Legislative/Practice Issues

Premier Health supports education and information for all partners and associates at every level. Here you will find up-to-date postings on legislative matters relevant to our patients and the care we provide.

House Bill 216 

Governor Kasich signed the APRN Modernization Bill, Sub. HB 216, into law on January 4, 2017. The legislation contains significant changes which improve the practice environment for nurse practitioners and other APRNs and advances access to quality health care services for Ohio’s citizens. The HB 216 legislative effort represents three years of hard work by you, the Ohio Association of Advanced Practice Nurses (an AANP NP Organization member), and other Nursing associations through numerous meetings and continuous negotiations with interested parties and stakeholders. Despite undergoing multiple revisions and adjustments with this legislation, many APRN practice barriers were eliminated. Please remember, that securing Schedule II prescribing authority was a prolonged six year effort. The final legislation made the following changes, which were effective on 4/4/17.

Below is a summary of the changes from this new law. Read the full bill and legislative summary.

Licensure

  • APRNs have two licenses—one as an RN and one as an APRN with role designation as a CRNA, CNM, CNS or CNP. This moves OH closer to the NCSBN Model Licensure framework
  • NP and CNS and CNM APRN licensure is now is inclusive of prescriptive authority. Prescribing authority and the Certificate of Authority no longer rely on certification. Licensure as an APRN and RN is sufficient
  • Certificate to Prescribe (CTP) and the Certificate to Prescribe – Externship (CTP-E) have been eliminated, prescribing is a component of licensure
  • All APRNs must have a Standard Care Arrangement
  • Increase in required CEs for re-licensure in 2017 which includes 24 hours of CE for RN license, including category A, (Ohio Nursing law), and 24 hours for APRN license, which includes 12 hours of pharmacology for a minimum requirement of 48 hours of CE every 2 years

Formulary/Prescribing

  • Formulary changes to an exclusionary drug formulary, listing only the drugs the APRN cannot prescribe. The previous formulary was both inclusionary and exclusionary
  • The formulary column “In accordance with the SCA” will be eliminated.
  • Expands the validity of the recognized pharmacology requirement course from 3 years to 5 years
  • Eliminates restrictions on sample and stock medications

Collaboration/Prescribing

  • Modifies the collaborating ratio for the prescribing component of practice at any one time was expanded from a 3 APRNs:1 physician ratio to a 5 APRNs:1 physician ratio
  • Adds Assisted Living sites to the list of schedule II authorized prescribing sites
  • For non-authorized sites where the APRN need to prescribe schedule II medications, the initial schedule II prescription may be prescribed by any physician. This law expanded the required initial prescription from the collaborating physician to any physician
  • Increased the time frame for prescribing for a terminal condition in a non-authorized site from 24 hour period to 72 hours
  • Psychiatric CNSs may collaborate with a psychiatric CP or a certified primary care CP in family, pediatric or internal medicine. Note: While psychiatric NPs were not included in this change and must still use psychiatric CPs only, this is a technical change which will be revisited in the near future

SCA Policy Changes Include

  • The APRN employer maintains the copy of the SCA. The requirement that the SCA be kept at all practice sites has been eliminated
  • Elimination of the required referral review and chart reviews for referral outcomes
  • Elimination of a Policy for Care of infants up to age 1 or recommendations for visits for children from birth to age 3
  • Provides a "120 day Buffer Period"; time frame in which the APRN may practice without a formal physician collaborator while working to secure a new one should an APRN be suddenly without a CP. Additional details pending OBON guidelines/rules
  • Removed statutory barriers to hospital staff membership and professional privileging for all APRNs
  • Realigns the makeup of the Committee on Prescriptive Governance for equal representation of APRNs and physicians members
  • All APRNs, including CNSs, must have a SCA whether or not they are prescribing in practice

OBON APRN Advisory Committee/OBON

  • Establishment of an Ohio BON APRN Advisory Committee, as recommended by the NCSBN, with appointees representing the APRN statewide organizations, OBON, OAAPN, academia and APRN employers
  • The OBON APRN Advisory Committee will advise the board on APRN practice issues
  • Committee members appointed by the BON must include: four APRNs in active practice, one APRN representing the OBON, two APRN faculty members, and one APRN employer representative
  • Requires the composition of the BON to have at least two of the eight RN members of the board are APRNs
  • BON is now authorized to discipline an APRN if clinical privileges are suspended, restricted, reduced or terminated by the VA and if the DEA terminated or suspended DEA registration to prescribe

Additional Changes

  • Testimonial privilege was extended to APRNs
  • Includes NPs as providers recognized to manage pediatric diabetes in school environments

Discipline

  • Authorizes the coroner to notify the BON and state dental Board of a drug overdose death. Notice includes information about the drug, and if it was prescribed and the name of the prescriber (physicians already included)

DNR Orders

  • DNR authority is extended to CNMs with same law that grants DNR authority to physicians, CNPs and CNSs

These changes address many of the barriers to practice and patient care that the Ohio Nursing community has been working together to remove or reduce. The last 3 years have seen intense coordination to raise the awareness of the impact that APRNs have on patients in the state and underscore the resolve that APRNs will not rest until we have removed all of the barriers to practice. AANP is already working with our Ohio NP Organization member associations to continue the work, and plan for the next session. AANP acknowledges our Ohio AANP NP Organization members for the lead role they had in this legislation, and all of our Ohio AANP members who have been involved and supported this initiative. 

Read the full bill and legislative summary.

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