Enact the Better Access to Health Care Act

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, 3707.511, 3727.06,
3923.233, 3923.301, 3923.63, 3923.64, 4723.01, 4723.02, 4723.06,
4723.07, 4723.24, 4723.28, 4723.36, 4723.41, 4723.42, 4723.43,
4723.431, 4723.44, 4723.46, 4723.481, 4723.482, 4723.483, 4723.493,
4723.50, 4731.27, 4761.17, and 5164.07; to enact section 4723.439;
and to repeal sections 4723.45 and 5164.73 of the Revised Code
to
modify the laws governing the practice of advanced practice
registered nurses and to name this act the Better Access to Health
Care Act.

BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section
1.
That
sections 1751.67, 2133.211, 3313.539, 3707.511, 3727.06, 3923.233,
3923.301, 3923.63, 3923.64, 4723.01, 4723.02, 4723.06, 4723.07,
4723.24, 4723.28, 4723.36, 4723.41, 4723.42, 4723.43, 4723.431,
4723.44, 4723.46, 4723.481, 4723.482, 4723.483, 4723.493, 4723.50,
4731.27, 4761.17, and 5164.07 be amended and section 4723.439 of the
Revised Code be enacted to read as follows:

Sec.
1751.67.
(A)
Each individual or group health insuring corporation policy,
contract, or agreement delivered, issued for delivery, or renewed in
this state that provides maternity benefits shall provide coverage of
inpatient care and follow-up care for a mother and her newborn as
follows:

(1)
The policy, contract, or agreement shall cover a minimum of
forty-eight hours of inpatient care following a normal vaginal
delivery and a minimum of ninety-six hours of inpatient care
following a cesarean delivery. Services covered as inpatient care
shall include medical, educational, and any other services that are
consistent with the inpatient care recommended in the protocols and
guidelines developed by national organizations that represent
pediatric, obstetric, and nursing professionals.

(2)
The policy, contract, or agreement shall cover a physician-directed
source of follow-up care or a source of follow-up care directed by an
advanced practice registered nurse. Services covered as follow-up
care shall include physical assessment of the mother and newborn,
parent education, assistance and training in breast or bottle
feeding, assessment of the home support system, performance of any
medically necessary and appropriate clinical tests, and any other
services that are consistent with the follow-up care recommended in
the protocols and guidelines developed by national organizations that
represent pediatric, obstetric, and nursing professionals. The
coverage shall apply to services provided in a medical setting or
through home health care visits. The coverage shall apply to a home
health care visit only if the provider who conducts the visit is
knowledgeable and experienced in maternity and newborn care.

When
a decision is made in accordance with division (B) of this section to
discharge a mother or newborn prior to the expiration of the
applicable number of hours of inpatient care required to be covered,
the coverage of follow-up care shall apply to all follow-up care that
is provided within seventy-two hours after discharge. When a mother
or newborn receives at least the number of hours of inpatient care
required to be covered, the coverage of follow-up care shall apply to
follow-up care that is determined to be medically necessary by the
provider responsible for discharging the mother or newborn.

(B)
Any decision to shorten the length of inpatient stay to less than
that specified under division (A)(1) of this section shall be made by
the physician attending the mother or newborn, except that if a
certified nurse-midwife is attending the mother

in collaboration with a physician
,
the decision may be made by the certified nurse-midwife.
Decisions

If
the certified nurse-midwife is practicing under a standard care
arrangement with one or more collaborating practitioners, as provided
in Chapter 4723. of the Revised Code, the nurse's decision shall be
made in collaboration with a collaborating practitioner.

Decisions

regarding
early discharge shall be made only after conferring with the mother
or a person responsible for the mother or newborn. For purposes of
this division, a person responsible for the mother or newborn may
include a parent, guardian, or any other person with authority to
make medical decisions for the mother or newborn.

(C)(1)
No health insuring corporation may do either of the following:

(a)
Terminate the participation of a provider or health care facility in
an individual or group health care plan solely for making
recommendations for inpatient or follow-up care for a particular
mother or newborn that are consistent with the care required to be
covered by this section;

(b)
Establish or offer monetary or other financial incentives for the
purpose of encouraging a person to decline the inpatient or follow-up
care required to be covered by this section.

(2)
Whoever violates division (C)(1)(a) or (b) of this section has
engaged in an unfair and deceptive act or practice in the business of
insurance under sections 3901.19 to 3901.26 of the Revised Code.

(D)
This section does not do any of the following:

(1)
Require a policy, contract, or agreement to cover inpatient or
follow-up care that is not received in accordance with the policy's,
contract's, or agreement's terms pertaining to the providers and
facilities from which an individual is authorized to receive health
care services;

(2)
Require a mother or newborn to stay in a hospital or other inpatient
setting for a fixed period of time following delivery;

(3)
Require a child to be delivered in a hospital or other inpatient
setting;

(4)
Authorize a certified nurse-midwife to practice beyond the authority
to practice nurse-midwifery in accordance with Chapter 4723. of the
Revised Code;

(5)
Establish minimum standards of medical diagnosis, care, or treatment
for inpatient or follow-up care for a mother or newborn. A deviation
from the care required to be covered under this section shall not,
solely on the basis of this section, give rise to a medical claim or
to derivative claims for relief, as those terms are defined in
section 2305.113 of the Revised Code.

Sec.
2133.211.
A
person who holds a current, valid license issued under Chapter 4723.
of the Revised Code to practice as an advanced practice registered
nurse may take any action that may be taken by an attending physician
under sections 2133.21 to 2133.26 of the Revised Code and has the
immunity provided by section 2133.22 of the Revised Code
,
except that

if
the
nurse is practicing under a standard care arrangement with one or
more collaborating practitioners,
the

immunity
applies only if the
action
is taken
pursuant
to a standard care arrangement
in
collaboration
with
a collaborating physician.

A
person who holds a license to practice as a physician assistant
issued under Chapter 4730. of the Revised Code may take any action
that may be taken by an attending physician under sections 2133.21 to
2133.26 of the Revised Code and has the immunity provided by section
2133.22 of the Revised Code if the action is taken pursuant to a
supervision agreement entered into under section 4730.19 of the
Revised Code, including, if applicable, the policies of a health care
facility in which the physician assistant is practicing.

Sec.
3313.539.
(A)
As used in this section:

(1)
"Licensing agency" has the same meaning as in section
4745.01 of the Revised Code.

(2)
"Licensed health care professional" means an individual,
other than a physician, who is authorized under Title XLVII of the
Revised Code to practice a health care profession.

(3)
"Physician" means a person authorized under Chapter 4731.
of the Revised Code to practice medicine and surgery or osteopathic
medicine and surgery.

(B)
No school district board of education or governing authority of a
chartered or nonchartered nonpublic school shall permit a student to
practice for or compete in interscholastic athletics until the
student has submitted, to a school official designated by the board
or governing authority, a form signed by the parent, guardian, or
other person having care or charge of the student stating that the
student and the parent, guardian, or other person having care or
charge of the student have received the concussion and head injury
information sheet required by section 3707.52 of the Revised Code. A
completed form shall be submitted each school year, as defined in
section 3313.62 of the Revised Code, for each sport or other category
of interscholastic athletics for or in which the student practices or
competes.

(C)(1)
No school district board of education or governing authority of a
chartered or nonchartered nonpublic school shall permit an individual
to coach interscholastic athletics unless the individual holds a
pupil-activity program permit issued under section 3319.303 of the
Revised Code for coaching interscholastic athletics.

(2)
No school district board of education or governing authority of a
chartered or nonchartered nonpublic school shall permit an individual
to referee interscholastic athletics unless the individual holds a
pupil-activity program permit issued under section 3319.303 of the
Revised Code for coaching interscholastic athletics or presents
evidence that the individual has successfully completed, within the
previous three years, a training program in recognizing the symptoms
of concussions and head injuries to which the department of health
has provided a link on its internet web site under section 3707.52 of
the Revised Code or a training program authorized and required by an
organization that regulates interscholastic athletic competition and
conducts interscholastic athletic events.

(D)
If a student practicing for or competing in an interscholastic
athletic event exhibits signs, symptoms, or behaviors consistent with
having sustained a concussion or head injury while participating in
the practice or competition, the student shall be removed from the
practice or competition by either of the following:

(1)
The individual who is serving as the student's coach during that
practice or competition;

(2)
An individual who is serving as a referee during that practice or
competition.

(E)(1)
If a student is removed from practice or competition under division
(D) of this section, the coach or referee who removed the student
shall not allow the student, on the same day the student is removed,
to return to that practice or competition or to participate in any
other practice or competition for which the coach or referee is
responsible. Thereafter, the coach or referee shall not allow the
student to return to that practice or competition or to participate
in any other practice or competition for which the coach or referee
is responsible until both of the following conditions are satisfied:

(a)
The student's condition is assessed by any of the following who has
complied with the requirements in division (E)(4) of this section:

(i)
A physician;

(ii)
A licensed health care professional the school district board of
education or governing authority of the chartered or nonchartered
nonpublic school, pursuant to division (E)(2) of this section,
authorizes to assess a student who has been removed from practice or
competition under division (D) of this section;

(iii)
A licensed health care professional who meets the minimum education
requirements established by rules adopted under section 3707.521 of
the Revised Code by the professional's licensing agency.

(b)
The student receives written clearance that it is safe for the
student to return to practice or competition from the physician or
licensed health care professional who assessed the student's
condition.

(2)
A
(2)(a)
Except as provided in division (E)(2)(b) of this section, a
school
district board of education or governing authority of a chartered or
nonchartered nonpublic school may authorize a licensed health care
professional to make an assessment or grant a clearance for purposes
of division (E)(1) of this section only if the professional is acting
in accordance with one of the following, as applicable to the
professional's authority to practice in this state:

(a)

(i)

In
consultation with a physician;

(b)

(ii)

Pursuant
to the referral of a physician;

(c)

(iii)

In
collaboration with a physician;

(d)

(iv)

Under
the supervision of a physician.

(b)
The requirement of division (E)(2)(a)(iii) of this section does not
apply to a clinical nurse specialist or certified nurse practitioner
who, in accordance with section 4723.439 of the Revised Code, is
practicing without a standard care arrangement or is eligible to
practice without a standard care arrangement.

(3)
A physician or licensed health care professional who makes an
assessment or grants a clearance for purposes of division (E)(1) of
this section may be a volunteer.

(4)

Beginning
one year after the effective date of this amendment, all
All

physicians
and licensed health care professionals who conduct assessments and
clearances under division (E)(1) of this section must meet the
minimum education requirements established by rules adopted under
section 3707.521 of the Revised Code by their respective licensing
agencies.

(F)
A school district board of education or governing authority of a
chartered or nonchartered nonpublic school that is subject to the
rules of an interscholastic conference or an organization that
regulates interscholastic athletic competition and conducts
interscholastic athletic events shall be considered to be in
compliance with divisions (B), (D), and (E) of this section, as long
as the requirements of those rules are substantially similar to the
requirements of divisions (B), (D), and (E) of this section.

(G)(1)
A school district, member of a school district board of education, or
school district employee or volunteer, including a coach or referee,
is not liable in damages in a civil action for injury, death, or loss
to person or property allegedly arising from providing services or
performing duties under this section, unless the act or omission
constitutes willful or wanton misconduct.

This
section does not eliminate, limit, or reduce any other immunity or
defense that a school district, member of a school district board of
education, or school district employee or volunteer, including a
coach or referee, may be entitled to under Chapter 2744. or any other
provision of the Revised Code or under the common law of this state.

(2)
A chartered or nonchartered nonpublic school or any officer,
director, employee, or volunteer of the school, including a coach or
referee, is not liable in damages in a civil action for injury,
death, or loss to person or property allegedly arising from providing
services or performing duties under this section, unless the act or
omission constitutes willful or wanton misconduct.

Sec.
3707.511.
(A)
As used in this section:

(1)
"Licensing agency" has the same meaning as in section
4745.01 of the Revised Code.

(2)
"Licensed health care professional" means an individual,
other than a physician, who is authorized under Title XLVII of the
Revised Code to practice a health care profession.

(3)
"Physician" means a person authorized under Chapter 4731.
of the Revised Code to practice medicine and surgery or osteopathic
medicine and surgery.

(B)
A youth sports organization shall provide to the parent, guardian, or
other person having care or charge of an individual who wishes to
practice for or compete in an athletic activity organized by a youth
sports organization the concussion and head injury information sheet
required by section 3707.52 of the Revised Code. The organization
shall provide the information sheet annually for each sport or other
category of athletic activity for or in which the individual
practices or competes.

(C)(1)
No individual shall act as a coach or referee for a youth sports
organization unless the individual holds a pupil-activity program
permit issued under section 3319.303 of the Revised Code for coaching
interscholastic athletics or presents evidence that the individual
has successfully completed, within the previous three years, a
training program in recognizing the symptoms of concussions and head
injuries to which the department of health has provided a link on its
internet web site under section 3707.52 of the Revised Code.

(2)
The youth sports organization for which the individual intends to act
as a coach or referee shall inform the individual of the requirement
described in division (C)(1) of this section.

(D)
If an individual practicing for or competing in an athletic event
organized by a youth sports organization exhibits signs, symptoms, or
behaviors consistent with having sustained a concussion or head
injury while participating in the practice or competition, the
individual shall be removed from the practice or competition by one
of the following:

(1)
The individual who is serving as the individual's coach during that
practice or competition;

(2)
An individual who is serving as a referee during that practice or
competition;

(3)
An official of the youth sports organization who is supervising that
practice or competition.

(E)(1)
If an individual is removed from practice or competition under
division (D) of this section, the coach, referee, or official who
removed the individual shall not allow the individual, on the same
day the individual is removed, to return to that practice or
competition or to participate in any other practice or competition
for which the coach, referee, or official is responsible. Thereafter,
the coach, referee, or official shall not allow the student to return
to that practice or competition or to participate in any other
practice or competition for which the coach, referee, or official is
responsible until both of the following conditions are satisfied:

(a)
The individual's condition is assessed by any of the following who
has complied with the requirements in division (E)(4) of this
section:

(i)
A physician;

(ii)
A licensed health care professional the youth sports organization,
pursuant to division (E)(2) of this section, authorizes to assess an
individual who has been removed from practice or competition under
division (D) of this section;

(iii)
A licensed health care professional who meets the minimum education
requirements established by rules adopted under section 3707.521 of
the Revised Code by the professional's licensing agency.

(b)
The individual receives written clearance that it is safe for the
individual to return to practice or competition from the physician or
licensed health care professional who assessed the individual's
condition.

(2)
A
(2)(a)
Except as provided in division (E)(2)(b) of this section, a
youth
sports organization may authorize a licensed health care professional
to make an assessment or grant a clearance for purposes of division
(E)(1) of this section only if the professional is acting in
accordance with one of the following, as applicable to the
professional's authority to practice in this state:

(a)

(i)

In
consultation with a physician;

(b)

(ii)

Pursuant
to the referral of a physician;

(c)

(iii)

In
collaboration with a physician;

(d)

(iv)

Under
the supervision of a physician.

(b)
The requirement of division (E)(2)(a)(iii) of this section does not
apply to a clinical nurse specialist or certified nurse practitioner
who, in accordance with section 4723.439 of the Revised Code, is
practicing without a standard care arrangement or is eligible to
practice without a standard care arrangement.

(3)
A physician or licensed health care professional who makes an
assessment or grants a clearance for purposes of division (E)(1) of
this section may be a volunteer.

(4)

Beginning
one year after the effective date of this amendment, all
All

physicians
and licensed health care professionals who conduct assessments and
clearances under division (E)(1) of this section must meet the
minimum education requirements established by rules adopted under
section 3707.521 of the Revised Code by their respective licensing
agencies.

(F)(1)
A youth sports organization or official, employee, or volunteer of a
youth sports organization, including a coach or referee, is not
liable in damages in a civil action for injury, death, or loss to
person or property allegedly arising from providing services or
performing duties under this section, unless the act or omission
constitutes willful or wanton misconduct.

(2)
This section does not eliminate, limit, or reduce any other immunity
or defense that a public entity, public official, or public employee
may be entitled to under Chapter 2744. or any other provision of the
Revised Code or under the common law of this state.

Sec.
3727.06.
(A)
As used in this section:

(1)
"Doctor" means an individual authorized
under
Chapter 4731. of the Revised Code
to
practice medicine and surgery or osteopathic medicine and surgery.

(2)
"Podiatrist" means an individual authorized
under
Chapter 4731. of the Revised Code
to
practice podiatric medicine and surgery.

(B)(1)
Only the following may admit a patient to a hospital:

(a)
A doctor who is a member of the hospital's medical staff;

(b)
A dentist who is a member of the hospital's medical staff;

(c)
A podiatrist who is a member of the hospital's medical staff;

(d)
A clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner if
all
of the following conditions are met:

(i)
The clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner has a standard care arrangement entered into
pursuant to section 4723.431 of the Revised Code with a collaborating
doctor or podiatrist who is a member of the medical staff;

(ii)
The patient will be under the medical supervision of the
collaborating doctor or podiatrist;

(iii)
The
the

hospital
has granted the clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner admitting privileges and appropriate
credentials.

(e)
A physician assistant if all of the following conditions are met:

(i)
The physician assistant is listed on a supervision agreement entered
into under section 4730.19 of the Revised Code for a doctor or
podiatrist who is a member of the hospital's medical staff.

(ii)
The patient will be under the medical supervision of the supervising
doctor or podiatrist.

(iii)
The hospital has granted the physician assistant admitting privileges
and appropriate credentials.

(2)
Prior to admitting a patient, a clinical nurse specialist, certified
nurse-midwife,
or

certified
nurse practitioner
,
or

who is practicing under a standard care arrangement with one or more
collaborating practitioners, as provided in Chapter 4723. of the
Revised Code, shall notify the collaborating practitioner of the
planned admission.

Prior
to admitting a patient, a
physician
assistant shall notify the
collaborating
or
supervising
doctor or podiatrist of the planned admission.

(C)
All hospital patients shall be under the medical supervision of a
doctor, except that services that may be rendered by a licensed
dentist pursuant to Chapter 4715. of the Revised Code provided to
patients admitted solely for the purpose of receiving such services
shall be under the supervision of the admitting dentist and that
services that may be rendered by a podiatrist pursuant to section
4731.51 of the Revised Code provided to patients admitted solely for
the purpose of receiving such services shall be under the supervision
of the admitting podiatrist. If treatment not within the scope of
Chapter 4715. or section 4731.51 of the Revised Code is required at
the time of admission by a dentist or podiatrist, or becomes
necessary during the course of hospital treatment by a dentist or
podiatrist, such treatment shall be under the supervision of a doctor
who is a member of the medical staff. It shall be the responsibility
of the admitting dentist or podiatrist to make arrangements with a
doctor who is a member of the medical staff to be responsible for the
patient's treatment outside the scope of Chapter 4715. or section
4731.51 of the Revised Code when necessary during the patient's stay
in the hospital.

Sec.
3923.233.
(A)

Notwithstanding
any provision of any certificate furnished by an insurer in
connection with or pursuant to any group sickness and accident
insurance policy delivered, issued, renewed, or used, in or outside
this state, on or after January 1, 1985, and notwithstanding any
provision of any policy of insurance delivered, issued for delivery,
renewed, or used, in or outside this state, on or after January 1,
1985, whenever the policy or certificate is subject to the
jurisdiction of this state and provides for reimbursement for any
service that may be legally performed by an advanced practice
registered nurse who holds a current, valid license issued under
Chapter 4723. of the Revised Code and is designated as a certified
nurse-midwife in accordance with section 4723.42 of the Revised Code,
reimbursement under the policy or certificate shall not be denied to
a certified nurse-midwife performing the service

in collaboration with a licensed physician
.

The
collaborating physician shall be identified on an insurance claim
form.

The
cost of collaboration with a certified nurse-midwife by a licensed
physician as required under section 4723.43 of the Revised Code is a
reimbursable expense.

The
division of any reimbursement payment for services performed by a
certified nurse-midwife between the certified nurse-midwife and the
certified nurse-midwife's collaborating physician shall be determined
and mutually agreed upon by the certified nurse-midwife and the
physician. The division of fees shall not be considered a violation
of division (B)(17) of section 4731.22 of the Revised Code. In no
case shall the total fees charged exceed the fee the physician would
have charged had the physician provided the entire service.

(B)
Division (A) of this section applies to any certified nurse-midwife
who is practicing in accordance with Chapter 4723. of the Revised
Code, regardless of whether the nurse is required or chooses to
practice under a standard care arrangement, as provided in section
4723.43 of the Revised Code, or the nurse exercises the authority to
practice without a standard care arrangement, as provided in section
4723.439 of the Revised Code.

Sec.
3923.301.
(A)

Every
person, the state and any of its instrumentalities, any county,
township, school district, or other political subdivision and any of
its instrumentalities, and any municipal corporation and any of its
instrumentalities that provides payment for health care benefits for
any of its employees resident in this state, which benefits are not
provided by contract with an insurer qualified to provide sickness
and accident insurance or a health insuring corporation, and that
includes reimbursement for any service that may be legally performed
by an advanced practice registered nurse who holds a current, valid
license issued under Chapter 4723. of the Revised Code and is
designated as a certified nurse-midwife in accordance with section
4723.42 of the Revised Code, shall not deny reimbursement to a
certified nurse-midwife performing the service

if the service is performed in collaboration with a licensed
physician
.

The
collaborating physician shall be identified on the claim form.

The
cost of collaboration with a certified nurse-midwife by a licensed
physician as required under section 4723.43 of the Revised Code is a
reimbursable expense.

The
division of any reimbursement payment for services performed by a
certified nurse-midwife between the certified nurse-midwife and the
certified nurse-midwife's collaborating physician shall be determined
and mutually agreed upon by the certified nurse-midwife and the
physician. The division of fees shall not be considered a violation
of division (B)(17) of section 4731.22 of the Revised Code. In no
case shall the total fees charged exceed the fee the physician would
have charged had the physician provided the entire service.

(B)
Division (A) of this section applies to any certified nurse-midwife
who is practicing in accordance with Chapter 4723. of the Revised
Code, regardless of whether the nurse is required or chooses to
practice under a standard care arrangement, as provided in section
4723.43 of the Revised Code, or the nurse exercises the authority to
practice without a standard care arrangement, as provided in section
4723.439 of the Revised Code.

Sec.
3923.63.
(A)
Notwithstanding section 3901.71 of the Revised Code, each individual
or group policy of sickness and accident insurance delivered, issued
for delivery, or renewed in this state that provides maternity
benefits shall provide coverage of inpatient care and follow-up care
for a mother and her newborn as follows:

(1)
The policy shall cover a minimum of forty-eight hours of inpatient
care following a normal vaginal delivery and a minimum of ninety-six
hours of inpatient care following a cesarean delivery. Services
covered as inpatient care shall include medical, educational, and any
other services that are consistent with the inpatient care
recommended in the protocols and guidelines developed by national
organizations that represent pediatric, obstetric, and nursing
professionals.

(2)
The policy shall cover a physician-directed source of follow-up care
or a source of follow-up care directed by an advanced practice
registered nurse. Services covered as follow-up care shall include
physical assessment of the mother and newborn, parent education,
assistance and training in breast or bottle feeding, assessment of
the home support system, performance of any medically necessary and
appropriate clinical tests, and any other services that are
consistent with the follow-up care recommended in the protocols and
guidelines developed by national organizations that represent
pediatric, obstetric, and nursing professionals. The coverage shall
apply to services provided in a medical setting or through home
health care visits. The coverage shall apply to a home health care
visit only if the health care professional who conducts the visit is
knowledgeable and experienced in maternity and newborn care.

When
a decision is made in accordance with division (B) of this section to
discharge a mother or newborn prior to the expiration of the
applicable number of hours of inpatient care required to be covered,
the coverage of follow-up care shall apply to all follow-up care that
is provided within seventy-two hours after discharge. When a mother
or newborn receives at least the number of hours of inpatient care
required to be covered, the coverage of follow-up care shall apply to
follow-up care that is determined to be medically necessary by the
health care professionals responsible for discharging the mother or
newborn.

(B)
Any decision to shorten the length of inpatient stay to less than
that specified under division (A)(1) of this section shall be made by
the physician attending the mother or newborn, except that if a
certified nurse-midwife is attending the mother

in collaboration with a physician
,
the decision may be made by the certified nurse-midwife.
Decisions

If
the certified nurse-midwife is practicing under a standard care
arrangement with one or more collaborating practitioners, as provided
in Chapter 4723. of the Revised Code, the nurse's decision shall be
made in collaboration with a collaborating practitioner. Decisions

regarding
early discharge shall be made only after conferring with the mother
or a person responsible for the mother or newborn. For purposes of
this division, a person responsible for the mother or newborn may
include a parent, guardian, or any other person with authority to
make medical decisions for the mother or newborn.

(C)(1)
No sickness and accident insurer may do either of the following:

(a)
Terminate the participation of a health care professional or health
care facility as a provider under a sickness and accident insurance
policy solely for making recommendations for inpatient or follow-up
care for a particular mother or newborn that are consistent with the
care required to be covered by this section;

(b)
Establish or offer monetary or other financial incentives for the
purpose of encouraging a person to decline the inpatient or follow-up
care required to be covered by this section.

(2)
Whoever violates division (C)(1)(a) or (b) of this section has
engaged in an unfair and deceptive act or practice in the business of
insurance under sections 3901.19 to 3901.26 of the Revised Code.

(D)
This section does not do any of the following:

(1)
Require a policy to cover inpatient or follow-up care that is not
received in accordance with the policy's terms pertaining to the
health care professionals and facilities from which an individual is
authorized to receive health care services;

(2)
Require a mother or newborn to stay in a hospital or other inpatient
setting for a fixed period of time following delivery;

(3)
Require a child to be delivered in a hospital or other inpatient
setting;

(4)
Authorize a certified nurse-midwife to practice beyond the authority
to practice nurse-midwifery in accordance with Chapter 4723. of the
Revised Code;

(5)
Establish minimum standards of medical diagnosis, care or treatment
for inpatient or follow-up care for a mother or newborn. A deviation
from the care required to be covered under this section shall not,
solely on the basis of this section, give rise to a medical claim or
derivative medical claim, as those terms are defined in section
2305.113 of the Revised Code.

Sec.
3923.64.
(A)
Notwithstanding section 3901.71 of the Revised Code, each public
employee benefit plan established or modified in this state that
provides maternity benefits shall provide coverage of inpatient care
and follow-up care for a mother and her newborn as follows:

(1)
The plan shall cover a minimum of forty-eight hours of inpatient care
following a normal vaginal delivery and a minimum of ninety-six hours
of inpatient care following a cesarean delivery. Services covered as
inpatient care shall include medical, educational, and any other
services that are consistent with the inpatient care recommended in
the protocols and guidelines developed by national organizations that
represent pediatric, obstetric, and nursing professionals.

(2)
The plan shall cover a physician-directed source of follow-up care or
a source of follow-up care directed by an advanced practice
registered nurse. Services covered as follow-up care shall include
physical assessment of the mother and newborn, parent education,
assistance and training in breast or bottle feeding, assessment of
the home support system, performance of any medically necessary and
appropriate clinical tests, and any other services that are
consistent with the follow-up care recommended in the protocols and
guidelines developed by national organizations that represent
pediatric, obstetric, and nursing professionals. The coverage shall
apply to services provided in a medical setting or through home
health care visits. The coverage shall apply to a home health care
visit only if the health care professional who conducts the visit is
knowledgeable and experienced in maternity and newborn care.

When
a decision is made in accordance with division (B) of this section to
discharge a mother or newborn prior to the expiration of the
applicable number of hours of inpatient care required to be covered,
the coverage of follow-up care shall apply to all follow-up care that
is provided within seventy-two hours after discharge. When a mother
or newborn receives at least the number of hours of inpatient care
required to be covered, the coverage of follow-up care shall apply to
follow-up care that is determined to be medically necessary by the
health care professionals responsible for discharging the mother or
newborn.

(B)
Any decision to shorten the length of inpatient stay to less than
that specified under division (A)(1) of this section shall be made by
the physician attending the mother or newborn, except that if a
certified nurse-midwife is attending the mother

in collaboration with a physician
,
the decision may be made by the certified nurse-midwife.
Decisions

If
the certified nurse-midwife is practicing under a standard care
arrangement with one or more collaborating practitioners, as provided
in Chapter 4723. of the Revised Code, the nurse's decision shall be
made in collaboration with a collaborating practitioner. Decisions

regarding
early discharge shall be made only after conferring with the mother
or a person responsible for the mother or newborn. For purposes of
this division, a person responsible for the mother or newborn may
include a parent, guardian, or any other person with authority to
make medical decisions for the mother or newborn.

(C)(1)
No public employer who offers an employee benefit plan may do either
of the following:

(a)
Terminate the participation of a health care professional or health
care facility as a provider under the plan solely for making
recommendations for inpatient or follow-up care for a particular
mother or newborn that are consistent with the care required to be
covered by this section;

(b)
Establish or offer monetary or other financial incentives for the
purpose of encouraging a person to decline the inpatient or follow-up
care required to be covered by this section.

(2)
Whoever violates division (C)(1)(a) or (b) of this section has
engaged in an unfair and deceptive act or practice in the business of
insurance under sections 3901.19 to 3901.26 of the Revised Code.

(D)
This section does not do any of the following:

(1)
Require a plan to cover inpatient or follow-up care that is not
received in accordance with the plan's terms pertaining to the health
care professionals and facilities from which an individual is
authorized to receive health care services;

(2)
Require a mother or newborn to stay in a hospital or other inpatient
setting for a fixed period of time following delivery;

(3)
Require a child to be delivered in a hospital or other inpatient
setting;

(4)
Authorize a certified nurse-midwife to practice beyond the authority
to practice nurse-midwifery in accordance with Chapter 4723. of the
Revised Code;

(5)
Establish minimum standards of medical diagnosis, care, or treatment
for inpatient or follow-up care for a mother or newborn. A deviation
from the care required to be covered under this section shall not,
solely on the basis of this section, give rise to a medical claim or
derivative medical claim, as those terms are defined in section
2305.113 of the Revised Code.

Sec.
4723.01.
As
used in this chapter:

(A)
"Registered nurse" means an individual who holds a current,
valid license issued under this chapter that authorizes the practice
of nursing as a registered nurse.

(B)
"Practice of nursing as a registered nurse" means providing
to individuals and groups nursing care requiring specialized
knowledge, judgment, and skill derived from the principles of
biological, physical, behavioral, social, and nursing sciences. Such
nursing care includes:

(1)
Identifying patterns of human responses to actual or potential health
problems amenable to a nursing regimen;

(2)
Executing a nursing regimen through the selection, performance,
management, and evaluation of nursing actions;

(3)
Assessing health status for the purpose of providing nursing care;

(4)
Providing health counseling and health teaching;

(5)
Administering medications, treatments, and executing regimens
authorized by an individual who is authorized to practice in this
state and is acting within the course of the individual's
professional practice;

(6)
Teaching, administering, supervising, delegating, and evaluating
nursing practice.

(C)
"Nursing regimen" may include preventative, restorative,
and health-promotion activities.

(D)
"Assessing health status" means the collection of data
through nursing assessment techniques, which may include interviews,
observation, and physical evaluations for the purpose of providing
nursing care.

(E)
"Licensed practical nurse" means an individual who holds a
current, valid license issued under this chapter that authorizes the
practice of nursing as a licensed practical nurse.

(F)
"The practice of nursing as a licensed practical nurse"
means providing to individuals and groups nursing care requiring the
application of basic knowledge of the biological, physical,
behavioral, social, and nursing sciences at the direction of a
registered nurse or any of the following who is authorized to
practice in this state: a physician, physician assistant, dentist,
podiatrist, optometrist, or chiropractor. Such nursing care includes:

(1)
Observation, patient teaching, and care in a diversity of health care
settings;

(2)
Contributions to the planning, implementation, and evaluation of
nursing;

(3)
Administration of medications and treatments authorized by an
individual who is authorized to practice in this state and is acting
within the course of the individual's professional practice;

(4)
Administration to an adult of intravenous therapy authorized by an
individual who is authorized to practice in this state and is acting
within the course of the individual's professional practice, on the
condition that the licensed practical nurse is authorized under
section 4723.18 or 4723.181 of the Revised Code to perform
intravenous therapy and performs intravenous therapy only in
accordance with those sections;

(5)
Delegation of nursing tasks as directed by a registered nurse;

(6)
Teaching nursing tasks to licensed practical nurses and individuals
to whom the licensed practical nurse is authorized to delegate
nursing tasks as directed by a registered nurse.

(G)
"Certified registered nurse anesthetist" means an advanced
practice registered nurse who holds a current, valid license issued
under this chapter and is designated as a certified registered nurse
anesthetist in accordance with section 4723.42 of the Revised Code
and rules adopted by the board of nursing.

(H)
"Clinical nurse specialist" means an advanced practice
registered nurse who holds a current, valid license issued under this
chapter and is designated as a clinical nurse specialist in
accordance with section 4723.42 of the Revised Code and rules adopted
by the board of nursing.

(I)
"Certified nurse-midwife" means an advanced practice
registered nurse who holds a current, valid license issued under this
chapter and is designated as a certified nurse-midwife in accordance
with section 4723.42 of the Revised Code and rules adopted by the
board of nursing.

(J)
"Certified nurse practitioner" means an advanced practice
registered nurse who holds a current, valid license issued under this
chapter and is designated as a certified nurse practitioner in
accordance with section 4723.42 of the Revised Code and rules adopted
by the board of nursing.

(K)
"Physician" means an individual authorized under Chapter
4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery.

(L)
"Collaboration" or "collaborating" means
the
following:

(1)
In the case of a clinical nurse specialist or a certified nurse
practitioner,
that
one or more
podiatrists
acting within the scope of practice of podiatry in accordance with
section 4731.51 of the Revised Code and with whom the nurse has
entered into a standard care arrangement or one or more physicians
with whom the nurse has entered into a standard care arrangement

collaborating
practitioners
are
continuously available to communicate with the clinical nurse
specialist
,
certified nurse-midwife,

or certified nurse practitioner either in person or by electronic
communication
;

(2)
In the case of a certified nurse-midwife, that one or more physicians
with whom the certified nurse-midwife has entered into a standard
care arrangement are continuously available to communicate with the
certified nurse-midwife either in person or by electronic
communication
.

(M)

"Collaborating
practitioner" means any of the following who is collaborating
under a standard care arrangement with a clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner:

(1)
A physician;

(2)
A podiatrist;

(3)
A clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner who is not practicing under a standard care
arrangement with another collaborating practitioner.

(N)

"Supervision,"
as it pertains to a certified registered nurse anesthetist, means
that the certified registered nurse anesthetist is under the
direction of a podiatrist acting within the podiatrist's scope of
practice in accordance with section 4731.51 of the Revised Code, a
dentist acting within the dentist's scope of practice in accordance
with Chapter 4715. of the Revised Code, or a physician, and, when
administering anesthesia, the certified registered nurse anesthetist
is in the immediate presence of the podiatrist, dentist, or
physician.

(N)
(O)

"Standard care arrangement" means a written, formal guide
for planning and evaluating a patient's health care that
meets
the requirements of section 4723.431 of the Revised Code and
is
developed by one or more collaborating
physicians
or podiatrists
practitioners

and

a

the

clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner
and
meets the requirements of section 4723.431 of the Revised Code
who
will practice under the arrangement
.

(O)
(P)

"Advanced practice registered nurse" means an individual
who holds a current, valid license issued under this chapter that
authorizes the practice of nursing as an advanced practice registered
nurse and is designated as any of the following:

(1)
A certified registered nurse anesthetist;

(2)
A clinical nurse specialist;

(3)
A certified nurse-midwife;

(4)
A certified nurse practitioner.

(P)
(Q)

"Practice of nursing as an advanced practice registered nurse"
means providing to individuals and groups nursing care that requires
knowledge and skill obtained from advanced formal education,

continuing
education,
training,
and clinical experience. Such nursing care includes the care
described in section 4723.43 of the Revised Code.

(Q)
(R)

"Dialysis care" means the care and procedures that a
dialysis technician or dialysis technician intern is authorized to
provide and perform, as specified in section 4723.72 of the Revised
Code.

(R)
(S)

"Dialysis technician" means an individual who holds a
current, valid certificate to practice as a dialysis technician
issued under section 4723.75 of the Revised Code.

(S)
(T)

"Dialysis technician intern" means an individual who has
not passed the dialysis technician certification examination required
by section 4723.751 of the Revised Code, but who has successfully
completed a dialysis training program approved by the board of
nursing under section 4723.74 of the Revised Code within the previous
eighteen months.

(T)
(U)

"Certified community health worker" means an individual who
holds a current, valid certificate as a community health worker
issued under section 4723.85 of the Revised Code.

(U)
(V)

"Medication aide" means an individual who holds a current,
valid certificate issued under this chapter that authorizes the
individual to administer medication in accordance with section
4723.67 of the Revised Code;

(V)
(W)

"
Nursing
specialty
Designation
"
means
a
specialty in practice
designation

as
a certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner.

(W)
(X)

"Physician assistant" means an individual who is licensed
to practice as a physician assistant under Chapter 4730. of the
Revised Code.

Sec.
4723.02.
The
board of nursing shall assume and exercise all the powers and perform
all the duties conferred and imposed on it by this chapter.

The
board shall consist of thirteen members who shall be citizens of the
United States and residents of Ohio. Eight members shall be
registered nurses, each of whom shall be a graduate of an approved
program of nursing education that prepares persons for licensure as a
registered nurse, shall hold a currently active license issued under
this chapter to practice nursing as a registered nurse, and shall
have been actively engaged in the practice of nursing as a registered
nurse for the five years immediately preceding the member's initial
appointment to the board. Of the eight members who are registered
nurses, at least two shall hold a current, valid license issued under
this chapter that authorizes the practice of nursing as an advanced
practice registered nurse. Four members shall be licensed practical
nurses, each of whom shall be a graduate of an approved program of
nursing education that prepares persons for licensure as a practical
nurse, shall hold a currently active license issued under this
chapter to practice nursing as a licensed practical nurse, and shall
have been actively engaged in the practice of nursing as a licensed
practical nurse for the five years immediately preceding the member's
initial appointment to the board. One member shall represent the
interests of consumers of health care. Neither this member nor any
person in the member's immediate family shall be a member of or
associated with a health care provider or profession or shall have a
financial interest in the delivery or financing of health care.
Representation of nursing service and nursing education and of the
various geographical areas of the state shall be considered in making
appointments.

As
the term of any member of the board expires, a successor shall be
appointed who has the qualifications the vacancy requires. Terms of
office shall be for four years, commencing on the first day of
January and ending on the thirty-first day of December.

A
current or former board member who has served not more than one full
term or one full term and not more than thirty months of another term
may be reappointed for one additional term.

Each
member shall hold office from the date of appointment until the end
of the term for which the member was appointed. The term of a member
shall expire if the member ceases to meet any requirement of this
section for the member's position on the board. Any member appointed
to fill a vacancy occurring prior to the expiration of the term for
which the member's predecessor was appointed shall hold office for
the remainder of such term. Any member shall continue in office
subsequent to the expiration date of the member's term until the
member's successor takes office, or until a period of sixty days has
elapsed, whichever occurs first.

Nursing
organizations of this state may each submit to the governor the names
of not more than five nominees for each position to be filled on the
board. From the names so submitted or from others, at the governor's
discretion, the governor with the advice and consent of the senate
shall make such appointments.

Any
member of the board may be removed by the governor for neglect of any
duty required by law or for incompetency or unprofessional or
dishonorable conduct, after a hearing as provided in Chapter 119. of
the Revised Code.

Seven
members of the board
including

constitute
a quorum, which shall include
at
least four registered nurses
,
one of whom is an advanced practice registered nurse,

and at least one licensed practical nurse

shall at all times constitute a quorum
.

Each
member of the board shall receive an amount fixed pursuant to
division (J) of section 124.15 of the Revised Code for each day in
attendance at board meetings and in discharge of official duties, and
in addition thereto, necessary expense incurred in the performance of
such duties.

The
board shall elect one of its nurse members as president and one as
vice-president. The board shall elect one of its registered nurse
members to serve as the supervising member for disciplinary matters.

The
board may establish advisory groups to serve in consultation with the
board or the executive director. Each advisory group shall be given a
specific charge in writing and shall report to the board. Members of
advisory groups shall serve without compensation but shall receive
their actual and necessary expenses incurred in the performance of
their official duties.

Sec.
4723.06.
(A)
The board of nursing shall:

(1)
Administer and enforce the provisions of this chapter, including the
taking of disciplinary action for violations of section 4723.28 of
the Revised Code, any other provisions of this chapter, or rules
adopted under this chapter;

(2)
Develop criteria that an applicant must meet to be eligible to sit
for the examination for licensure to practice as a registered nurse
or as a licensed practical nurse;

(3)
Issue and renew nursing licenses, dialysis technician certificates,
and community health worker certificates, as provided in this
chapter;

(4)
Define the minimum educational standards for the schools and programs
of registered nursing and practical nursing in this state;

(5)
Survey, inspect, and grant full approval to prelicensure nursing
education programs in this state that meet the standards established
by rules adopted under section 4723.07 of the Revised Code.
Prelicensure nursing education programs include, but are not limited
to, diploma, associate degree, baccalaureate degree, master's degree,
and doctor of nursing programs leading to initial licensure to
practice nursing as a registered nurse and practical nurse programs
leading to initial licensure to practice nursing as a licensed
practical nurse.

(6)
Grant conditional approval, by a vote of a quorum of the board, to a
new prelicensure nursing education program or a program that is being
reestablished after having ceased to operate, if the program meets
and maintains the minimum standards of the board established by rules
adopted under section 4723.07 of the Revised Code. If the board does
not grant conditional approval, it shall hold an adjudication under
Chapter 119. of the Revised Code to consider conditional approval of
the program. If the board grants conditional approval, at the first
meeting following completion of the survey process required by
division (A)(5) of this section, the board shall determine whether to
grant full approval to the program. If the board does not grant full
approval or if it appears that the program has failed to meet and
maintain standards established by rules adopted under section 4723.07
of the Revised Code, the board shall hold an adjudication under
Chapter 119. of the Revised Code to consider the program. Based on
results of the adjudication, the board may continue or withdraw
conditional approval, or grant full approval.

(7)
Place on provisional approval, for a period of time specified by the
board, a prelicensure nursing education program that has ceased to
meet and maintain the minimum standards of the board established by
rules adopted under section 4723.07 of the Revised Code. Prior to or
at the end of the period, the board shall reconsider whether the
program meets the standards and shall grant full approval if it does.
If it does not, the board may withdraw approval, pursuant to an
adjudication under Chapter 119. of the Revised Code.

(8)
Approve continuing education programs and courses under standards
established in rules adopted under sections 4723.07, 4723.69,
4723.79, and 4723.88 of the Revised Code;

(9)
Establish the safe haven program in accordance with sections 4723.35
and 4723.351 of the Revised Code;

(10)
Establish the practice intervention and improvement program in
accordance with section 4723.282 of the Revised Code;

(11)
Grant approval to the course of study in advanced pharmacology and
related topics described in section 4723.482 of the Revised Code;

(12)
Make an annual edition of the exclusionary formulary established in
rules adopted under section 4723.50 of the Revised Code available to
the public by electronic means and, as soon as possible after any
revision of the formulary becomes effective, make the revision
available to the public by electronic means;

(13)
Approve under section 4723.46 of the Revised Code national certifying
organizations for examination and licensure of advanced practice
registered nurses, which may include separate organizations for each
nursing
specialty
designation
;

(14)
Provide guidance and make recommendations to the general assembly,
the governor, state agencies, and the federal government with respect
to the regulation of the practice of nursing and the enforcement of
this chapter;

(15)
Make an annual report to the governor, which shall be open for public
inspection;

(16)
Maintain and have open for public inspection the following records:

(a)
A record of all its meetings and proceedings;

(b)
A record of all applicants for, and holders of, licenses and
certificates issued by the board under this chapter or in accordance
with rules adopted under this chapter. The record shall be maintained
in a format determined by the board.

(c)
A list of education and training programs approved by the board.

(17)
Deny conditional approval to a new prelicensure nursing education
program or a program that is being reestablished after having ceased
to operate if the program or a person acting on behalf of the program
submits or causes to be submitted to the board false, misleading, or
deceptive statements, information, or documentation in the process of
applying for approval of the program. If the board proposes to deny
approval of the program, it shall do so pursuant to an adjudication
conducted under Chapter 119. of the Revised Code.

(B)
The board may fulfill the requirement of division (A)(8) of this
section by authorizing persons who meet the standards established in
rules adopted under section 4723.07 of the Revised Code to approve
continuing education programs and courses. Persons so authorized
shall approve continuing education programs and courses in accordance
with standards established in rules adopted under section 4723.07 of
the Revised Code.

Persons
seeking authorization to approve continuing education programs and
courses shall apply to the board and pay the appropriate fee
established under section 4723.08 of the Revised Code. Authorizations
to approve continuing education programs and courses shall expire and
may be renewed according to the schedule established in rules adopted
under section 4723.07 of the Revised Code.

In
addition to approving continuing education programs under division
(A)(8) of this section, the board may sponsor continuing education
activities that are directly related to the statutes and rules the
board enforces.

(C)(1)
The board may deny conditional approval to a new prelicensure nursing
education program or program that is being reestablished after having
ceased to operate if the program is controlled by a person who
controls or has controlled a program that had its approval withdrawn,
revoked, suspended, or restricted by the board or a board of another
jurisdiction that is a member of the national council of state boards
of nursing. If the board proposes to deny approval, it shall do so
pursuant to an adjudication conducted under Chapter 119. of the
Revised Code.

(2)
As used in this division, "control" means any of the
following:

(a)
Holding fifty per cent or more of the outstanding voting securities
or membership interest of a prelicensure nursing education program;

(b)
In the case of an unincorporated prelicensure nursing education
program, having the right to fifty per cent or more of the program's
profits or in the event of a dissolution, fifty per cent or more of
the program's assets;

(c)
In the case of a prelicensure nursing education program that is a
for-profit or not-for-profit corporation, having the contractual
authority presently to designate fifty per cent or more of its
directors;

(d)
In the case of a prelicensure nursing education program that is a
trust, having the contractual authority presently to designate fifty
per cent or more of its trustees;

(e)
Having the authority to direct the management, policies, or
investments of a prelicensure nursing education program.

(D)(1)
When an action taken by the board under division (A)(6), (7), or (17)
or (C)(1) of this section is required to be taken pursuant to an
adjudication conducted under Chapter 119. of the Revised Code, the
board may, in lieu of an adjudication hearing, enter into a consent
agreement to resolve the matter. A consent agreement, when ratified
by a vote of a quorum of the board, constitutes the findings and
order of the board with respect to the matter addressed in the
agreement. If the board refuses to ratify a consent agreement, the
admissions and findings contained in the agreement are of no effect.

(2)
In any instance in which the board is required under Chapter 119. of
the Revised Code to give notice to a person seeking approval of a
prelicensure nursing education program of an opportunity for a
hearing and the person does not make a timely request for a hearing
in accordance with section 119.07 of the Revised Code, the board is
not required to hold a hearing, but may adopt, by a vote of a quorum,
a final order that contains the board's findings.

(3)
When the board denies or withdraws approval of a prelicensure nursing
education program, the board may specify that its action is
permanent. A program subject to a permanent action taken by the board
is forever ineligible for approval and the board shall not accept an
application for the program's reinstatement or approval.

Sec.
4723.07.
In
accordance with Chapter 119. of the Revised Code, the board of
nursing shall adopt and may amend and rescind rules that establish
all of the following:

(A)
Provisions for the board's government and control of its actions and
business affairs;

(B)
Subject to section 4723.072 of the Revised Code, minimum standards
for nursing education programs that prepare graduates to be licensed
under this chapter and procedures for granting, renewing, and
withdrawing approval of those programs;

(C)
Criteria that applicants for licensure must meet to be eligible to
take examinations for licensure;

(D)
Standards and procedures for renewal of the licenses and certificates
issued by the board;

(E)
Standards for approval of continuing nursing education programs and
courses for registered nurses, advanced practice registered nurses,
and licensed practical nurses. The standards may provide for approval
of continuing nursing education programs and courses that have been
approved by other state boards of nursing or by national
accreditation systems for nursing, including, but not limited to, the
American nurses' credentialing center and the national association
for practical nurse education and service.

(F)
Standards that persons must meet to be authorized by the board to
approve continuing education programs and courses and a schedule by
which that authorization expires and may be renewed;

(G)
Requirements, including continuing education requirements, for
reactivating inactive licenses or certificates, and for reinstating
licenses or certificates that have lapsed;

(H)
Conditions that may be imposed for reinstatement of a license or
certificate following action taken under section 3123.47, 4723.28,
4723.281, 4723.652, or 4723.86 of the Revised Code resulting in a
license or certificate suspension;

(I)
Criteria for evaluating the qualifications of an applicant for a
license to practice nursing as a registered nurse, a license to
practice nursing as an advanced practice registered nurse, or a
license to practice nursing as a licensed practical nurse for the
purpose of issuing the license by the board's endorsement of the
applicant's authority to practice issued by the licensing agency of
another state;

(J)
Universal and standard precautions that shall be used by each
licensee or certificate holder. The rules shall define and establish
requirements for universal and standard precautions that include the
following:

(1)
Appropriate use of hand washing;

(2)
Disinfection and sterilization of equipment;

(3)
Handling and disposal of needles and other sharp instruments;

(4)
Wearing and disposal of gloves and other protective garments and
devices.

(K)
Quality assurance standards for advanced practice registered nurses

who have practiced in a clinical setting for less than two thousand
hours and are clinical nurse specialists, certified nurse-midwives,
or certified nurse practitioners
;

(L)

Additional

For
purposes of division (B)(5) of section 4723.431 of the Revised Code,
any other
criteria
for
the

standard
care
arrangement
required by section 4723.431 of the Revised Code entered into by a
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner and the nurse's collaborating physician or
podiatrist
arrangements
;

(M)
For purposes of division (B)(31) of section 4723.28 of the Revised
Code, the actions, omissions, or other circumstances that constitute
failure to establish and maintain professional boundaries with a
patient;

(N)
Standards and procedures for delegation under section 4723.48 of the
Revised Code of the authority to administer drugs.

The
board may adopt other rules necessary to carry out the provisions of
this chapter. The rules shall be adopted in accordance with Chapter
119. of the Revised Code.

Sec.
4723.24.
(A)(1)
Except as otherwise provided in this chapter, all of the following
apply with respect to the schedules for renewal of licenses and
certificates issued by the board of nursing:

(a)
An active license to practice nursing as a registered nurse is
subject to renewal in odd-numbered years. An application for renewal
of the license is due on the fifteenth day of September of the
renewal year. A late application may be submitted before the license
lapses. If a license is not renewed or classified as inactive, the
license lapses on the first day of November of the renewal year.

(b)
An active license to practice nursing as a licensed practical nurse
is subject to renewal in even-numbered years. An application for
renewal of the license is due on the fifteenth day of September of
the renewal year. A late application may be submitted before the
license lapses. If a license is not renewed or classified as
inactive, the license lapses on the first day of November of the
renewal year.

(c)
An active license to practice nursing as an advanced practice
registered nurse is subject to renewal in odd-numbered years. An
application for renewal of the license is due on the fifteenth day of
September of the renewal year. A late application may be submitted
before the license lapses. If a license is not renewed or classified
as inactive, the license lapses on the first day of November of the
renewal year.

(d)
All other active licenses and certificates issued under this chapter
are subject to renewal according to a schedule established by the
board in rules adopted under section 4723.07 of the Revised Code.

(2)
The board shall provide an application for renewal to every holder of
an active license or certificate, except when the board is aware that
an individual is ineligible for license or certificate renewal for
any reason, including pending criminal charges in this state or
another jurisdiction, failure to comply with a disciplinary order
from the board or the terms of a consent agreement entered into with
the board, failure to pay fines or fees owed to the board, or failure
to provide on the board's request documentation of having completed
the continuing nursing education requirements specified in division
(C) of this section.

If
the board provides a renewal application by mail, the application
shall be addressed to the last known post-office address of the
license or certificate holder and mailed before the date the
application is due. Failure of the license or certificate holder to
receive an application for renewal from the board shall not excuse
the holder from the requirements contained in this section, except as
provided in section 5903.10 of the Revised Code.

(3)
A license or certificate holder seeking renewal of the license or
certificate shall complete the renewal application and submit it to
the board with the renewal fee established under section 4723.08 of
the Revised Code. If a renewal application is submitted after the
date the application is due, but before the date the license or
certificate lapses, the applicant shall include with the application
the fee established under section 4723.08 of the Revised Code for
processing a late application for renewal.

With
the renewal application, the applicant shall report any conviction,
plea, or judicial finding regarding a criminal offense that
constitutes grounds for the board to impose sanctions under section
4723.28 of the Revised Code since the applicant last submitted an
application to the board.

(4)
On receipt of the renewal application, the board shall verify whether
the applicant meets the renewal requirements. If the applicant meets
the requirements, the board shall renew the license or certificate.

(B)
Every license or certificate holder shall give written

or electronic

notice to the board of any change of name or address within thirty
days of the change. The board shall require the holder to document a
change of name in a manner acceptable to the board.

(C)(1)
Except in the case of a first renewal after licensure by examination,
to be eligible for renewal of an active license to practice nursing
as a registered nurse or licensed practical nurse, each individual
who holds an active license shall, in each two-year period specified
by the board, complete continuing nursing education as follows:

(a)
For renewal of a license that was issued for a two-year renewal
period, twenty-four hours of continuing nursing education;

(b)
For renewal of a license that was issued for less than a two-year
renewal period, the number of hours of continuing nursing education
specified by the board in rules adopted in accordance with Chapter
119. of the Revised Code;

(c)
Of the hours of continuing nursing education completed in any renewal
period, at least one hour of the education must be directly related
to the statutes and rules pertaining to the practice of nursing in
this state.

(2)
To be eligible for renewal of an active license to practice nursing
as an advanced practice registered nurse, each individual who holds
an active license shall, in each two-year period specified by the
board, complete continuing education as follows:

(a)
For renewal of a license that was issued for a two-year renewal
period, twenty-four hours of continuing nursing education;

(b)
For renewal of a license that was issued for less than a two-year
renewal period, the number of hours of continuing nursing education
specified by the board in rules adopted in accordance with Chapter
119. of the Revised Code, including the number of hours of continuing
education in advanced pharmacology;

(c)
In the case of an advanced practice registered nurse who is
designated as a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner, of the hours of continuing nursing
education completed in any renewal period, at least twelve hours of
the education must be in advanced pharmacology and be received from
an accredited institution recognized by the board.

(d)
The continuing education required by division (C)(2)(a) or (b) of
this section is in addition to the continuing education required by
division (C)(1)(a) or (b) of this section.

(3)
The board shall adopt rules establishing the procedure for a license
holder to certify to the board completion of the required continuing
nursing education. The board may conduct a random sample of license
holders and require that the license holders included in the sample
submit satisfactory documentation of having completed the
requirements for continuing nursing education. On the board's
request, a license holder included in the sample shall submit the
required documentation.

(4)
An educational activity may be applied toward meeting the continuing
nursing education requirement only if it is obtained through a
program or course approved by the board or a person the board has
authorized to approve continuing nursing education programs and
courses.

(5)
The continuing education required of a certified registered nurse
anesthetist, clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner to maintain certification by a national
certifying organization shall be applied toward the continuing
education requirements for renewal of the following if the continuing
education is obtained through a program or course approved by the
board or a person the board has authorized to approve continuing
nursing education programs and courses:

(a)
A license to practice nursing as a registered nurse;

(b)
A license to practice nursing as an advanced practice registered
nurse.

(D)
Except as otherwise provided in section 4723.28 of the Revised Code,
an individual who holds an active license to practice nursing as a
registered nurse or licensed practical nurse and who does not intend
to practice in Ohio may send to the board written
or
electronic
notice
to that effect on or before the date the license lapses, and the
board shall classify the license as inactive. During the period that
the license is classified as inactive, the holder may not engage in
the practice of nursing as a registered nurse or licensed practical
nurse in Ohio and is not required to pay the renewal fee.

The
holder of an inactive license to practice nursing as a registered
nurse or licensed practical nurse or an individual who has failed to
renew the individual's license to practice nursing as a registered
nurse or licensed practical nurse may have the license reactivated or
reinstated upon doing the following, as applicable to the holder or
individual:

(1)
Applying to the board for license reactivation or reinstatement on
forms provided by the board;

(2)
Meeting the requirements for reactivating or reinstating licenses
established in rules adopted under section 4723.07 of the Revised
Code or, if the individual did not renew because of service in the
armed forces of the United States or a reserve component of the armed
forces of the United States, including the Ohio national guard or the
national guard of any other state, as provided in section 5903.10 of
the Revised Code;

(3)
If the license has been inactive for at least five years from the
date of application for reactivation or has lapsed for at least five
years from the date of application for reinstatement, submitting a
request to the bureau of criminal identification and investigation
for a criminal records check and check of federal bureau of
investigation records pursuant to section 4723.091 of the Revised
Code.

(E)
Except as otherwise provided in section 4723.28 of the Revised Code,
an individual who holds an active license to practice nursing as an
advanced practice registered nurse and does not intend to practice in
Ohio as an advanced practice registered nurse may send to the board
written
or
electronic
notice
to that effect on or before the renewal date, and the board shall
classify the license as inactive. During the period that the license
is classified as inactive, the holder may not engage in the practice
of nursing as an advanced practice registered nurse in Ohio and is
not required to pay the renewal fee.

The
holder of an inactive license to practice nursing as an advanced
practice registered nurse or an individual who has failed to renew
the individual's license to practice nursing as an advanced practice
registered nurse may have the license reactivated or reinstated upon
doing the following, as applicable to the holder or individual:

(1)
Applying to the board for license reactivation or reinstatement on
forms provided by the board;

(2)
Meeting the requirements for reactivating or reinstating licenses
established in rules adopted under section 4723.07 of the Revised
Code or, if the individual did not renew because of service in the
armed forces of the United States or a reserve component of the armed
forces of the United States, including the Ohio national guard or the
national guard of any other state, as provided in section 5903.10 of
the Revised Code.

Sec.
4723.28.
(A)
The board of nursing, by a vote of a quorum, may impose one or more
of the following sanctions if it finds that a person committed fraud
in passing an examination required to obtain a license or dialysis
technician certificate issued by the board or to have committed
fraud, misrepresentation, or deception in applying for or securing
any nursing license or dialysis technician certificate issued by the
board: deny, revoke, suspend, or place restrictions on any nursing
license or dialysis technician certificate issued by the board;
reprimand or otherwise discipline a holder of a nursing license or
dialysis technician certificate; or impose a fine of not more than
five hundred dollars per violation.

(B)
Except as provided in section 4723.092 of the Revised Code, the board
of nursing, by a vote of a quorum, may impose one or more of the
following sanctions: deny, revoke, suspend, or place restrictions on
any nursing license or dialysis technician certificate issued by the
board; reprimand or otherwise discipline a holder of a nursing
license or dialysis technician certificate; or impose a fine of not
more than five hundred dollars per violation. The sanctions may be
imposed for any of the following:

(1)
Denial, revocation, suspension, or restriction of authority to engage
in a licensed profession or practice a health care occupation,
including nursing or practice as a dialysis technician, for any
reason other than a failure to renew, in Ohio or another state or
jurisdiction;

(2)
Engaging in the practice of nursing or engaging in practice as a
dialysis technician, having failed to renew a nursing license or
dialysis technician certificate issued under this chapter, or while a
nursing license or dialysis technician certificate is under
suspension;

(3)
Conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, a misdemeanor
committed in the course of practice;

(4)
Conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, any felony or
of any crime involving gross immorality or moral turpitude;

(5)
Selling, giving away, or administering drugs or therapeutic devices
for other than legal and legitimate therapeutic purposes; or
conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, violating any
municipal, state, county, or federal drug law;

(6)
Conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, an act in
another jurisdiction that would constitute a felony or a crime of
moral turpitude in Ohio;

(7)
Conviction of, a plea of guilty to, a judicial finding of guilt of, a
judicial finding of guilt resulting from a plea of no contest to, or
a judicial finding of eligibility for a pretrial diversion or similar
program or for intervention in lieu of conviction for, an act in the
course of practice in another jurisdiction that would constitute a
misdemeanor in Ohio;

(8)
Self-administering or otherwise taking into the body any dangerous
drug, as defined in section 4729.01 of the Revised Code, in any way
that is not in accordance with a legal, valid prescription issued for
that individual, or self-administering or otherwise taking into the
body any drug that is a schedule I controlled substance;

(9)
Habitual or excessive use of controlled substances, other
habit-forming drugs, or alcohol or other chemical substances to an
extent that impairs the individual's ability to provide safe nursing
care or safe dialysis care;

(10)
Impairment of the ability to practice according to acceptable and
prevailing standards of safe nursing care or safe dialysis care
because of the use of drugs, alcohol, or other chemical substances;

(11)
Impairment of the ability to practice according to acceptable and
prevailing standards of safe nursing care or safe dialysis care
because of a physical or mental disability;

(12)
Assaulting or causing harm to a patient or depriving a patient of the
means to summon assistance;

(13)
Misappropriation or attempted misappropriation of money or anything
of value in the course of practice;

(14)
Adjudication by a probate court of being mentally ill or mentally
incompetent. The board may reinstate the person's nursing license or
dialysis technician certificate upon adjudication by a probate court
of the person's restoration to competency or upon submission to the
board of other proof of competency.

(15)
The suspension or termination of employment by the United States
department of defense or department of veterans affairs for any act
that violates or would violate this chapter;

(16)
Violation of this chapter or any rules adopted under it;

(17)
Violation of any restrictions placed by the board on a nursing
license or dialysis technician certificate;

(18)
Failure to use universal and standard precautions established by
rules adopted under section 4723.07 of the Revised Code;

(19)
Failure to practice in accordance with acceptable and prevailing
standards of safe nursing care or safe dialysis care;

(20)
In the case of a registered nurse, engaging in activities that exceed
the practice of nursing as a registered nurse;

(21)
In the case of a licensed practical nurse, engaging in activities
that exceed the practice of nursing as a licensed practical nurse;

(22)
In the case of a dialysis technician, engaging in activities that
exceed those permitted under section 4723.72 of the Revised Code;

(23)
Aiding and abetting a person in that person's practice of nursing
without a license or practice as a dialysis technician without a
certificate issued under this chapter;

(24)
In the case of an advanced practice registered nurse, except as
provided in division (M) of this section, either of the following:

(a)
Waiving the payment of all or any part of a deductible or copayment
that a patient, pursuant to a health insurance or health care policy,
contract, or plan that covers such nursing services, would otherwise
be required to pay if the waiver is used as an enticement to a
patient or group of patients to receive health care services from
that provider;

(b)
Advertising that the nurse will waive the payment of all or any part
of a deductible or copayment that a patient, pursuant to a health
insurance or health care policy, contract, or plan that covers such
nursing services, would otherwise be required to pay.

(25)
Failure to comply with the terms and conditions of participation in
the safe haven program conducted under sections 4723.35 and 4723.351
of the Revised Code;

(26)
Failure to comply with the terms and conditions required under the
practice intervention and improvement program established under
section 4723.282 of the Revised Code;

(27)
In the case of an advanced practice registered nurse:

(a)
Engaging in activities that exceed those permitted
for
the nurse's nursing specialty
under
section 4723.43 of the Revised Code

for the nurse's designation
;

(b)
Failure to meet the quality assurance standards established under
section 4723.07 of the Revised Code

that apply to the nurse as a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner who has practiced in a
clinical setting for less than two thousand hours
.

(28)
In the case of an advanced practice registered nurse
other
than a certified registered nurse anesthetist
who
is required or chooses to practice under a standard care arrangement,
as provided in section 4723.43 of the Revised Code
,
failure to maintain a standard care arrangement in accordance with
section 4723.431 of the Revised Code or to practice in accordance
with the standard care arrangement;

(29)
In the case of an advanced practice registered nurse who is
designated as a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner, failure to prescribe drugs and
therapeutic devices in accordance with section 4723.481 of the
Revised Code;

(30)
Prescribing any drug or device to perform or induce an abortion, or
otherwise performing or inducing an abortion;

(31)
Failure to establish and maintain professional boundaries with a
patient, as specified in rules adopted under section 4723.07 of the
Revised Code;

(32)
Regardless of whether the contact or verbal behavior is consensual,
engaging with a patient other than the spouse of the registered
nurse, licensed practical nurse, or dialysis technician in any of the
following:

(a)
Sexual contact, as defined in section 2907.01 of the Revised Code;

(b)
Verbal behavior that is sexually demeaning to the patient or may be
reasonably interpreted by the patient as sexually demeaning.

(33)
Assisting suicide, as defined in section 3795.01 of the Revised Code;

(34)
Failure to comply with the requirements in section 3719.061 of the
Revised Code before issuing for a minor a prescription for an opioid
analgesic, as defined in section 3719.01 of the Revised Code;

(35)
Failure to comply with section 4723.487 of the Revised Code, unless
the state board of pharmacy no longer maintains a drug database
pursuant to section 4729.75 of the Revised Code;

(36)
The revocation, suspension, restriction, reduction, or termination of
clinical privileges by the United States department of defense or
department of veterans affairs or the termination or suspension of a
certificate of registration to prescribe drugs by the drug
enforcement administration of the United States department of
justice;

(37)
In the case of an advanced practice registered nurse who is
designated as a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner, failure to comply with the terms of
a consult agreement entered into with a pharmacist pursuant to
section 4729.39 of the Revised Code;

(38)
Violation of section 4723.93 of the Revised Code
;

(39)
In the case of a collaborating practitioner who is a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner,
failure to enter into a standard care arrangement with the clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner with whom the nurse will collaborate or failure to
fulfill the responsibilities of collaboration after entering into the
standard care arrangement
.

(C)
Disciplinary actions taken by the board under divisions (A) and (B)
of this section shall be taken pursuant to an adjudication conducted
under Chapter 119. of the Revised Code, except that in lieu of a
hearing, the board may enter into a consent agreement with an
individual to resolve an allegation of a violation of this chapter or
any rule adopted under it. A consent agreement, when ratified by a
vote of a quorum, shall constitute the findings and order of the
board with respect to the matter addressed in the agreement. If the
board refuses to ratify a consent agreement, the admissions and
findings contained in the agreement shall be of no effect.

(D)
The hearings of the board shall be conducted in accordance with
Chapter 119. of the Revised Code, the board may appoint a hearing
examiner, as provided in section 119.09 of the Revised Code, to
conduct any hearing the board is authorized to hold under Chapter
119. of the Revised Code.

In
any instance in which the board is required under Chapter 119. of the
Revised Code to give notice of an opportunity for a hearing and the
applicant, licensee, or certificate holder does not make a timely
request for a hearing in accordance with section 119.07 of the
Revised Code, the board is not required to hold a hearing, but may
adopt, by a vote of a quorum, a final order that contains the board's
findings. In the final order, the board may order any of the
sanctions listed in division (A) or (B) of this section.

(E)
If a criminal action is brought against a registered nurse, licensed
practical nurse, or dialysis technician for an act or crime described
in divisions (B)(3) to (7) of this section and the action is
dismissed by the trial court other than on the merits, the board
shall conduct an adjudication to determine whether the registered
nurse, licensed practical nurse, or dialysis technician committed the
act on which the action was based. If the board determines on the
basis of the adjudication that the registered nurse, licensed
practical nurse, or dialysis technician committed the act, or if the
registered nurse, licensed practical nurse, or dialysis technician
fails to participate in the adjudication, the board may take action
as though the registered nurse, licensed practical nurse, or dialysis
technician had been convicted of the act.

If
the board takes action on the basis of a conviction, plea, or a
judicial finding as described in divisions (B)(3) to (7) of this
section that is overturned on appeal, the registered nurse, licensed
practical nurse, or dialysis technician may, on exhaustion of the
appeal process, petition the board for reconsideration of its action.
On receipt of the petition and supporting court documents, the board
shall temporarily rescind its action. If the board determines that
the decision on appeal was a decision on the merits, it shall
permanently rescind its action. If the board determines that the
decision on appeal was not a decision on the merits, it shall conduct
an adjudication to determine whether the registered nurse, licensed
practical nurse, or dialysis technician committed the act on which
the original conviction, plea, or judicial finding was based. If the
board determines on the basis of the adjudication that the registered
nurse, licensed practical nurse, or dialysis technician committed
such act, or if the registered nurse, licensed practical nurse, or
dialysis technician does not request an adjudication, the board shall
reinstate its action; otherwise, the board shall permanently rescind
its action.

Notwithstanding
the provision of division (D)(2) of section 2953.32 or division
(F)(1) of section 2953.39 of the Revised Code specifying that if
records pertaining to a criminal case are sealed or expunged under
that section the proceedings in the case shall be deemed not to have
occurred, sealing or expungement of the following records on which
the board has based an action under this section shall have no effect
on the board's action or any sanction imposed by the board under this
section: records of any conviction, guilty plea, judicial finding of
guilt resulting from a plea of no contest, or a judicial finding of
eligibility for a pretrial diversion program or intervention in lieu
of conviction.

The
board shall not be required to seal, destroy, redact, or otherwise
modify its records to reflect the court's sealing or expungement of
conviction records.

(F)
The board may investigate an individual's criminal background in
performing its duties under this section. As part of such
investigation, the board may order the individual to submit, at the
individual's expense, a request to the bureau of criminal
identification and investigation for a criminal records check and
check of federal bureau of investigation records in accordance with
the procedure described in section 4723.091 of the Revised Code.

(G)
During the course of an investigation conducted under this section,
the board may compel any registered nurse, licensed practical nurse,
or dialysis technician or applicant under this chapter to submit to a
mental or physical examination, or both, as required by the board and
at the expense of the individual, if the board finds reason to
believe that the individual under investigation may have a physical
or mental impairment that may affect the individual's ability to
provide safe nursing care.

The
board shall not compel an individual who has been referred to the
safe haven program as described in sections 4723.35 and 4723.351 of
the Revised Code to submit to a mental or physical examination.

Failure
of any individual to submit to a mental or physical examination when
directed constitutes an admission of the allegations, unless the
failure is due to circumstances beyond the individual's control, and
a default and final order may be entered without the taking of
testimony or presentation of evidence.

If
the board finds that an individual is impaired, the board shall
require the individual to submit to care, counseling, or treatment
approved or designated by the board, as a condition for initial,
continued, reinstated, or renewed authority to practice. The
individual shall be afforded an opportunity to demonstrate to the
board that the individual can begin or resume the individual's
occupation in compliance with acceptable and prevailing standards of
care under the provisions of the individual's authority to practice.

For
purposes of this division, any registered nurse, licensed practical
nurse, or dialysis technician or applicant under this chapter shall
be deemed to have given consent to submit to a mental or physical
examination when directed to do so in writing by the board, and to
have waived all objections to the admissibility of testimony or
examination reports that constitute a privileged communication.

(H)
The board shall investigate evidence that appears to show that any
person has violated any provision of this chapter or any rule of the
board. Any person may report to the board any information the person
may have that appears to show a violation of any provision of this
chapter or rule of the board. In the absence of bad faith, any person
who reports such information or who testifies before the board in any
adjudication conducted under Chapter 119. of the Revised Code shall
not be liable for civil damages as a result of the report or
testimony.

(I)
All of the following apply under this chapter with respect to the
confidentiality of information:

(1)
Information received by the board pursuant to a complaint or an
investigation is confidential and not subject to discovery in any
civil action, except that the board may disclose information to law
enforcement officers and government entities for purposes of an
investigation of either a licensed health care professional,
including a registered nurse, licensed practical nurse, or dialysis
technician, or a person who may have engaged in the unauthorized
practice of nursing or dialysis care. No law enforcement officer or
government entity with knowledge of any information disclosed by the
board pursuant to this division shall divulge the information to any
other person or government entity except for the purpose of a
government investigation, a prosecution, or an adjudication by a
court or government entity.

(2)
If an investigation requires a review of patient records, the
investigation and proceeding shall be conducted in such a manner as
to protect patient confidentiality.

(3)
All adjudications and investigations of the board shall be considered
civil actions for the purposes of section 2305.252 of the Revised
Code.

(4)
Any board activity that involves continued monitoring of an
individual as part of or following any disciplinary action taken
under this section shall be conducted in a manner that maintains the
individual's confidentiality. Information received or maintained by
the board with respect to the board's monitoring activities is not
subject to discovery in any civil action and is confidential, except
that the board may disclose information to law enforcement officers
and government entities for purposes of an investigation of a
licensee or certificate holder.

(J)
Any action taken by the board under this section resulting in a
suspension from practice shall be accompanied by a written statement
of the conditions under which the person may be reinstated to
practice.

(K)
When the board refuses to grant a license or certificate to an
applicant, revokes a license or certificate, or refuses to reinstate
a license or certificate, the board may specify that its action is
permanent. An individual subject to permanent action taken by the
board is forever ineligible to hold a license or certificate of the
type that was refused or revoked and the board shall not accept from
the individual an application for reinstatement of the license or
certificate or for a new license or certificate.

(L)
No unilateral surrender of a nursing license or dialysis technician
certificate issued under this chapter shall be effective unless
accepted by majority vote of the board. No application for a nursing
license or dialysis technician certificate issued under this chapter
may be withdrawn without a majority vote of the board. The board's
jurisdiction to take disciplinary action under this section is not
removed or limited when an individual has a license or certificate
classified as inactive or fails to renew a license or certificate.

(M)
Sanctions shall not be imposed under division (B)(24) of this section
against any licensee who waives deductibles and copayments as
follows:

(1)
In compliance with the health benefit plan that expressly allows such
a practice. Waiver of the deductibles or copayments shall be made
only with the full knowledge and consent of the plan purchaser,
payer, and third-party administrator. Documentation of the consent
shall be made available to the board upon request.

(2)
For professional services rendered to any other person licensed
pursuant to this chapter to the extent allowed by this chapter and
the rules of the board.

Sec.
4723.36.
(A)
A certified nurse-midwife, certified nurse practitioner, or clinical
nurse specialist may determine and pronounce an individual's death.

(B)(1)
(B)

A registered nurse who is not described in division (A) of this
section may determine and pronounce an individual's death, but only
if the individual's respiratory and circulatory functions are not
being artificially sustained and, at the time the determination and
pronouncement of death is made, the registered nurse is providing or
supervising the individual's care through a hospice care program
licensed under Chapter 3712. of the Revised Code or any other entity
that provides palliative care.

(2)
A registered
(C)
A
nurse
who determines and pronounces an individual's death under division

(B)(1)
(A)
or (B)

of this section shall
comply
with both of the following:

(a)
The nurse shall not complete any portion of the individual's death
certificate.

(b)
The nurse shall
notify
the individual's attending physician
,
certified nurse-midwife, certified nurse practitioner, or clinical
nurse specialist

of the determination and pronouncement of death in order for the
physician
,
certified nurse-midwife, certified nurse practitioner, or clinical
nurse specialist

to fulfill the physician's
,
certified nurse-midwife's, certified nurse practitioner's, or
clinical nurse specialist's

duties under section 3705.16 of the Revised Code. The nurse shall
provide the notification within a period of time that is reasonable
but not later than twenty-four hours following the determination and
pronouncement of the individual's death.

(D)
A nurse described in division (A) or (B) of this section, whether
acting under this section or any other provision of this chapter,
shall not complete the medical certification portion or any other
portion of a death certificate.

Sec.
4723.41.
(A)
Each person who
desires

is
seeking
to
practice nursing as a certified nurse-midwife and has not been
authorized to practice midwifery prior to December 1, 1967, and each
person who
desires

is
seeking
to
practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, or certified nurse practitioner
,

shall file with the board of nursing a written
or
electronic
application
for a license to practice nursing as an advanced practice registered
nurse
and

that
specifies the
designation

in
the desired specialty
being
sought
.
The application must be filed, under oath, on a form prescribed by
the board accompanied by the application fee required by section
4723.08 of the Revised Code.

Except
as provided in division (B), (C), or (D) of this section, at the time
of making application, the applicant shall meet all of the following
requirements:

(1)
Be a registered nurse;

(2)
Submit documentation satisfactory to the board that the applicant has
earned a master's or doctoral degree with a major in
a

nursing

specialty

or

in

a
related field that qualifies the applicant to sit for the
certification examination of a national certifying organization
approved by the board under section 4723.46 of the Revised Code;

(3)
Submit documentation satisfactory to the board of having passed the
certification examination of a national certifying organization
approved by the board under section 4723.46 of the Revised Code to
examine and certify, as applicable, nurse-midwives, registered nurse
anesthetists, clinical nurse specialists, or nurse practitioners;

(4)
Submit an affidavit with the application that states all of the
following:

(a)
That the applicant is the person named in the documents submitted
under this section and is the lawful possessor thereof;

(b)
The applicant's age, residence, the school at which the applicant
obtained
education
in the applicant's nursing specialty
the
required master's or doctoral degree
,
and any other facts that the board requires;

(c)
The
specialty
in which
designation
being sought by
the
applicant

seeks designation
.

(B)(1)
A certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner who is
practicing or has practiced as such in another jurisdiction other
than another state may apply for a license by endorsement to practice
nursing as an advanced practice registered nurse
and
designation as a certified registered nurse anesthetist, clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner
in
this state if the nurse meets the requirements set forth in division
(A) of this section or division (B)(2) of this section.

(2)
If an applicant who is practicing or has practiced in another
jurisdiction other than another state applies for
designation

licensure

under
division (B)(2) of this section, the application shall be submitted
to the board in the form prescribed by rules of the board and be
accompanied by the application fee required by section 4723.08 of the
Revised Code. The application shall include evidence that the
applicant meets the requirements of division (B)(2) of this section,
holds authority to practice nursing and is in good standing in
another jurisdiction other than another state granted after meeting
requirements approved by the entity of that jurisdiction that
regulates nurses, and other information required by rules of the
board of nursing.

With
respect to the educational requirements and national certification
requirements that an applicant under division (B)(2) of this section
must meet, both of the following apply:

(a)
If the applicant is a certified registered nurse anesthetist,
certified nurse-midwife, or certified nurse practitioner who, on or
before December 31, 2000, obtained certification
in
the applicant's nursing specialty with
from

a
national certifying organization listed in division (A)(3) of section
4723.41 of the Revised Code as that division existed prior to March
20, 2013, or that was at that time approved by the board under
section 4723.46 of the Revised Code, the applicant must have
maintained the certification. The applicant is not required to have
earned a master's or doctoral degree with a major in
a

nursing

specialty

or

in

a
related field that qualifies the applicant to sit for the
certification examination.

(b)
If the applicant is a clinical nurse specialist, one of the following
must apply to the applicant:

(i)
On or before December 31, 2000, the applicant obtained a master's or
doctoral degree with a major in a clinical area of nursing from an
educational institution accredited by a national or regional
accrediting organization. The applicant is not required to have
passed a certification examination.

(ii)
On or before December 31, 2000, the applicant obtained a master's or
doctoral degree in nursing or a related field and was certified as a
clinical nurse specialist by the American nurses credentialing center
or another national certifying organization that was at that time
approved by the board under section 4723.46 of the Revised Code.

(3)
The board shall grant a license to practice nursing as an advanced
practice registered nurse in accordance with Chapter 4796. of the
Revised Code to an applicant if either of the following applies:

(a)
The applicant holds a license in another state.

(b)
The applicant has satisfactory work experience, a government
certification, or a private certification as described in that
chapter as an advanced practice registered nurse in a state that does
not issue that license.

(4)
The board may grant a nonrenewable temporary permit to practice
nursing as an advanced practice registered nurse to an applicant for
licensure under division (B)(2) or (3) of this section if the board
is satisfied by the evidence that the applicant holds a valid,
unrestricted license in or equivalent authorization from another
jurisdiction. Chapter 4796. of the Revised Code does not apply to a
temporary permit issued under this division. The temporary permit
shall expire at the earlier of one hundred eighty days after issuance
or upon the issuance of a license under division (B)(2) or (3) of
this section.

(C)
An applicant
who
desires
seeking

to
practice nursing as a certified registered nurse anesthetist,
certified nurse-midwife, or certified nurse practitioner is exempt
from the educational requirements in division (A)(2) of this section
if all of the following are the case:

(1)
Before January 1, 2001, the board issued to the applicant a
certificate of authority to practice as a certified registered nurse
anesthetist, certified nurse-midwife, or certified nurse
practitioner;

(2)
The applicant submits documentation satisfactory to the board that
the applicant obtained certification
in
the applicant's nursing specialty with
from

a
national certifying organization listed in division (A)(3) of section
4723.41 of the Revised Code as that division existed prior to March
20, 2013, or that was at that time approved by the board under
section 4723.46 of the Revised Code;

(3)
The applicant submits documentation satisfactory to the board that
the applicant has maintained the certification described in division
(C)(2) of this section.

(D)
An applicant
who
desires
seeking

to
practice as a clinical nurse specialist is exempt from the
examination requirement in division (A)(3) of this section if both of
the following are the case:

(1)
Before January 1, 2001, the board issued to the applicant a
certificate of authority to practice as a clinical nurse specialist;

(2)
The applicant submits documentation satisfactory to the board that
the applicant earned either of the following:

(a)
A master's or doctoral degree with a major in a clinical area of
nursing from an educational institution accredited by a national or
regional accrediting organization;

(b)
A master's or doctoral degree in nursing or a related field and was
certified as a clinical nurse specialist by the American nurses
credentialing center or another national certifying organization that
was at that time approved by the board under section 4723.46 of the
Revised Code.

Sec.
4723.42.
(A)
If the applicant for a license to practice nursing as an advanced
practice registered nurse has met all the requirements of section
4723.41 of the Revised Code and has paid the fee required by section
4723.08 of the Revised Code, the board of nursing shall issue the
license and designate the license holder as a certified registered
nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner. The license and
designation authorize the holder to practice as an advanced practice
registered nurse
in
the specialty
as

indicated
by the designation.

The
board shall issue or deny the license not later than thirty days
after receiving all of the documents required by section 4723.41 of
the Revised Code.

If
an applicant is under investigation for a violation of this chapter,
the board shall conclude the investigation not later than ninety days
after receipt of all required documents, unless this ninety-day
period is extended by written consent of the applicant, or unless the
board determines that a substantial question of such a violation
exists and the board has notified the applicant in writing of the
reasons for the continuation of the investigation. If the board
determines that the applicant has not violated this chapter, it shall
issue a certificate not later than forty-five days after making that
determination.

(B)
A license to practice nursing as an advanced practice registered
nurse is subject to the renewal schedule that applies under section
4723.24 of the Revised Code. In providing renewal applications, the
board shall follow the procedures that apply under section 4723.24 of
the Revised Code for providing renewal applications to license
holders. Failure of the license holder to receive an application for
renewal from the board does not excuse the holder from the
requirements of section 4723.44 of the Revised Code.

A
license holder seeking renewal of the license shall complete the
renewal application and submit it to the board with all of the
following:

(1)
The renewal fee established under section 4723.08 of the Revised Code
and, if the application is submitted after it is due but before the
license lapses, the fee established under that section for processing
a late application for renewal;

(2)
Documentation satisfactory to the board that the holder has
maintained certification
in
the nursing specialty with
from

a
national certifying organization approved by the board under section
4723.46 of the Revised Code;

(3)
A list of the names and business addresses of the holder's current
collaborating
physicians
and podiatrists
practitioners
,
if the holder is a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner

and is practicing under a standard care arrangement
;

(4)
If the license holder is a clinical nurse specialist, documentation
satisfactory to the board that the holder has completed continuing
education for that
specialty

designation

as
required by rule of the board.

On
receipt of the renewal application, fees, and documents, the board
shall verify that the applicant holds a current, valid license to
practice nursing as a registered nurse in this state and a current,
valid license to practice nursing as an advanced practice registered
nurse in this state, and, if it so verifies, shall renew the license
to practice nursing as an advanced practice registered nurse.

(C)
An applicant for reinstatement of a license that has lapsed shall
submit the reinstatement fee established under section 4723.08 of the
Revised Code.

(D)
An individual who holds an active license and does not intend to
practice in this state as an advanced practice registered nurse may
send to the board written or electronic notice to that effect on or
before the date the license lapses, and the board shall classify the
license as inactive.

Sec.
4723.43.
A
certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner may provide
to individuals and groups nursing care that requires knowledge and
skill obtained from advanced formal education
,
continuing education, training,

and clinical experience. In this capacity as an advanced practice
registered nurse, a certified nurse-midwife is subject to division
(A) of this section, a certified registered nurse anesthetist is
subject to division (B) of this section, a certified nurse
practitioner is subject to division (C) of this section, and a
clinical nurse specialist is subject to division (D) of this section.

Each
advanced practice registered nurse shall practice in accordance with
rules adopted by the board of nursing and in a manner that is
consistent with the nurse's certification from a national certifying
organization approved by the board under section 4723.46 of the
Revised Code. An advanced practice registered nurse who is a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner may prescribe drugs and therapeutic devices in
accordance with section 4723.481 of the Revised Code.

In
the case of an advanced practice registered nurse who has practiced
in a clinical setting for less than two thousand hours and is a
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner, the nurse may practice only under a standard care
arrangement that meets the requirements of section 4723.431 of the
Revised Code. Thereafter, the nurse may practice without a standard
care arrangement if the requirements of section 4723.439 of the
Revised Code are met or may choose to continue practicing under a
standard care arrangement. When a nurse is required or chooses to
practice under a standard care arrangement, the nurse shall practice
only in accordance with the terms of the arrangement.

(A)
A nurse authorized to practice as a certified nurse-midwife
,
in collaboration with one or more physicians,

may provide the management of preventive services and those primary
care services necessary to provide health care to women antepartally,
intrapartally, postpartally, and gynecologically
,
consistent with the nurse's education and certification, and in
accordance with rules adopted by the board of nursing
.

No
certified nurse-midwife may perform version, deliver breech or face
presentation, use forceps,
or

do
any obstetric operation,
or
treat any other abnormal condition,
except
in emergencies. Division (A) of this section does not prohibit a
certified nurse-midwife from performing episiotomies or normal
vaginal deliveries, or repairing vaginal tears.

A certified nurse-midwife may, in collaboration with one or more
physicians, prescribe drugs and therapeutic devices in accordance
with section 4723.481 of the Revised Code.

(B)
A nurse authorized to practice as a certified registered nurse
anesthetist
,
consistent with the nurse's education and certification and in
accordance with rules adopted by the board,

may do the following:

(1)
With supervision and in the immediate presence of a physician,
podiatrist, or dentist, administer anesthesia and perform anesthesia
induction, maintenance, and emergence;

(2)
With supervision, obtain informed consent for anesthesia care and
perform preanesthetic preparation and evaluation, postanesthetic
preparation and evaluation, postanesthesia care, and, subject to
section 4723.433 of the Revised Code, clinical support functions;

(3)
With supervision and in accordance with section 4723.434 of the
Revised Code, engage in the activities described in division (A) of
that section.

The
physician, podiatrist, or dentist supervising a certified registered
nurse anesthetist must be actively engaged in practice in this state.
When a certified registered nurse anesthetist is supervised by a
podiatrist, the nurse's scope of practice is limited to the
anesthesia procedures that the podiatrist has the authority under
section 4731.51 of the Revised Code to perform. A certified
registered nurse anesthetist may not administer general anesthesia
under the supervision of a podiatrist in a podiatrist's office. When
a certified registered nurse anesthetist is supervised by a dentist,
the nurse's scope of practice is limited to the anesthesia procedures
that the dentist has the authority under Chapter 4715. of the Revised
Code to perform.

(C)
A nurse authorized to practice as a certified nurse practitioner
,
in collaboration with one or more physicians or podiatrists,

may provide preventive

and
,

primary
care
,
and acute care

services
,
provide services for acute illnesses,

and evaluate and promote patient wellness

within the nurse's nursing specialty, consistent with the nurse's
education and certification, and in accordance with rules adopted by
the board. A certified nurse practitioner may, in collaboration with
one or more physicians or podiatrists, prescribe drugs and
therapeutic devices in accordance with section 4723.481 of the
Revised Code
.

When
a certified nurse practitioner
is
collaborating

practices under a standard care arrangement entered into
with
a
collaborating
practitioner who is a
podiatrist,
the nurse's scope of practice is limited to the procedures that the
podiatrist has the authority under section 4731.51 of the Revised
Code to perform.

(D)
A nurse authorized to practice as a clinical nurse specialist
,
in collaboration with one or more physicians or podiatrists,

may provide and manage the care of individuals and groups with
complex health problems and provide health care services that
promote, improve, and manage health care

within the nurse's nursing specialty, consistent with the nurse's
education and in accordance with rules adopted by the board. A
clinical nurse specialist may, in collaboration with one or more
physicians or podiatrists, prescribe drugs and therapeutic devices in
accordance with section 4723.481 of the Revised Code
.

When
a clinical nurse specialist
is
collaborating

practices under a standard care arrangement entered into
with
a
collaborating
practitioner who is a
podiatrist,
the nurse's scope of practice is limited to the procedures that the
podiatrist has the authority under section 4731.51 of the Revised
Code to perform.

Sec.
4723.431.
(A)(1)
An
This
section establishes standards and conditions regarding the standard
care arrangements that are required or permitted by section 4723.43
of the Revised Code to be maintained between an
advanced
practice registered nurse who is designated as a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner

may
practice only in accordance with a standard care arrangement entered
into with
and

each

physician
or podiatrist
collaborating
practitioner
with
whom the nurse collaborates.
A

(A)(1)
A
copy
of the
nurse's

standard
care arrangement shall be retained on file by the nurse's employer.
Prior approval of the standard care arrangement by the board of
nursing is not required, but the board may periodically review it for
compliance with this section.

A
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner
(2)
The nurse
may
enter into a standard care arrangement with one or more collaborating

physicians
or podiatrists
practitioners
.

If
a collaborating physician or podiatrist enters into standard care
arrangements with more than five nurses, the physician or podiatrist
shall not collaborate at the same time with more than five nurses in
the prescribing component of their practices.

Not
later than thirty days after first engaging in the practice of

advanced
practice registered
nursing

as a clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner
,
the nurse shall submit to the board the name
and
business address
of
each collaborating
physician
or podiatrist
practitioner
.
Thereafter, the nurse shall notify the board of any additions or
deletions to the nurse's collaborating
physicians
or podiatrists
practitioners
.

Except
as provided in division (D) of this section, the
The

notice
must be provided not later than thirty days after the change takes
effect.

(2)
All
(3)
All
of
the following conditions apply with respect to the practice of a
collaborating
physician
or podiatrist with whom a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner may enter into a
standard care arrangement
practitioner
:

(a)

The

In
the case of a collaborating practitioner who is a
physician
or podiatrist
,
the collaborating physician or podiatrist

must be
authorized

both
of the following:

(i)
Authorized
to
practice in this state
.

(b)
Except as provided in division (A)(2)(c) of this section, the
physician or podiatrist must be practicing
;

(ii)
Practicing

in
an
area of health care, including
a
specialty
,

that is the same as or similar to
that
in which
the

nurse's
nursing specialty
nurse
is or will be practicing
.

(b)
In the case of a collaborating practitioner who is a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner,
the collaborating nurse must satisfy all of the following:

(i)
Be authorized to practice in this state;

(ii)
Be practicing under a designation that is the same designation as the
nurse with whom the collaborating nurse has entered into a standard
care arrangement;

(iii)
Have met the requirements of section 4723.439 of the Revised Code;

(iv)
Not practice under a standard care arrangement entered into with
another collaborating practitioner.

(c)
If the nurse is a clinical nurse specialist who is certified as a
psychiatric-mental health CNS or the equivalent of such title by the
American nurses credentialing center or a certified nurse
practitioner who is certified as a psychiatric-mental health NP or
the equivalent of such title by the American nurses credentialing
center or American academy of nurse practitioners certification
board, the nurse may enter into a standard care arrangement with a

physician
but not a podiatrist and the
collaborating

physician
must be
practitioner

practicing
in one of the following specialties:

(i)
Psychiatry;

(ii)
Pediatrics;

(iii)
Primary care or family practice.

(B)
A standard care arrangement shall be in writing and shall contain all
of the following:

(1)
Criteria for referral of a patient by the
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner
nurse
practicing under the standard care arrangement
to
a collaborating
physician
or podiatrist
practitioner

or

to

another
physician or podiatrist

or a clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner who meets the requirements of section 4723.439 of
the Revised Code
;

(2)
A process for the
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner
nurse
practicing under the standard care arrangement
to
obtain a consultation with a collaborating
physician
or podiatrist
practitioner

or

with

another
physician or podiatrist

or a clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner who meets the requirements of section 4723.439 of
the Revised Code
;

(3)
A plan for coverage
in
instances of emergency or planned absences of either the clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner or a collaborating physician or podiatrist
that
provides the means whereby a physician or podiatrist
or
a clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner that meets the requirements of section 4723.439 of
the Revised Code
is
available for emergency care

in instances of emergency or planned absences of either the nurse who
is practicing under the standard care arrangement or the
collaborating practitioner who entered into the arrangement
;

(4)
The process for resolution of disagreements regarding matters of
patient management between the
clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner
nurse
practicing under the standard care arrangement
and
a collaborating
physician
or podiatrist
practitioner
;

(5)

An
agreement that the collaborating physician shall complete and sign
the medical certificate of death pursuant to section 3705.16 of the
Revised Code;

(6)

Any
other criteria required by rule of the board adopted pursuant to
section 4723.07 or 4723.50 of the Revised Code.

(C)
A standard care arrangement entered into pursuant to this section may
permit a clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner to do any of the following:

(1)
Supervise services provided by a home health agency as defined in
section 3740.01 of the Revised Code;

(2)
Admit a patient to a hospital in accordance with section 3727.06 of
the Revised Code;

(3)
Sign any document relating to the admission, treatment, or discharge
of an inpatient receiving psychiatric or other behavioral health care
services, but only if the conditions of section 4723.436 of the
Revised Code have been met.

(D)(1)
Except as provided in division (D)(2) of this section, if a
physician
or podiatrist
collaborating
practitioner
terminates
the collaboration between the
physician
or podiatrist
collaborating
practitioner
and
a certified nurse-midwife, certified nurse practitioner, or clinical
nurse specialist before their standard care arrangement expires, all
of the following apply:

(a)
The
physician
or podiatrist
collaborating
practitioner
must
give the nurse written or electronic notice of the termination.

(b)
Once the nurse receives the termination notice, the nurse must notify
the board of nursing of the termination as soon as practicable by
submitting to the board a copy of the
physician's
or podiatrist's
collaborating
practitioner's
termination
notice.

(c)

Notwithstanding
the requirement of section 4723.43 of the Revised Code that the nurse
practice in collaboration with a physician or podiatrist, the
The

nurse
may continue to practice under the existing standard care arrangement
without a collaborating
physician
or podiatrist
practitioner

for
not more than one hundred twenty days after submitting to the board a
copy of the termination notice.

(2)
In the event that the collaboration between a
physician
or podiatrist
collaborating
practitioner
and
a certified nurse-midwife, certified nurse practitioner, or clinical
nurse specialist terminates because of the
physician's
or podiatrist's
collaborating
practitioner's
death,
the nurse must notify the board of the death as soon as practicable.
The nurse may continue to practice under the existing standard care
arrangement without a collaborating
physician
or podiatrist
practitioner

for
not more than one hundred twenty days after notifying the board of
the
physician's
or podiatrist's
collaborating
practitioner's
death.

(E)(1)
Nothing in this section prohibits a hospital from hiring a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner as an employee and negotiating standard care
arrangements on behalf of the employee as necessary to meet the
requirements of this section

or section 4723.43 of the Revised Code
.
A standard care arrangement between the hospital's employee and the
employee's collaborating
physician

practitioner

is
subject to approval by the medical staff and governing body of the
hospital prior to implementation of the arrangement at the hospital.

(2)
Nothing in this section prohibits a standard care arrangement from
specifying actions that a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner is authorized to take,
or is prohibited from taking, as part of the nurse's practice in
collaboration with a physician or podiatrist

or a clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner that meets the requirements of section 4723.439 of
the Revised Code
.
In specifying such actions, the standard care arrangement shall not
authorize the nurse
practicing
under the standard care arrangement
to
take any action that is otherwise prohibited by the Revised Code or
rule of the board.

Sec.
4723.439.
(A)
An advanced practice registered nurse who is a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
may practice without a standard care arrangement, and therefore
without a collaborating practitioner, if the requirements of division
(B) of this section are met.

(B)(1)
To be eligible to practice without a standard care arrangement, a
nurse must have both collaborated with one or more collaborating
practitioners under a standard care arrangement and practiced in a
clinical setting for two thousand hours.

(2)
A nurse who seeks to practice without a standard care arrangement
shall submit to the board of nursing documentation demonstrating that
the requirements described in division (B)(1) of this section have
been met.

(3)
In the case of a nurse who obtained a license by endorsement as
described in division (B) of section 4723.41 of the Revised Code, the
board of nursing shall accept practice in a clinical setting
completed in another jurisdiction if the board determines that the
nurse practiced in that jurisdiction in a manner equivalent to
practicing in this state.

(C)
The board of nursing shall adopt rules as necessary to implement this
section, including rules specifying the documentation that a nurse
must submit in order to demonstrate that the nurse has met the
requirements described in division (B)(1) of this section. The rules
shall be adopted in accordance with Chapter 119. of the Revised Code.

Sec.
4723.44.
(A)
No person shall knowingly do any of the following unless the person
holds a current, valid license issued by the board of nursing under
this chapter to practice nursing as an advanced practice registered
nurse

in the specialty indicated by the designation
:

(1)
Engage in the practice of nursing as an advanced practice registered
nurse for a fee, salary, or other consideration, or as a volunteer;

(2)
Represent the person as being an advanced practice registered nurse,
including representing the person as being a certified registered
nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner;

(3)
Use any title or initials implying that the person is an advanced
practice registered nurse, including using any title or initials
implying the person is a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner.

(B)
No advanced practice registered nurse shall knowingly do any of the
following:

(1)
Engage, for a fee, salary, or other consideration, or as a volunteer,
in the practice of
a
nursing specialty
nursing
as an advanced practice registered nurse in a manner
other
than
the
specialty designated
that
which is indicated by the designation
on
the nurse's current, valid license issued by the board under this
chapter to practice nursing as an advanced practice registered nurse;

(2)
Represent the
person

nurse

as
being authorized to practice
any
nursing specialty
nursing
as an advanced practice registered nurse in a manner
other
than
the
specialty designated
that
which is indicated by the designation
on
the
nurse's

current,
valid license to practice nursing as an advanced practice registered
nurse;

(3)
Use the title "certified registered nurse anesthetist" or
the initials "N.A." or "C.R.N.A.," the title
"clinical nurse specialist" or the initials "C.N.S.,"
the title "certified nurse-midwife" or the initials
"C.N.M.," the title "certified nurse practitioner"
or the initials "C.N.P.," the title "advanced practice
registered nurse" or the initials "A.P.R.N.," or any
other title or initials implying that the nurse is authorized to
practice
any
nursing specialty
nursing
as an advanced practice registered nurse in a manner
other
than
the
specialty designated
that
which is indicated by the designation
on
the nurse's current, valid license to practice nursing as an advanced
practice registered nurse;

(4)

Except
as provided in division (A)(2)(c) of section 4723.431 of the Revised
Code, enter
Enter

into
a standard care arrangement with a
physician
or podiatrist
collaborating
practitioner
who
is practicing in
a
specialty
an
area of health care, including a specialty,
that
is not the same as or similar to
that
in which
the

nurse's
nursing specialty
nurse
is or will be practicing
;

(5)
Prescribe drugs or therapeutic devices in a manner that does not
comply with section 4723.481 of the Revised Code;

(6)
Prescribe any drug or device to perform or induce an abortion, or
otherwise perform or induce an abortion.

(C)
No person shall knowingly employ a person to engage in the practice
of nursing as an advanced practice registered nurse unless the person
so employed holds a current, valid license and designation issued by
the board under this chapter to practice as an advanced practice
registered nurse
in
the specialty
as

indicated
by the designation.

(D)
A document certified by the executive director of the board, under
the official seal of the board, to the effect that it appears from
the records of the board that no license to practice nursing as an
advanced practice registered nurse has been issued to the person
specified in the document, or that a license to practice nursing as
an advanced practice registered nurse, if issued, has been revoked or
suspended, shall be received as prima-facie evidence of the record of
the board in any court or before any officer of the state.

Sec.
4723.46.
(A)
The board of nursing shall establish a list of national certifying
organizations approved by the board to examine and certify advanced
practice registered nurses to practice

nursing specialties
.
To be approved by the board, a national certifying organization must
meet all of the following requirements:

(1)
Be national in the scope of its credentialing;

(2)
Have an educational requirement beyond that required for registered
nurse licensure;

(3)
Have practice requirements beyond those required for registered nurse
licensure;

(4)
Have testing requirements beyond those required for registered nurse
licensure that measure the theoretical and clinical content of
a
nursing specialty
practice
as an advanced practice registered nurse
,
are developed in accordance with accepted standards of validity and
reliability, and are open to registered nurses who have successfully
completed the educational program required by the organization;

(5)
Issue certificates to advanced practice registered nurses, including
certified registered nurse anesthetists, clinical nurse specialists,
certified nurse-midwives, or certified nurse practitioners;

(6)
Periodically review the qualifications of advanced practice
registered nurses, including certified registered nurse anesthetists,
clinical nurse specialists, certified nurse-midwives, or certified
nurse practitioners.

(B)
Not later than the thirtieth day of January of each year, the board
shall publish the list of national certifying organizations that have
met the requirements of division (A) of this section within the
previous year and remove from the list organizations that no longer
meet the requirements.

Sec.
4723.481.
This
section establishes standards and conditions regarding the authority
of an advanced practice registered nurse who is designated as a
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner to prescribe and personally furnish drugs and
therapeutic devices under a license issued under section 4723.42 of
the Revised Code.

(A)
A clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner shall not prescribe or furnish any drug or
therapeutic device that is listed on the exclusionary formulary
established in rules adopted under section 4723.50 of the Revised
Code.

(B)
The prescriptive authority of a clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner
practicing
under a standard care arrangement
shall
not exceed the prescriptive authority of the collaborating
physician
or podiatrist
practitioner
,
including
,
in

the

case of a

collaborating
practitioner
who is a physician, the
physician's
authority to treat chronic pain with controlled substances and
products containing tramadol as described in section 4731.052 of the
Revised Code.

(C)(1)
Except as provided in division (C)(2) or (3) of this section, a
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner may prescribe to a patient a schedule II
controlled substance only if all of the following are the case:

(a)
The patient has a terminal condition, as defined in section 2133.01
of the Revised Code.

(b)
A physician initially prescribed the substance for the patient.

(c)
The prescription is for an amount that does not exceed the amount
necessary for the patient's use in a single, seventy-two-hour period.

(2)
The restrictions on prescriptive authority
described

in
division (C)(1) of this section do not apply if a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
issues the prescription to the patient from any of the following
entities:

(a)
A hospital as defined in section 3722.01 of the Revised Code;

(b)
An entity owned or controlled, in whole or in part, by a hospital or
by an entity that owns or controls, in whole or in part, one or more
hospitals;

(c)
A health care facility operated by the department of mental health
and addiction services or the department of developmental
disabilities;

(d)
A nursing home licensed under section 3721.02 of the Revised Code or
by a political subdivision certified under section 3721.09 of the
Revised Code;

(e)
A county home or district home operated under Chapter 5155. of the
Revised Code that is certified under the medicare or medicaid
program;

(f)
A hospice care program, as defined in section 3712.01 of the Revised
Code;

(g)
A community mental health services provider, as defined in section
5122.01 of the Revised Code;

(h)
An ambulatory surgical facility, as defined in section 3702.30 of the
Revised Code;

(i)
A freestanding birthing center, as defined in section 3701.503 of the
Revised Code;

(j)
A federally qualified health center, as defined in section 3701.047
of the Revised Code;

(k)
A federally qualified health center look-alike, as defined in section
3701.047 of the Revised Code;

(l)
A health care office or facility operated by the board of health of a
city or general health district or the authority having the duties of
a board of health under section 3709.05 of the Revised Code;

(m)
A site where a medical practice is operated, but only if the practice
is comprised of one or more physicians who also are owners of the
practice; the practice is organized to provide direct patient care;
and the clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner
providing

provides

services
at the site

has a standard care arrangement and collaborates with at least one of
the physician owners who practices primarily at that site
;

(n)
A site where a behavioral health practice is operated that does not
qualify as a location otherwise described in division (C)(2) of this
section, but only if the practice is organized to provide outpatient
services for the treatment of mental health conditions, substance use
disorders, or both, and the clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner providing services at
the site of the practice has a standard care arrangement and
collaborates with at least one physician who is employed by that
practice;

(o)
A residential care facility, as defined in section 3721.01 of the
Revised Code.

(3)
A clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner shall not issue to a patient a prescription for a
schedule II controlled substance from a convenience care clinic even
if the clinic is owned or operated by an entity specified in division
(C)(2) of this section.

(D)
A pharmacist who acts in good faith reliance on a prescription issued
by a clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner under division (C)(2) of this section is not
liable for or subject to any of the following for relying on the
prescription: damages in any civil action, prosecution in any
criminal proceeding, or professional disciplinary action by the state
board of pharmacy under Chapter 4729. of the Revised Code.

(E)
A clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner shall comply with section 3719.061 of the Revised
Code if the nurse prescribes for a minor, as defined in that section,
an opioid analgesic, as defined in section 3719.01 of the Revised
Code.

Sec.
4723.482.
(A)
Except as provided in divisions (C) and (D) of this section, an
applicant for a license to practice nursing as an advanced practice
registered nurse who seeks designation as a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
shall include with the application submitted under section 4723.41 of
the Revised Code evidence of successfully completing the course of
study in advanced pharmacology and related topics in accordance with
the requirements specified in division (B) of this section.

(B)
With respect to the course of study in advanced pharmacology and
related topics, all of the following requirements apply:

(1)
The course of study shall be completed not longer than five years
before the application is filed.

(2)
The course of study shall be not less than forty-five contact hours.

(3)
The course of study shall meet the requirements to be approved by the
board
of
nursing
in
accordance with standards established in rules adopted under section
4723.50 of the Revised Code.

(4)
The content of the course of study shall be specific to the

applicant's nursing specialty

designation being sought by the applicant
.

(5)
The instruction provided in the course of study shall include all of
the following:

(a)
A minimum of thirty-six contact hours of instruction in advanced
pharmacology that includes pharmacokinetic principles and clinical
application and the use of drugs and therapeutic devices in the
prevention of illness and maintenance of health;

(b)
Instruction in the fiscal and ethical implications of prescribing
drugs and therapeutic devices;

(c)
Instruction in the state and federal laws that apply to the authority
to prescribe;

(d)
Instruction that is specific to schedule II controlled substances,
including instruction in all of the following:

(i)
Indications for the use of schedule II controlled substances in drug
therapies;

(ii)

The
most recent
Pain
management therapy
guidelines

for
pain management therapies, as
established
by state and national organizations

such as the Ohio pain initiative and the American pain society
;

(iii)
Fiscal and ethical implications of prescribing schedule II controlled
substances;

(iv)
State and federal laws that apply to the authority to prescribe
schedule II controlled substances;

(v)
Prevention of abuse and diversion of schedule II controlled
substances, including identification of the risk of abuse and
diversion, recognition of abuse and diversion, types of assistance
available for prevention of abuse and diversion, and methods of
establishing safeguards against abuse and diversion.

(C)
An applicant who practiced or is practicing as a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
in another jurisdiction or as an employee of the United States
government shall include with the application submitted under section
4723.41 of the Revised Code all of the following:

(1)
Evidence of having completed a two-hour course of instruction
approved by the board in the laws of this state that govern drugs and
prescriptive authority;

(2)
Either of the following:

(a)
Evidence of having held, for a continuous period of at least one year
during the three years immediately preceding the date of application,
valid authority issued by another jurisdiction to prescribe
therapeutic devices and drugs, including at least some controlled
substances;

(b)
Evidence of having been employed by the United States government and
authorized, for a continuous period of at least one year during the
three years immediately preceding the date of application, to
prescribe therapeutic devices and drugs, including at least some
controlled substances, in conjunction with that employment.

(D)
In lieu of including with an application submitted under section
4723.41 of the Revised Code the evidence described in division (A) of
this section, an applicant described in division (C) or (D) of
section 4723.41 of the Revised Code may include evidence of all of
the following:

(1)
Successfully completing the course of study in advanced pharmacology
and related topics more than five years before the date the
application is filed;

(2)
Holding, for a continuous period of at least one year during the
three years immediately preceding the date of application, valid
authority in any jurisdiction to prescribe therapeutic devices and
drugs, including at least some controlled substances;

(3)
Exercising the prescriptive authority described in division (D)(2) of
this section for the minimum one-year period.

Sec.
4723.483.
(A)(1)
Subject to division (A)(2) of this section, and notwithstanding any
provision of this chapter or rule adopted by the board of nursing, a
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner
who
holds a certificate to prescribe issued under section 4723.48 of the
Revised Code
may
do either of the following without having examined an individual to
whom epinephrine may be administered:

(a)
Personally furnish a supply of epinephrine autoinjectors for use in
accordance with sections 3313.7110, 3313.7111, 3314.143, 3326.28,
3328.29, 3728.03 to 3728.05, and 5101.76 of the Revised Code;

(b)
Issue a prescription for epinephrine autoinjectors for use in
accordance with sections 3313.7110, 3313.7111, 3314.143, 3326.28,
3328.29, 3728.03 to 3728.05, and 5101.76 of the Revised Code.

(2)
An epinephrine autoinjector personally furnished or prescribed under
division (A)(1) of this section must be furnished or prescribed in
such a manner that it may be administered only in a manufactured
dosage form.

(B)
A nurse who acts in good faith in accordance with this section is not
liable for or subject to any of the following for any action or
omission of an entity to which an epinephrine autoinjector is
furnished or a prescription is issued: damages in any civil action,
prosecution in any criminal proceeding, or professional disciplinary
action.

Sec.
4723.493.
(A)
There is hereby created within the board of nursing the advisory
committee on advanced practice registered nursing. The committee
shall consist of the following members

and any other members the board appoints under division (B) of this
section
:

(1)
Four advanced practice registered nurses, each actively engaged in
the practice of advanced practice registered nursing in a clinical
setting in this state, at least one of whom is actively engaged in
providing primary care, at least one of whom is actively engaged in
practice as a certified registered nurse anesthetist, and at least
one of whom is actively engaged in practice as a certified
nurse-midwife;

(2)
Two advanced practice registered nurses, each serving as a faculty
member of an approved program of nursing education that prepares
students for licensure as advanced practice registered nurses;

(3)
A member of the board of nursing who is an advanced practice
registered nurse;

(4)
A representative of an entity employing ten or more advanced practice
registered nurses actively engaged in practice in this state.

(B)
The board of nursing shall appoint the members described in division
(A) of this section

and may appoint additional members as described in division (D) of
this section
.

Recommendations
for
For
purposes of
initial
appointments and
for

filling
any vacancies

may be submitted to
,

the
board
by

shall
accept recommendations, if any, from
organizations
representing advanced practice registered nurses practicing in this
state and
by

from

schools
of advanced practice registered nursing. The board shall appoint
initial members and fill vacancies according to the recommendations
it receives. If it does not receive any recommendations or receives
an insufficient number of recommendations, the board shall appoint
members and fill vacancies on its own advice.

Initial
appointments to the committee shall be made not later than sixty days
after April 6, 2017. Of the initial appointments described in
division (A)(1) of this section, two shall be for terms of one year
and two shall be for terms of two years. Of the initial appointments
described in division (A)(2) of this section, one shall be for a term
of one year and one shall be for a term of two years. Of the initial
appointments described in divisions (A)(3) and (4) of this section,
each shall be for a term of two years. Thereafter, terms shall be for
two years, with each term ending on the same day of the same month as
did the term that it succeeds. Vacancies shall be filled in the same
manner as appointments.

When
the term of any member expires, a successor shall be appointed in the
same manner as the initial appointment. Any member appointed to fill
a vacancy occurring prior to the expiration of the term for which the
member's predecessor was appointed shall hold office for the
remainder of that term. A member shall continue in office subsequent
to the expiration date of the member's term until the member's
successor takes office or until a period of sixty days has elapsed,
whichever occurs first. A member may be reappointed for one
additional term only.

(C)
The committee shall organize by selecting a chairperson from among
its members. The committee may select a new chairperson at any time.
Five members constitute a quorum for the transaction of official
business. Members shall serve without compensation but receive
payment for their actual and necessary expenses incurred in the
performance of their official duties. The expenses shall be paid by
the board of nursing.

(D)
The committee shall advise the board regarding the practice and
regulation of advanced practice registered nurses. The committee may
also recommend to the board that
an
individual with expertise in
an
advanced practice registered
nursing
specialty
nurse
who practices in a specialized area of nursing
be
appointed under division (B) of this section as an additional member
of the committee.

Sec.
4723.50.
(A)
As used in this section:

(1)
"Controlled substance" has the same meaning as in section
3719.01 of the Revised Code.

(2)
"Medication-assisted treatment" has the same meaning as in
section 340.01 of the Revised Code.

(B)

In
accordance with Chapter 119. of the Revised Code, the
The

board
of nursing shall adopt rules as necessary to implement the provisions
of this chapter pertaining to the authority of
advanced
practice registered nurses who are designated as
clinical
nurse specialists, certified nurse-midwives, and certified nurse
practitioners to prescribe and furnish drugs and therapeutic devices
.

The
board shall adopt
,
including

rules establishing an exclusionary formulary. The exclusionary
formulary shall permit, in a manner consistent with section 4723.481
of the Revised Code, the prescribing of controlled substances,
including drugs that contain buprenorphine used in
medication-assisted treatment and both oral and long-acting opioid
antagonists.
The

The

formulary
shall not permit the prescribing or furnishing of any of the
following:

(1)
A drug or device to perform or induce an abortion;

(2)
A drug or device prohibited by federal or state law.

(C)
In addition to the rules described in division (B) of this section,
the board shall adopt rules
under
this section
that
do the following:

(1)
Establish standards for board approval of the course of study in
advanced pharmacology and related topics required by section 4723.482
of the Revised Code;

(2)
Establish requirements for board approval of the two-hour course of
instruction in the laws of this state as required under division
(C)(1) of section 4723.482 of the Revised Code;

(3)

Establish

For
purposes of division (B)(5) of section 4723.431 of the Revised Code,
establish
criteria
for the components of
the

any

standard
care
arrangements
described in section 4723.431 of the Revised Code
arrangement

that
apply to the authority to prescribe, including the components that
apply to the authority to prescribe schedule II controlled
substances. The rules shall be consistent with that section and
include all of the following:

(a)
Quality assurance standards;

(b)
Standards for periodic review by a collaborating
physician
or podiatrist
practitioner

of
the records of patients treated by
the

a

clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner

who is practicing under a standard care arrangement with the
collaborating practitioner
;

(c)

Acceptable
travel time between the location at which the clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
is engaging in the prescribing components of the nurse's practice and
the location of the nurse's collaborating physician or podiatrist
Any
other criteria the board considers appropriate
.

(D)
All rules adopted under this section shall be adopted in accordance
with Chapter 119. of the Revised Code.

Sec.
4731.27.
(A)
As used in this section, "collaboration," "physician,"
"standard care arrangement," and "supervision"
have the same meanings as in section 4723.01 of the Revised Code.

(B)
A physician or podiatrist shall enter into a standard care
arrangement with each clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner with whom the
physician or podiatrist is in collaboration.

The
collaborating physician or podiatrist shall fulfill the
responsibilities of collaboration, as specified in the arrangement
and in accordance with division (A) of section 4723.431 of the
Revised Code. A copy of the standard care arrangement shall be
retained on file by the nurse's employer. Prior approval of the
standard care arrangement by the state medical board is not required,
but the board may periodically review it.

A
physician or podiatrist who terminates collaboration with a certified
nurse-midwife, certified nurse practitioner, or clinical nurse
specialist before their standard care arrangement expires shall give
the nurse the written or electronic notice of termination required by
division (D)(1) of section 4723.431 of the Revised Code.

Nothing
in this division prohibits a hospital from hiring a clinical nurse
specialist, certified nurse-midwife, or certified nurse practitioner
as an employee and negotiating standard care arrangements on behalf
of the employee as necessary to meet the requirements of this
section. A standard care arrangement between the hospital's employee
and the employee's collaborating
physician

practitioner

is
subject to approval by the medical staff and governing body of the
hospital prior to implementation of the arrangement at the hospital.

(C)
A physician or podiatrist shall cooperate with the board of nursing
in any investigation the board conducts with respect to a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner who collaborates with the physician or podiatrist or
with respect to a certified registered nurse anesthetist who
practices with the supervision of the physician or podiatrist.

Sec.
4761.17.
All
of the following apply to the practice of respiratory care by a
person who holds a license or limited permit issued under this
chapter:

(A)
The person shall practice only pursuant to a prescription or other
order for respiratory care issued by any of the following:

(1)
A physician;

(2)
A
clinical
nurse specialist, certified nurse-midwife, or
certified
nurse practitioner
,
certified nurse-midwife, or clinical nurse specialist

who holds a current, valid license issued under Chapter 4723. of the
Revised Code to practice nursing as an advanced practice registered
nurse

and has entered into a standard care arrangement with a physician
;

(3)
A certified registered nurse anesthetist who holds a current, valid
license issued under Chapter 4723. of the Revised Code to practice
nursing as an advanced practice registered nurse and acts in
compliance with sections 4723.43, 4723.433, and 4723.434 of the
Revised Code;

(4)
A physician assistant who holds a valid prescriber number issued by
the state medical board, has been granted physician-delegated
prescriptive authority, and has entered into a supervision agreement
that allows the physician assistant to prescribe or order respiratory
care services.

(B)
The person shall practice only under the supervision of any of the
following:

(1)
A physician;

(2)
A certified nurse practitioner, certified nurse-midwife, or clinical
nurse specialist;

(3)
A physician assistant who is authorized to prescribe or order
respiratory care services as provided in division (A)(4) of this
section.

(C)(1)
When practicing under the prescription or order of a certified nurse
practitioner, certified nurse midwife, or clinical nurse specialist
or under the supervision of such a nurse, the person's administration
of medication that requires a prescription is limited to the drugs
that the nurse is authorized to prescribe pursuant to section
4723.481 of the Revised Code.

(2)
When practicing under the order of a certified registered nurse
anesthetist, the person's administration of medication is limited to
the drugs that the nurse is authorized to order or direct the person
to administer, as provided in sections 4723.43, 4723.433, and
4723.434 of the Revised Code.

(3)
When practicing under the prescription or order of a physician
assistant or under the supervision of a physician assistant, the
person's administration of medication that requires a prescription is
limited to the drugs that the physician assistant is authorized to
prescribe pursuant to the physician assistant's physician-delegated
prescriptive authority.

Sec.
5164.07.
(A)
The medicaid program shall include coverage of inpatient care and
follow-up care for a mother and her newborn as follows:

(1)
The medicaid program shall cover a minimum of forty-eight hours of
inpatient care following a normal vaginal delivery and a minimum of
ninety-six hours of inpatient care following a cesarean delivery.
Services covered as inpatient care shall include medical,
educational, and any other services that are consistent with the
inpatient care recommended in the protocols and guidelines developed
by national organizations that represent pediatric, obstetric, and
nursing professionals.

(2)
The medicaid program shall cover a physician-directed source of
follow-up care or a source of follow-up care directed by an advanced
practice registered nurse. Services covered as follow-up care shall
include physical assessment of the mother and newborn, parent
education, assistance and training in breast or bottle feeding,
assessment of the home support system, performance of any medically
necessary and appropriate clinical tests, and any other services that
are consistent with the follow-up care recommended in the protocols
and guidelines developed by national organizations that represent
pediatric, obstetric, and nursing professionals. The coverage shall
apply to services provided in a medical setting or through home
health care visits. The coverage shall apply to a home health care
visit only if the health care professional who conducts the visit is
knowledgeable and experienced in maternity and newborn care.

When
a decision is made in accordance with division (B) of this section to
discharge a mother or newborn prior to the expiration of the
applicable number of hours of inpatient care required to be covered,
the coverage of follow-up care shall apply to all follow-up care that
is provided within forty-eight hours after discharge. When a mother
or newborn receives at least the number of hours of inpatient care
required to be covered, the coverage of follow-up care shall apply to
follow-up care that is determined to be medically necessary by the
health care professionals responsible for discharging the mother or
newborn.

(B)
Any decision to shorten the length of inpatient stay to less than
that specified under division (A)(1) of this section shall be made by
the physician attending the mother or newborn, except that if a
certified nurse-midwife is attending the mother

in collaboration with a physician
,
the decision may be made by the certified nurse-midwife.
Decisions

If
the certified nurse-midwife is practicing under a standard care
arrangement with one or more collaborating practitioners, as provided
in Chapter 4723. of the Revised Code, the nurse's decision shall be
made in collaboration with a collaborating practitioner.

Decisions

regarding
early discharge shall be made only after conferring with the mother
or a person responsible for the mother or newborn. For purposes of
this division, a person responsible for the mother or newborn may
include a parent, guardian, or any other person with authority to
make medical decisions for the mother or newborn.

(C)
The department of medicaid, in administering the medicaid program,
may not do either of the following:

(1)
Terminate the provider agreement of a health care professional or
health care facility solely for making recommendations for inpatient
or follow-up care for a particular mother or newborn that are
consistent with the care required to be covered by this section;

(2)
Establish or offer monetary or other financial incentives for the
purpose of encouraging a person to decline the inpatient or follow-up
care required to be covered by this section.

(D)
This section does not do any of the following:

(1)
Require the medicaid program to cover inpatient or follow-up care
that is not received in accordance with the program's terms
pertaining to the health care professionals and facilities from which
a medicaid recipient is authorized to receive health care services.

(2)
Require a mother or newborn to stay in a hospital or other inpatient
setting for a fixed period of time following delivery;

(3)
Require a child to be delivered in a hospital or other inpatient
setting;

(4)
Authorize a certified nurse-midwife to practice beyond the authority
to practice nurse-midwifery in accordance with Chapter 4723. of the
Revised Code;

(5)
Establish minimum standards of medical diagnosis, care, or treatment
for inpatient or follow-up care for a mother or newborn. A deviation
from the care required to be covered under this section shall not, on
the basis of this section, give rise to a medical claim or derivative
medical claim, as those terms are defined in section 2305.113 of the
Revised Code.

Section
2.
That
existing sections 1751.67, 2133.211, 3313.539, 3707.511, 3727.06,
3923.233, 3923.301, 3923.63, 3923.64, 4723.01, 4723.02, 4723.06,
4723.07, 4723.24, 4723.28, 4723.36, 4723.41, 4723.42, 4723.43,
4723.431, 4723.44, 4723.46, 4723.481, 4723.482, 4723.483, 4723.493,
4723.50, 4731.27, 4761.17, and 5164.07 of the Revised Code are hereby
repealed.

Section
3.
That
sections 4723.45 and 5164.73 of the Revised Code are hereby repealed.

Section
4.
(A)
Subject to division (B) of this section, the Board of Nursing shall
consider a clinical nurse specialist, certified nurse practitioner,
or certified nurse-midwife to have satisfied the requirements of
section 4723.439 of the Revised Code, as enacted by this act, if the
nurse, immediately prior to the effective date of this section, both
collaborated with one or more physicians or podiatrists under a
standard care arrangement and practiced in a clinical setting for two
thousand hours.

(B)
Not later than the date that occurs six months after the effective
date of this section, a clinical nurse specialist, certified nurse
practitioner, or certified nurse-midwife seeking authority to
practice without a standard care arrangement shall submit to the
Board documentation, acceptable to the Board, demonstrating that the
nurse, immediately prior to the effective date of this section, both
collaborated with one or more physicians or podiatrists under a
standard care arrangement and practiced in a clinical setting for two
thousand hours.

In
the case of a nurse who obtained a license by endorsement as
described in division (B) of section 4723.41 of the Revised Code, the
Board shall accept practice in a clinical setting completed in
another jurisdiction if the Board determines that the nurse practiced
in that jurisdiction in a manner equivalent to practicing in this
state.

(C)
If the nurse fails to submit documentation by the date that occurs
six months after the effective date of this section, the nurse shall
cease practicing without a standard care arrangement until the nurse
meets the requirements of section 4723.439 of the Revised Code, as
enacted by this act.

Section
5.
This
act shall be known as the Better Access to Health Care Act.

Section
6.
The
General Assembly, applying the principle stated in division (B) of
section 1.52 of the Revised Code that amendments are to be harmonized
if reasonably capable of simultaneous operation, finds that the
following sections, presented in this act as composites of the
sections as amended by the acts indicated, are the resulting versions
of the sections in effect prior to the effective date of the sections
as presented in this act:

Section
4723.431 of the Revised Code as amended by both H.B. 497 and S.B. 196
of the 135th General Assembly.

Section
4723.481 of the Revised Code as amended by H.B. 33 of the 135th
General Assembly and by H.B. 110 and H.B. 509 of the 134th General
Assembly.