As Introduced
136th General Assembly
Regular Session H. B. No. 224
2025-2026
Representatives McClain, Miller, M.
Cosponsors: Representatives Newman, Gross, Creech, Fowler Arthur,
Klopfenstein
To amend sections 3701.351, 3702.30, 4723.01,
4723.02, 4723.03, 4723.06, 4723.07, 4723.08,
4723.271, 4723.28, 4723.282, 4723.33, 4723.34,
4723.341, 4723.35, 4723.41, 4723.43, 4723.431,
4723.432, 4723.481, 4723.483, 4723.487,
4723.488, 4723.4810, 4723.4811, 4723.50,
4723.91, 4723.99, 4731.22, and 4731.27 and to
enact sections 5.2322, 4723.53, 4723.54,
4723.55, 4723.551, 4723.56, 4723.57, 4723.58,
4723.581, 4723.582, 4723.583, 4723.584, 4723.59,
4723.60, 4724.01, 4724.02, 4724.03, 4724.04,
4724.05, 4724.06, 4724.07, 4724.08, 4724.09,
4724.10, 4724.11, 4724.12, 4724.13, 4724.14, and
4724.99 of the Revised Code to regulate the
practice of certified nurse-midwives, certified
midwives, and licensed midwives and to designate
May 5th as the "Day of the Midwife."
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3701.351, 3702.30, 4723.01,
4723.02, 4723.03, 4723.06, 4723.07, 4723.08, 4723.271, 4723.28,
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4723.282, 4723.33, 4723.34, 4723.341, 4723.35, 4723.41, 4723.43,
4723.431, 4723.432, 4723.481, 4723.483, 4723.487, 4723.488,
4723.4810, 4723.4811, 4723.50, 4723.91, 4723.99, 4731.22, and
4731.27 be amended and sections 5.2322, 4723.53, 4723.54,
4723.55, 4723.551, 4723.56, 4723.57, 4723.58, 4723.581,
4723.582, 4723.583, 4723.584, 4723.59, 4723.60, 4724.01,
4724.02, 4724.03, 4724.04, 4724.05, 4724.06, 4724.07, 4724.08,
4724.09, 4724.10, 4724.11, 4724.12, 4724.13, 4724.14, and
4724.99 of the Revised Code be enacted to read as follows:
Sec. 5.2322. The fifth day of May is designated as the
"Day of the Midwife."
Sec. 3701.351. (A) The governing body of every hospital
shall set standards and procedures to be applied by the hospital
and its medical staff in considering and acting upon
applications for staff membership or professional privileges.
These standards and procedures shall be available for public
inspection.
(B) The governing body of any hospital, in considering and
acting upon applications for staff membership or professional
privileges within the scope of the applicants' respective
licensures, shall not discriminate against a qualified person
solely on the basis of whether that person is licensed to
practice medicine, osteopathic medicine, or podiatry, is
licensed to practice dentistry or psychology, or is licensed to
practice nursing as an advanced practice registered nurse , or is
licensed to practice as a certified midwife or licensed midwife .
Staff membership or professional privileges shall be considered
and acted on in accordance with standards and procedures
established under division (A) of this section. This section
does not permit a psychologist to admit a patient to a hospital
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in violation of section 3727.06 of the Revised Code.
(C) The governing body of any hospital that provides
maternity services, in considering and acting upon applications
for clinical privileges, shall not discriminate against a
qualified person solely on the basis that the person is
authorized to practice nurse-midwifery or midwifery. An
application from a certified nurse-midwife or certified midwife
who is not employed by the hospital shall contain the name of a
physician member of the hospital's medical staff who holds
clinical privileges in obstetrics at that hospital and who has
agreed to be the collaborating physician for the applicant in
accordance with section 4723.43 4723.431 of the Revised Code.
(D) Any person may apply to the court of common pleas for
temporary or permanent injunctions restraining a violation of
division (A), (B), or (C) of this section. This action is an
additional remedy not dependent on the adequacy of the remedy at
law.
(E)(1) If a hospital does not provide or permit the
provision of any diagnostic or treatment service for mental or
emotional disorders or any other service that may be legally
performed by a psychologist licensed under Chapter 4732. of the
Revised Code, this section does not require the hospital to
provide or permit the provision of any such service and the
hospital shall be exempt from requirements of this section
pertaining to psychologists.
(2) This section does not impair the right of a hospital
to enter into an employment, personal service, or any other kind
of contract with a licensed psychologist, upon any such terms as
the parties may mutually agree, for the provision of any service
that may be legally performed by a licensed psychologist.
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Sec. 3702.30. (A) As used in this section:
(1) "Ambulatory surgical facility" means a facility in
which surgical services are provided to patients who do not
require hospitalization for inpatient care, the duration of
services for any patient does not extend beyond twenty-four
hours after the patient's admission, and to which any of the
following apply:
(a) The surgical services are provided in a building that
is separate from another building in which inpatient care is
provided, regardless of whether the separate building is part of
the same organization as the building in which inpatient care is
provided.
(b) The surgical services are provided within a building
in which inpatient care is provided and the entity that operates
the portion of the building where the surgical services are
provided is not the entity that operates the remainder of the
building.
(c) The facility is held out to any person or government
entity as an ambulatory surgical facility or similar facility by
means of signage, advertising, or other promotional efforts.
"Ambulatory surgical facility" does not include a hospital
emergency department, hospital provider-based department that is
otherwise licensed under Chapter 3722. of the Revised Code, or
an office of a physician, podiatrist, or dentist.
(2) "Health care facility" means any of the following:
(a) An ambulatory surgical facility;
(b) A freestanding dialysis center;
(c) A freestanding inpatient rehabilitation facility;
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(d) A freestanding birthing center;
(e) A freestanding radiation therapy center;
(f) A freestanding or mobile diagnostic imaging center.
(B) By rule adopted in accordance with sections 3702.12
and 3702.13 of the Revised Code, the director of health shall
establish quality standards for health care facilities. The
standards may incorporate accreditation standards or other
quality standards established by any entity recognized by the
director.
(1) In the case of an ambulatory surgical facility, the
standards shall require the ambulatory surgical facility to
maintain an infection control program. The purposes of the
program are to minimize infections and communicable diseases and
facilitate a functional and sanitary environment consistent with
standards of professional practice. To achieve these purposes,
ambulatory surgical facility staff managing the program shall
create and administer a plan designed to prevent, identify, and
manage infections and communicable diseases; ensure that the
program is directed by a qualified professional trained in
infection control; ensure that the program is an integral part
of the ambulatory surgical facility's quality assessment and
performance improvement program; and implement in an expeditious
manner corrective and preventive measures that result in
improvement.
(2) In the case of a freestanding birthing center, the
standards shall require both of the following:
(a) At least one of the following to attend each birth:
(i) A physician licensed under Chapter 4731. of the
Revised Code to practice medicine and surgery or osteopathic
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medicine and surgery;
(ii) A certified nurse-midwife licensed under Chapter
4723. of the Revised Code;
(iii) A certified midwife licensed under Chapter 4723. of
the Revised Code;
(iv) A licensed midwife licensed under Chapter 4724. of
the Revised Code.
(b) That each freestanding birthing center have a director
of patient services who is one of the following:
(i) A physician licensed under Chapter 4731. of the
Revised Code to practice medicine and surgery or osteopathic
medicine and surgery;
(ii) A certified nurse-midwife licensed under Chapter
4723. of the Revised Code who has contracted with a
collaborating physician;
(iii) A certified midwife licensed under Chapter 4723. of
the Revised Code who has contracted with a collaborating
physician.
(C) Every ambulatory surgical facility shall require that
each physician who practices at the facility comply with all
relevant provisions in the Revised Code that relate to the
obtaining of informed consent from a patient.
(D) The director shall issue a license to each health care
facility that makes application for a license and demonstrates
to the director that it meets the quality standards established
by the rules adopted under division (B) of this section and
satisfies the informed consent compliance requirements specified
in division (C) of this section.
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(E)(1) Except as provided in division (H) of this section
and in section 3702.301 of the Revised Code, no health care
facility shall operate without a license issued under this
section.
The general assembly does not intend for the provisions of
this section or section 3702.301 of the Revised Code that
establish health care facility licensing requirements or
exemptions to have an effect on any third-party payments that
may be available for the services provided by either a licensed
health care facility or an entity exempt from licensure.
(2) If the department of health finds that a physician who
practices at a health care facility is not complying with any
provision of the Revised Code related to the obtaining of
informed consent from a patient, the department shall report its
finding to the state medical board, the physician, and the
health care facility.
(3) Division (E)(2) of this section does not create, and
shall not be construed as creating, a new cause of action or
substantive legal right against a health care facility and in
favor of a patient who allegedly sustains harm as a result of
the failure of the patient's physician to obtain informed
consent from the patient prior to performing a procedure on or
otherwise caring for the patient in the health care facility.
(F) The rules adopted under division (B) of this section
shall include all of the following:
(1) Provisions governing application for, renewal,
suspension, and revocation of a license under this section;
(2) Provisions governing orders issued pursuant to section
3702.32 of the Revised Code for a health care facility to cease
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its operations or to prohibit certain types of services provided
by a health care facility;
(3) Provisions governing the imposition under section
3702.32 of the Revised Code of civil penalties for violations of
this section or the rules adopted under this section, including
a scale for determining the amount of the penalties;
(4) Provisions specifying the form inspectors must use
when conducting inspections of ambulatory surgical facilities.
(G) An ambulatory surgical facility that performs or
induces abortions shall comply with section 3701.791 of the
Revised Code.
(H) The following entities are not required to obtain a
license as a freestanding diagnostic imaging center issued under
this section:
(1) A hospital registered under section 3701.07 of the
Revised Code that provides diagnostic imaging;
(2) An entity that is reviewed as part of a hospital
accreditation or certification program and that provides
diagnostic imaging;
(3) An ambulatory surgical facility that provides
diagnostic imaging in conjunction with or during any portion of
a surgical procedure.
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
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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.
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(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.
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(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. A certified nurse-midwife does
not include a certified midwife, licensed midwife, or
traditional midwife.
(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
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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 are continuously available to communicate with the
clinical nurse specialist or certified nurse practitioner either
in person or by electronic communication;
(2) In the case of a certified nurse-midwife or certified
midwife, that one or more physicians with whom the certified
nurse-midwife or certified midwife has entered into a standard
care arrangement are continuously available to communicate with
the certified nurse-midwife or certified midwife either in
person or by electronic communication.
(M) "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) "Standard care arrangement" means a written, formal
guide for planning and evaluating a patient's health care that
is developed by one or more collaborating physicians or
podiatrists and a clinical nurse specialist, certified nurse-
midwife, certified midwife, or certified nurse practitioner and
meets the requirements of section 4723.431 of the Revised Code.
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(O) "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) "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, training, and clinical experience.
Such nursing care includes the care described in section 4723.43
of the Revised Code.
(Q) "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) "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) "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.
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(T) "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) "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) "Nursing specialty" means a specialty in practice as a
certified registered nurse anesthetist, clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner.
(W) "Physician assistant" means an individual who is
licensed to practice as a physician assistant under Chapter
4730. of the Revised Code.
(X) "Certified midwife" means an individual who is
licensed under section 4723.56 of the Revised Code and engages
in one or more of the activities described in that section. A
certified midwife does not include a certified nurse-midwife,
licensed midwife, or traditional midwife.
(Y) "Licensed midwife" has the same meaning as in section
4724.01 of the Revised Code. A licensed midwife does not include
a certified nurse-midwife, certified midwife, or traditional
midwife.
(Z) "Traditional midwife" has the same meaning as in
section 4724.01 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.
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The board shall consist of thirteen fifteen 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 be a
certified nurse-midwife or a certified midwife practicing in an
urban setting. One member shall be a certified nurse-midwife or
a certified midwife practicing in a rural setting. 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.
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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.
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Seven Eight members of the board , including at least four
registered nurses 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. 4723.03. (A) No person shall engage in the practice
of nursing as a registered nurse, represent the person as being
a registered nurse, or use the title "registered nurse," the
initials "R.N.," or any other title implying that the person is
a registered nurse, for a fee, salary, or other consideration,
or as a volunteer, without holding a current, valid license as a
registered nurse under this chapter.
(B) No person shall knowingly do any of the following
without holding a current, valid license to practice nursing as
an advanced practice registered nurse issued under this chapter:
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(1) Engage in the practice of nursing as an advanced
practice registered nurse;
(2) Represent the person as being an advanced practice
registered nurse;
(3) Use the title "advanced practice registered nurse,"
the initials "A.P.R.N.," or any other title implying that the
person is an advanced practice registered nurse, for a fee,
salary, or other consideration, or as a volunteer.
(C) No person who is not otherwise authorized to do so
shall knowingly prescribe or personally furnish drugs or
therapeutic devices without holding a current, valid license to
practice nursing as an advanced practice registered nurse issued
under this chapter and being designated as a clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner under section 4723.42 of the Revised Code;
(D) No person shall engage in the practice of nursing as a
licensed practical nurse, represent the person as being a
licensed practical nurse, or use the title "licensed practical
nurse," the initials "L.P.N.," or any other title implying that
the person is a licensed practical nurse, for a fee, salary, or
other consideration, or as a volunteer, without holding a
current, valid license as a practical nurse under this chapter.
(E) No person shall use the titles or initials "graduate
nurse," "G.N.," "professional nurse," "P.N.," "graduate
practical nurse," "G.P.N.," "practical nurse," "P.N.," "trained
nurse," "T.N.," or any other statement, title, or initials that
would imply or represent to the public that the person is
authorized to practice nursing in this state, except as follows:
(1) A person licensed under this chapter to practice
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nursing as a registered nurse may use that title and the
initials "R.N.";
(2) A person licensed under this chapter to practice
nursing as a licensed practical nurse may use that title and the
initials "L.P.N.";
(3) A person licensed under this chapter to practice
nursing as an advanced practice registered nurse and designated
as a certified registered nurse anesthetist may use that title
or the initials "A.P.R.N.-C.R.N.A.";
(4) A person licensed under this chapter to practice
nursing as an advanced practice registered nurse and designated
as a clinical nurse specialist may use that title or the
initials "A.P.R.N.-C.N.S.";
(5) A person licensed under this chapter to practice
nursing as an advanced practice registered nurse and designated
as a certified nurse-midwife may use that title or the initials
"A.P.R.N.-C.N.M.";
(6) A person licensed under this chapter to practice
nursing as an advanced practice registered nurse and designated
as a certified nurse practitioner may use that title or the
initials "A.P.R.N.-C.N.P.";
(7) A person licensed under this chapter to practice
nursing as an advanced practice registered nurse may use the
title "advanced practice registered nurse" or the initials
"A.P.R.N."
(F) No person shall employ a person not licensed as a
registered nurse under this chapter to engage in the practice of
nursing as a registered nurse.
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No person shall knowingly employ a person not licensed as
an advanced practice registered nurse under this chapter to
engage in the practice of nursing as an advanced practice
registered nurse.
No person shall employ a person not licensed as a
practical nurse under this chapter to engage in the practice of
nursing as a licensed practical nurse.
(G) No person shall sell or fraudulently obtain or furnish
any nursing diploma, license, certificate, renewal, or record,
or aid or abet such acts.
(H)(1) No person shall knowingly use the title "certified
nurse-midwife," the initials "C.N.M.," or any other title
implying that the person is a certified nurse-midwife without
holding a current, valid license as a certified nurse-midwife
under this chapter.
(2) No person shall knowingly use the title "certified
midwife," the initials "C.M.," or any other title implying that
the person is a certified midwife without holding a current,
valid license as a certified midwife under this chapter.
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, certified midwife
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licenses, dialysis technician certificates, medication aide
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
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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 or
4723.551 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;
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(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;
(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.
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653 H. B. No. 224 Page 24
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(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
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As Introduced
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
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712 H. B. No. 224 Page 26
As Introduced
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
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741 H. B. No. 224 Page 27
As Introduced
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:
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770 H. B. No. 224 Page 28
As Introduced
(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;
(L) Additional criteria for the standard care arrangement
required by section 4723.431 of the Revised Code entered into by
a certified midwife, clinical nurse specialist, certified nurse-
midwife, or certified nurse practitioner and the nurse's
collaborating physician or podiatrist;
(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. 4723.08. (A) The board of nursing may impose fees not
to exceed the following limits:
(1) For application for licensure by examination or
endorsement to practice nursing as a registered nurse or as a
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797 H. B. No. 224 Page 29
As Introduced
licensed practical nurse submitted under division (A) or (B) of
section 4723.09 of the Revised Code, seventy-five dollars;
(2) For application for licensure to practice nursing as
an advanced practice registered nurse submitted under division
(A) or (B)(2) of section 4723.41 of the Revised Code, one
hundred fifty dollars;
(3) For application for a dialysis technician certificate,
the amount specified in rules adopted under section 4723.79 of
the Revised Code;
(4) For providing, pursuant to division (B) of section
4723.271 of the Revised Code, written verification of a nursing
license, dialysis technician certificate, medication aide
certificate, or community health worker certificate to another
jurisdiction, fifteen dollars;
(5) For providing, pursuant to division (A) of section
4723.271 of the Revised Code, a replacement copy of a wall
certificate suitable for framing as described in that division,
twenty-five dollars;
(6) For renewal of a license to practice as a registered
nurse or licensed practical nurse, sixty-five dollars;
(7) For renewal of a license to practice as an advanced
practice registered nurse, one hundred thirty-five dollars;
(8) For renewal of a dialysis technician certificate, the
amount specified in rules adopted under section 4723.79 of the
Revised Code;
(9) For processing a late application for renewal of a
nursing license or dialysis technician certificate, fifty
dollars;
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825 H. B. No. 224 Page 30
As Introduced
(10) For application for authorization to approve
continuing education programs and courses from an applicant
accredited by a national accreditation system for nursing, five
hundred dollars;
(11) For application for authorization to approve
continuing education programs and courses from an applicant not
accredited by a national accreditation system for nursing, one
thousand dollars;
(12) For each year for which authorization to approve
continuing education programs and courses is renewed, one
hundred fifty dollars;
(13) For application for approval to operate a dialysis
training program, the amount specified in rules adopted under
section 4723.79 of the Revised Code;
(14) For reinstatement of a lapsed license or certificate
issued under this chapter, one hundred dollars except as
provided in section 5903.10 of the Revised Code;
(15) For processing a check returned to the board by a
financial institution, twenty-five dollars;
(16) The amounts specified in rules adopted under section
4723.88 of the Revised Code pertaining to the issuance of
certificates to community health workers, including fees for
application for a certificate, renewal of a certificate,
processing a late application for renewal of a certificate,
reinstatement of a lapsed certificate, application for approval
of a community health worker training program for community
health workers, and renewal of the approval of a training
program for community health workers ;
(17) For application for licensure to practice as a
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854 H. B. No. 224 Page 31
As Introduced
certified midwife, forty-five dollars;
(18) For renewal of a license to practice as a certified
midwife, twenty dollars .
(B) Each quarter, for purposes of transferring funds under
section 4743.05 of the Revised Code to the nurse education
assistance fund created in section 3333.28 of the Revised Code,
the board of nursing shall certify to the director of budget and
management the number of licenses renewed under this chapter
during the preceding quarter and the amount equal to that number
times five dollars.
(C) The board may charge a participant in a board-
sponsored continuing education activity an amount not exceeding
fifteen dollars for each activity.
(D) The board may contract for services pertaining to the
process of providing written verification of a license or
certificate when the verification is performed for purposes
other than providing verification to another jurisdiction. The
contract may include provisions pertaining to the collection of
the fee charged for providing the written verification. As part
of these provisions, the board may permit the contractor to
retain a portion of the fees as compensation, before any amounts
are deposited into the state treasury.
Sec. 4723.271. (A) Upon request of the holder of a nursing
license, certified midwife license, dialysis technician
certificate, medication aide certificate, or community health
worker certificate issued under this chapter, the presentment of
proper identification as prescribed in rules adopted by the
board of nursing, and payment of the fee authorized under
section 4723.08 of the Revised Code, the board of nursing shall
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As Introduced
provide to the requestor a replacement copy of a wall
certificate suitable for framing.
(B) Upon request of the holder of a nursing license,
certified midwife license, volunteer's certificate, dialysis
technician certificate, medication aide certificate, or
community health worker certificate issued under this chapter
and payment of the fee authorized under section 4723.08 of the
Revised Code, the board shall verify to an agency of another
jurisdiction or foreign country the fact that the person holds
such nursing license, certified midwife license, volunteer's
certificate, dialysis technician certificate, medication aide
certificate, or community health worker certificate.
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, certified midwife license, or dialysis
technician certificate issued by the board: deny, revoke,
suspend, or place restrictions on any nursing license , certified
midwife license, or dialysis technician certificate issued by
the board; reprimand or otherwise discipline a holder of a
nursing license, certified midwife 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 , certified midwife
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913 H. B. No. 224 Page 33
As Introduced
license, or dialysis technician certificate issued by the board;
reprimand or otherwise discipline a holder of a nursing license ,
certified midwife 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
certified midwife or 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 certified midwife or dialysis technician, having
failed to renew a nursing license , certified midwife license, or
dialysis technician certificate issued under this chapter, or
while a nursing license , certified midwife 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;
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As Introduced
(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
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973 H. B. No. 224 Page 35
As Introduced
provide safe nursing care , safe care as a certified midwife, or
safe dialysis care;
(10) Impairment of the ability to practice according to
acceptable and prevailing standards of safe nursing care , safe
care as a certified midwife, 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, certified midwife 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, certified midwife license, or dialysis
technician certificate;
(18) Failure to use universal and standard precautions
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1001 H. B. No. 224 Page 36
As Introduced
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 , safe care as a
certified midwife, 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 or as a certified midwife 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
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1029 H. B. No. 224 Page 37
As Introduced
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;
(b) Failure to meet the quality assurance standards
established under section 4723.07 of the Revised Code.
(28) In the case of an advanced practice registered nurse
other than a certified registered nurse anesthetist, 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;
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1057 H. B. No. 224 Page 38
As Introduced
(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, certified
midwife, 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;
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(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 certified midwife:
(a) Engaging in activities that exceed those permitted
under section 4723.57 of the Revised Code;
(b) Failure to prescribe drugs and therapeutic devices in
accordance with section 4723.481 of the Revised Code;
(c) 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 .
(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
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1114 H. B. No. 224 Page 40
As Introduced
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, certified midwife, 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, certified midwife, 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, certified midwife, or dialysis
technician committed the act, or if the registered nurse,
licensed practical nurse, certified midwife, or dialysis
technician fails to participate in the adjudication, the board
may take action as though the registered nurse, licensed
practical nurse, certified midwife, 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, certified midwife, or dialysis
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1144 H. B. No. 224 Page 41
As Introduced
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, certified midwife, 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, certified midwife, or dialysis
technician committed such act, or if the registered nurse,
licensed practical nurse, certified midwife, 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,
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1175 H. B. No. 224 Page 42
As Introduced
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, certified midwife, 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.
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1204 H. B. No. 224 Page 43
As Introduced
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, certified midwife, 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
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1234 H. B. No. 224 Page 44
As Introduced
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, certified midwife, or dialysis technician, or a
person who may have engaged in the unauthorized practice of
nursing, certified midwifery, 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
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1264 H. B. No. 224 Page 45
As Introduced
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 ,
certified midwife 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, certified midwife 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.
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1293 H. B. No. 224 Page 46
As Introduced
(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. 4723.282. (A) As used in this section, "practice
deficiency" means any activity that does not meet acceptable and
prevailing standards of safe and effective nursing care or
dialysis care or safe and effective care as a certified midwife .
(B) The board of nursing may abstain from taking
disciplinary action under section 4723.28 of the Revised Code
against the holder of a license or certificate issued under this
chapter who has a practice deficiency that has been identified
by the board through an investigation conducted under section
4723.28 of the Revised Code. The board may abstain from taking
action only if the board has reason to believe that the
individual's practice deficiency can be corrected through
remediation, and if the individual enters into an agreement with
the board to seek remediation as prescribed by the board,
complies with the terms and conditions of the remediation, and
successfully completes the remediation. If an individual fails
to complete the remediation or the board determines that
remediation cannot correct the individual's practice deficiency,
the board shall proceed with disciplinary action in accordance
with section 4723.28 of the Revised Code.
(C) To implement its authority under this section to
abstain from taking disciplinary action, the board shall
establish a practice intervention and improvement program. The
board shall designate an administrator to operate the program
and, in accordance with Chapter 119. of the Revised Code, adopt
rules for the program that establish the following:
(1) Criteria for use in identifying an individual's
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1323 H. B. No. 224 Page 47
As Introduced
practice deficiency;
(2) Requirements that an individual must meet to be
eligible for remediation and the board's abstention from
disciplinary action;
(3) Standards and procedures for prescribing remediation
that is appropriate for an individual's identified practice
deficiency;
(4) Terms and conditions that an individual must meet to
be successful in completing the remediation prescribed;
(5) Procedures for the board's monitoring of the
individual's remediation;
(6) Procedures for maintaining confidential records
regarding individuals who participate in remediation;
(7) Any other requirements or procedures necessary to
develop and administer the program.
(D) All records held by the board for purposes of the
program shall be confidential, are not public records for
purposes of section 149.43 of the Revised Code, and are not
subject to discovery by subpoena or admissible as evidence in
any judicial proceeding. The administrator of the program shall
maintain all records in the board's office in accordance with
the board's record retention schedule.
(E) When an individual begins the remediation prescribed
by the board, the individual shall sign a waiver permitting any
entity that provides services related to the remediation to
release to the board information regarding the individual's
progress. An entity that provides services related to
remediation shall report to the board if the individual fails to
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1351 H. B. No. 224 Page 48
As Introduced
complete the remediation or does not make satisfactory progress
in remediation.
In the absence of fraud or bad faith, an entity that
reports to the board regarding an individual's practice
deficiency, or progress or lack of progress in remediation, is
not liable in damages to any person as a result of making the
report.
(F) An individual participating in remediation prescribed
under this section is responsible for all financial obligations
that may arise from obtaining or completing the remediation.
Sec. 4723.33. A registered nurse, licensed practical
nurse, certified midwife, dialysis technician, community health
worker, or medication aide who in good faith makes a report
under this chapter or any other provision of the Revised Code
regarding a violation of this chapter or any other provision of
the Revised Code, or participates in any investigation,
administrative proceeding, or judicial proceeding resulting from
the report, has the full protection against retaliatory action
provided by sections 4113.51 to 4113.53 of the Revised Code.
Sec. 4723.34. (A) A person or governmental entity that
employs, or contracts directly or through another person or
governmental entity for the provision of services by, registered
nurses, licensed practical nurses, nurses holding multistate
licenses to practice registered or licensed practical nursing
issued pursuant to section 4723.11 of the Revised Code,
certified midwives, dialysis technicians, medication aides, or
certified community health workers and that knows or has reason
to believe that a current or former employee or person providing
services under a contract who holds a license or certificate
issued under this chapter engaged in conduct that would be
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1381 H. B. No. 224 Page 49
As Introduced
grounds for disciplinary action by the board of nursing under
this chapter or rules adopted under it shall report to the board
of nursing the name of such current or former employee or person
providing services under a contract. The report shall be made on
the person's or governmental entity's behalf by an individual
licensed by the board who the person or governmental entity has
designated to make such reports.
A prosecutor in a case described in divisions (B)(3) to
(5) of section 4723.28 of the Revised Code, or in a case where
the trial court issued an order of dismissal upon technical or
procedural grounds of a charge of a misdemeanor committed in the
course of practice, a felony charge, or a charge of gross
immorality or moral turpitude, who knows or has reason to
believe that the person charged is licensed under this chapter
to practice nursing as a registered nurse or as a licensed
practical nurse, is licensed under this chapter to practice as a
certified midwife, or holds a certificate issued under this
chapter to practice as a dialysis technician shall notify the
board of nursing of the charge. With regard to certified
community health workers and medication aides, the prosecutor in
a case involving a charge of a misdemeanor committed in the
course of employment, a felony charge, or a charge of gross
immorality or moral turpitude, including a case dismissed on
technical or procedural grounds, who knows or has reason to
believe that the person charged holds a community health worker
or medication aide certificate issued under this chapter shall
notify the board of the charge.
Each notification from a prosecutor shall be made on forms
prescribed and provided by the board. The report shall include
the name and address of the license or certificate holder, the
charge, and the certified court documents recording the action.
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1412 H. B. No. 224 Page 50
As Introduced
(B) If any person or governmental entity fails to provide
a report required by this section, the board may seek an order
from a court of competent jurisdiction compelling submission of
the report.
Sec. 4723.341. (A) As used in this section, "person" has
the same meaning as in section 1.59 of the Revised Code and also
includes the board of nursing and its members and employees;
health care facilities, associations, and societies; insurers;
and individuals.
(B) In the absence of fraud or bad faith, no person
reporting to the board of nursing or testifying in an
adjudication conducted under Chapter 119. of the Revised Code
with regard to alleged incidents of negligence or malpractice or
matters subject to this chapter or sections 3123.41 to 3123.50
of the Revised Code and any applicable rules adopted under
section 3123.63 of the Revised Code shall be subject to either
of the following based on making the report or testifying:
(1) Liability in damages in a civil action for injury,
death, or loss to person or property;
(2) Discipline or dismissal by an employer.
(C) An individual who is disciplined or dismissed in
violation of division (B)(2) of this section has the same rights
and duties accorded an employee under sections 4113.52 and
4113.53 of the Revised Code.
(D) In the absence of fraud or bad faith, no professional
association of registered nurses, advanced practice registered
nurses, licensed practical nurses, certified midwives, dialysis
technicians, community health workers, or medication aides that
sponsors a committee or program to provide peer assistance to
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1441 H. B. No. 224 Page 51
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individuals with substance abuse problems, no representative or
agent of such a committee or program, and no member of the board
of nursing shall be liable to any person for damages in a civil
action by reason of actions taken to refer a nurse, certified
midwife, dialysis technician, community health worker, or
medication aide to a treatment provider or actions or omissions
of the provider in treating a nurse, certified midwife, dialysis
technician, community health worker, or medication aide.
Sec. 4723.35. (A) As used in this section and section
4723.351 of the Revised Code:
(1) "Applicant" means an individual who has applied for a
license or certificate to practice issued under this chapter.
"Applicant" may include an individual who has been granted
authority by the board of nursing to practice as one type of
practitioner, but has applied for authority to practice as
another type of practitioner.
(2) "Impaired" or "impairment" means either or both of the
following:
(a) Impairment of the ability to practice as described in
division (B)(10) of section 4723.28 of the Revised Code;
(b) Impairment of the ability to practice as described in
division (B)(11) of section 4723.28 of the Revised Code.
(3) "Practitioner" means an individual authorized under
this chapter to practice as a registered nurse, including as an
advanced practice registered nurse, licensed practical nurse,
certified midwife, dialysis technician, community health worker,
or medication aide.
(B) The board of nursing shall establish the safe haven
program to monitor applicants and practitioners who are or may
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1470 H. B. No. 224 Page 52
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be impaired, but against whom the board has abstained from
taking disciplinary action. The program is to be conducted by
the monitoring organization under contract with the board as
described in section 4723.351 of the Revised Code.
(C)(1) On the establishment of the program, the board may
transfer to the monitoring organization, in whole or in part,
either or both of the following responsibilities:
(a) The monitoring and oversight of licensees as part of
the substance use disorder program as that program existed on or
before the effective date of this section September 20, 2024;
(b) The monitoring and oversight of licensees under terms
specified in a board adjudication order or consent agreement.
(2) If the board transfers the responsibilities described
in division (C)(1) of this section, both of the following apply:
(a) The monitoring organization shall provide to the board
quarterly reports regarding the compliance of transferred
licensees.
(b) The monitoring organization shall immediately report
to the board any licensee who is not in compliance with the
terms and conditions of monitoring.
(D) The board shall refer to the monitoring organization
any applicant or practitioner whose health and effectiveness
show signs of impairment or potential impairment, but only if
the applicant or practitioner meets the eligibility conditions
of division (G) of this section.
(E) Determinations regarding an applicant's or
practitioner's eligibility for admission to, continued
participation in, and successful completion of the safe haven
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1498 H. B. No. 224 Page 53
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program shall be made by the monitoring organization in
accordance with rules adopted under section 4723.351 of the
Revised Code.
(F) The board shall abstain from taking disciplinary
action under section 4723.28, 4723.652, or 4723.86 of the
Revised Code against an individual whose health and
effectiveness show signs of impairment or potential impairment,
but who is not currently under the terms of a consent agreement
with the board for impairment or an order issued by the board
for impairment if the individual is participating in the safe
haven program.
An applicant's or practitioner's impairment neither
excuses an applicant or practitioner who has committed other
violations of this chapter nor precludes the board from
investigating or taking disciplinary action against an applicant
or practitioner for other violations of this chapter.
(G) An applicant or practitioner is eligible to
participate in the safe haven program if both of the following
conditions are met:
(1) The applicant or practitioner needs assistance with
impairment or potential impairment.
(2) The applicant or practitioner has an unencumbered
license and is not currently under the terms of a consent
agreement with the board for impairment or an order issued by
the board for impairment.
Sec. 4723.41. (A) Each person who desires to practice
nursing as a certified nurse-midwife and has not been authorized
to practice midwifery nurse-midwifery prior to December 1, 1967,
and each person who desires to practice nursing as a certified
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1527 H. B. No. 224 Page 54
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registered nurse anesthetist, clinical nurse specialist, or
certified nurse practitioner shall file with the board of
nursing a written application for a license to practice nursing
as an advanced practice registered nurse and designation in the
desired specialty. 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
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1556 H. B. No. 224 Page 55
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the applicant obtained education in the applicant's nursing
specialty, and any other facts that the board requires;
(c) The specialty in which 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 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:
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1586 H. B. No. 224 Page 56
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(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 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:
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1616 H. B. No. 224 Page 57
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(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 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 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,
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1645 H. B. No. 224 Page 58
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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 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. 4723.43. 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 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
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1674 H. B. No. 224 Page 59
As Introduced
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.
(A) A Subject to sections 4723.58 to 4723.584 of the
Revised Code, 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, do any obstetric
operation, or treat any other abnormal condition outside of the
scope of practice for certified nurse-midwives established by
the American college of nurse-midwives , except in emergencies .
No certified nurse-midwife may deliver breech or face
presentation except in an emergency or as provided in section
4723.581 of the Revised Code . 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. A
certified nurse-midwife may, in collaboration with one or more
physicians, attend births in hospitals, homes, medical offices,
and freestanding birthing centers and provide care for normal
newborns during the period consistent with the scope of practice
for certified nurse-midwives established by the American college
of nurse-midwives.
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1705 H. B. No. 224 Page 60
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(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
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1734 H. B. No. 224 Page 61
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practitioner, in collaboration with one or more physicians or
podiatrists, may provide preventive and primary 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 with
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 with 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 A certified midwife or an
advanced practice registered nurse who is designated as a
clinical nurse specialist, certified nurse-midwife, or certified
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1764 H. B. No. 224 Page 62
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nurse practitioner may practice only in accordance with a
standard care arrangement entered into with each physician or
podiatrist with whom the certified midwife or nurse
collaborates. A copy of the standard care arrangement shall be
retained on file by the certified midwife's or 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 certified midwife, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner may enter into a
standard care arrangement with one or more collaborating
physicians or podiatrists. If a collaborating physician or
podiatrist enters into standard care arrangements with more than
five certified midwives or nurses, the physician or podiatrist
shall not collaborate at the same time with more than five
certified midwives or nurses in the prescribing component of
their practices.
Not later than thirty days after first engaging in the
practice of midwifery as a certified midwife or the practice of
nursing as a clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner, the certified midwife or nurse
shall submit to the board the name and business address of each
collaborating physician or podiatrist. Thereafter, the certified
midwife or nurse shall notify the board of any additions or
deletions to the midwife's or nurse's collaborating physicians
or podiatrists. Except as provided in division (D) of this
section, the notice must be provided not later than thirty days
after the change takes effect.
(2) All of the following conditions apply with respect to
the practice of a collaborating physician or podiatrist with
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1794 H. B. No. 224 Page 63
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whom a certified midwife, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner may enter into a
standard care arrangement:
(a) The physician or podiatrist must be 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 in a
specialty that is the same as or similar to the certified
midwife's specialty or nurse's nursing specialty.
(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 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 certified
midwife, clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner to a collaborating physician or
podiatrist or another physician or podiatrist;
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1822 H. B. No. 224 Page 64
As Introduced
(2) A process for the certified midwife, clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner to obtain a consultation with a collaborating
physician or podiatrist or another physician or podiatrist;
(3) A plan for coverage in instances of emergency or
planned absences of either the certified midwife, 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 is
available for emergency care;
(4) The process for resolution of disagreements regarding
matters of patient management between the certified midwife,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner and a collaborating physician or podiatrist;
(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;
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1850 H. B. No. 224 Page 65
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(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 terminates the
collaboration between the physician or podiatrist and a
certified midwife, 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 must give the certified
midwife or nurse written or electronic notice of the
termination.
(b) Once the certified midwife or nurse receives the
termination notice, the certified midwife or 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 termination notice.
(c) Notwithstanding the requirement requirements of
section sections 4723.43 and 4723.57 of the Revised Code that
the certified midwife or nurse practice in collaboration with a
physician or podiatrist, the certified midwife or nurse may
continue to practice under the existing standard care
arrangement without a collaborating physician or podiatrist 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 and a certified midwife, certified
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1879 H. B. No. 224 Page 66
As Introduced
nurse-midwife, certified nurse practitioner, or clinical nurse
specialist terminates because of the physician's or podiatrist's
death, the certified midwife or nurse must notify the board of
the death as soon as practicable. The certified midwife or nurse
may continue to practice under the existing standard care
arrangement without a collaborating physician or podiatrist for
not more than one hundred twenty days after notifying the board
of the physician's or podiatrist's death.
(E)(1) Nothing in this section prohibits a hospital from
hiring a certified midwife, 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 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. In specifying such actions, the
standard care arrangement shall not authorize the nurse to take
any action that is otherwise prohibited by the Revised Code or
rule of the board.
Sec. 4723.432. (A) An A certified midwife or an advanced
practice registered nurse who is designated as a clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner shall cooperate with the state medical board in any
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1909 H. B. No. 224 Page 67
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investigation the board conducts with respect to a physician or
podiatrist who collaborates with the certified midwife or nurse.
The certified midwife or nurse shall cooperate with the board in
any investigation the board conducts with respect to the
unauthorized practice of medicine by the certified midwife or
nurse.
(B) An advanced practice registered nurse who is
designated as a certified registered nurse anesthetist shall
cooperate with the state medical board or state dental board in
any investigation either board conducts with respect to a
physician, podiatrist, or dentist who permits the nurse to
practice with the supervision of that physician, podiatrist, or
dentist. The nurse shall cooperate with either board in any
investigation it conducts with respect to the unauthorized
practice of medicine or dentistry by the nurse.
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.
This section also establishes standards and conditions
regarding the authority of a certified midwife to prescribe and
personally furnish drugs and therapeutic devices under a license
issued under section 4723.56 of the Revised Code.
(A) A clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner , or certified midwife shall not
prescribe or furnish any drug or therapeutic device that is
listed on the exclusionary formulary established in rules
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1939 H. B. No. 224 Page 68
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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, or certified midwife shall not exceed the
prescriptive authority of the collaborating physician or
podiatrist, including the collaborating 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 , or certified midwife
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 in division
(C)(1) of this section do not apply if a clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner, or certified midwife 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;
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1967 H. B. No. 224 Page 69
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(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
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1994 H. B. No. 224 Page 70
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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 , or
certified midwife providing 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 , or certified midwife 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 , or certified midwife 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
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2023 H. B. No. 224 Page 71
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nurse-midwife, or certified nurse practitioner , or certified
midwife 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 , or certified midwife 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. 4723.483. (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 , or certified midwife 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
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2052 H. B. No. 224 Page 72
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furnished or prescribed in such a manner that it may be
administered only in a manufactured dosage form.
(B) A nurse or certified midwife 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. 4723.487. (A) As used in this section:
(1) "Drug database" means the database established and
maintained by the state board of pharmacy pursuant to section
4729.75 of the Revised Code.
(2) "Opioid analgesic" and "benzodiazepine" have the same
meanings as in section 3719.01 of the Revised Code.
(B) Except as provided in divisions (C) and (E) of this
section, an advanced practice registered nurse who is designated
as a clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner or a certified midwife shall comply
with all of the following as conditions of prescribing a drug
that is either an opioid analgesic or a benzodiazepine as part
of a patient's course of treatment for a particular condition:
(1) Before initially prescribing the drug, the advanced
practice registered nurse or certified midwife or the advanced
practice registered nurse's or certified midwife's delegate
shall request from the drug database a report of information
related to the patient that covers at least the twelve months
immediately preceding the date of the request. If the advanced
practice registered nurse or certified midwife practices
primarily in a county of this state that adjoins another state,
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2081 H. B. No. 224 Page 73
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the advanced practice registered nurse or certified midwife or
delegate also shall request a report of any information
available in the drug database that pertains to prescriptions
issued or drugs furnished to the patient in the state adjoining
that county.
(2) If the patient's course of treatment for the condition
continues for more than ninety days after the initial report is
requested, the advanced practice registered nurse or certified
midwife or delegate shall make periodic requests for reports of
information from the drug database until the course of treatment
has ended. The requests shall be made at intervals not exceeding
ninety days, determined according to the date the initial
request was made. The request shall be made in the same manner
provided in division (B)(1) of this section for requesting the
initial report of information from the drug database.
(3) On receipt of a report under division (B)(1) or (2) of
this section, the advanced practice registered nurse or
certified midwife shall assess the information in the report.
The advanced practice registered nurse or certified midwife
shall document in the patient's record that the report was
received and the information was assessed.
(C) Division (B) of this section does not apply if in any
of the following circumstances:
(1) A drug database report regarding the patient is not
available, in which case the advanced practice registered nurse
or certified midwife shall document in the patient's record the
reason that the report is not available.
(2) The drug is prescribed in an amount indicated for a
period not to exceed seven days.
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(3) The drug is prescribed for the treatment of cancer or
another condition associated with cancer.
(4) The drug is prescribed to a hospice patient in a
hospice care program, as those terms are defined in section
3712.01 of the Revised Code, or any other patient diagnosed as
terminally ill.
(5) The drug is prescribed for administration in a
hospital, nursing home, or residential care facility.
(D) The board of nursing may adopt rules, in accordance
with Chapter 119. of the Revised Code, that establish standards
and procedures to be followed by an advanced practice registered
nurse or certified midwife regarding the review of patient
information available through the drug database under division
(A)(5) of section 4729.80 of the Revised Code. The rules shall
be adopted in accordance with Chapter 119. of the Revised Code.
(E) This section and any rules adopted under it do not
apply if the state board of pharmacy no longer maintains the
drug database.
Sec. 4723.488. (A) Except as provided in division (B) of
this section, in the case of a license holder who is seeking
renewal of a license to practice nursing as an advanced practice
registered nurse or a license to practice as a certified midwife
and who prescribes opioid analgesics or benzodiazepines, as
defined in section 3719.01 of the Revised Code, the holder shall
certify to the board whether the holder has been granted access
to the drug database established and maintained by the state
board of pharmacy pursuant to section 4729.75 of the Revised
Code.
(B) The requirement in division (A) of this section does
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2139 H. B. No. 224 Page 75
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not apply if any of the following is the case:
(1) The state board of pharmacy notifies the board of
nursing pursuant to section 4729.861 of the Revised Code that
the license holder has been restricted from obtaining further
information from the drug database.
(2) The state board of pharmacy no longer maintains the
drug database.
(3) The license holder does not practice nursing as an
advanced practice registered nurse or certified midwife in this
state.
(C) If a license holder certifies to the board of nursing
that the holder has been granted access to the drug database and
the board finds through an audit or other means that the holder
has not been granted access, the board may take action under
section 4723.28 of the Revised Code.
Sec. 4723.4810. (A)(1) Notwithstanding any conflicting
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 license to practice
nursing as an advanced practice registered nurse issued under
section 4723.42 of the Revised Code or certified midwife may
issue a prescription for or personally furnish a complete or
partial supply of a drug to treat chlamydia, gonorrhea, or
trichomoniasis, without having examined the individual for whom
the drug is intended, if all of the following conditions are
met:
(a) The individual is a sexual partner of the nurse's or
certified midwife's patient.
(b) The patient has been diagnosed with chlamydia,
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gonorrhea, or trichomoniasis.
(c) The patient reports to the nurse or certified midwife
that the individual is unable or unlikely to be evaluated or
treated by a health professional.
(2) A prescription issued under this section shall include
the individual's name and address, if known. If the nurse or
certified midwife is unable to obtain the individual's name and
address, the prescription shall include the patient's name and
address and the words "expedited partner therapy" or the letters
"EPT."
(3) A nurse or certified midwife may prescribe or
personally furnish a drug under this section for not more than a
total of two individuals who are sexual partners of the nurse's
or certified midwife's patient.
(B) For each drug prescribed or personally furnished under
this section, the nurse or certified midwife shall do all of the
following:
(1) Provide the patient with information concerning the
drug for the purpose of sharing the information with the
individual, including directions for use of the drug and any
side effects, adverse reactions, or known contraindications
associated with the drug;
(2) Recommend to the patient that the individual seek
treatment from a health professional;
(3) Document all of the following in the patient's record:
(a) The name of the drug prescribed or furnished and its
dosage;
(b) That information concerning the drug was provided to
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the patient for the purpose of sharing the information with the
individual;
(c) If known, any adverse reactions the individual
experiences from treatment with the drug.
(C) A nurse or certified midwife who prescribes or
personally furnishes a drug under this section may contact the
individual for whom the drug is intended.
(1) If the nurse or certified midwife contacts the
individual, the nurse or certified midwife shall do all of the
following:
(a) Inform the individual that the individual may have
been exposed to chlamydia, gonorrhea, or trichomoniasis;
(b) Encourage the individual to seek treatment from a
health professional;
(c) Explain the treatment options available to the
individual, including treatment with a prescription drug,
directions for use of the drug, and any side effects, adverse
reactions, or known contraindications associated with the drug;
(d) Document in the patient's record that the nurse or
certified midwife contacted the individual.
(2) If the nurse or certified midwife does not contact the
individual, the nurse or certified midwife shall document that
fact in the patient's record.
(D) A nurse or certified midwife who in good faith
prescribes or personally furnishes a drug under this section is
not liable for or subject to any of the following:
(1) Damages in any civil action;
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2223 H. B. No. 224 Page 78
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(2) Prosecution in any criminal proceeding;
(3) Professional disciplinary action.
Sec. 4723.4811. (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 licensed as an advanced practice registered nurse
under Chapter 4723. of the Revised Code , or certified midwife
may do either of the following without having examined an
individual to whom glucagon may be administered:
(a) Personally furnish a supply of injectable or nasally
administered glucagon for use in accordance with sections
3313.7115, 3313.7116, 3314.147, 3326.60, 3328.38, and 5101.78 of
the Revised Code;
(b) Issue a prescription for injectable or nasally
administered glucagon for use in accordance with sections
3313.7115, 3313.7116, 3314.147, 3326.60, 3328.38, and 5101.78 of
the Revised Code.
(2) Injectable or nasally administered glucagon 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 or certified midwife 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 injectable or nasally administered glucagon is furnished
or a prescription is issued: damages in any civil action,
prosecution in any criminal proceeding, or professional
disciplinary action.
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2252 H. B. No. 224 Page 79
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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 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 , and certified midwives to
prescribe and furnish drugs and therapeutic devices.
The board shall adopt 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 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 sections 4723.482 and 4723.551 of the Revised Code;
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2280 H. B. No. 224 Page 80
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(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 criteria for the components of the standard
care arrangements described in section 4723.431 of the Revised
Code 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 of the records of patients treated by
the clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner , or certified midwife ;
(c) Acceptable travel time between the location at which
the clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner , or certified midwife is engaging
in the prescribing components of the nurse's practice and the
location of the nurse's or certified midwife's collaborating
physician or podiatrist.
Sec. 4723.53. As used in sections 4723.43 and 4723.53 to
4723.60 of the Revised Code:
(A) "Accreditation commission for midwifery education"
means the organization known by that name or its successor
organization.
(B) "American college of nurse-midwives" means the
organization known by that name or its successor organization.
(C) "American midwifery certification board" means the
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organization known by that name or its successor organization.
Sec. 4723.54. (A) Except as provided in division (B) of
this section, no individual shall knowingly practice as a
certified midwife unless the individual holds a current, valid
license to practice as a certified midwife issued under section
4723.56 of the Revised Code.
(B) Division (A) of this section does not apply to any of
the following:
(1) A physician authorized under Chapter 4731. of the
Revised Code to practice medicine and surgery, osteopathic
medicine and surgery, or podiatric medicine and surgery;
(2) A physician assistant authorized under Chapter 4730.
of the Revised Code to practice as a physician assistant;
(3) A registered nurse, advanced practice registered
nurse, or licensed practical nurse authorized under this chapter
to practice nursing as a registered nurse, advanced practice
registered nurse, or licensed practical nurse;
(4) A licensed midwife;
(5) A traditional midwife;
(6) A student who is participating in a midwifery
education program accredited by the accreditation commission for
midwifery education and who provides midwifery services under
the auspices of the program and under the supervision of a
certified midwife serving for the program as a faculty member,
instructor, teaching assistant, or preceptor.
Sec. 4723.55. (A) An individual seeking a license to
practice as a certified midwife shall file with the board of
nursing an application in a manner prescribed by the board. The
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application shall include all the information the board
considers necessary to process the application, including
evidence satisfactory to the board that the applicant meets the
requirements specified in division (B) of this section.
(B) To be eligible to receive a license to practice as a
certified midwife, an applicant shall demonstrate to the board
that the applicant meets all of the following requirements:
(1) Is at least eighteen years of age;
(2) Has attained a master's degree or higher;
(3) Has graduated from a midwifery education program
accredited by the accreditation commission for midwifery
education;
(4) Is certified by the American midwifery certification
board;
(5) Is certified in neonatal and adult cardiopulmonary
resuscitation;
(6) Has successfully completed the course of study in
advanced pharmacology required by section 4723.551 of the
Revised Code.
(C) The board shall review all applications received under
this section. After receiving an application it considers
complete, the board shall determine whether the applicant meets
the requirements for a license to practice as a certified
midwife.
Sec. 4723.551. (A) An applicant for a license to practice
as a certified midwife shall include with the application
submitted under section 4723.55 of the Revised Code evidence of
successfully completing the course of study in advanced
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2364 H. B. No. 224 Page 83
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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 more than
five years before the application is filed.
(2) The course of study shall include at least forty-five
contact hours.
(3) The course of study shall meet the requirements to be
approved by the board 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 midwifery.
(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:
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2391 H. B. No. 224 Page 84
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(i) Indications for the use of schedule II controlled
substances in drug therapies;
(ii) The most recent 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.
Sec. 4723.56. (A) If the board of nursing determines under
section 4723.55 of the Revised Code that an applicant meets the
requirements for a license to practice as a certified midwife,
the secretary of the board shall issue the license to the
applicant.
(B) Each license shall be valid for a two-year period
unless revoked or suspended, shall expire on the date that is
two years after the date of issuance, and may be renewed for
additional two-year periods in accordance with rules adopted
under section 4723.59 of the Revised Code.
(C) To renew a license to practice as a certified midwife,
an applicant for renewal shall demonstrate both of the following
to the board:
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2419 H. B. No. 224 Page 85
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(1) That the applicant has maintained certification in
neonatal and adult cardiopulmonary resuscitation;
(2) That the applicant has satisfied the continuing
education requirements of the American midwifery certification
board.
Sec. 4723.57. (A) An individual who holds a current, valid
license to practice as a certified midwife may, in collaboration
with one or more physicians, engage in one or more of the
following activities:
(1) Providing primary health care services for women from
adolescence and beyond menopause, including the independent
provision of gynecologic and family planning services,
preconception care, and care during pregnancy, childbirth, and
the postpartum period;
(2) Attending births in hospitals, homes, medical offices,
and freestanding birthing centers;
(3) Providing care for normal newborns during the period
consistent with the scope of practice for certified nurse-
midwives established by the American college of nurse-midwives;
(4) Providing initial and ongoing comprehensive
assessment, diagnosis, and treatment;
(5) Conducting physical examinations;
(6) Ordering and interpreting laboratory and diagnostic
tests;
(7) 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;
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2447 H. B. No. 224 Page 86
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(8) Providing care that includes health promotion, disease
prevention, and individualized wellness education and
counseling.
(B) When engaging in any of the activities permitted under
this section, a certified midwife shall maintain appropriate
medical records regarding patient history, treatment, and
outcomes.
Sec. 4723.58. (A) This section establishes the process by
which a certified nurse-midwife or certified midwife obtains a
patient's consent to treatment authorized by section 4723.43 or
4723.57 of the Revised Code, but only when the certified nurse-
midwife or certified midwife seeks to provide the treatment in a
setting other than a hospital or facility.
(B) The following information shall be exchanged in
writing between a certified nurse-midwife or certified midwife
and patient when obtaining consent to treatment as described in
division (A) of this section:
(1) The name and license number of the certified nurse-
midwife or certified midwife;
(2) The patient's name, address, telephone number, and
primary care provider, if the patient has one;
(3) A description of the certified nurse-midwife's or
certified midwife's education, training, and experience in
nurse-midwifery or midwifery;
(4) The certified nurse-midwife's or certified midwife's
practice philosophy;
(5) A promise to provide the patient, upon request, with
separate documents describing the rules governing the practice
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of a certified nurse-midwife or certified midwife, including a
list of conditions indicating the need for consultation,
referral, transfer, or mandatory transfer and the certified
nurse-midwife's or certified midwife's personal written practice
guidelines;
(6) A written plan for medical consultation and transfer
of care;
(7) A description of any hospital care and procedures that
may be necessary in the event of an emergency transfer or care;
(8) A description of the services provided to the patient
by the certified nurse-midwife or certified midwife;
(9) That the certified nurse-midwife or certified midwife
holds a current, valid license to practice issued under this
chapter;
(10) The availability of a grievance process;
(11) Whether the certified nurse-midwife or certified
midwife is covered by professional liability insurance;
(12) Any other information required in rules adopted by
the board.
(C) Once the required information has been exchanged and
if the patient consents to treatment, the patient and certified
nurse-midwife or certified midwife shall sign a written document
to indicate as such. The certified nurse-midwife or certified
midwife shall retain a copy of the document for at least four
years from the date on which the document was signed.
Sec. 4723.581. (A) The board of nursing shall adopt rules
establishing the circumstances in which a certified nurse-
midwife or certified midwife shall be prohibited from attending
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2503 H. B. No. 224 Page 88
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a home birth, which may include a high-risk pregnancy. In
adopting the rules, the board shall allow a certified nurse-
midwife or certified midwife to attend any of the following as a
home birth only if the conditions described in division (B) of
this section are satisfied: a vaginal birth after cesarean,
birth of twins, or breech birth.
(B) In the event of a home birth described in division (A)
of this section, a certified nurse-midwife or certified midwife
may attend the birth only if all of the following conditions are
satisfied:
(1) In addition to the informed consent required under
section 4723.58 of the Revised Code, the certified nurse-midwife
or certified midwife obtains the patient's written informed
consent for the vaginal birth after cesarean, birth of twins, or
breech birth, including a description of risks associated with
the procedure.
(2) The certified nurse-midwife or certified midwife
consults with a physician or other health care provider about
the patient and together with the physician or provider
determines whether referral is appropriate for the patient.
If a referral is determined to be appropriate and the
patient consents to the referral, the certified nurse-midwife or
certified midwife shall refer the patient to the physician or
provider. If the patient refuses the referral, the certified
nurse-midwife or certified midwife shall document the refusal
and may continue to provide care to the patient, including
attending the vaginal birth after cesarean, birth of twins, or
breech birth at home.
(3) The certified nurse-midwife or certified midwife
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2532 H. B. No. 224 Page 89
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satisfies any other conditions required in rules adopted by the
board of nursing.
(C) In adopting rules under this section, the board of
nursing shall do both of the following:
(1) Consider any relevant peer-reviewed medical
literature;
(2) Specify the content and format of the document to be
used when obtaining informed consent as described in this
section.
Sec. 4723.582. (A) As used in this section and section
4723.583 of the Revised Code, "emergency medical service,"
"emergency medical service personnel," and "emergency medical
service organization" have the same meanings as in section
4765.01 of the Revised Code.
(B) For any pregnancy or childbirth in which a certified
nurse-midwife or certified midwife provides care and a home
birth is planned, both of the following apply:
(1) The certified nurse-midwife or certified midwife shall
create an individualized transfer of care plan with each
patient.
(2) The certified nurse-midwife or certified midwife shall
assess the status of the patient, fetus, and newborn throughout
the maternity care cycle and shall determine when or if a
transfer to a hospital or facility is necessary.
(C) Each individualized transfer of care plan shall
contain all of the following:
(1) The name and location of geographically adjacent
hospitals and other facilities that are appropriately equipped
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2560 H. B. No. 224 Page 90
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to provide emergency care, obstetrical care, and newborn care;
(2) The approximate travel time to each hospital or
facility;
(3) A list of the modes of transport services available,
including an emergency medical service organization available by
calling 9-1-1;
(4) The requirements for activating each mode of
transportation;
(5) The mechanism by which medical records and other
information concerning the patient may be rapidly transmitted to
each hospital or facility;
(6) Confirmation that the certified nurse-midwife or
certified midwife has recommended that the patient pre-register
with the hospital closest to the patient's home that is
appropriately equipped to provide emergency care, obstetrical
care, and newborn care;
(7) Contact information for either a health care provider
or practice group who has agreed in advance to accept patients
in transfer, or a hospital's or facility's preferred method of
accessing care by the hospital's or facility's designated
provider on call;
(8) Any other information required in rules adopted by the
board of nursing.
(D) When it becomes necessary to transfer a patient, a
certified nurse-midwife or certified midwife shall notify the
receiving provider, hospital, or facility of all of the
following:
(1) The incoming transfer;
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2588 H. B. No. 224 Page 91
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(2) The reason for the transfer;
(3) A brief relevant clinical history;
(4) The planned mode of transport;
(5) The expected time of arrival;
(6) Any other information required in rules adopted by the
board.
The certified nurse-midwife or certified midwife shall
continue to provide routine or urgent care en route in
coordination with any emergency medical services personnel or
emergency medical service organization and shall address the
psychosocial needs of the patient during the change of birth
setting.
(E) On arrival at the hospital or facility, the certified
nurse-midwife or certified midwife shall do all of the
following:
(1) Provide a verbal report that includes details on the
patient's current health status and the need for urgent care;
(2) Provide a legible copy of relevant prenatal and labor
medical records;
(3) Transfer clinical responsibility to the receiving
provider, hospital, or facility;
(4) Satisfy any other requirement established in rules
adopted by the board of nursing.
If the patient chooses, the certified nurse-midwife or
certified midwife may remain at the hospital or facility to
provide continuous support. The certified nurse-midwife or
certified midwife also may continue to provide midwifery
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2615 H. B. No. 224 Page 92
As Introduced
services, but only if the hospital or facility has granted the
certified nurse-midwife or certified midwife clinical
privileges. Whenever possible, the patient and her newborn shall
be together during the transfer and after admission to the
hospital or facility.
Sec. 4723.583. Emergency medical service personnel or an
emergency medical service organization, hospital, facility,
physician, advanced practice registered nurse, or certified
midwife that provides services or care following an adverse
incident as defined in section 4723.584 of the Revised Code or
during and after a transfer of care as described in section
4723.582 of the Revised Code are not liable in damages in a tort
or other civil action for injury or loss to person or property
arising from the services or care, unless the services or care
are provided in a manner that constitutes willful or wanton
misconduct.
Sec. 4723.584. (A) As used in this section, "adverse
incident" means an incident over which a certified nurse-midwife
or certified midwife could exercise control, that is associated
with an attempted or completed birth in a setting or facility
other than a hospital, and that results in one or more of the
following injuries or conditions:
(1) A maternal death that occurs during delivery or within
forty-two days after delivery;
(2) The transfer of a maternal patient to a hospital
intensive care unit;
(3) A maternal patient experiencing hemorrhagic shock or
requiring a transfusion of more than two units of blood or blood
products;
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2644 H. B. No. 224 Page 93
As Introduced
(4) A fetal or newborn death, including a stillbirth,
associated with an obstetrical delivery;
(5) A transfer of a newborn to a neonatal intensive care
unit due to a traumatic physical or neurological birth injury,
including any degree of a brachial plexus injury;
(6) A transfer of a newborn to a neonatal intensive care
unit within the first seventy-two hours after birth if the
newborn remains in such unit for more than seventy-two hours;
(7) Any other condition as determined by the board of
nursing in rules adopted under section 4723.07 or 4723.59 of the
Revised Code.
(B) Beginning July 1, 2027, a certified nurse-midwife or
certified midwife who attends a birth planned for a facility or
setting other than a hospital must report any adverse incident,
along with a medical summary of events, to both of the following
within fifteen days after the adverse incident occurs:
(1) The department of health;
(2) The Ohio perinatal quality collaborative.
(C) Beginning July 1, 2027, each certified nurse-midwife
or certified midwife shall report annually to the department of
health the following information regarding cases in which the
midwife provided services when the intended place of birth at
the onset of care was in a facility or setting other than a
hospital:
(1) The total number of patients provided nurse-midwifery
or certified midwifery services at the onset of care;
(2) The number of live births attended;
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2671 H. B. No. 224 Page 94
As Introduced
(3) The number of cases of fetal demise, newborn deaths,
and maternal deaths attended as a certified nurse-midwife or
certified midwife at the discovery of the demise or death;
(4) The number, reason for, and outcome of each transport
of a patient in the antepartum, intrapartum period, or immediate
postpartum period;
(5) A brief description of any complications resulting in
the morbidity or mortality of a maternal patient or a newborn;
(6) The planned delivery setting and the actual setting;
(7) Any other information required in rules adopted by the
department.
(D) The department shall adopt rules to implement this
section and shall develop a form to be used for the reporting
required under divisions (B) and (C) of this section.
Sec. 4723.59. (A) In addition to the rules described in
section 4723.07 of the Revised Code, the board of nursing shall
adopt rules establishing standards and procedures for the
licensure and regulation of certified midwives, including those
establishing license application and renewal procedures. The
rules shall be adopted in accordance with Chapter 119. of the
Revised Code.
(B) The board also may adopt, in accordance with Chapter
119. of the Revised Code, any other rules it considers necessary
to implement and administer sections 4723.53 to 4723.60 of the
Revised Code. The rules may require the completion of a criminal
records check and, in the case of a license to practice as a
certified midwife issued by another jurisdiction, may provide
for licensure by endorsement.
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2699 H. B. No. 224 Page 95
As Introduced
Sec. 4723.60. Sections 4723.53 to 4723.59 of the Revised
Code do not abridge, change, or limit in any way the right of a
parent to deliver the parent's baby where, when, how, and with
whom the parent chooses, regardless of the licensure
requirements established in those sections.
Sec. 4723.91. On receipt of a notice pursuant to section
3123.43 of the Revised Code, the board of nursing shall comply
with sections 3123.41 to 3123.50 of the Revised Code and any
applicable rules adopted under section 3123.63 of the Revised
Code with respect to a nursing license, certified midwife
license, medication aide certificate, dialysis technician
certificate, or community health worker certificate issued
pursuant to this chapter.
Sec. 4723.99. (A) Except as provided in division (B) or
(C) of this section, whoever violates section 4723.03, 4723.44,
4723.54, 4723.653, or 4723.73 of the Revised Code is guilty of a
felony of the fifth degree on a first offense and a felony of
the fourth degree on each subsequent offense.
(B) Each of the following is guilty of a minor
misdemeanor:
(1) A registered nurse, advanced practice registered
nurse, or licensed practical nurse who violates division (A),
(B), (C), or (D) of section 4723.03 of the Revised Code by
reason of a license to practice nursing that has lapsed for
failure to renew or by practicing nursing after a license has
been classified as inactive;
(2) A medication aide who violates section 4723.653 of the
Revised Code by reason of a medication aide certificate that has
lapsed for failure to renew or by administering medication as a
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2728 H. B. No. 224 Page 96
As Introduced
medication aide after a certificate has been classified as
inactive.
(C) Whoever violates division (H) of section 4723.03 of
the Revised Code is guilty of a misdemeanor of the first degree.
Sec. 4724.01. As used in this chapter:
(A) "Certified international midwife" means an individual
who is certified by the international registry of midwives but
is not a licensed midwife.
(B) "Certified professional midwife" means an individual
who is certified by the north American registry of midwives but
is not a licensed midwife.
(C) "International registry of midwives" means the
organization known by that name or its successor organization.
(D) "Licensed midwife" means an individual holding a
license to practice issued under section 4724.04 of the Revised
Code.
(E) "Midwifery education accreditation council" means the
organization known by that name or its successor organization.
(F) "North American registry of midwives" means the
organization known by that name or its successor organization.
(G) "Traditional midwife" means an individual who has
entered the midwifery profession through an apprenticeship
program with an experienced practicing midwife, does not hold a
license to practice as a licensed midwife issued under this
chapter, does not hold a license to practice as a certified
nurse-midwife or certified midwife issued under Chapter 4723. of
the Revised Code, and, before providing midwifery services,
discloses to each client in writing that the individual is not a
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As Introduced
certified nurse-midwife, certified midwife, or licensed midwife.
Sec. 4724.02. (A) Except as provided in division (B) of
this section, no individual shall knowingly practice as a
licensed midwife unless the individual holds a current, valid
license to practice issued under section 4724.04 of the Revised
Code.
(B) Division (A) of this section does not apply to any of
the following:
(1) A physician authorized under Chapter 4731. of the
Revised Code to practice medicine and surgery, osteopathic
medicine and surgery, or podiatric medicine and surgery;
(2) A physician assistant authorized under Chapter 4730.
of the Revised Code to practice as a physician assistant;
(3) A registered nurse, advanced practice registered
nurse, or licensed practical nurse authorized under Chapter
4723. of the Revised Code to practice nursing as a registered
nurse, advanced practice registered nurse, or licensed practical
nurse;
(4) A certified midwife authorized under Chapter 4723. of
the Revised Code to practice as a certified midwife;
(5) A student who is participating in a professional
midwifery education program and who provides midwifery services
under the auspices of the program and under the supervision of a
licensed midwife serving for the program as a faculty member,
instructor, teaching assistant, or preceptor;
(6) An individual who is participating in a professional
midwifery apprenticeship and who provides midwifery services as
part of the apprenticeship program and under the supervision of
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2784 H. B. No. 224 Page 98
As Introduced
a licensed midwife serving for the program as an instructor,
teaching assistant, or preceptor;
(7) An individual who provides midwifery services without
a license while engaging in good faith in the practice of the
religious tenets of any church or in any religious act;
(8) An individual who is not engaged in the practice of
the religious tenets of any church or in any religious act but
who provides midwifery services without a license to others
engaging in good faith in the practice of the religious tenets
of any church or in any religious act;
(9) An individual who is a member of a Native American
community and provides midwifery services without a license to
another member of the community;
(10) A traditional midwife;
(11) An individual who is participating in a midwifery
apprenticeship under the supervision of a traditional midwife
and who provides midwifery services as part of the
apprenticeship program under the supervision of a traditional
midwife;
(12) A certified professional midwife or certified
international midwife, but only if the certified professional
midwife or certified international midwife does not, as a part
of the midwife's practice, obtain or administer drugs or perform
surgical suturing.
(C) No individual shall knowingly use the title "licensed
midwife" or any other title implying that the individual is a
licensed midwife unless the individual holds a current, valid
license to practice issued under section 4724.04 of the Revised
Code.
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2813 H. B. No. 224 Page 99
As Introduced
Sec. 4724.03. (A) An individual seeking a license to
practice as a licensed midwife shall file with the department of
commerce an application in a manner prescribed by the
department. The application shall include all the information
the department considers necessary to process the application,
including evidence satisfactory to the department that the
applicant meets the requirements specified in division (B)(1) or
(2) of this section.
(B)(1) To be eligible to receive a license to practice as
a licensed midwife, an applicant shall demonstrate to the
department that the applicant meets all of the following
requirements:
(a) Is at least eighteen years of age;
(b) Has attained a high school degree or equivalent;
(c) Is certified by the north American registry of
midwives, international registry of midwives, or another
certifying organization approved by the department in rules
adopted under section 4724.11 of the Revised Code;
(d) Is certified in neonatal and adult cardiopulmonary
resuscitation;
(e) Has successfully completed a course of study in breech
births approved by the department in rules adopted under section
4724.11 of the Revised Code;
(f) Has successfully completed a course of study in
pharmacology approved by the department in rules adopted under
section 4724.11 of the Revised Code.
(2) In lieu of meeting the requirements described in
division (B)(1)(c) of this section, an applicant may demonstrate
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either of the following:
(a) That the applicant holds a current, valid license to
practice as a licensed midwife issued by another state and the
department has determined that the other state's requirements
for licensure are substantially similar to those described in
division (B)(1) of this section;
(b) That the applicant is certified by the north American
registry of midwives and holds a midwifery bridge certificate.
(C) The department shall review all applications received
under this section. After receiving an application it considers
complete, the department shall determine whether the applicant
meets the requirements for a license to practice as a licensed
midwife.
Sec. 4724.04. (A) If the department of commerce determines
under section 4724.03 of the Revised Code that an applicant
meets the requirements for a license to practice as a licensed
midwife, the department shall issue the license to the
applicant.
(B) Each license shall be valid for a two-year period
unless revoked or suspended, shall expire on the date that is
two years after the date of issuance, and may be renewed for
additional two-year periods in accordance with rules adopted
under section 4724.11 of the Revised Code.
(C) To renew a license to practice as a licensed midwife,
an applicant for renewal shall demonstrate both of the following
to the department:
(1) That the applicant has maintained certification in
neonatal and adult cardiopulmonary resuscitation;
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(2) That the applicant has maintained certification with
the north American registry of midwives, international registry
of midwives, or another certifying organization approved by the
department in rules adopted under section 4724.11 of the Revised
Code.
(D) In the event a license issued under this section is
not renewed and is therefore expired or inactive, the department
shall reinstate or restore the license if the individual seeking
reinstatement or restoration satisfies the conditions specified
in rules adopted under section 4724.11 of the Revised Code.
Sec. 4724.05. (A) An individual who holds a current, valid
license to practice as a licensed midwife may engage in one or
more of the following activities during the antepartum,
intrapartum, postpartum, and newborn period as part of the scope
of practice for a licensed midwife:
(1) Offering care, education, counseling, and support to
women and their families during pregnancy, birth, and the
postpartum period;
(2) Attending births in hospitals, homes, medical offices,
and freestanding birthing centers;
(3) Providing ongoing care throughout pregnancy and hands
on care during labor, birth, and the immediate postpartum
period;
(4) Providing maternal and newborn assessment for the six-
to eight-week period following delivery;
(5) Providing initial and ongoing comprehensive
assessment, diagnosis, and treatment;
(6) Recognizing abnormal or dangerous conditions requiring
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consultations with or referrals to other licensed health care
professionals;
(7) Conducting maternal and newborn physical examinations;
(8) Ordering and interpreting laboratory and diagnostic
tests without a physician's order.
(B) An individual who holds a current, valid license to
practice as a licensed midwife shall not engage in any of the
following activities:
(1) Administering cytotec or oxytocics, including pitocin
and methergine, except when indicated during the postpartum
period;
(2) Using forceps or vacuum extraction to assist with
birth;
(3) Performing any operative procedures or surgical
repairs other than the following: artificial rupture of
membranes; episiotomies; first or second degree perineal,
vaginal, or labial repairs; clamping or cutting the umbilical
cord; or frenotomies.
(C) For the purpose of engaging in one or more of the
activities permitted under division (A) of this section, the
scope of practice for a licensed midwife shall include the
ability to purchase, obtain, possess, and administer the
following:
(1) Subject to division (B) of this section, an
antihemorraghic agent or device, including tranexamic acid,
pitocin, oxytocin, misoprostol, and methergine;
(2) Intravenous fluids to stabilize the laboring or
postpartum patient or as necessary to administer another drug
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2925 H. B. No. 224 Page 103
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authorized by this division;
(3) Neonatal injectable vitamin K;
(4) Newborn antibiotic eye prophylaxis;
(5) Oxygen;
(6) Intravenous antibiotics for group B streptococcal
prophylaxis;
(7) Rho (D) immune globulin;
(8) Local anesthesia;
(9) Epinephrine, but only to address an adverse reaction
to a medication;
(10) A drug prescribed for the patient by a prescriber.
A licensed midwife also may obtain, without a physician's
order, one or more supplies necessary to administer any of the
drugs described in division (C) of this section.
(D) This section does not authorize a licensed midwife to
prescribe, personally furnish, obtain, or administer either of
the following:
(1) Any controlled substance as defined in section 3719.01
of the Revised Code;
(2) A drug or device to perform or induce an abortion.
(E) When engaging in any of the activities permitted under
this section, a licensed midwife shall maintain appropriate
medical records regarding patient history, treatment, and
outcomes.
Sec. 4724.06. The department of commerce shall limit,
revoke, or suspend an individual's license to practice as a
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licensed midwife, refuse to issue a license to an applicant,
refuse to renew a license, refuse to reinstate or restore a
license, or reprimand or place on probation the holder of a
license for any of the reasons specified in rules adopted under
section 4724.11 of the Revised Code.
Sec. 4724.07. (A) This section establishes the process by
which a licensed midwife obtains a patient's consent to
treatment authorized by section 4724.05 of the Revised Code,
including attending a home birth or providing care during a
high-risk pregnancy.
(B) The following information shall be exchanged in
writing between a licensed midwife and patient when obtaining
consent to treatment as described in division (A) of this
section:
(1) The name and license number of the licensed midwife;
(2) The patient's name, address, telephone number, and
primary care provider, if the patient has one;
(3) A description of the licensed midwife's education,
training, and experience in midwifery;
(4) The licensed midwife's practice philosophy;
(5) A promise to provide the patient, upon request, with
separate documents describing the rules governing the practice
of midwifery, including a list of conditions indicating the need
for consultation, referral, transfer, or mandatory transfer and
the licensed midwife's personal written practice guidelines;
(6) A written plan for medical consultation and transfer
of care;
(7) A description of any hospital care and procedures that
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2979 H. B. No. 224 Page 105
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may be necessary in the event of an emergency transfer or care;
(8) A description of the services provided to the patient
by the licensed midwife;
(9) That the licensed midwife holds a current, valid
license to practice issued under this chapter;
(10) The availability of a grievance process;
(11) Whether the licensed midwife is covered by
professional liability insurance;
(12) Any other information required in rules adopted by
the department.
(C) Once the required information has been exchanged and
if the patient consents to treatment, the patient and licensed
midwife shall sign a written document to indicate as such. The
licensed midwife shall retain a copy of the document for at
least four years from the date on which the document was signed.
Sec. 4724.08. (A) The department of commerce shall adopt
rules establishing the circumstances in which a licensed midwife
shall be prohibited from attending a home birth, which may
include a high-risk pregnancy. In adopting the rules, the
department shall allow a licensed midwife to attend a vaginal
birth after cesarean, birth of twins, or breech birth as a home
birth if the conditions described in division (B) of this
section are satisfied.
(B) In the event of a home birth described in division (A)
of this section, a licensed midwife may attend the birth only if
all of the following conditions are satisfied:
(1) In addition to the informed consent required under
section 4724.06 of the Revised Code, the licensed midwife
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3007 H. B. No. 224 Page 106
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obtains the patient's written informed consent for the vaginal
birth after cesarean, birth of twins, or breech birth, including
a description of risks associated with the procedure.
(2) The licensed midwife consults with a physician or
other health care provider about the patient and together with
the physician or provider determines whether referral is
appropriate for the patient. If a referral is determined to be
appropriate and the patient consents to the referral, the
licensed midwife shall refer the patient to the physician or
provider. If the patient refuses the referral, the licensed
midwife shall document the refusal and may continue to provide
care to the patient, including attending the vaginal birth after
cesarean, birth of twins, or breech birth.
(3) The licensed midwife satisfies any other conditions
required in rules adopted by the department.
(C) In adopting rules under this section, the department
shall do both of the following:
(1) Adhere to the recommendations of the licensed
midwifery advisory council and any relevant peer-reviewed
medical literature;
(2) Specify the content and format of the document to be
used when obtaining informed consent as described in this
section.
Sec. 4724.09. (A) As used in this section and section
4724.10 of the Revised Code, "emergency medical service,"
"emergency medical service personnel," and "emergency medical
service organization" have the same meanings as in section
4765.01 of the Revised Code.
(B) For any pregnancy or childbirth in which a licensed
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3036 H. B. No. 224 Page 107
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midwife provides care and a home birth is planned, both of the
following apply:
(1) The licensed midwife shall create an individualized
transfer of care plan with each patient.
(2) The licensed midwife shall assess the status of the
patient, fetus, and newborn throughout the maternity care cycle
and shall determine when or if a transfer to a hospital or
facility is necessary.
(C) Each individualized transfer of care plan shall
contain all of the following:
(1) The name and location of geographically adjacent
hospitals and other facilities that are appropriately equipped
to provide emergency care, obstetrical care, and newborn care;
(2) The approximate travel time to each hospital or
facility;
(3) A list of the modes of transport services available,
including an emergency medical service organization available by
calling 9-1-1;
(4) The requirements for activating each mode of
transportation;
(5) The mechanism by which medical records and other
information concerning the patient may be rapidly transmitted to
each hospital or facility;
(6) Confirmation that the licensed midwife has recommended
that the patient pre-register with the hospital closest to the
patient's home that is appropriately equipped to provide
emergency care, obstetrical care, and newborn care;
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3063 H. B. No. 224 Page 108
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(7) Contact information for either a health care provider
or practice group who has agreed in advance to accept patients
in transfer, or a hospital's or facility's preferred method of
accessing care by the hospital's or facility's designated
provider on call;
(8) Any other information required in rules adopted by the
department of commerce.
(D) When it becomes necessary to transfer a patient, a
licensed midwife shall notify the receiving provider, hospital,
or facility of all of the following:
(1) The incoming transfer;
(2) The reason for the transfer;
(3) A brief relevant clinical history;
(4) The planned mode of transport;
(5) The expected time of arrival;
(6) Any other information required in rules adopted by the
department.
The licensed midwife may continue to provide routine or
urgent care en route in coordination with any emergency medical
services personnel or emergency medical service organization
and, if continued care is provided, the licensed midwife shall
address the psychosocial needs of the patient during the change
of birth setting.
(E) On arrival at the hospital or facility, the licensed
midwife shall do all of the following:
(1) Provide a verbal report that includes details on the
patient's current health status and the need for urgent care;
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3090 H. B. No. 224 Page 109
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(2) Provide a legible copy of relevant prenatal and labor
medical records;
(3) Transfer clinical responsibility to the receiving
provider, hospital, or facility;
(4) Satisfy any other requirement established in rules
adopted by the department.
If the patient chooses, the licensed midwife may remain at
the hospital or facility to provide continuous support. The
licensed midwife also may continue to provide midwifery
services, but only if the hospital or facility has granted the
licensed midwife clinical privileges. Whenever possible, the
patient and her newborn shall be together during the transfer
and after admission to the hospital or facility.
Sec. 4724.10. (A) As used in this section, "adverse
incident" means an incident over which a licensed midwife could
exercise control, that is associated with an attempted or
completed birth in a setting or facility other than a hospital,
and that results in one or more of the following injuries or
conditions:
(1) A maternal death that occurs during delivery or within
forty-two days after delivery;
(2) The transfer of a maternal patient to a hospital
intensive care unit;
(3) A maternal patient experiencing hemorrhagic shock or
requiring a transfusion of more than two units of blood or blood
products;
(4) A fetal or neonatal death, including a stillbirth;
(5) A transfer of a newborn to a neonatal intensive care
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3118 H. B. No. 224 Page 110
As Introduced
unit due to a traumatic physical or neurological birth injury,
including any degree of a brachial plexus injury;
(6) A transfer of a newborn to a neonatal intensive care
unit within the first seventy-two hours after birth if the
newborn remains in such unit for more than seventy-two hours;
(7) Any other condition as determined by the department of
commerce in rules adopted under section 4724.11 of the Revised
Code.
(B) Beginning July 1, 2027, a licensed midwife who attends
a birth planned for a facility or setting other than a hospital
must report any adverse incident, along with a medical summary
of events, to both of the following within fifteen days after
the adverse incident occurs:
(1) The licensed midwifery advisory council;
(2) The Ohio perinatal quality collaborative.
(C) Beginning July 1, 2027, each licensed midwife shall
report annually to the licensed midwifery advisory council the
following information regarding cases in which the licensed
midwife provided services when the intended place of birth at
the onset of care was in a facility or setting other than a
hospital:
(1) The total number of patients provided licensed
midwifery services at the onset of care;
(2) The number of live births attended;
(3) The number of cases of fetal demise, newborn deaths,
and maternal deaths attended as a licensed midwife at the
discovery of the demise or death;
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3145 H. B. No. 224 Page 111
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(4) The number, reason for, and outcome of each transport
of a patient in the antepartum, intrapartum period, or immediate
postpartum period;
(5) A brief description of any complications resulting in
the morbidity or mortality of a maternal patient or a newborn;
(6) The planned delivery setting and the actual setting;
(7) Any other information required in rules adopted by the
department of commerce.
(D) The department shall adopt rules to implement this
section and shall develop a form to be used for the reporting
required under divisions (B) and (C) of this section.
Sec. 4724.11. (A) In accordance with Chapter 119. of the
Revised Code, the department of commerce shall adopt rules that
establish all of the following:
(1) Standards and procedures for applying for, renewing,
reinstating, or restoring a license to practice as a licensed
midwife;
(2) Application, renewal, reinstatement, and restoration
fee amounts for a license to practice as a licensed midwife,
with the amount of the application fee not to exceed forty-five
dollars and the amount of the renewal fee not to exceed twenty
dollars;
(3) Standards and procedures for approving and
successfully completing a course of study in breech births and a
course of study in pharmacology, each as described in section
4724.03 of the Revised Code;
(4) Subject to division (C) of this section, standards and
procedures for approving certifying organizations as described
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3173 H. B. No. 224 Page 112
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in section 4724.03 of the Revised Code;
(5) Reasons for which the department may refuse to issue,
or renew, suspend, or revoke a license or otherwise impose
discipline on a licensed midwife;
(6) Conditions to be satisfied before the department
reinstates or restores an expired or inactive license;
(7) Procedures for reporting to the department license
holder misconduct;
(8) Procedures by which the department conducts
disciplinary investigations.
(B) In adopting rules establishing standards and
procedures for the approval of certifying organizations, the
department shall approve an organization only if its
certification requirements meet or exceed those of the north
American registry of midwives or the international registry of
midwives.
(C) The department also may adopt, in accordance with
Chapter 119. of the Revised Code, any other rules it considers
necessary to implement and administer this chapter. The rules
may require the completion of a criminal records check.
Sec. 4724.12. This chapter does not abridge, change, or
limit in any way the right of a parent to deliver the parent's
baby where, when, how, and with whom the parent chooses,
regardless of the licensure requirements established in this
chapter.
Sec. 4724.13. (A) There is hereby created within the
department of commerce the licensed midwifery advisory council.
The council shall consist of all of the following members:
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As Introduced
(1) One certified nurse-midwife and one certified midwife
or certified nurse-midwife, preferably with experience attending
a birth in a setting or facility other than a hospital;
(2) Four licensed midwives, including one practicing in an
urban setting and one serving a plain Amish or Mennonite
community;
(3) One physician who is board-certified in obstetrics and
gynecology, as those designations are issued by a medical
specialty certifying board recognized by the American board of
medical specialties or American osteopathic association, and
with experience consulting with midwives who provide midwifery
services in locations other than hospitals;
(4) One physician who is board-certified in neonatal
medicine, as that designation is issued by a medical specialty
certifying board recognized by the American board of medical
specialties or American osteopathic association, and with
experience consulting with midwives who provide midwifery
services in locations other than hospitals;
(5) One member of the public who has experience utilizing
or receiving midwifery services in locations other than
hospitals.
Of the members who are licensed midwives, each shall
obtain licensure as a licensed midwife under this chapter not
later than January 1, 2028.
(B) The department shall appoint the members described in
division (A) of this section. The department may solicit
nominations for initial appointments and for filling any
vacancies from individuals or organizations with an interest in
midwifery services. If the department does not receive any
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nominations or receives an insufficient number of nominations,
the department shall appoint members and fill vacancies on its
own advice.
Of the physician members described in divisions (A)(3) and
(4) of this section, if the department does not receive any
nominations for physicians with experience consulting with
midwives who provide midwifery services in locations other than
hospitals, the department shall appoint physicians without such
experience, but only if the department determines that each
physician satisfies the other requirements of division (A)(3) or
(4) of this section.
Initial appointments to the council shall be made not
later than ninety days after the effective date of this section.
Of the initial appointments described in division (A) of this
section, four shall be for terms of three years and five shall
be for terms of four years. Thereafter, terms shall be for four
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.
(C) The council shall organize by selecting a chairperson
from among its members. The council may select a new chairperson
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at any time. Four members constitute a quorum for the
transaction of official business. Members shall serve without
compensation but shall receive payment for their actual and
necessary expenses incurred in the performance of their official
duties. The expenses shall be paid by the department.
(D) The council shall advise and make recommendations to
the department regarding the practice and regulation of licensed
midwives. The department shall adhere to such advice and
recommendations when adopting any rules governing the practice
of licensed midwives, including rules to address the following:
(1) Circumstances in which attending a home birth is
prohibited, as described in section 4724.08 of the Revised Code;
(2) Limitations on providing care during a high-risk
pregnancy, including when a home birth is planned;
(3) Adverse incident reporting and annual reporting, both
required under section 4724.10 of the Revised Code;
(4) Obtaining a patient's informed consent, as described
in section 4724.07 of the Revised Code;
(5) Creating an individualized transfer of care plan, as
described in section 4724.09 of the Revised Code.
(E) The council shall review each adverse incident report
submitted to the council as described in section 4724.10 of the
Revised Code. As soon as practicable after the required review,
the council shall make a recommendation to the department
regarding whether discipline should be imposed on the licensed
midwife, and if so, the type of discipline to be imposed.
The council shall develop a policy by which it addresses
and considers adverse incident reports.
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Sec. 4724.14. Emergency medical service personnel or an
emergency medical service organization, hospital, facility,
physician, advanced practice registered nurse, licensed midwife,
or traditional midwife that provides services or care following
an adverse incident as defined in section 4724.10 of the Revised
Code, or during and after a transfer of care as described in
section 4724.09 of the Revised Code, are not liable in damages
in a tort or other civil action for injury or loss to person or
property arising from the services or care, unless the services
or care are provided in a manner that constitutes willful or
wanton misconduct.
Sec. 4724.99. (A) Whoever violates division (A) of section
4724.02 of the Revised Code is guilty of a felony of the fifth
degree on a first offense and a felony of the fourth degree on
each subsequent offense.
(B) Whoever violates division (C) of section 4724.02 of
the Revised Code is guilty of a misdemeanor of the first degree
and is subject to a fine in the amount of one thousand dollars
and a jail term of not more than one hundred eighty days.
Sec. 4731.22. (A) The state medical board, by an
affirmative vote of not fewer than six of its members, may
limit, revoke, or suspend a license or certificate to practice
or certificate to recommend, refuse to grant a license or
certificate, refuse to renew a license or certificate, refuse to
reinstate a license or certificate, or reprimand or place on
probation the holder of a license or certificate if the
individual applying for or holding the license or certificate is
found by the board to have committed fraud during the
administration of the examination for a license or certificate
to practice or to have committed fraud, misrepresentation, or
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3318 H. B. No. 224 Page 117
As Introduced
deception in applying for, renewing, or securing any license or
certificate to practice or certificate to recommend issued by
the board.
(B) Except as provided in division (P) of this section,
the board, by an affirmative vote of not fewer than six members,
shall, to the extent permitted by law, limit, revoke, or suspend
a license or certificate to practice or certificate to
recommend, refuse to issue a license or certificate, refuse to
renew a license or certificate, refuse to reinstate a license or
certificate, or reprimand or place on probation the holder of a
license or certificate for one or more of the following reasons:
(1) Permitting one's name or one's license or certificate
to practice to be used by a person, group, or corporation when
the individual concerned is not actually directing the treatment
given;
(2) Failure to maintain minimal standards applicable to
the selection or administration of drugs, or failure to employ
acceptable scientific methods in the selection of drugs or other
modalities for treatment of disease;
(3) Except as provided in section 4731.97 of the Revised
Code, selling, giving away, personally furnishing, prescribing,
or administering drugs for other than legal and legitimate
therapeutic purposes or a plea of guilty to, a judicial finding
of guilt of, or a judicial finding of eligibility for
intervention in lieu of conviction of, a violation of any
federal or state law regulating the possession, distribution, or
use of any drug;
(4) Willfully betraying a professional confidence.
For purposes of this division, "willfully betraying a
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3347 H. B. No. 224 Page 118
As Introduced
professional confidence" does not include providing any
information, documents, or reports under sections 307.621 to
307.629 of the Revised Code to a child fatality review board;
does not include providing any information, documents, or
reports under sections 307.631 to 307.6410 of the Revised Code
to a drug overdose fatality review committee, a suicide fatality
review committee, or hybrid drug overdose fatality and suicide
fatality review committee; does not include providing any
information, documents, or reports under sections 307.651 to
307.659 of the Revised Code to a domestic violence fatality
review board; does not include providing any information,
documents, or reports to the director of health pursuant to
guidelines established under section 3701.70 of the Revised
Code; does not include written notice to a mental health
professional under section 4731.62 of the Revised Code; does not
include making a report as described in division (F) of section
2921.22 and section 4731.224 of the Revised Code; and does not
include the making of a report of an employee's use of a drug of
abuse, or a report of a condition of an employee other than one
involving the use of a drug of abuse, to the employer of the
employee as described in division (B) of section 2305.33 of the
Revised Code. Nothing in this division affects the immunity from
civil liability conferred by section 2305.33 or 4731.62 of the
Revised Code upon a physician who makes a report in accordance
with section 2305.33 or notifies a mental health professional in
accordance with section 4731.62 of the Revised Code. As used in
this division, "employee," "employer," and "physician" have the
same meanings as in section 2305.33 of the Revised Code.
(5) Making a false, fraudulent, deceptive, or misleading
statement in the solicitation of or advertising for patients; in
relation to the practice of medicine and surgery, osteopathic
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3378 H. B. No. 224 Page 119
As Introduced
medicine and surgery, podiatric medicine and surgery, or a
limited branch of medicine; or in securing or attempting to
secure any license or certificate to practice issued by the
board.
As used in this division, "false, fraudulent, deceptive,
or misleading statement" means a statement that includes a
misrepresentation of fact, is likely to mislead or deceive
because of a failure to disclose material facts, is intended or
is likely to create false or unjustified expectations of
favorable results, or includes representations or implications
that in reasonable probability will cause an ordinarily prudent
person to misunderstand or be deceived.
(6) A departure from, or the failure to conform to,
minimal standards of care of similar practitioners under the
same or similar circumstances, whether or not actual injury to a
patient is established;
(7) Representing, with the purpose of obtaining
compensation or other advantage as personal gain or for any
other person, that an incurable disease or injury, or other
incurable condition, can be permanently cured;
(8) The obtaining of, or attempting to obtain, money or
anything of value by fraudulent misrepresentations in the course
of practice;
(9) A plea of guilty to, a judicial finding of guilt of,
or a judicial finding of eligibility for intervention in lieu of
conviction for, a felony;
(10) Commission of an act that constitutes a felony in
this state, regardless of the jurisdiction in which the act was
committed;
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3407 H. B. No. 224 Page 120
As Introduced
(11) A plea of guilty to, a judicial finding of guilt of,
or a judicial finding of eligibility for intervention in lieu of
conviction for, a misdemeanor committed in the course of
practice;
(12) Commission of an act in the course of practice that
constitutes a misdemeanor in this state, regardless of the
jurisdiction in which the act was committed;
(13) A plea of guilty to, a judicial finding of guilt of,
or a judicial finding of eligibility for intervention in lieu of
conviction for, a misdemeanor involving moral turpitude;
(14) Commission of an act involving moral turpitude that
constitutes a misdemeanor in this state, regardless of the
jurisdiction in which the act was committed;
(15) Violation of the conditions of limitation placed by
the board upon a license or certificate to practice;
(16) Failure to pay license renewal fees specified in this
chapter;
(17) Except as authorized in section 4731.31 of the
Revised Code, engaging in the division of fees for referral of
patients, or the receiving of a thing of value in return for a
specific referral of a patient to utilize a particular service
or business;
(18) Subject to section 4731.226 of the Revised Code,
violation of any provision of a code of ethics of the American
medical association, the American osteopathic association, the
American podiatric medical association, or any other national
professional organizations that the board specifies by rule. The
state medical board shall obtain and keep on file current copies
of the codes of ethics of the various national professional
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3436 H. B. No. 224 Page 121
As Introduced
organizations. The individual whose license or certificate is
being suspended or revoked shall not be found to have violated
any provision of a code of ethics of an organization not
appropriate to the individual's profession.
For purposes of this division, a "provision of a code of
ethics of a national professional organization" does not include
any provision that would preclude the making of a report by a
physician of an employee's use of a drug of abuse, or of a
condition of an employee other than one involving the use of a
drug of abuse, to the employer of the employee as described in
division (B) of section 2305.33 of the Revised Code. Nothing in
this division affects the immunity from civil liability
conferred by that section upon a physician who makes either type
of report in accordance with division (B) of that section. As
used in this division, "employee," "employer," and "physician"
have the same meanings as in section 2305.33 of the Revised
Code.
(19) Inability to practice according to acceptable and
prevailing standards of care by reason of mental illness or
physical illness, including, but not limited to, physical
deterioration that adversely affects cognitive, motor, or
perceptive skills.
In enforcing this division, the board, upon a showing of a
possible violation, shall refer any individual who is authorized
to practice by this chapter or who has submitted an application
pursuant to this chapter to the monitoring organization that
conducts the confidential monitoring program established under
section 4731.25 of the Revised Code. The board also may compel
the individual to submit to a mental examination, physical
examination, including an HIV test, or both a mental and a
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3466 H. B. No. 224 Page 122
As Introduced
physical examination. The expense of the examination is the
responsibility of the individual compelled to be examined.
Failure to submit to a mental or physical examination or consent
to an HIV test ordered by the board constitutes an admission of
the allegations against the individual 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 an individual
unable to practice because of the reasons set forth in this
division, the board shall require the individual to submit to
care, counseling, or treatment by physicians approved or
designated by the board, as a condition for initial, continued,
reinstated, or renewed authority to practice. An individual
affected under this division shall be afforded an opportunity to
demonstrate to the board the ability to resume practice in
compliance with acceptable and prevailing standards under the
provisions of the individual's license or certificate. For the
purpose of this division, any individual who applies for or
receives a license or certificate to practice under this chapter
accepts the privilege of practicing in this state and, by so
doing, 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.
(20) Except as provided in division (F)(1)(b) of section
4731.282 of the Revised Code or when civil penalties are imposed
under section 4731.225 of the Revised Code, and subject to
section 4731.226 of the Revised Code, violating or attempting to
violate, directly or indirectly, or assisting in or abetting the
violation of, or conspiring to violate, any provisions of this
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3497 H. B. No. 224 Page 123
As Introduced
chapter or any rule promulgated by the board.
This division does not apply to a violation or attempted
violation of, assisting in or abetting the violation of, or a
conspiracy to violate, any provision of this chapter or any rule
adopted by the board that would preclude the making of a report
by a physician of an employee's use of a drug of abuse, or of a
condition of an employee other than one involving the use of a
drug of abuse, to the employer of the employee as described in
division (B) of section 2305.33 of the Revised Code. Nothing in
this division affects the immunity from civil liability
conferred by that section upon a physician who makes either type
of report in accordance with division (B) of that section. As
used in this division, "employee," "employer," and "physician"
have the same meanings as in section 2305.33 of the Revised
Code.
(21) The violation of section 3701.79 of the Revised Code
or of any abortion rule adopted by the director of health
pursuant to section 3701.341 of the Revised Code;
(22) Any of the following actions taken by an agency
responsible for authorizing, certifying, or regulating an
individual to practice a health care occupation or provide
health care services in this state or another jurisdiction, for
any reason other than the nonpayment of fees: the limitation,
revocation, or suspension of an individual's license to
practice; acceptance of an individual's license surrender;
denial of a license; refusal to renew or reinstate a license;
imposition of probation; or issuance of an order of censure or
other reprimand;
(23) The violation of section 2919.12 of the Revised Code
or the performance or inducement of an abortion upon a pregnant
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3527 H. B. No. 224 Page 124
As Introduced
woman with actual knowledge that the conditions specified in
division (B) of section 2317.56 of the Revised Code have not
been satisfied or with a heedless indifference as to whether
those conditions have been satisfied, unless an affirmative
defense as specified in division (H)(2) of that section would
apply in a civil action authorized by division (H)(1) of that
section;
(24) 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;
(25) Termination or suspension from participation in the
medicare or medicaid programs by the department of health and
human services or other responsible agency;
(26) Impairment of ability to practice according to
acceptable and prevailing standards of care because of substance
use disorder or excessive use or abuse of drugs, alcohol, or
other substances that may impair ability to practice.
For the purposes of this division, any individual
authorized to practice by this chapter accepts the privilege of
practicing in this state subject to supervision by the board. By
filing an application for or holding a license or certificate to
practice under this chapter, an individual shall be deemed to
have given consent to submit to a mental or physical examination
when ordered to do so by the board in writing, and to have
waived all objections to the admissibility of testimony or
examination reports that constitute privileged communications.
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3556 H. B. No. 224 Page 125
As Introduced
If it has reason to believe that any individual authorized
to practice by this chapter or any applicant for licensure or
certification to practice suffers such impairment, the board
shall refer the individual to the monitoring organization that
conducts the confidential monitoring program established under
section 4731.25 of the Revised Code. The board also may compel
the individual to submit to a mental or physical examination, or
both. The expense of the examination is the responsibility of
the individual compelled to be examined. Any mental or physical
examination required under this division shall be undertaken by
a treatment provider or physician who is qualified to conduct
the examination and who is approved under section 4731.251 of
the Revised Code.
Failure to submit to a mental or physical examination
ordered by the board constitutes an admission of the allegations
against the individual 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 determines that the
individual's ability to practice is impaired, the board shall
suspend the individual's license or certificate or deny the
individual's application and shall require the individual, as a
condition for initial, continued, reinstated, or renewed
licensure or certification to practice, to submit to treatment.
Before being eligible to apply for reinstatement of a
license or certificate suspended under this division, the
impaired practitioner shall demonstrate to the board the ability
to resume practice in compliance with acceptable and prevailing
standards of care under the provisions of the practitioner's
license or certificate. The demonstration shall include, but
shall not be limited to, the following:
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3587 H. B. No. 224 Page 126
As Introduced
(a) Certification from a treatment provider approved under
section 4731.251 of the Revised Code that the individual has
successfully completed any required inpatient treatment;
(b) Evidence of continuing full compliance with an
aftercare contract or consent agreement;
(c) Two written reports indicating that the individual's
ability to practice has been assessed and that the individual
has been found capable of practicing according to acceptable and
prevailing standards of care. The reports shall be made by
individuals or providers approved by the board for making the
assessments and shall describe the basis for their
determination.
The board may reinstate a license or certificate suspended
under this division after that demonstration and after the
individual has entered into a written consent agreement.
When the impaired practitioner resumes practice, the board
shall require continued monitoring of the individual. The
monitoring shall include, but not be limited to, compliance with
the written consent agreement entered into before reinstatement
or with conditions imposed by board order after a hearing, and,
upon termination of the consent agreement, submission to the
board for at least two years of annual written progress reports
made under penalty of perjury stating whether the individual has
maintained sobriety.
(27) A second or subsequent violation of section 4731.66
or 4731.69 of the Revised Code;
(28) Except as provided in division (N) of this section:
(a) Waiving the payment of all or any part of a deductible
or copayment that a patient, pursuant to a health insurance or
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3616 H. B. No. 224 Page 127
As Introduced
health care policy, contract, or plan that covers the
individual's services, otherwise would 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 individual;
(b) Advertising that the individual 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 the individual's services, otherwise would
be required to pay.
(29) Failure to use universal blood and body fluid
precautions established by rules adopted under section 4731.051
of the Revised Code;
(30) Failure to provide notice to, and receive
acknowledgment of the notice from, a patient when required by
section 4731.143 of the Revised Code prior to providing
nonemergency professional services, or failure to maintain that
notice in the patient's medical record;
(31) Failure of a physician supervising a physician
assistant to maintain supervision in accordance with the
requirements of Chapter 4730. of the Revised Code and the rules
adopted under that chapter;
(32) Failure of a physician or podiatrist to enter into a
standard care arrangement with a certified midwife, clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner with whom the physician or podiatrist is in
collaboration pursuant to section 4731.27 of the Revised Code or
failure to fulfill the responsibilities of collaboration after
entering into a standard care arrangement;
(33) Failure to comply with the terms of a consult
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3645 H. B. No. 224 Page 128
As Introduced
agreement entered into with a pharmacist pursuant to section
4729.39 of the Revised Code;
(34) Failure to cooperate in an investigation conducted by
the board under division (F) of this section, including failure
to comply with a subpoena or order issued by the board or
failure to answer truthfully a question presented by the board
in an investigative interview, an investigative office
conference, at a deposition, or in written interrogatories,
except that failure to cooperate with an investigation shall not
constitute grounds for discipline under this section if a court
of competent jurisdiction has issued an order that either
quashes a subpoena or permits the individual to withhold the
testimony or evidence in issue;
(35) Failure to supervise an anesthesiologist assistant in
accordance with Chapter 4760. of the Revised Code and the
board's rules for supervision of an anesthesiologist assistant;
(36) Assisting suicide, as defined in section 3795.01 of
the Revised Code;
(37) Failure to comply with the requirements of section
2317.561 of the Revised Code;
(38) Failure to supervise a radiologist assistant in
accordance with Chapter 4774. of the Revised Code and the
board's rules for supervision of radiologist assistants;
(39) Performing or inducing an abortion at an office or
facility with knowledge that the office or facility fails to
post the notice required under section 3701.791 of the Revised
Code;
(40) Failure to comply with the standards and procedures
established in rules under section 4731.054 of the Revised Code
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3674 H. B. No. 224 Page 129
As Introduced
for the operation of or the provision of care at a pain
management clinic;
(41) Failure to comply with the standards and procedures
established in rules under section 4731.054 of the Revised Code
for providing supervision, direction, and control of individuals
at a pain management clinic;
(42) Failure to comply with the requirements of section
4729.79 or 4731.055 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;
(43) Failure to comply with the requirements of section
2919.171, 2919.202, or 2919.203 of the Revised Code or failure
to submit to the department of health in accordance with a court
order a complete report as described in section 2919.171 or
2919.202 of the Revised Code;
(44) Practicing at a facility that is subject to licensure
as a category III terminal distributor of dangerous drugs with a
pain management clinic classification unless the person
operating the facility has obtained and maintains the license
with the classification;
(45) Owning a facility that is subject to licensure as a
category III terminal distributor of dangerous drugs with a pain
management clinic classification unless the facility is licensed
with the classification;
(46) Failure to comply with any of the requirements
regarding making or maintaining medical records or documents
described in division (A) of section 2919.192, division (C) of
section 2919.193, division (B) of section 2919.195, or division
(A) of section 2919.196 of the Revised Code;
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3703 H. B. No. 224 Page 130
As Introduced
(47) 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;
(48) Failure to comply with the requirements of section
4731.30 of the Revised Code or rules adopted under section
4731.301 of the Revised Code when recommending treatment with
medical marijuana;
(49) A pattern of continuous or repeated violations of
division (E)(2) or (3) of section 3963.02 of the Revised Code;
(50) Failure to fulfill the responsibilities of a
collaboration agreement entered into with an athletic trainer as
described in section 4755.621 of the Revised Code;
(51) Failure to take the steps specified in section
4731.911 of the Revised Code following an abortion or attempted
abortion in an ambulatory surgical facility or other location
that is not a hospital when a child is born alive;
(52) Violation of section 4731.77 of the Revised Code;
(53) Failure of a physician supervising a certified mental
health assistant to maintain supervision in accordance with the
requirements of Chapter 4772. of the Revised Code and the rules
adopted under that chapter.
(C) Disciplinary actions taken by the board under
divisions (A) and (B) of this section shall be taken pursuant to
an adjudication under Chapter 119. of the Revised Code, except
that in lieu of an adjudication, 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 an affirmative vote of not
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3732 H. B. No. 224 Page 131
As Introduced
fewer than six members of the board, 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
consent agreement shall be of no force or effect.
A telephone conference call may be utilized for
ratification of a consent agreement that revokes or suspends an
individual's license or certificate to practice or certificate
to recommend. The telephone conference call shall be considered
a special meeting under division (F) of section 121.22 of the
Revised Code.
If the board takes disciplinary action against an
individual under division (B) of this section for a second or
subsequent plea of guilty to, or judicial finding of guilt of, a
violation of section 2919.123 or 2919.124 of the Revised Code,
the disciplinary action shall consist of a suspension of the
individual's license or certificate to practice for a period of
at least one year or, if determined appropriate by the board, a
more serious sanction involving the individual's license or
certificate to practice. Any consent agreement entered into
under this division with an individual that pertains to a second
or subsequent plea of guilty to, or judicial finding of guilt
of, a violation of that section shall provide for a suspension
of the individual's license or certificate to practice for a
period of at least one year or, if determined appropriate by the
board, a more serious sanction involving the individual's
license or certificate to practice.
(D) For purposes of divisions (B)(10), (12), and (14) of
this section, the commission of the act may be established by a
finding by the board, pursuant to an adjudication under Chapter
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3762 H. B. No. 224 Page 132
As Introduced
119. of the Revised Code, that the individual committed the act.
The board does not have jurisdiction under those divisions if
the trial court renders a final judgment in the individual's
favor and that judgment is based upon an adjudication on the
merits. The board has jurisdiction under those divisions if the
trial court issues an order of dismissal upon technical or
procedural grounds.
(E) The sealing or expungement of conviction records by
any court shall have no effect upon a prior board order entered
under this section or upon the board's jurisdiction to take
action under this section if, based upon a plea of guilty, a
judicial finding of guilt, or a judicial finding of eligibility
for intervention in lieu of conviction, the board issued a
notice of opportunity for a hearing prior to the court's order
to seal or expunge the records. The board shall not be required
to seal, expunge, destroy, redact, or otherwise modify its
records to reflect the court's sealing of conviction records.
(F)(1) The board shall investigate evidence that appears
to show that a person has violated any provision of this chapter
or any rule adopted under it. Any person may report to the board
in a signed writing any information that the person may have
that appears to show a violation of any provision of this
chapter or any rule adopted under it. In the absence of bad
faith, any person who reports information of that nature or who
testifies before the board in any adjudication conducted under
Chapter 119. of the Revised Code shall not be liable in damages
in a civil action as a result of the report or testimony. Each
complaint or allegation of a violation received by the board
shall be assigned a case number and shall be recorded by the
board.
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3792 H. B. No. 224 Page 133
As Introduced
(2) Investigations of alleged violations of this chapter
or any rule adopted under it shall be supervised by the
supervising member elected by the board in accordance with
section 4731.02 of the Revised Code and by the secretary as
provided in section 4731.39 of the Revised Code. The president
may designate another member of the board to supervise the
investigation in place of the supervising member. Upon a vote of
the majority of the board to authorize the addition of a
consumer member in the supervision of any part of any
investigation, the president shall designate a consumer member
for supervision of investigations as determined by the
president. The authorization of consumer member participation in
investigation supervision may be rescinded by a majority vote of
the board. No member of the board who supervises the
investigation of a case shall participate in further
adjudication of the case.
(3) In investigating a possible violation of this chapter
or any rule adopted under this chapter, or in conducting an
inspection under division (E) of section 4731.054 of the Revised
Code, the board may question witnesses, conduct interviews,
administer oaths, order the taking of depositions, inspect and
copy any books, accounts, papers, records, or documents, issue
subpoenas, and compel the attendance of witnesses and production
of books, accounts, papers, records, documents, and testimony,
except that a subpoena for patient record information shall not
be issued without consultation with the attorney general's
office and approval of the secretary of the board.
(a) Before issuance of a subpoena for patient record
information, the secretary shall determine whether there is
probable cause to believe that the complaint filed alleges a
violation of this chapter or any rule adopted under it and that
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3823 H. B. No. 224 Page 134
As Introduced
the records sought are relevant to the alleged violation and
material to the investigation. The subpoena may apply only to
records that cover a reasonable period of time surrounding the
alleged violation.
(b) On failure to comply with any subpoena issued by the
board and after reasonable notice to the person being
subpoenaed, the board may move for an order compelling the
production of persons or records pursuant to the Rules of Civil
Procedure.
(c) A subpoena issued by the board may be served by a
sheriff, the sheriff's deputy, or a board employee or agent
designated by the board. Service of a subpoena issued by the
board may be made by delivering a copy of the subpoena to the
person named therein, reading it to the person, or leaving it at
the person's usual place of residence, usual place of business,
or address on file with the board. When serving a subpoena to an
applicant for or the holder of a license or certificate issued
under this chapter, service of the subpoena may be made by
certified mail, return receipt requested, and the subpoena shall
be deemed served on the date delivery is made or the date the
person refuses to accept delivery. If the person being served
refuses to accept the subpoena or is not located, service may be
made to an attorney who notifies the board that the attorney is
representing the person.
(d) A sheriff's deputy who serves a subpoena shall receive
the same fees as a sheriff. Each witness who appears before the
board in obedience to a subpoena shall receive the fees and
mileage provided for under section 119.094 of the Revised Code.
(4) All hearings, investigations, and inspections of the
board shall be considered civil actions for the purposes of
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3853 H. B. No. 224 Page 135
As Introduced
section 2305.252 of the Revised Code.
(5) A report required to be submitted to the board under
this chapter, a complaint, or information received by the board
pursuant to an investigation or pursuant to an inspection under
division (E) of section 4731.054 of the Revised Code is
confidential and not subject to discovery in any civil action.
The board shall conduct all investigations or inspections
and proceedings in a manner that protects the confidentiality of
patients and persons who file complaints with the board. The
board shall not make public the names or any other identifying
information about patients or complainants unless proper consent
is given or, in the case of a patient, a waiver of the patient
privilege exists under division (B) of section 2317.02 of the
Revised Code, except that consent or a waiver of that nature is
not required if the board possesses reliable and substantial
evidence that no bona fide physician-patient relationship
exists.
The board may share any information it receives pursuant
to an investigation or inspection, including patient records and
patient record information, with law enforcement agencies, other
licensing boards, and other governmental agencies that are
prosecuting, adjudicating, or investigating alleged violations
of statutes or administrative rules. An agency or board that
receives the information shall comply with the same requirements
regarding confidentiality as those with which the state medical
board must comply, notwithstanding any conflicting provision of
the Revised Code or procedure of the agency or board that
applies when it is dealing with other information in its
possession. In a judicial proceeding, the information may be
admitted into evidence only in accordance with the Rules of
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3883 H. B. No. 224 Page 136
As Introduced
Evidence, but the court shall require that appropriate measures
are taken to ensure that confidentiality is maintained with
respect to any part of the information that contains names or
other identifying information about patients or complainants
whose confidentiality was protected by the state medical board
when the information was in the board's possession. Measures to
ensure confidentiality that may be taken by the court include
sealing its records or deleting specific information from its
records.
No person shall knowingly access, use, or disclose
confidential investigatory information in a manner prohibited by
law.
(6) On a quarterly basis, the board shall prepare a report
that documents the disposition of all cases during the preceding
three months. The report shall contain the following information
for each case with which the board has completed its activities:
(a) The case number assigned to the complaint or alleged
violation;
(b) The type of license or certificate to practice, if
any, held by the individual against whom the complaint is
directed;
(c) A description of the allegations contained in the
complaint;
(d) Whether witnesses were interviewed;
(e) Whether the individual against whom the complaint is
directed is the subject of any pending complaints;
(f) The disposition of the case.
The report shall state how many cases are still pending
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3911 H. B. No. 224 Page 137
As Introduced
and shall be prepared in a manner that protects the identity of
each person involved in each case. The report shall be a public
record under section 149.43 of the Revised Code.
(7) The board may provide a status update regarding an
investigation to a complainant on request if the board verifies
the complainant's identity.
(G)(1) If either of the following circumstances occur, the
secretary and supervising member may recommend that the board
suspend an individual's license or certificate to practice or
certificate to recommend without a prior hearing:
(a) The secretary and supervising member determine both of
the following:
(i) That there is clear and convincing evidence that an
individual has violated division (B) of this section;
(ii) That the individual's continued practice presents a
danger of immediate and serious harm to the public.
(b) The board receives verifiable information that a
licensee has been charged in any state or federal court with a
crime classified as a felony under the charging court's law and
the conduct constitutes a violation of division (B) of this
section.
(2) If a recommendation is made to suspend without a prior
hearing pursuant to division (G)(1) of this section, written
allegations shall be prepared for consideration by the board.
The board, upon review of those allegations and by an
affirmative vote of not fewer than six of its members, excluding
the secretary and supervising member, may suspend a license or
certificate without a prior hearing. A telephone conference call
may be utilized for reviewing the allegations and taking the
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3940 H. B. No. 224 Page 138
As Introduced
vote on the summary suspension.
The board shall serve a written order of suspension in
accordance with sections 119.05 and 119.07 of the Revised Code.
The order shall not be subject to suspension by the court during
pendency of any appeal filed under section 119.12 of the Revised
Code. If the individual subject to the summary suspension
requests an adjudicatory hearing by the board, the date set for
the hearing shall be within fifteen days, but not earlier than
seven days, after the individual requests the hearing, unless
otherwise agreed to by both the board and the individual.
(3) Any summary suspension imposed under this division
shall remain in effect, unless reversed on appeal, until a final
adjudicative order issued by the board pursuant to this section
and Chapter 119. of the Revised Code becomes effective. The
board shall issue its final adjudicative order within seventy-
five days after completion of its hearing. A failure to issue
the order within seventy-five days shall result in dissolution
of the summary suspension order but shall not invalidate any
subsequent, final adjudicative order.
(H) If the board takes action under division (B)(9), (11),
or (13) of this section and the judicial finding of guilt,
guilty plea, or judicial finding of eligibility for intervention
in lieu of conviction is overturned on appeal, upon exhaustion
of the criminal appeal, a petition for reconsideration of the
order may be filed with the board along with appropriate court
documents. Upon receipt of a petition of that nature and
supporting court documents, the board shall reinstate the
individual's license or certificate to practice. The board may
then hold an adjudication under Chapter 119. of the Revised Code
to determine whether the individual committed the act in
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3970 H. B. No. 224 Page 139
As Introduced
question. Notice of an opportunity for a hearing shall be given
in accordance with Chapter 119. of the Revised Code. If the
board finds, pursuant to an adjudication held under this
division, that the individual committed the act or if no hearing
is requested, the board may order any of the sanctions
identified under division (B) of this section.
(I) The license or certificate to practice issued to an
individual under this chapter and the individual's practice in
this state are automatically suspended as of the date of the
individual's second or subsequent plea of guilty to, or judicial
finding of guilt of, a violation of section 2919.123 or 2919.124
of the Revised Code. In addition, the license or certificate to
practice or certificate to recommend issued to an individual
under this chapter and the individual's practice in this state
are automatically suspended as of the date the individual pleads
guilty to, is found by a judge or jury to be guilty of, or is
subject to a judicial finding of eligibility for intervention in
lieu of conviction in this state or treatment or intervention in
lieu of conviction in another jurisdiction for any of the
following criminal offenses in this state or a substantially
equivalent criminal offense in another jurisdiction: aggravated
murder, murder, voluntary manslaughter, felonious assault,
trafficking in persons, kidnapping, rape, sexual battery, gross
sexual imposition, aggravated arson, aggravated robbery, or
aggravated burglary. Continued practice after suspension shall
be considered practicing without a license or certificate.
The board shall notify the individual subject to the
suspension in accordance with sections 119.05 and 119.07 of the
Revised Code. If an individual whose license or certificate is
automatically suspended under this division fails to make a
timely request for an adjudication under Chapter 119. of the
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4001 H. B. No. 224 Page 140
As Introduced
Revised Code, the board shall do whichever of the following is
applicable:
(1) If the automatic suspension under this division is for
a second or subsequent plea of guilty to, or judicial finding of
guilt of, a violation of section 2919.123 or 2919.124 of the
Revised Code, the board shall enter an order suspending the
individual's license or certificate to practice for a period of
at least one year or, if determined appropriate by the board,
imposing a more serious sanction involving the individual's
license or certificate to practice.
(2) In all circumstances in which division (I)(1) of this
section does not apply, enter a final order permanently revoking
the individual's license or certificate to practice.
(J) If the board is required by Chapter 119. of the
Revised Code to give notice of an opportunity for a hearing and
if the individual subject to the notice does not timely request
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
an affirmative vote of not fewer than six of its members, a
final order that contains the board's findings. In that final
order, the board may order any of the sanctions identified under
division (A) or (B) of this section.
(K) Any action taken by the board under division (B) of
this section resulting in a suspension from practice shall be
accompanied by a written statement of the conditions under which
the individual's license or certificate to practice may be
reinstated. The board shall adopt rules governing conditions to
be imposed for reinstatement. Reinstatement of a license or
certificate suspended pursuant to division (B) of this section
requires an affirmative vote of not fewer than six members of
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4031 H. B. No. 224 Page 141
As Introduced
the board.
(L) When the board refuses to grant or issue a license or
certificate to practice to an applicant, revokes an individual's
license or certificate to practice, refuses to renew an
individual's license or certificate to practice, or refuses to
reinstate an individual's license or certificate to practice,
the board may specify that its action is permanent. An
individual subject to a permanent action taken by the board is
forever thereafter ineligible to hold a license or certificate
to practice and the board shall not accept an application for
reinstatement of the license or certificate or for issuance of a
new license or certificate.
(M) Notwithstanding any other provision of the Revised
Code, all of the following apply:
(1) The surrender of a license or certificate issued under
this chapter shall not be effective unless or until accepted by
the board. A telephone conference call may be utilized for
acceptance of the surrender of an individual's license or
certificate to practice. The telephone conference call shall be
considered a special meeting under division (F) of section
121.22 of the Revised Code. Reinstatement of a license or
certificate surrendered to the board requires an affirmative
vote of not fewer than six members of the board.
(2) An application for a license or certificate made under
the provisions of this chapter may not be withdrawn without
approval of the board.
(3) Failure by an individual to renew a license or
certificate to practice in accordance with this chapter or a
certificate to recommend in accordance with rules adopted under
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4060 H. B. No. 224 Page 142
As Introduced
section 4731.301 of the Revised Code does not remove or limit
the board's jurisdiction to take any disciplinary action under
this section against the individual.
(4) The placement of an individual's license on retired
status, as described in section 4731.283 of the Revised Code,
does not remove or limit the board's jurisdiction to take any
disciplinary action against the individual with regard to the
license as it existed before being placed on retired status.
(5) At the request of the board, a license or certificate
holder shall immediately surrender to the board a license or
certificate that the board has suspended, revoked, or
permanently revoked.
(N) Sanctions shall not be imposed under division (B)(28)
of this section against any person 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
authorized to practice pursuant to this chapter, to the extent
allowed by this chapter and rules adopted by the board.
(O) Under the board's investigative duties described in
this section and subject to division (F) of this section, the
board shall develop and implement a quality intervention program
designed to improve through remedial education the clinical and
communication skills of individuals authorized under this
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4089 H. B. No. 224 Page 143
As Introduced
chapter to practice medicine and surgery, osteopathic medicine
and surgery, and podiatric medicine and surgery. In developing
and implementing the quality intervention program, the board may
do all of the following:
(1) Offer in appropriate cases as determined by the board
an educational and assessment program pursuant to an
investigation the board conducts under this section;
(2) Select providers of educational and assessment
services, including a quality intervention program panel of case
reviewers;
(3) Make referrals to educational and assessment service
providers and approve individual educational programs
recommended by those providers. The board shall monitor the
progress of each individual undertaking a recommended individual
educational program.
(4) Determine what constitutes successful completion of an
individual educational program and require further monitoring of
the individual who completed the program or other action that
the board determines to be appropriate;
(5) Adopt rules in accordance with Chapter 119. of the
Revised Code to further implement the quality intervention
program.
An individual who participates in an individual
educational program pursuant to this division shall pay the
financial obligations arising from that educational program.
(P) The board shall not refuse to issue a license to an
applicant because of a conviction, plea of guilty, judicial
finding of guilt, judicial finding of eligibility for
intervention in lieu of conviction, or the commission of an act
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4118 H. B. No. 224 Page 144
As Introduced
that constitutes a criminal offense, unless the refusal is in
accordance with section 9.79 of the Revised Code.
(Q) A license or certificate to practice or certificate to
recommend issued to an individual under this chapter and an
individual's practice under this chapter in this state are
automatically suspended if the individual's license or
certificate to practice a health care occupation or provide
health care services is suspended, revoked, or surrendered or
relinquished in lieu of discipline by an agency responsible for
authorizing, certifying, or regulating an individual to practice
a health care occupation or provide health care services in this
state or another jurisdiction. The automatic suspension begins
immediately upon entry of the order by the agency and lasts for
ninety days to permit the board to investigate the basis for the
action under this chapter. Continued practice during the
automatic suspension shall be considered practicing without a
license or certificate.
The board shall notify the individual subject to the
automatic suspension by certified mail or in person in
accordance with section 119.07 of the Revised Code. If an
individual subject to an automatic suspension under this
division fails to make a timely request for an adjudication
under Chapter 119. of the Revised Code, the board is not
required to hold a hearing, but may adopt, by an affirmative
vote of not fewer than six of its members, a final order that
contains the board's findings. In that final order, the board
may order any of the sanctions identified under division (A) or
(B) of this section.
Sec. 4731.27. (A) As used in this section,
"collaboration," "physician," "standard care arrangement," and
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4148 H. B. No. 224 Page 145
As Introduced
"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 certified midwife, 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 certified midwife's
or 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 midwife, certified nurse-midwife, certified
nurse practitioner, or clinical nurse specialist before their
standard care arrangement expires shall give the certified
midwife or 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 certified midwife, 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 is subject to approval by
the medical staff and governing body of the hospital prior to
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4178 H. B. No. 224 Page 146
As Introduced
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 certified midwife, 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.
Section 2. That existing sections 3701.351, 3702.30,
4723.01, 4723.02, 4723.03, 4723.06, 4723.07, 4723.08, 4723.271,
4723.28, 4723.282, 4723.33, 4723.34, 4723.341, 4723.35, 4723.41,
4723.43, 4723.431, 4723.432, 4723.481, 4723.483, 4723.487,
4723.488, 4723.4810, 4723.4811, 4723.50, 4723.91, 4723.99,
4731.22, and 4731.27 of the Revised Code are hereby repealed.
Section 3. Sections 4723.54 and 4724.02 of the Revised
Code, as enacted by this act, take effect January 1, 2028.
Section 4. 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 4723.08 of the Revised Code as amended by both
H.B. 509 and S.B. 131 of the 134th General Assembly.
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
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4207 H. B. No. 224 Page 147
As Introduced
of the 135th General Assembly and by H.B. 110 and H.B. 509 of
the 134th General Assembly.
Section 4731.22 of the Revised Code as amended by both
S.B. 95 and S.B. 109 of the 135th General Assembly.
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