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| To amend sections 2305.25 and 2305.252 and to enact | 1 |
| section 5111.0216 of the Revised Code regarding | 2 |
| health care peer review committee proceedings and | 3 |
| Medicaid coverage of telehealth services. | 4 |
| Section 1. That sections 2305.25 and 2305.252 be amended and | 5 |
| section 5111.0216 of the Revised Code be enacted to read as | 6 |
| follows: | 7 |
| Sec. 2305.25. As used in this section and sections 2305.251 | 8 |
| to 2305.253 of the Revised Code: | 9 |
| (A)(1) "Health care entity" means an entity, whether acting | 10 |
| on its own behalf or on behalf of or in affiliation with other | 11 |
| health care entities, that conducts as part of its regular | 12 |
| business activities professional credentialing or quality review | 13 |
| activities involving the competence of, professional conduct of, | 14 |
| or quality of care provided by health care providers, including | 15 |
| both individuals who provide health care and entities that provide | 16 |
| health care. | 17 |
| (2) "Health care entity" includes any entity described in | 18 |
| division (A)(1) of this section, regardless of whether it is a | 19 |
| government entity; for-profit or nonprofit corporation; limited | 20 |
| liability company; partnership; professional corporation; state or | 21 |
| local society composed of physicians, dentists, optometrists, | 22 |
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psychologists, or pharmacists; | 23 |
| other health care organization; or combination of any of the | 24 |
| foregoing entities. | 25 |
| (B) "Health insuring corporation" means an entity that holds | 26 |
| a certificate of authority under Chapter 1751. of the Revised | 27 |
| Code. "Health insuring corporation" includes wholly owned | 28 |
| subsidiaries of a health insuring corporation. | 29 |
| (C) "Hospital" means | 30 |
| (1) An institution that has been registered or licensed by | 31 |
| the department of health as a hospital; | 32 |
| (2) An entity, other than an insurance company authorized to | 33 |
| do business in this state, that owns, controls, or is affiliated | 34 |
| with an institution that has been registered or licensed by the | 35 |
| department of health as a hospital; | 36 |
| (3) A group of hospitals that are owned, sponsored, or | 37 |
| managed by a single entity. | 38 |
| (D) "Incident report or risk management report" means a | 39 |
| report of an incident involving injury or potential injury to a | 40 |
| patient as a result of patient care provided by health care | 41 |
| providers, including both individuals who provide health care and | 42 |
| entities that provide health care, that is prepared by or for the | 43 |
| use of a peer review committee of a health care entity and is | 44 |
| within the scope of the functions of that committee. | 45 |
| (E)(1) "Peer review committee" means a utilization review | 46 |
| committee, quality assessment committee, performance improvement | 47 |
| committee, tissue committee, credentialing committee, or other | 48 |
| committee that does either of the following: | 49 |
| (a) Conducts professional credentialing or quality review | 50 |
| activities involving the competence of, professional conduct of, | 51 |
| or quality of care provided by health care providers, including | 52 |
| both individuals who provide health care and entities that provide | 53 |
| health care; | 54 |
| (b) Conducts any other attendant hearing process initiated as | 55 |
| a result of a peer review committee's recommendations or actions. | 56 |
| (2) "Peer review committee" includes all of the following: | 57 |
| (a) A peer review committee of a hospital or long-term care | 58 |
| facility or a peer review committee of a nonprofit health care | 59 |
| corporation that is a member of the hospital or long-term care | 60 |
| facility or of which the hospital or facility is a member; | 61 |
| (b) A peer review committee of a community mental health | 62 |
| center; | 63 |
| (c) A board or committee of a hospital, a long-term care | 64 |
| facility, or other health care entity when reviewing professional | 65 |
| qualifications or activities of health care providers, including | 66 |
| both individuals who provide health care and entities that provide | 67 |
| health care; | 68 |
| (d) A peer review committee, professional standards review | 69 |
| committee, or arbitration committee of a state or local society | 70 |
| composed of members who are in active practice as physicians, | 71 |
| dentists, optometrists, psychologists, or pharmacists; | 72 |
| (e) A peer review committee of a health insuring corporation | 73 |
| that has at least a two-thirds majority of member physicians in | 74 |
| active practice and that conducts professional credentialing and | 75 |
| quality review activities involving the competence or professional | 76 |
| conduct of health care providers that adversely affects or could | 77 |
| adversely affect the health or welfare of any patient; | 78 |
| (f) A peer review committee of a health insuring corporation | 79 |
| that has at least a two-thirds majority of member physicians in | 80 |
| active practice and that conducts professional credentialing and | 81 |
| quality review activities involving the competence or professional | 82 |
| conduct of a health care facility that has contracted with the | 83 |
| health insuring corporation to provide health care services to | 84 |
| enrollees, which conduct adversely affects, or could adversely | 85 |
| affect, the health or welfare of any patient; | 86 |
| (g) A peer review committee of a sickness and accident | 87 |
| insurer that has at least a two-thirds majority of physicians in | 88 |
| active practice and that conducts professional credentialing and | 89 |
| quality review activities involving the competence or professional | 90 |
| conduct of health care providers that adversely affects or could | 91 |
| adversely affect the health or welfare of any patient; | 92 |
| (h) A peer review committee of a sickness and accident | 93 |
| insurer that has at least a two-thirds majority of physicians in | 94 |
| active practice and that conducts professional credentialing and | 95 |
| quality review activities involving the competence or professional | 96 |
| conduct of a health care facility that has contracted with the | 97 |
| insurer to provide health care services to insureds, which conduct | 98 |
| adversely affects, or could adversely affect, the health or | 99 |
| welfare of any patient; | 100 |
| (i) A peer review committee of any insurer authorized under | 101 |
| Title XXXIX of the Revised Code to do the business of medical | 102 |
| professional liability insurance in this state that conducts | 103 |
| professional quality review activities involving the competence or | 104 |
| professional conduct of health care providers that adversely | 105 |
| affects or could affect the health or welfare of any patient; | 106 |
| (j) A peer review committee of the bureau of workers' | 107 |
| compensation or the industrial commission that is responsible for | 108 |
| reviewing the professional qualifications and the performance of | 109 |
| providers conducting medical examinations or file reviews for the | 110 |
| bureau or the commission; | 111 |
| (k) Any other peer review committee of a health care entity. | 112 |
| (F) "Physician" means an individual authorized to practice | 113 |
| medicine and surgery, osteopathic medicine and surgery, or | 114 |
| podiatric medicine and surgery. | 115 |
| (G) "Sickness and accident insurer" means an entity | 116 |
| authorized under Title XXXIX of the Revised Code to do the | 117 |
| business of sickness and accident insurance in this state. | 118 |
| (H) "Tort action" means a civil action for damages for | 119 |
| injury, death, or loss to a patient of a health care entity. "Tort | 120 |
| action" includes a product liability claim, as defined in section | 121 |
| 2307.71 of the Revised Code, and an asbestos claim, as defined in | 122 |
| section 2307.91 of the Revised Code, but does not include a civil | 123 |
| action for a breach of contract or another agreement between | 124 |
| persons. | 125 |
| (I) "Accountable care organization" means such an | 126 |
| organization as defined in 42 C.F.R. 425.20. | 127 |
| Sec. 2305.252. Proceedings and records within the scope of a | 128 |
| peer review committee of a health care entity shall be held in | 129 |
| confidence and shall not be subject to discovery or introduction | 130 |
| in evidence in any civil action against a health care entity or | 131 |
| health care provider, including both individuals who provide | 132 |
| health care and entities that provide health care, arising out of | 133 |
| matters that are the subject of evaluation and review by the peer | 134 |
| review committee. No individual who attends a meeting of a peer | 135 |
| review committee, serves as a member of a peer review committee, | 136 |
| works for or on behalf of a peer review committee, or provides | 137 |
| information to a peer review committee shall be permitted or | 138 |
| required to testify in any civil action as to any evidence or | 139 |
| other matters produced or presented during the proceedings of the | 140 |
| peer review committee or as to any finding, recommendation, | 141 |
| evaluation, opinion, or other action of the committee or a member | 142 |
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thereof. | 143 |
| Information, documents, or records otherwise available from | 144 |
| original sources are not to be construed as being unavailable for | 145 |
| discovery or for use in any civil action merely because they were | 146 |
| produced or presented during proceedings of a peer review | 147 |
| committee, but the information, documents, or records are | 148 |
| available only from the original sources and cannot be obtained | 149 |
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from the peer review committee's proceedings or records. | 150 |
| Release of any information, documents, or records that were | 151 |
| produced or presented during proceedings of a peer review | 152 |
| committee or created to document the proceedings does not affect | 153 |
| the confidentiality of any other information, documents, or | 154 |
| records produced or presented during those proceedings or created | 155 |
| to document them. Only the information, documents, or records | 156 |
| actually released cease to be privileged under this section. | 157 |
| Nothing in this section precludes health care entities from | 158 |
| sharing information, documents, or records that were produced or | 159 |
| presented during proceedings of a peer review committee or created | 160 |
| to document them as long as the information, documents, or records | 161 |
| are used only for peer review purposes. | 162 |
| An individual who testifies before a peer review committee, | 163 |
| serves as a representative of a peer review committee, serves as a | 164 |
| member of a peer review committee, works for or on behalf of a | 165 |
| peer review committee, or provides information to a peer review | 166 |
| committee shall not be prevented from testifying as to matters | 167 |
| within the individual's knowledge, but the individual cannot be | 168 |
| asked about the individual's testimony before the peer review | 169 |
| committee, information the individual provided to the peer review | 170 |
| committee, or any opinion the individual formed as a result of the | 171 |
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peer review committee's activities. | 172 |
| An order by a court to produce for discovery or for use at | 173 |
| trial the proceedings or records described in this section is a | 174 |
| final order. | 175 |
| Sec. 5111.0216. (A) As used in this section, "telehealth | 176 |
| service" means a health care service delivered to a patient | 177 |
| through the use of interactive audio, video, or other | 178 |
| telecommunications or electronic technology from a site other than | 179 |
| the site where the patient is located. | 180 |
| (B) The office of medical assistance shall establish | 181 |
| standards for medicaid reimbursement for health care services the | 182 |
| office determines are appropriate to be covered by the medicaid | 183 |
| program when provided as telehealth services. The standards shall | 184 |
| be established in rules adopted under section 5111.02 of the | 185 |
| Revised Code. | 186 |
| Section 2. That existing sections 2305.25 and 2305.252 of the | 187 |
| Revised Code are hereby repealed. | 188 |