of health shall make the report publicly  192
available on the internet web site maintained by the department.  193
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       (4) When making reports publicly available under division  194
(F)(3) of this section, the department shall use a format that  195
is accessible to the public and searchable by hospital name,  196
location, and reporting period. The department also shall ensure  197
that such reports include the information described in division  198
(F)(1) of this section.  199
       (G) The department of health may audit a hospital if  200
either of the following circumstances occurs:  201
       (1) A compliance report submitted by a hospital as  202
required by division (F) of this section indicates that the  203
hospital's compliance rate for any unit falls below the  204
percentages described in division (E) of this section;  205
       (2) The department receives three or more complaints about  206
the hospital's compliance rates that the department determines  207
are credible and substantiated.  208
       (H) If the department of health determines that a hospital  209
has not made a prompt and diligent effort to adhere to the  210
hospital's nursing services staffing plan at the percentages  211
described in division (E) of this section, the department shall  212
assess a fine on the hospital in an amount that is equal to five  213
times the average hourly wage for each hour of staffing under  214
the staffing percentages. The department shall deposit any fines  215
collected under this division to the credit of the nurse  216
education grant program fund created under section 4723.063 of  217
the Revised Code.  218
       Sec. 3727.54. (A) At least once every two years, the  219
hospital-wide nursing care committee convened pursuant to  220
section 3727.51 of the Revised Code shall do both of the  221
following:  222
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       (1) Review how the nursing services staffing plan in  223
effect at the time of the review does all of the following:  224
       (a) Affects inpatient care outcomes;  225
       (b) Affects clinical management;  226
       (c) Facilitates a delivery system that provides, on a  227
cost-effective basis, quality nursing care consistent with  228
acceptable and prevailing standards of safe nursing care and  229
evidence-based guidelines established by national nursing  230
organizations.  231
       (2) Make recommendations, based on the review conducted  232
under division (A)(1) of this section, regarding how the nursing  233
services staffing plan should be revised, if at all.  234
       (B) For the purpose of maintaining a repository for public  235
access, beginning in 2018, a hospital shall submit to the  236
department of health, by March 1 of each even-numbered year, a  237
copy of the hospital's nursing services staffing plan in effect  238
at that time. The copy of the plan is a public record under  239
section 149.43 of the Revised Code.  240
       Sec. 3727.55. To provide staffing flexibility to meet  241
patient needs, every hospital hospital-wide nursing care  242
committee shall identify a model for adjusting the a nursing  243
services staffing plan created adopted under section 3727.53 of  244
the Revised Code for each inpatient care unit.  245
       Every hospital-wide nursing care committee also shall  246
adopt a standardized, evidence-based patient acuity assessment  247
tool for use in adjusting a nursing services staffing plan.  248
       Sec. 3727.56. (A) A hospital shall provide copies of its  249
nursing services staffing plan created adopted under section  250
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3727.53 of the Revised Code, in accordance with both of the  251
following:  252
       (1) Free of charge, a copy of the staffing plan and  253
subsequent changes to the plan shall be provided to each member  254
of the hospital's nursing staff.  255
       (2) For a fee not to exceed actual copying costs, a copy  256
of the staffing plan shall be provided to any person who  257
requests it.  258
       (B) In a conspicuous location in the hospital, a notice  259
shall be posted informing the public of the availability of the  260
staffing plan. The notice shall specify the appropriate person,  261
office, or department to be contacted to review or obtain a copy  262
of the staffing plan.  263
       Sec. 4123.293. (A) As used in this section, "hospital" has  264
the same meaning as in section 3727.50 of the Revised Code.  265
       (B) The administrator of workers' compensation, subject to  266
the approval of the bureau of workers' compensation board of  267
directors, shall establish a program to encourage a hospital to  268
adhere to its nursing services staffing plan adopted under  269
section 3727.53 of the Revised Code. The administrator, in  270
consultation with the director of health, shall establish all of  271
the following:  272
       (1) A discount on premium rates for a hospital that  273
adheres to a staffing plan at least eighty per cent of the time  274
in each inpatient unit in a calendar year during normal  275
operations and at least sixty per cent of the time in each  276
hospital unit during a public health emergency as described in  277
division (B)(2) of section 3727.53 of the Revised Code;  278
       (2) Procedures for verifying eligibility for a discount  279
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under the program;  280
       (3) A process for resolving disputes related to the amount  281
of a discount and the eligibility for a discount.  282
       Section 2. That existing sections 3727.50, 3727.51,  283
3727.52, 3727.54, 3727.55, and 3727.56 of the Revised Code are  284
hereby repealed.  285
       Section 3. That section 3727.53 of the Revised Code is  286
hereby repealed.  287