OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 466 Bill Analysis
134th General Assembly
Click here for H.B. 466’s Fiscal Note
Version: As Reported by House Commerce and Labor
Primary Sponsor: Rep. Edwards
Effective Date:
Audra Tidball, Attorney
SUMMARY
Registration of health care staffing agencies
Requires annual registration with the Director of Health for health care staffing agencies
that provide certain health care personnel to health care providers on a temporary
basis.
Specifies various requirements and prohibitions applicable to registered staffing
agencies, including a limitation on the maximum fees and charges a staffing agency may
charge to a health care provider.
Authorizes the Director to take disciplinary action against the registration holder.
Temporary certificate of need changes
For a certificate of need (CON) granted during the period of the COVID-19 state of
emergency:
Requires the Director to grant a CON holder a 24-month extension to obligate
capital expenditures for the proposed project;
Authorizes the owner of an entity for which a CON was granted to sell its ownership
in the entity without voiding the CON held by the owner.
ICF/IID Medicaid payment rates
Eliminates an exception, enacted as uncodified law in the Main Operating Budget,
specifying that if the statewide average Medicaid rate for ICFs/IID exceeds $365.05, the
payment rates for FY 2023 are reduced by the percentage the statewide average
exceeds that amount.
Instead, requires the Department of Developmental Disabilities, for FY 2023, to pay each
ICF/IID a rate as determined under existing codified law, using funds from the enhanced
May 31, 2022
Office of Research and Drafting LSC Legislative Budget Office
federal medical assistance percentage (FMAP) enacted in the “Families First Coronavirus
Response Act.”
DETAILED ANALYSIS
Registration of health care staffing agencies
The bill requires health care staffing agencies to annually register with the Director of
Health.1 As defined by the bill, “health care staffing agency” is a person that is regularly
engaged in the business of providing or procuring, for a fee, certain health care personnel to
serve as temporary staff for certain health care providers, including an online health care staff
matching service.2 For purposes of this definition and the bill:
“Health care personnel” is defined as any licensed health care professional or unlicensed
health care personnel who provides care, support, or services directly to patients.3
“Health care provider” is defined as nursing homes, residential care facilities, home
health agencies, hospice care programs, residential facilities,4 community addiction
services providers, community mental health services providers, and Medicaid providers
of waiver services.5
“Online health care staff matching service” is defined as a person that operates or offers
an electronic platform on which health care personnel may be listed as available to
serve as temporary staff for health care providers.6
The bill excludes from the definition of “health care staffing agency” and, as a result,
from the requirement for annual registration, both of the following: (1) individuals who provide
their own services to health care providers as temporary employees or contractors and
(2) government entities.7
Prohibition
The bill prohibits any person from knowingly operating a health care staffing agency
unless the agency is registered.8 Anyone who violates this prohibition is guilty of a second
1 R.C. 3724.02(A).
2 R.C. 3724.01(D).
3 R.C. 3724.01(B).
4See R.C. 5119.35 and 5123.19, not in the bill, for a description of residential facilities licensed by the
Department of Mental Health and Addiction Services and Department of Developmental Disabilities.
5 R.C. 3724.01(C).
6 R.C. 3724.01(E).
7 R.C. 3724.01(D).
8 R.C. 3724.06(A).
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degree misdemeanor for the first offense, and a first degree misdemeanor for subsequent
offenses.9
In the case of a health care staffing agency that is operating at the time the bill becomes
effective, the agency is required to submit an application for registration within 30 days. If the
application is submitted within that time period, the agency may continue to operate without
being registered until the earlier of the date the registration is denied or 120 days after the
bill’s effective date.10
Registration application requirements and procedures
The bill requires each physical location of a health care staffing agency to separately
register.11 Each application must include a nonrefundable $2,000 fee and all of the following:12
Information about company ownership and, if applicable, copies of associated articles of
incorporation, bylaws, and officer and director information;
Copies of the staffing agency’s policies and procedures designed to ensure compliance
with the bill;
Certification that the staffing agency has not had a health care staffing agency
registration revoked by the Director of Health within the past three years;
Any other information required by the Director.
The Director is required to establish registration application forms and procedures.13
The Director must review each application received and must register an applicant if the
application is complete, the fee is paid, and the Director is satisfied that the bill’s registration
requirements are met.14
Period of registration validity
Health care staffing agency registration is valid for one year, unless earlier revoked or
suspended, or unless the staffing agency is sold, or ownership or management is transferred. A
transfer includes a transfer of ownership or management such that 40% or more of the owners
or management were not previously registered.15
9 R.C. 3724.99.
10 R.C. 3724.06(B).
11 R.C. 3724.02(A).
12 R.C. 3724.02(B) and (C).
13 R.C. 3724.02(B).
14 R.C. 3724.03.
15 R.C. 3724.04.
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Registration renewal
To be eligible for registration renewal, a health care staffing agency must provide
documentation demonstrating that it provided staffing services during the year preceding the
renewal date, and must describe any changes regarding application items. An eligible staffing
agency must apply to the Director using forms and procedures established by the Director. The
Director must renew a registration for one year if an applicant has paid the $2,000 renewal fee
and continues to meet requirements for registration as established by the bill (discussed
above).
The bill requires renewal applicants to pay the renewal fee during the month of the
renewal date. If an applicant fails to pay the renewal fee during that month, the applicant must
pay a late fee of $200. If the renewal fee or any late fee is not paid by the 30th day after the
renewal date, the Director may, in accordance with the Administrative Procedure Act, revoke
the agency’s registration.16
A health care staffing agency that has not provided staffing services during the year
preceding the agency’s registration renewal date is not eligible for renewal, but may apply for a
new registration.17
Health care staffing agency obligations and prohibitions
Obligations
Health care staffing agencies registered under the bill must do all of the following:18
Ensure that when the agency provides health care personnel to a health care provider
for a specific shift or time period, the personnel or a substitute works for the agreed
time period at no additional charge to the provider;
Establish and provide to health care providers a schedule of fees and charges that
cannot be modified except with written notice 30 days in advance;
Employ as employees of the staffing agency the health care personnel provided to a
health care provider;
Verify, maintain, and furnish on request supporting documentation that each temporary
employee provided to a health care provider meets (1) minimum licensing, training, and
continuing education standards for the position, (2) criminal records check
requirements of the provider, (3) requirements for reviewing registries of persons with
findings of abuse or neglect, (4) requirements for determining whether exclusions from
Medicare or Medicaid exist, (5) any health requirement of the provider, including
16 R.C. 3724.05.
17 R.C. 3724.05(F).
18 R.C. 3724.07.
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requirements related to drug testing and infectious disease testing and vaccination, and
(6) any other provider qualification or requirement;
Prohibit staffing agency employees from recruiting employees of the health care
provider and instruct agency employees on the prohibition;
Make staffing agency records available to the Director during normal business hours;
Retain staffing agency records for at least five years;
Carry professional liability insurance of at least $1 million per occurrence and $3 million
aggregate;
Secure and maintain workers’ compensation coverage in accordance with Ohio law;
Carry a surety bond for employee dishonesty of at least $100,000.
Prohibitions
Health care staffing agencies are prohibited under the bill from doing the following:19
Restricting employee employment opportunities, including by requiring the payment of
money to terminate employment, requiring noncompete agreements, and requiring
employment buyouts;
Requiring the payment of liquidated damages, employment fees, or other compensation
related to an employee being hired as a permanent employee of the health care
provider;
Recruiting, soliciting, or enticing an employee of a health care provider to leave the
employee’s employment; however, the bill specifies that it does not prohibit a health
care staffing agency from generally advertising to the public that the staffing agency
may pay a signing bonus, or from offering or paying a signing bonus to an individual who
was or is an employee of a health care provider, so long as the staffing agency did not
initiate contact related to employment while the individual was actively employed by a
health care provider;
Paying or making a gift to the employees of a health care provider;
Contracting with health care personnel as independent contractors.
Additionally, the bill prohibits a health care staffing agency from attempting to require a
health care provider, by contract or otherwise, to waive any of the requirements of the bill or
related rules that will be adopted. Any waiver of the requirements that may result from such an
attempt is void and unenforceable.20
19 R.C. 3724.08.
20 R.C. 3724.07(B).
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Maximum charges for wages and other fees
The bill limits the total amount a health care staffing agency can charge a health care
provider for employees, including for all wages and other fees or charges associated with each
employee. Under the bill, health care staffing agencies are prohibited from billing or receiving
payments from health care providers for any category of health care personnel listed in the
Medicaid cost reports submitted under existing law at a rate that is higher than 150% of the
statewide direct care median hourly wage for that category of personnel, as that wage is
determined by the Department of Medicaid, and adjusted for inflation in accordance with the
Employment Cost Index for Total Compensation, Health Care and Social Assistance Component,
published by the U.S. Bureau of Labor Statistics. The Department of Medicaid is required to
calculate and publish statewide direct care median hourly wages for all personnel categories
reported on the cost reports as soon as practicable after receiving the reports.21 The Director of
Medicaid may establish median hourly wages for any category of personnel not on the cost
reports, based on data submitted by health care providers that utilize that category of
personnel. If such wages are established, they must be used to set a maximum charge for that
category of personnel.22
A maximum rate established under the bill must include all charges for administrative
fees, contract fees, shift bonuses, or any other charges in addition to the hourly rates of the
health care personnel supplied to a health care provider. The bill specifies, however, that the
agency may charge the provider an additional hourly amount of not more than 10% of the
maximum rate for the individual, if providing care to patients with an infectious disease for
which a declared public health emergency is in effect.23
Disciplinary actions
The Director of Health may deny, refuse to renew, revoke, or suspend a health care
staffing agency’s registration for any of the following:
--Lack of financial solvency or suitability;
--Inadequate treatment and care or criminal activity by personnel supplied by the
agency or by any person managing the agency;
--Interference with a survey or other inspection conducted by the Director;
--Failure to comply with the conditions or requirements that must be met to obtain and
retain a registration;
--Failure to comply with any other requirement of the bill or related rules.24
21 R.C. 3724.09(A)(1).
22 R.C. 3724.09(B).
23 R.C. 3724.09(A)(2).
24 R.C. 3724.10(B).
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Additionally, the Director must revoke the registration of a health care staffing agency
that knowingly provides to a health care provider a person with an illegally or fraudulently
obtained or issued diploma, registration, license, certificate, criminal records check, or other
item required for employment by a health care provider.25 All of the above disciplinary actions,
and the fines discussed below, must be taken in accordance with the Administrative Procedure
Act (R.C. Chapter 119).26
The bill provides that a controlling person of a health care staffing agency whose
registration has not been renewed or has been revoked is not eligible to apply for or to be
granted a registration for five years following the date that the registration is terminated for
failure to renew or the date of the final order of revocation. Further, the Director is prohibited
from issuing or renewing a registration to such a person during the five-year period
immediately preceding the date the application for registration or renewal under consideration
was submitted.27 “Controlling person” is defined as a business entity, officer, program
administrator, or director whose responsibilities include directing the management or policies
of a health care staffing agency and individuals who, directly or indirectly, own an interest in
such a business entity.28
Fines
A health care staffing agency that violates the maximum charge provisions of the bill, as
discussed above, must be fined 200% of the amount billed or received in excess of the
maximum. A health care staffing agency is authorized by the bill to request a reconsideration by
the Director if such a fine is imposed.29
Complaint reporting
The Director is required to establish a system for reporting complaints against health
care staffing agencies and their employees. The Director must investigate all complaints.30
Inspections
As part of overseeing the operation of health care staffing ag