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New State Budget Institutes Licensure Requirement for Ohio’s Hospitals

Client Alert

On July 1, 2021, Governor Mike DeWine signed Ohio’s final budget codified at Ohio Revised Code 3722.01 et seq., which includes a new licensing requirement for Ohio’s hospitals.

For years, Ohio was the only state in the country that did not license its hospitals. This approach will now be replaced with new, detailed requirements that will require careful review and compliance. Here are some of the highlights concerning these new changes:

When will a license be required?

All hospitals operating in the state of Ohio will be required to be licensed with the Ohio Director of Health within three years of the effective date of the new budget.  “Hospital” is defined by the Act as any institution or facility that provides inpatient medical or surgical services for a continuous period longer than 24 hours.

Some facilities will be exempt from the new licensing requirement, including hospitals operated by the federal government, nursing homes, and facilities used exclusively for hospice patients.

How do you receive a license?

License applications will begin to be considered by the Director after the Act has been effective for one year. The following will be required to be eligible for a license:

  • A completed application submitted with the accompanying fee;
  • Title XVIII certification under the “Social Security Act” or accreditation from a national accrediting organization approved by the Centers for Medicare and Medicaid Services; and
  • A detailed breakdown of the number of beds available in the hospital.

An issued license will be valid for three years unless it is revoked or suspended, and a license can be renewed for additional periods of three years upon expiration.

What new policies will necessitate hospital compliance?

Upon issuance of a license, further steps must be taken by the institution to maintain compliance. First, the hospital must have a governing board that is tasked with overseeing the hospital’s management and control. Second, the hospital will be required to comply with rules adopted by the Director establishing health, safety, welfare, and quality standards for licensed hospitals. These rules are required to be provided to hospitals within one year of the effective date of the budget.

The new regulations also carry steep civil penalties for hospitals that fail to comply with their terms. The Director of Health may levy a $250,000 civil penalty against the hospital and fine the institution an additional $1,000 to $10,000 for every day the hospital operates without a license. If a hospital fails to comply with any of the Director’s rules, a civil penalty between $1,000 and $250,000 may be levied. The Director may also petition for injunctive relief in the proper Court of Common Pleas if an imminent threat of harm exists at a licensed hospital; a granted injunction can only be lifted after a showing that the harmful condition identified has been removed.

To learn more about these new, detailed regulations and to discuss any required changes to your current policies and procedures, please contact BMD Government Affairs Member and Lobbyist Victoria L. Ferrise (vlferrise@bmdllc.com – (330) 374-5184).


Substance Use Disorder Providers: 42 CFR Part 2 Now Enforceable

Updates to 42 CFR Part 2 are now enforceable, bringing significant changes to how substance use disorder (SUD) records are handled. The Final Rule aligns Part 2 more closely with HIPAA, introduces updated penalties, allows a single patient consent for treatment, payment, and operations, and adds new requirements for Notices of Privacy Practices. It also creates a formal definition of SUD counseling notes and imposes strict consent requirements for their use and disclosure. Providers should review and update policies to ensure compliance.

AAA Introduces AI-Assisted Arbitrator for Certain Disputes

The American Arbitration Association has introduced an AI-assisted arbitration platform designed to streamline certain document-based disputes. While a human arbitrator still makes the final decision, the technology can improve efficiency, reduce costs, and accelerate case resolution. Companies should weigh these benefits against considerations such as transparency, risk, and contractual requirements before adopting AI-assisted arbitration.

Quiet Hours Texts and TCPA Claims: Consent Remains King as Courts Divide on Text Messages

Businesses face increasing TCPA lawsuits over off-hours marketing texts, but recent court decisions highlight strong defenses. Clear consumer consent and updated terms and conditions can defeat many claims, while a growing number of courts are finding that text messages are not “telephone calls” under the statute. Proactive compliance measures, including clickwrap agreements and forum-selection clauses, are critical to reducing risk.

New Ohio Reporting Requirements for Non-Residential Contractors

Ohio’s E-Verify Workforce Integrity Act, effective March 19, 2026, requires all nonresidential construction companies, subcontractors, and labor brokers to use E-Verify to confirm employee work eligibility on projects across the state. The law applies regardless of company size and carries financial penalties and potential restrictions on future state contracts for noncompliance. Some uncertainty remains around requirements for existing employees, making early compliance planning important.

DOT Non-Domiciled CDL Rule

A new rule from the Federal Motor Carrier Safety Administration (FMCSA) will significantly narrow eligibility for non-domiciled Commercial Driver’s Licenses (CDLs) beginning March 16, 2026. The rule limits eligibility to holders of H-2A, H-2B, and E-2 visas and eliminates Employment Authorization Documents (EADs) as qualifying proof of work authorization. As a result, many lawfully present and work-authorized immigrants, including refugees, asylees, DACA recipients, and Temporary Protected Status holders, will no longer be able to obtain or renew a non-domiciled CDL. The change is expected to affect roughly 194,000 drivers nationwide and has prompted multiple legal challenges, including a pending emergency stay request before the United States Court of Appeals for the District of Columbia Circuit.