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Ohio S.B. 310 Loosens Practice Barrier for Advanced Practice Providers

S.B. 310, signed by Ohio Governor DeWine on and effective from December 29, 2020 until May 1, 2021, provides flexibility regarding the regulatorily mandated supervision and collaboration agreements for physician assistants, certified nurse-midwives, clinical nurse specialists and certified nurse practitioners working in a hospital or other health care facility. Originally drafted as a bill to distribute federal COVID funding to local subdivisions, the healthcare related provisions were added to help relieve some of the stresses hospitals and other healthcare facilities are facing during the COVID-19 pandemic.

FAQ:  When may an APRN practice without a standard care arrangement or a physician assistant practice without a supervision agreement under SB 310?

By temporarily relaxing certain requirements from Chapters 4730, 4731, and 4723 of the Revised Code, S.B. 310 allows certified nurse-midwives, clinical nurse specialists, and certified nurse practitioners (“APRNs”) who are employed by or under contract with a hospital or other health care facility to “practice with a physician or podiatrist without having entered into a standard care arrangement with that physician or podiatrist, as long as the physician or podiatrist is continuously available to communicate with the nurse either in person or by electronic communication.” Any services performed by an APRN who has not entered into a SCA with a physician must be authorized by the hospital or health care facility within which the nurse is practicing.

Furthermore, S.B. 310 permits a physician assistant to practice without a supervision agreement if the if the physician assistant is employed by or under contract with a hospital or other health care facility and the services are authorized by a physician or podiatrist and by the hospital or other health care facility within which the physician assistant is practicing

These provisions are in effect until May 1, 2021.   

FAQ:  What qualifies as a “health care facility” under S.B. 310?

The term “health care facility” is not defined in S.B. 310.  However, the statutes and regulations governing physician assistant practice already defines “health care facility.”  Unfortunately, there is no such definition for APRNs.  

As an initial note, the term “health care facility” is defined in numerous other places in Ohio law.  The most common bond between the various definitions of “health care facility” in other Ohio statutes and regulations, appears to be the concept that a “health care facility” is a facility providing health care services and is not a practitioner’s office.  Each location will need to be evaluated on a case by case basis to determine whether it can be considered a “health care facility.” 

Under the statute governing physician assistant practice, ORC 4730.01(B), "Health care facility" means any of the following:

(1) A hospital registered with the department of health under section 3701.07 of the Revised Code;

(2) A health care facility licensed by the department of health under section 3702.30 of the Revised Code;

(3) Any other facility designated by the state medical board in rules adopted pursuant to division (B) of section 4730.08 of the Revised Code.

It is possible that the APRN definition of “health care facility” could be construed broadly by the Ohio Board of Nursing.  However, lacking further guidance from the Ohio Board of Nursing, it seems reasonable that APRNs could use an interpretation of “health care facility” that is similar to the definition found in physician assistant practice.

FAQ:  What else does S.B. 310 do?

In addition to the suspension of standard care arrangement and supervision agreement requirements in certain circumstances, S.B. 310 also permits emergency medical technicians to administer a test for COVID-19, respiratory care professionals to direct the practice of a licensed practical nurse, and retired or inactive health care professionals including nurses, pharmacists, physician assistants, physicians, podiatrists, respiratory therapists or EMTs to practice under a temporary license.

FAQ:  What are the requirements under S.B. 310 for a retired or inactive health care professional to practice under a temporary license?

To practice temporarily, a health care professional: (1) must have held a license or certificate to practice issued by a licensing board in the five-year period immediately preceding December 29, 2020 and (2) within that five years, the professional’s license or certificate expired or became inactive, which may have occurred because the professional retired from practice. A temporary license will not be extended to any professional whose license was revoked or suspended or who surrendered their license in order to avoid disciplinary action.

FAQ:  Does S.B. 310 change an APRN’s or physician assistant’s scope of practice?

No. The language in S.B. 310 does not change the scope of practice of an APRN or a physician assistant. For example, S.B. 310 does not limit the authority of an APRN or physician assistant to administer, deliver, or distribute drugs pursuant to a protocol implemented under section 3701.048 of the Revised Code following the declaration of an emergency that affects the public health. However, S.B. 310 also does not expand an APRN’s or physician assistant’s scope of practice beyond the services and procedures they have the knowledge, skill, and ability to perform.

FAQ:  When do the S.B. 310 changes expire?

As stated above, the changes provided by S.B. 310 are only temporary and will expire on May 1, 2021.

For questions regarding S.B. 310 or other matters affecting advanced practice providers, please contact BMD Healthcare and Hospital Law Member Jeana M. Singleton at jmsingleton@bmdllc.com or 330-253-2001, Attorney Ashley Watson at abwatson@bmdllc.com, or any member of the BMD Healthcare and Hospital Law group.

COVID, Privacy and More! New Challenges for Physicians in 2021

While hopefully we are coming out of the pandemic, the legal repercussions related to legislative initiatives and other actions during that time continue to apply to businesses in general and healthcare practices. It is a helpful reminder that practices make certain that they maintain accurate records in order to satisfy the reporting requirements under the various COVID-related bills and protect yourself from future employment claims.

Banking and Cannabis: Bank Lending, The Next Frontier

A fortuitous combination of developments and circumstances present the banking and cannabis industries a large opportunity to enhance each of their respective bottom lines: conventional bank lending, payment processing, treasury management and other services, and bank administered SBA and revenue bond financing to cannabis businesses.

EKRA Updates: COVID-19 Testing, Employment Agreements, and More

Ever since the Eliminating Kickbacks in Recovery Act (“EKRA”) was passed by Congress in 2018, we have been waiting to see how the law is interpreted and ultimately enforced. As a reminder, EKRA seeks to eliminate kickbacks in return for patient referrals to facilities that treat those overcoming addiction, such as recovery homes, clinical treatment centers, and laboratories. (NOTE: EKRA applies to all laboratories, not just those related to addiction treatment.) It is essentially an expansion of the Anti-Kickback Statute, which only applies to those services that are reimbursable through federal healthcare programs such as Medicare and Medicaid, to now also cover services reimbursable through private insurers.

New Interpretation of the Fair Debt Collection Practices Act Rocks the Industry

It’s not lost on us that our interpretation of § 1692c(b) runs the risk of upsetting the status quo in the debt-collection industry. This quote from the Eleventh Circuit Court of Appeal in its April 21, 2021 opinion from the case of Hunstein v. Preferred Collection and Management Services, Inc. is possibly the biggest understatement in the history of the Fair Debt Collection Practices Act. At a minimum, the Eleventh Circuit’s opinion has sent shockwaves and fear throughout multiple sectors of the financial services industry.

Construction Industry Trends and Predictions Through 2021 and Beyond: Insurance and Emerging Threats

A 2021 survey identified three key issues impacting the construction industry in 2021: (1) the financial health of contractors; (2) the continuing risk of the pandemic; and (3) technology driving productivity, but also increasing the risk of cybersecurity threats. With this backdrop, insurance premiums in the construction industry are generally on the rise in 2021.