Bill Text: OH SB83 | 2011-2012 | 129th General Assembly | Engrossed
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: To modify the authority of certain advanced practice nurses to prescribe schedule II controlled substances and to authorize the Board of Nursing to take disciplinary actions for self-administration of schedule I controlled substances.
Spectrum: Slight Partisan Bill (Democrat 34-22)
Status: (Passed) 2012-06-08 - Effective Date [SB83 Detail]
Download: Ohio-2011-SB83-Engrossed.html
As Passed by the Senate
A BILL
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Bill Title: To modify the authority of certain advanced practice nurses to prescribe schedule II controlled substances and to authorize the Board of Nursing to take disciplinary actions for self-administration of schedule I controlled substances.
Spectrum: Slight Partisan Bill (Democrat 34-22)
Status: (Passed) 2012-06-08 - Effective Date [SB83 Detail]
Download: Ohio-2011-SB83-Engrossed.html
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Senator Oelslager
Cosponsors:
Senators Tavares, Cafaro, Brown, Coley, Daniels, Hughes, Niehaus, Sawyer, Schiavoni, Turner, Wilson
To amend sections 3719.06, 4723.481, 4723.482, | 1 |
4723.492, and 4723.50 of the Revised Code to | 2 |
modify the authority of certain advanced practice | 3 |
nurses to prescribe schedule II controlled | 4 |
substances. | 5 |
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3719.06, 4723.481, 4723.482, | 6 |
4723.492, and 4723.50 of the Revised Code be amended to read as | 7 |
follows: | 8 |
Sec. 3719.06. (A)(1) A licensed health professional | 9 |
authorized to prescribe drugs, if acting in the course of | 10 |
professional practice, in accordance with the laws regulating the | 11 |
professional's practice, and in accordance with rules adopted by | 12 |
the state board of pharmacy, may, except as provided in division | 13 |
(A)(2) or (3) of this section, do the following: | 14 |
(a) Prescribe schedule II, III, IV, and V controlled | 15 |
substances; | 16 |
(b) Administer or personally furnish to patients schedule II, | 17 |
III, IV, and V controlled substances; | 18 |
(c) Cause schedule II, III, IV, and V controlled substances | 19 |
to be administered under the prescriber's direction and | 20 |
supervision. | 21 |
(2) A licensed health professional authorized to prescribe | 22 |
drugs who is a clinical nurse specialist, certified nurse-midwife, | 23 |
or certified nurse practitioner is subject to both of the | 24 |
following: | 25 |
(a) A schedule II controlled substance may be prescribed only | 26 |
27 | |
28 | |
29 | |
30 | |
31 | |
accordance with division (C) of section 4723.481 of the Revised | 32 |
Code. | 33 |
(b) No schedule II controlled substance shall be personally | 34 |
furnished to any patient. | 35 |
(3) A licensed health professional authorized to prescribe | 36 |
drugs who is a physician assistant shall not prescribe or | 37 |
personally furnish to patients any controlled substance that is | 38 |
not included in the physician-delegated prescriptive authority | 39 |
granted to the physician assistant in accordance with Chapter | 40 |
4730. of the Revised Code. | 41 |
(B) No licensed health professional authorized to prescribe | 42 |
drugs shall prescribe, administer, or personally furnish a | 43 |
schedule III anabolic steroid for the purpose of human muscle | 44 |
building or enhancing human athletic performance and no pharmacist | 45 |
shall dispense a schedule III anabolic steroid for either purpose, | 46 |
unless it has been approved for that purpose under the "Federal | 47 |
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A. | 48 |
301, as amended. | 49 |
(C) Each written prescription shall be properly executed, | 50 |
dated, and signed by the prescriber on the day when issued and | 51 |
shall bear the full name and address of the person for whom, or | 52 |
the owner of the animal for which, the controlled substance is | 53 |
prescribed and the full name, address, and registry number under | 54 |
the federal drug abuse control laws of the prescriber. If the | 55 |
prescription is for an animal, it shall state the species of the | 56 |
animal for which the controlled substance is prescribed. | 57 |
Sec. 4723.481. Under a certificate to prescribe issued under | 58 |
section 4723.48 of the Revised Code, a clinical nurse specialist, | 59 |
certified nurse-midwife, or certified nurse practitioner is | 60 |
subject to all of the following: | 61 |
(A) The clinical nurse specialist, certified nurse-midwife, | 62 |
or certified nurse practitioner shall not prescribe any drug or | 63 |
therapeutic device that is not included in the types of drugs and | 64 |
devices listed on the formulary established in rules adopted under | 65 |
section 4723.50 of the Revised Code. | 66 |
(B) The | 67 |
specialist, certified nurse-midwife, or certified nurse | 68 |
practitioner shall not exceed the prescriptive authority of the | 69 |
collaborating physician or podiatrist. | 70 |
(C) | 71 |
72 | |
73 | |
74 | |
provided in division (C)(2) or (3) of this section, the clinical | 75 |
nurse specialist, certified nurse-midwife, or certified nurse | 76 |
practitioner may prescribe to a patient a schedule II controlled | 77 |
substance only if all of the following are the case: | 78 |
(a) The patient has a terminal condition, as defined in | 79 |
section 2133.01 of the Revised Code. | 80 |
(b) The collaborating physician of the clinical nurse | 81 |
specialist, certified nurse-midwife, or certified nurse | 82 |
practitioner initially prescribed the substance for the patient. | 83 |
(c) The prescription is for an amount that does not exceed | 84 |
the amount necessary for the patient's use in a single, | 85 |
twenty-four hour period. | 86 |
(2) The restrictions on prescriptive authority in division | 87 |
(C)(1) of this section do not apply if a clinical nurse | 88 |
specialist, certified nurse-midwife, or certified nurse | 89 |
practitioner issues the prescription to the patient from any of | 90 |
the following locations: | 91 |
(a) A hospital registered under section 3701.07 of the | 92 |
Revised Code; | 93 |
(b) A health care facility operated by the department of | 94 |
mental health or the department of developmental disabilities; | 95 |
(c) A nursing home licensed under section 3721.02 of the | 96 |
Revised Code or by a political subdivision certified under section | 97 |
3721.09 of the Revised Code; | 98 |
(d) A county home or district home operated under Chapter | 99 |
5155. of the Revised Code that is certified under Title XVIII or | 100 |
XIX of the Social Security Act of 1935; | 101 |
(e) A hospice care program, as defined in section 3712.01 of | 102 |
the Revised Code; | 103 |
(f) A community mental health facility, as defined in section | 104 |
5122.01 of the Revised Code; | 105 |
(g) An ambulatory surgical facility, as defined in section | 106 |
3702.30 of the Revised Code; | 107 |
(h) A freestanding birthing center, as defined in section | 108 |
3702.51 of the Revised Code; | 109 |
(i) A federally qualified health center, as defined in | 110 |
section 1905(l)(2)(B) of the "Social Security Act," 103 Stat. 2264 | 111 |
(1989), 42 U.S.C. 1396d(l)(2)(B); | 112 |
(j) A health care office or facility operated by the board of | 113 |
health of a city or general health district or the authority | 114 |
having the duties of a board of health under section 3709.05 of | 115 |
the Revised Code. | 116 |
(3) A clinical nurse specialist, certified nurse-midwife, or | 117 |
certified nurse practitioner shall not issue to a patient a | 118 |
prescription for a schedule II controlled substance from a | 119 |
convenience care clinic even if the clinic is owned or operated by | 120 |
an entity specified in division (C)(2) of this section. | 121 |
(D) The clinical nurse specialist, certified nurse-midwife, | 122 |
or certified nurse practitioner may personally furnish to a | 123 |
patient a sample of any drug or therapeutic device included in the | 124 |
types of drugs and devices listed on the formulary,
| 125 |
except that all of the following conditions apply: | 126 |
(1) The amount of the sample furnished shall not exceed a | 127 |
seventy-two-hour supply, except when the minimum available | 128 |
quantity of the sample is packaged in an amount that is greater | 129 |
than a seventy-two-hour supply, in which case
| 130 |
131 |
(2) No charge may be imposed for the sample or for furnishing | 132 |
it. | 133 |
(3) Samples of controlled substances may not be personally | 134 |
furnished. | 135 |
(E) The clinical nurse specialist, certified nurse-midwife, | 136 |
or certified nurse practitioner may personally furnish to a | 137 |
patient a complete or partial supply of a drug or therapeutic | 138 |
device included in the types of drugs and devices listed on the | 139 |
formulary, | 140 |
apply: | 141 |
(1) The clinical nurse specialist, certified nurse-midwife, | 142 |
or certified nurse practitioner shall personally furnish only | 143 |
antibiotics, antifungals, scabicides, contraceptives, prenatal | 144 |
vitamins, antihypertensives, drugs and devices used in the | 145 |
treatment of diabetes, drugs and devices used in the treatment of | 146 |
asthma, and drugs used in the treatment of dyslipidemia. | 147 |
(2) The clinical nurse specialist, certified nurse-midwife, | 148 |
or certified nurse practitioner shall not furnish the drugs and | 149 |
devices in locations other than a health department operated by | 150 |
the board of health of a city or general health district or the | 151 |
authority having the duties of a board of health under section | 152 |
3709.05 of the Revised Code, a federally funded comprehensive | 153 |
primary care clinic, or a nonprofit health care clinic or program. | 154 |
(3) The clinical nurse specialist, certified nurse-midwife, | 155 |
or certified nurse practitioner shall comply with all safety | 156 |
standards for personally furnishing supplies of drugs and devices, | 157 |
as established in rules adopted under section 4723.50 of the | 158 |
Revised Code. | 159 |
Sec. 4723.482. (A) Except as provided in divisions (C) and | 160 |
(D) of this section, an applicant shall include with the | 161 |
application submitted under section 4723.48 of the Revised Code | 162 |
all of the following: | 163 |
(1) Subject to section 4723.483 of the Revised Code, evidence | 164 |
of holding a current, valid certificate of authority issued under | 165 |
this chapter to practice as a clinical nurse specialist, certified | 166 |
nurse-midwife, or certified nurse practitioner; | 167 |
(2) | 168 |
169 | |
170 | |
Evidence of successfully completing the | 171 |
study in advanced pharmacology and related topics in accordance | 172 |
with the requirements specified in division (B) of this section; | 173 |
(3) The fee required by section 4723.08 of the Revised Code | 174 |
for a certificate to prescribe; | 175 |
(4) Any additional information the board of nursing requires | 176 |
pursuant to rules adopted under section 4723.50 of the Revised | 177 |
Code. | 178 |
(B) | 179 |
pharmacology and related topics that must be successfully | 180 |
completed to obtain a certificate to prescribe, all of the | 181 |
following requirements apply | 182 |
183 |
(1) The | 184 |
completed not longer than three years before the application for | 185 |
the certificate to prescribe is filed. | 186 |
(2) The | 187 |
study | 188 |
189 | |
contact hours. | 190 |
(3) The course of study shall meet the requirements to be | 191 |
approved by the board | 192 |
established in rules adopted under section 4723.50 of the Revised | 193 |
Code. | 194 |
| 195 |
shall be specific to the applicant's nursing specialty | 196 |
(5) The instruction provided in the course of study shall | 197 |
include all of the following: | 198 |
(a) A minimum of | 199 |
instruction in advanced pharmacology that includes pharmacokinetic | 200 |
principles and clinical application and the use of drugs and | 201 |
therapeutic devices in the prevention of illness and maintenance | 202 |
of health; | 203 |
(b) | 204 |
implications of prescribing drugs and therapeutic devices; | 205 |
(c) | 206 |
apply to the authority to prescribe; | 207 |
(d) Instruction that is specific to schedule II controlled | 208 |
substances, including instruction in all of the following: | 209 |
(i) Indications for the use of schedule II controlled | 210 |
substances in drug therapies; | 211 |
(ii) The most recent guidelines for pain management | 212 |
therapies, as established by state and national organizations such | 213 |
as the Ohio pain initiative and the American pain society; | 214 |
(iii) Fiscal and ethical implications of prescribing schedule | 215 |
II controlled substances; | 216 |
(iv) State and federal laws that apply to the authority to | 217 |
prescribe schedule II controlled substances; | 218 |
(v) Prevention of abuse and diversion of schedule II | 219 |
controlled substances, including identification of the risk of | 220 |
abuse and diversion, recognition of abuse and diversion, types of | 221 |
assistance available for prevention of abuse and diversion, and | 222 |
methods of establishing safeguards against abuse and diversion. | 223 |
(e) Any additional | 224 |
rules adopted under section 4723.50 of the Revised Code. | 225 |
(C) An applicant who practiced or is practicing as a clinical | 226 |
nurse specialist, certified nurse-midwife, or certified nurse | 227 |
practitioner in another jurisdiction or as an employee of the | 228 |
United States government, and is not seeking authority to | 229 |
prescribe drugs and therapeutic devices by meeting the | 230 |
requirements of division (A) or (D) of this section, shall include | 231 |
with the application submitted under section 4723.48 of the | 232 |
Revised Code all of the following: | 233 |
(1) Subject to section 4723.483 of the Revised Code, evidence | 234 |
of holding a current, valid certificate of authority issued under | 235 |
this chapter to practice as a clinical nurse specialist, certified | 236 |
nurse-midwife, or certified nurse practitioner; | 237 |
(2) The fee required by section 4723.08 of the Revised Code | 238 |
for a certificate to prescribe; | 239 |
(3) Either of the following: | 240 |
(a) Evidence of having held, for a continuous period of at | 241 |
least one year during the three years immediately preceding the | 242 |
date of application, valid authority issued by another | 243 |
jurisdiction to prescribe therapeutic devices and drugs, including | 244 |
at least some controlled substances; | 245 |
(b) Evidence of having been employed by the United States | 246 |
government and authorized, for a continuous period of at least one | 247 |
year during the three years immediately preceding the date of | 248 |
application, to prescribe therapeutic devices and drugs, including | 249 |
at least some controlled substances, in conjunction with that | 250 |
employment. | 251 |
(4) If the applicant includes the evidence described in | 252 |
division (C)(3)(a) of this section, documentation from a licensed | 253 |
physician in a form acceptable to the board that the prescribing | 254 |
component of the nurse's practice was overseen or supervised by a | 255 |
licensed physician in the other jurisdiction; | 256 |
(5) If the applicant includes the evidence described in | 257 |
division (C)(3)(b) of this section, documentation from a licensed | 258 |
physician employed by the United States government in a form | 259 |
acceptable to the board that the prescribing component of the | 260 |
nurse's practice was overseen or supervised by a licensed | 261 |
physician employed by the United States government; | 262 |
(6) Evidence of having completed a two-hour course of | 263 |
instruction approved by the board in the laws of this state that | 264 |
govern drugs and prescriptive authority; | 265 |
(7) Any additional information the board requires pursuant to | 266 |
rules adopted under section 4723.50 of the Revised Code. | 267 |
(D) An applicant who practiced or is practicing as a clinical | 268 |
nurse specialist, certified nurse-midwife, or certified nurse | 269 |
practitioner in another jurisdiction or as an employee of the | 270 |
United States government, and is not seeking authority to | 271 |
prescribe drugs and therapeutic devices by meeting the | 272 |
requirements of division (A) or (C) of this section, shall include | 273 |
with the application submitted under section 4723.48 of the | 274 |
Revised Code all of the following: | 275 |
(1) Subject to section 4723.483 of the Revised Code, evidence | 276 |
of holding a current, valid certificate of authority issued under | 277 |
this chapter to practice as a clinical nurse specialist, certified | 278 |
nurse-midwife, or certified nurse practitioner; | 279 |
(2) The fee required by section 4723.08 of the Revised Code | 280 |
for a certificate to prescribe; | 281 |
(3) Either of the following: | 282 |
(a) Evidence of having held, for a continuous period of at | 283 |
least one year during the three years immediately preceding the | 284 |
date of application, valid authority issued by another | 285 |
jurisdiction to prescribe therapeutic devices and drugs, excluding | 286 |
controlled substances; | 287 |
(b) Evidence of having been employed by the United States | 288 |
government and authorized, for a continuous period of at least one | 289 |
year during the three years immediately preceding the date of | 290 |
application, to prescribe therapeutic devices and drugs, excluding | 291 |
controlled substances, in conjunction with that employment. | 292 |
(4) If the applicant includes the evidence described in | 293 |
division (D)(3)(a) of this section, documentation from a licensed | 294 |
physician in a form acceptable to the board that the prescribing | 295 |
component of the nurse's practice was overseen or supervised by a | 296 |
licensed physician in the other jurisdiction; | 297 |
(5) If the applicant includes the evidence described in | 298 |
division (D)(3)(b) of this section, documentation from a licensed | 299 |
physician employed by the United States government in a form | 300 |
acceptable to the board that the prescribing component of the | 301 |
nurse's practice was overseen or supervised by a licensed | 302 |
physician employed by the United States government; | 303 |
(6) Any additional information the board requires pursuant to | 304 |
rules adopted under section 4723.50 of the Revised Code. | 305 |
Sec. 4723.492. The committee on prescriptive governance | 306 |
shall develop recommendations regarding the authority to prescribe | 307 |
drugs and therapeutic devices pursuant to a certificate to | 308 |
prescribe issued under section 4723.48 of the Revised Code. | 309 |
310 | |
311 | |
apply specifically to the authority to prescribe schedule II | 312 |
controlled substances. | 313 |
The committee shall submit recommendations to the board of | 314 |
nursing as necessary for the board to fulfill its duty to adopt | 315 |
rules under section 4723.50 of the Revised Code. At the board's | 316 |
request, the committee shall reconsider a recommendation it has | 317 |
submitted and resubmit the recommendation to the board | 318 |
accordingly. | 319 |
Sec. 4723.50. (A) In accordance with Chapter 119. of the | 320 |
Revised Code, the board of nursing shall adopt rules as necessary | 321 |
to implement the provisions of this chapter pertaining to the | 322 |
authority of clinical nurse specialists, certified nurse-midwives, | 323 |
and certified nurse practitioners to prescribe drugs and | 324 |
therapeutic devices and the issuance and renewal of certificates | 325 |
to prescribe. | 326 |
327 |
The board shall adopt rules that are consistent with the | 328 |
recommendations the board receives from the committee on | 329 |
prescriptive governance pursuant to section 4723.492 of the | 330 |
Revised Code. After reviewing a recommendation submitted by the | 331 |
committee, the board may either adopt the recommendation as a rule | 332 |
or ask the committee to reconsider and resubmit the | 333 |
recommendation. The board shall not adopt any rule that does not | 334 |
conform to a recommendation made by the committee. | 335 |
(B) The board shall adopt rules under this section that do | 336 |
all of the following: | 337 |
(1) Establish a formulary listing the types of drugs and | 338 |
therapeutic devices that may be prescribed by a clinical nurse | 339 |
specialist, certified nurse-midwife, or certified nurse | 340 |
practitioner. The formulary may include controlled substances, as | 341 |
defined in section 3719.01 of the Revised Code. The formulary | 342 |
shall not permit the prescribing of any drug or device to perform | 343 |
or induce an abortion. | 344 |
(2) Establish safety standards to be followed by a clinical | 345 |
nurse specialist, certified nurse-midwife, or certified nurse | 346 |
practitioner when personally furnishing to patients complete or | 347 |
partial supplies of antibiotics, antifungals, scabicides, | 348 |
contraceptives, prenatal vitamins, antihypertensives, drugs and | 349 |
devices used in the treatment of diabetes, drugs and devices used | 350 |
in the treatment of asthma, and drugs used in the treatment of | 351 |
dyslipidemia | 352 |
(3) Establish criteria for the components of the standard | 353 |
care arrangements described in section 4723.431 of the Revised | 354 |
Code that apply to | 355 |
the components that apply to the authority to prescribe schedule | 356 |
II controlled substances. The rules shall be consistent with that | 357 |
section and include all of the following: | 358 |
(a) Quality assurance standards; | 359 |
(b) Standards for periodic review by a collaborating | 360 |
physician or podiatrist of the records of patients treated by the | 361 |
clinical nurse specialist, certified nurse-midwife, or certified | 362 |
nurse practitioner; | 363 |
(c) Acceptable travel time between the location at which the | 364 |
clinical nurse specialist, certified nurse-midwife, or certified | 365 |
nurse practitioner is engaging in the prescribing components of | 366 |
the nurse's practice and the location of the nurse's collaborating | 367 |
physician or podiatrist; | 368 |
(d) Any other criteria recommended by the committee on | 369 |
prescriptive governance. | 370 |
(4) Establish standards and procedures for issuance and | 371 |
renewal of a certificate to prescribe, including specification of | 372 |
any additional information the board may require under division | 373 |
(A)(4), (C)(7), or (D)(6) of section 4723.482 or division (B)(3) | 374 |
of section 4723.485 of the Revised Code; | 375 |
(5) Establish | 376 |
the
| 377 |
related topics required by section 4723.482 of the Revised Code; | 378 |
(6) Establish requirements for board approval of the two-hour | 379 |
course of instruction in the laws of this state as required under | 380 |
division (C)(6) of section 4723.482 of the Revised Code and | 381 |
division (B)(2) of section 4723.484 of the Revised Code; | 382 |
(7) Establish standards and procedures for the appropriate | 383 |
conduct of an externship as described in section 4723.484 of the | 384 |
Revised Code, including the following: | 385 |
(a) Standards and procedures to be used in evaluating | 386 |
387 |
(b) Standards and procedures for the supervision that a | 388 |
physician must provide during an externship, including supervision | 389 |
provided by working with the | 390 |
provided by making timely reviews of the records of patients | 391 |
treated by the
| 392 |
must be provided may vary according to the location where the | 393 |
394 | |
level of experience. | 395 |
Section 2. That existing sections 3719.06, 4723.481, | 396 |
4723.482, 4723.492, and 4723.50 of the Revised Code are hereby | 397 |
repealed. | 398 |
Section 3. (A) Notwithstanding the provisions of section | 399 |
4723.486 of the Revised Code specifying the requirements for | 400 |
renewal of a certificate to prescribe, or the provisions of | 401 |
division (B) of section 4723.485 of the Revised Code specifying | 402 |
the conditions of eligibility for a certificate to prescribe | 403 |
issued after practicing under an externship certificate, a | 404 |
clinical nurse specialist, certified nurse-midwife, or certified | 405 |
nurse practitioner holding a certificate to prescribe that was | 406 |
issued prior to the effective date of this act shall successfully | 407 |
complete, as a condition of renewing the certificate or receiving | 408 |
a new certificate, a minimum of six contact hours of instruction | 409 |
regarding schedule II controlled substances as described in | 410 |
section 4723.482 of the Revised Code, as amended by this act. In | 411 |
the case of a certificate that is being renewed, the certificate | 412 |
holder shall complete the instruction in addition to all other | 413 |
continuing nursing education that must be completed by the | 414 |
certificate holder not later than August 31, 2013. | 415 |
(B) Notwithstanding the amendments made by this act to | 416 |
sections 3719.06 and 4723.481 of the Revised Code, until the | 417 |
applicable requirements of division (A) of this section have been | 418 |
complied with, a certificate holder shall not prescribe a schedule | 419 |
II controlled substance to a patient unless all of the following | 420 |
conditions are met: | 421 |
(1) The patient is in a terminal condition, as defined in | 422 |
section 2133.01 of the Revised Code. | 423 |
(2) The certificate holder's collaborating physician | 424 |
initially prescribed the substance for the patient. | 425 |
(3) The amount prescribed does not exceed the amount | 426 |
necessary for the patient's use in a single, twenty-four-hour | 427 |
period. | 428 |
Section 4. Not later than 90 days after the effective date of | 429 |
this section, the Committee on Prescriptive Governance shall | 430 |
develop recommendations under section 4723.492 of the Revised Code | 431 |
regarding the authority to prescribe schedule II controlled | 432 |
substances pursuant to a certificate to prescribe. The Committee | 433 |
shall submit the recommendations to the Board of Nursing in | 434 |
accordance with the procedures specified in section 4723.492 of | 435 |
the Revised Code. | 436 |
Section 5. The Board of Nursing shall adopt rules under | 437 |
section 4723.50 of the Revised Code as necessary to implement the | 438 |
provisions of this act pertaining to the authority to prescribe | 439 |
schedule II controlled substances pursuant to a certificate to | 440 |
prescribe. The rules shall conform to the recommendations | 441 |
submitted by the Committee on Prescriptive Governance. | 442 |