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