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As Passed by the House
136th
General Assembly
Regular
Session
Sub. H. B. No. 141
2025-2026
Representatives Baker, Abrams
Cosponsors: Representatives
Schmidt, Deeter, Brownlee, Grim, White, A., Abdullahi, Barhorst,
Brennan, Brent, Brewer, Cockley, Creech, Daniels, Denson, Dovilla,
Fischer, Glassburn, Hall, D., Isaacsohn, Jarrells, Johnson, King,
Kishman, Klopfenstein, LaRe, Lawson-Rowe, Lear, Lett, Manning,
Mathews, A., Mathews, T., Miller, J., Mohamed, Odioso, Peterson,
Piccolantonio, Plummer, Rader, Richardson, Ritter, Robb Blasdel,
Robinson, Rogers, Russo, Salvo, Sigrist, Sims, Sweeney, Synenberg,
Thomas, C., Tims, Troy, Upchurch, White, E., Williams, Willis, Young
To
enact sections 3724.01, 3724.02, 3724.03, 3724.04, 3724.05, 3724.06,
3724.07, 3724.08, 3724.09
,
3724.10
,
3724.99, 5164.27, and 5166.111 of the Revised Code
regarding
prescribed pediatric extended care centers.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
sections 3724.01, 3724.02, 3724.03, 3724.04, 3724.05, 3724.06,
3724.07, 3724.08, 3724.09
,
3724.10
,
3724.99, 5164.27, and 5166.111 of the Revised Code be enacted to read
as follows:
Sec.
3724.01.
As
used in this chapter:
(A)
"Hospital" has the same meaning as in section 3722.01 of
the Revised Code.
(B)
"Licensed practical nurse" and "registered nurse"
have the same meanings as in section 4723.01 of the Revised Code.
(C)
"Medically dependent or technologically dependent child"
means an individual who is less than twenty-one years of age and
requires, as a result of a medical condition, continuous therapeutic
interventions or skilled nursing supervision.
(D)
"Owner or operator" means any individual who owns or has
general administrative charge of a prescribed pediatric extended care
center.
(E)
"Physician" means an individual authorized under Chapter
4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery.
(F)
"Prescribed pediatric extended care center" means a
facility other than a hospital, whether operated for profit or not,
that provides and delivers, or allows for the provision of, services,
supports, and therapies to medically dependent or technologically
dependent children and their legal guardians as described in section
3724.06 of the Revised Code.
Sec.
3724.02.
No
person, firm, organization, institution, or agency shall knowingly
operate a prescribed pediatric extended care center without a license
issued under this chapter.
Sec.
3724.03.
(A)
A person, firm, organization, institution, or agency seeking a
license to operate a prescribed pediatric extended care center shall
file with the director of health an application in a manner
prescribed by the director. The application shall include all the
information the director considers necessary to process the
application, including evidence satisfactory to the director that the
applicant satisfies the requirements of division (B) of this section.
(B)
To be eligible to receive a license to operate a prescribed pediatric
extended care center, an applicant shall satisfy all of the following
requirements:
(1)
Hold a current, valid child care center license issued under Chapter
5104. of the Revised Code and operate the child care center at the
same address at which the prescribed pediatric extended care center
will operate;
(2)
Contract with or employ a medical director who is a physician
specializing in pediatric medicine and has at least three years of
clinical experience in that specialty;
(3)
Contract with or employ one or more nurse managers, with each nurse
manager being a registered nurse with clinical experience in
pediatric nursing;
(4)
Submit an initial application fee of one thousand dollars or, in the
case of an applicant that already holds a license to operate a
prescribed pediatric extended care center, an initial application fee
of two hundred fifty dollars.
(C)
The director shall review all applications received under this
section. After receiving an application the director considers
complete, the director shall determine whether the applicant meets
the requirements for a license to operate a prescribed pediatric
extended care center.
Sec.
3724.04.
(A)
If the director of health determines that an applicant meets the
requirements of section 3724.03 of the Revised Code, the director
shall issue the license to the applicant.
(B)
The license shall be valid for three years, unless revoked or
suspended, shall expire on the date that is three years after the
date of issuance, and may be renewed for additional three-year
periods in accordance with division (C) of this section and rules
adopted under section 3724.05 of the Revised Code.
(C)
To renew a license issued under this section, a prescribed pediatric
extended care center shall, on or before the license's expiration
date, apply to the director of health for renewal. Renewal
applications shall be submitted to the director in a manner
prescribed by the director. Each application shall be accompanied by
a renewal fee of five hundred dollars. The director shall renew a
license if the director determines that the applicant holds a
current, valid child care center license issued under Chapter 5104.
of the Revised Code and meets the requirements for renewal
established in rules adopted under section 3724.05 of the Revised
Code.
Sec.
3724.05.
(A)
Not later than ninety days after the effective date of this section,
the director of health shall adopt rules establishing standards and
procedures for the licensure and regulation of prescribed pediatric
extended care centers, including rules that do all of the following:
(1)
Establish license application and renewal procedures;
(2)
Specify the reasons for which the department may refuse to issue or
renew, suspend, or revoke a license or otherwise impose discipline on
a license holder;
(3)
Establish standards for providing and delivering, and for allowing
for the provision of, the services, supports, and therapies described
in section 3724.06 of the Revised Code, in particular, in a manner
that is family-centered while also individualized for each medically
dependent or technologically dependent child and the child's
caregiver and in a setting that is both integrated and inclusive;
(4)
Establish standards to ensure that the center's conditions and
physical surroundings are healthy, safe, and sanitary;
(5)
Establish minimum qualifications for employment as an operator,
registered nurse, licensed practical nurse, or other staff member as
well as training requirements for such employees;
(6)
Specify the manner in which medical records, data, and other
information relating to the children and families receiving services,
supports, and therapies are to be maintained;
(7)
Establish standards and procedures for providing medical
transportation services to and from prescribed pediatric extended
care centers, including by ensuring both of the following:
(a)
That nursing support is available when such services are provided;
(b)
That a provider of medical transportation services is prohibited from
providing such services to and from a center if the provider is
related to the center's owner or operator by blood, marriage, or
adoption.
(8)
Establish procedures and a timeline for conducting center inspections
and audits.
The
director also may adopt any other rules the director considers
necessary to implement and administer this chapter.
(B)
The rules described in this section shall be adopted in accordance
with Chapter 119. of the Revised Code.
Sec.
3724.06.
(A)(1)
A prescribed pediatric extended care center licensed under this
chapter may provide and deliver at the center, for a part of the day,
any of the following nonresidential services to medically dependent
or technologically dependent children who are not related to the
center's owner or operator by blood, marriage, or adoption:
(a)
Medical services;
(b)
Nursing services;
(c)
Psychosocial services;
(d)
Developmental education.
(2)
The center also may provide and deliver services to meet the
caregiver training needs of a medically dependent or technologically
dependent child's legal guardian.
(B)
In addition to the services a prescribed pediatric extended care
center may provide and deliver under division (A) of this section,
the center may allow for any of the following nonresidential
services, supports, and therapies to be provided, for a part of the
day, at the center:
(1)
Speech therapy;
(2)
Occupational therapy;
(3)
Physical therapy;
(4)
Social work services;
(5)
Developmental services;
(6)
Child life services;
(7)
Psychological services;
(8)
Behavioral supports.
In
allowing for the services, supports, and therapies described in this
division to be provided for at the center, the center may contract
with another entity to provide those services, supports, and
therapies.
Sec.
3724.07.
In
operating a prescribed pediatric extended care center, a center is
subject to all of the following requirements:
(A)
The center shall maintain the following medically dependent or
technologically dependent child-to-staff ratios:
(1)
When caring for not more than twelve children, two registered nurses;
(2)
When caring for at least thirteen but not more than twenty children,
two registered nurses and one licensed practical nurse;
(3)
When caring for at least twenty-one but not more than thirty
children, three registered nurses and two licensed practical nurses.
For
every eight children added to the thirty children described in
division (A)(3) of this section, the center shall ensure that another
registered nurse is providing care, in addition to the three
registered nurses described in that division.
(B)
A nurse manager, or nurse manager's designee, shall be present at the
center during its hours of operation.
(C)
The center shall utilize an electronic medical records system to
maintain records relating to the medically dependent and
technologically dependent children it enrolls. Such a system shall
include all of the following records: daily assessments, medication
lists, and reports of medications administered, medication errors,
and therapeutic interventions. The center shall ensure that the
system allows for periodic audits and assists the center in
implementing internal compliance programs.
(D)
The center shall assist the department of health in any audits the
department conducts of the center, including those related to the
center's delivery of and billing for services.
(E)
The center shall consider both of the following when prioritizing
enrollment of medically dependent or technologically dependent
children:
(1)
The employment status of parents;
(2)
The extent of children's medical needs.
Sec.
3724.08.
(A)
Before a medically dependent or technologically dependent child may
enroll in a prescribed pediatric extended care center, the child's
parent or legal guardian shall submit to the center a referral from
the child's provider, describing the child's medical condition,
medical stability, and the continuous therapeutic interventions or
skilled nursing supervision that the child requires.
(B)
Once a medically dependent or technologically dependent child enrolls
and begins to receive services, supports, and therapies as described
in division (A) of section 3724.06 of the Revised Code, the child
shall remain under the care of a provider other than the center's
medical director. The center's medical director, in consultation with
the child's provider and parent or legal guardian, shall develop for
the child a treatment plan that outlines the child's required
therapeutic interventions and skilled nursing supervision. The
center's nurse manager shall coordinate the implementation of the
child's treatment plan, with the plan's interventions and skilled
nursing to be administered by either a registered nurse employed by
the center or a licensed practical nurse employed by the center and
under the direct supervision of the registered nurse.
(C)
The center's medical director shall be available either in person or
by electronic communication to consult with the center's nurse
manager and other nursing staff. On at least a monthly basis, the
medical director shall review each child's treatment plan and medical
records and shall update the plan as necessary.
Sec.
3724.09.
The
department of health may refuse to issue or renew, suspend, or revoke
a license or otherwise impose discipline on a license holder for any
violation of this chapter or rules adopted under it. Such discipline
may include the imposition of a civil penalty in an amount not more
than five hundred dollars for each violation and for each day the
violation continues.
Sec.
3724.10.
Nothing
in this chapter prohibits a child care center licensed under Chapter
5104. of the Revised Code from providing, or continuing to provide,
special needs child care, as that term is defined in section 5104.01
of the Revised Code.
Sec.
3724.99.
Whoever
violates section 3724.02 of the Revised Code shall be fined in an
amount not less than five hundred dollars and not more than ten
thousand dollars for each offense.
Sec.
5164.27.
(A)
As used in this section, "medically dependent or technologically
dependent child" and "prescribed pediatric extended care
center" have the same meanings as in section 3724.01 of the
Revised Code.
(B)
The medicaid director shall seek approval from the United States
centers for medicare and medicaid services to cover services provided
by a prescribed pediatric extended care center, as described in
division (A)(1) of section 3724.06 of the Revised Code, to medically
dependent or technologically dependent children in this state as part
of the early and periodic screening, diagnostic, and treatment
program.
(C)
To be eligible to receive medicaid payments under this section, a
prescribed pediatric extended care center shall hold both of the
following:
(1)
A valid license issued under section 3724.04 of the Revised Code;
(2)
A valid medicaid provider agreement.
Sec.
5166.111.
Not
later than ninety days after the effective date of this section, the
department of medicaid shall establish pediatric-specific processes
for level of care determinations that apply when determining if an
individual qualifies for services provided under the Ohio home care
waiver program.