Legislative Updates
SB 196 Update
Did you know that APRNs in Ohio have limitations, surrounding medical forms they are authorized to sign related to patient care?
Currently, APRNs in Ohio cannot sign forms related to pre-employment and health screening exams, patient orders for life-sustaining treatment, and more. As a result of this outdated policy, delays in patient care can occur.
Senate Bill 196, Global Signature Authority Legislation, introduced by Senator Kristina Roegner, gives APRNs the authority under Ohio law to sign and complete paperwork associated with patient care within their scope of practice.
If signed into law, Ohio APRNs will join 16 other states that have global signature authority.
Telehealth
On February 21, 2023 the State Medical Board of Ohio released its final telehealth rules to implement Ohio’s telehealth statute (O.R.C. 4743.09) You can find a summary and more detailed information HERE.
Rule Comment Submissions
|
Proposed Rule |
Agency |
Submission |
Agency Response |
|
OAC 4123-6-21.2 (Pharmacy and therapeutics committee) |
Ohio BWC |
Submitted 5.31.2024 |
BWC refused to add NPs and CNSs to the Pharmacy & Therapeutics committee at this time. “While these individuals can prescribe medications, they may do so only in collaboration with one or more physicians. The P&T committee reviews issues specific to prescribing; therefore, the current committee requirement for physician is considered a “peer-to-peer” review.” |
|
OAC 5160-27-01 (Community behavioral health services – request to add CNMs) |
Ohio Department of Medicaid |
Submitted 11.27.2023 |
Medicaid requested a meeting to discuss. Such meeting occurred on 2.22.2024. Medicaid stated that they would be discussing internally and had no official timeline. We have followed up with the last follow-up being on 8.22.2024. |
|
Medicaid Non-institutional Rate Increases (Request for 100% reimbursement) |
Ohio Department of Medicaid |
Submitted 10.9.2023 |
Medicaid and OAAPN met on the topic 100% reimbursement. Medicaid responded on 11.14.2024 stating that APRNs are currently reimbursed at 100% in non-hospital settings. OAAPN also met with Medicaid on this topic in October 2023. The open question is whether OAAPN members are experiencing difficulty in receiving 100% reimbursement from Medicaid in non-hospital settings, as well as whether OAAPN wants to pursue 100% reimbursement rates in hospital settings. |
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| OAC 5160-8-42 (Lactation consultant services) | Ohio Department of Medicaid | Submitted 9.19.2023 | OAAPN participated in a preliminary review of this rule and submitted a comment letter. Medicaid responded by pulling the original proposed rule and resubmitting a new version. OAAPN indicated on 8.6.2024 that the new version of the rule was acceptable and no further comments were submitted. |
| OAC 5122-40-05 | Ohio Department of Mental Health and Addiction Services | Submitted 4.14.2023 | The Department did not accept any of OAAPNs changes. No explanation offered. |
| OAC 5160-1-80 (pre-clearance review) | Ohio Department of Medicaid | Submitted 2.13.2023 | The Department adopted the proposed change to remove paragraph (B)(2) from the OAC 5160-1-80 rule. The Department did not adopt the second request for physician assistants to be added to the list of practitioners to perform the services of a locum tenens. ODM feels that this is not appropriate because services provided by a physician assistant require supervision by a physician. As stated in paragraph (B)(1) of OAC rule 5160-4-03, a physician assistant provides services under the supervision of a physician with whom the PA has entered into a supervision agreement. For this reason, ODM will not be adding PAs to the list of substitute practitioners at this time. |
| OAC 3301-69-02 | Ohio Department of Education | Submitted 2.13.2023 | Proposed changes were not adopted. |
| OAC 4729:1-3-02 | Ohio Board of Pharmacy | Submitted 1.31.2023 | Proposed changes were adopted, and new rule was finalized on 6.1.23. |
| OAC 5122-40-05 | Ohio Department of Mental Health and Addiction Services | Submitted 11.4.2022 | The Department has not finalized these rules as of 1.30.23. |
| OAC 5160-19-01 | Ohio Department of Medicaid | Submitted 10.3.2022 |
“Thank you for your comments on the draft amendment for OAC 5160-19-01 (C)(2), requesting the addition of “Advanced Practice Registered Nurses excluding Certified Registered Nurse Anesthetists” to the list of eligible providers and aligning the language in 5160-19-01 (C)(2) to reflect the existing language in 5160-19-01 (D)(2), citing section 4723.01 of the Revised Code. ODM recognizes and supports all providers practicing at the top of their licenses, including Certified Nurse Midwives (CNMs) providing primary care. However, ODM is currently working through major system updates bringing forth a new provider network module and a new fiscal intermediary. Adding new providers to these systems takes a great effort that cannot possibly be completed by the start of this 2023 program year. ODM will consider adding CNMs next year to further support the nursing workforce and allow CNMs to practice at the top of their licenses.” |
| OAC 4501:1-7-02 | Ohio Department of Public Safety | Submitted 5.20.2022 (via certified mail) | The Department made the requested changes. |
| OAC 5160-1-18 |
Ohio Department of Medicaid (telehealth) |
Submitted 5.13.2022 | At this time, ODM intends to keep the language as is in 5160-1-18 (D)(1) and 5160-1-168 (D)(2) regarding payment for evaluation and management services delivered through telehealth. Specific level of complexity terminology is included in the E&M code definitions we currently allow for codes 99202-99204 and 99211-99214 for new and established patients respectively. We will allow the more highly complex codes 99205 and 99215 to be provided by OhioMHAS certified behavioral health providers only. Ensuring the highest standards in quality of care is our greatest priority and the agency’s clinical team sustains support for required in-person physical exams for more complicated patients. |
| OAC 5160-2-17 | Ohio Department of Medicaid | Submitted 5.13.2022 | The Department is going to be making the suggested change. |
| OAC 5122-40-01, 5122-40-06 & 5122-40-08 | Ohio Department of Mental Health and Addiction Services | Submitted 4.22.2022 | The Department made no requested changes to OAC 5122-40-01 or 5122-40-06(E), (F)(3), (G), or (U)(7)(b). The Department did add language allowing a medical director or other “authorized prescriber” to prescribe per requested in OAC 5122-40-06(L) and (U)(6)(g). The Department did not add “advanced practice nurse practitioners” to OAC 5122-40-08(A)(1) and (A)(2) but did add “the physician, or their designees” instead. |
| OAC 4731-37-01 | Ohio Board of Medicine | Submitted 4.11.2022 | New rule has not been adopted yet as of 1.30.23. |
| OAC 5122-29-14 | Ohio Department of Mental Health and Addiction Services | Submitted 3.30.2022 | The Department is going to be making the suggested change. |
| OAC 5160-2-40 |
Ohio Department of Medicaid (Pre-certification review – Psych) |
Submitted 3.3.2022 (Comment period was cancelled, but we submitted comments as a preemptive measure.) | Rule was rescinded on 2.23.2022 and resubmitted. ODM incorporated all suggestions except allowing APRNs to make negative review decisions. |
| OAC 4121-3-09, 4121-3-15, and 4121-3-32 | Ohio Industrial Commission (Bureau of Worker’s Compensation) | Submitted 2.25.2022 | Rules are listed as under 5-year rule review. However, they are not currently scheduled for hearing. We submitted comments as a preemptive measure. |
| OAC 5160-2-13 | Ohio Department of Medicaid | Submitted 2.23.2022 | Rule package was withdrawn and resubmitted with some of OAAPN’s proposed changes. We have followed-up with Medicaid regarding incorporation of our comments in a future revision. |
| OAC 5123-2-06 | Ohio Department of Developmental Disabilities | Submitted 2.7.2022 | Section (C)(14)(h) was revised to allow APRNs to administer ECT but not prescribe. Addition of “Ohio Board of Nursing” to (D)(4)(a) was denied. |
| OAC 5160-5-01 |
Ohio Department of Medicaid (Dental Services) |
Submitted 2.2.2022 | Changes approved by Medicaid on 2.4.2022. |
| OAC 5122-2-13 | Ohio Department of Mental Health and Addiction Services | Submitted 12.20.2021 | Changes made by ODMHAS on 1.3.2021 |
| OAC 5160-8-42 | Ohio Department of Medicaid | Submitted 11.10.2021. | Medicaid provided clarifying comments on 11.22.2021 and explained why the requested changes were not necessary. |
|
OAC 5160-10-25 OAC 5160-21-05 OAC 5160-8-42 OAC 5160-21-04 |
Ohio Department of Medicaid (Maternal and Infant Support Program) |
Submitted 9.3.2021 | On 9.16.2021, Medicaid responded with clarifying comments, but no changes were made. Changes regarding services after 40 weeks of pregnancy, 2nd provider reimbursement during delivery, and STI/drug use/abuse counseling were “logged and will be considered in ODM’s next review of this rule.” |
| OAC 5123-7-08 | Ohio Department of Developmental Disabilities | Submitted 8.31.2021 | Change was approved to add APRNs as approved providers. |
| OAC 5160-19-01 | Ohio Department of Medicaid | Submitted 8.3.2021 | Changes denied. Medicaid has asked for examples of APRN practices who have enough covered lives to be PCMH practices. OAAPN was unable to locate such examples. |
|
OAC 5160-10-06 OAC 5160-10-07 |
Ohio Department of Medicaid | Submitted 7.27.2021 |
On 7.29.2021, Medicaid acknowledged that the requested changes were appropriate, but they decided they were not important enough to grant at this time. Medicaid indicated that these small changes would require them to re-start the rulemaking process.
OAAPN resubmitted the comments to JCARR on 8.3.2021. However, JCARR denied the changes. |
| OAC 1301-11-7-04 | Ohio Real Estate Board | Submitted 7.7.2021 | On 7.15.2021, a Real Estate Board represented indicated they would recommend making the changes. |
| OAC 5160-31-03 (Eligibility for enrollment in the PASSPORT HCBS waiver program) | Ohio Department of Medicaid | (Nothing submitted.) | |
| OAC 4123-6-21 (Payment for outpatient medication) | Ohio Bureau of Worker’s Compensation | Submitted 5.24.2021 | On 6.9.2021, BWC responded that it reimburses APRNs and will examine “physician” references to update to provider neutral language at the next rule review. BWC denied the request to include APRNs as a “physician of record.” Paragraph (J) was updated to be “provider” instead of “physician.” |
| OAC 4729-1-6-02 (Pharmacy consult agreements) | Ohio Department of Pharmacy | Correction submitted to Cameron McNamee on 5.18.2021. | Correction made by Ohio Department of Pharmacy on 5.18.2021. |
| OAC 5160-21-04 (Reproductive health services; pregnancy-related services) | Ohio Department of Medicaid | Submitted 5.7.2021. | Most changes were granted on 5.21.2021. |
| OAC 5160-18-01 (Freestanding Birth Center Services) | Ohio Department of Medicaid | Submitted 5.6.2021. | Medicaid is still developing rule to propose for 5-year rule review in 2022. |
|
OAC 5122-40-05 (Personnel) OAC 5122-40-06 (Medication Assisted Treatment administration) OAC 5122-40-07 (Program policies and patient records) OAC 5122-40-08 (Monitoring program) |
Ohio Department of Mental Health and Addiction | Sent to OAAPN on 4.15.2021. Nothing submitted. |
We Stand for Better Healthcare Access for All Ohioans
OAAPN continues to advocate for better access to care. We thank our coalition partners who stand with us in the pursuit of better access to care for all Ohioans.
