OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
S.B. 60 Bill Analysis
135th General Assembly
Click here for S.B. 60’s Fiscal Note
Version: As Passed by the Senate
Primary Sponsor: Sen. Gavarone
Effective date:
Meredith Bray, Attorney
SUMMARY
 Establishes licensure by the State Medical Board for certified mental health assistants
(CMHAs).
 Authorizes CMHAs to provide mental health care under the supervision, control, and
direction of a physician with whom the CMHA has entered into a supervision
agreement.
 Authorizes CMHAs to prescribe and personally furnish drugs and therapeutic devices in
the exercise of physician-delegated prescriptive authority, including certain identified
controlled substances.
 Specifies application procedures including education requirements, renewal procedures,
and continuing education requirements for CMHAs.
 Establishes within the Medical Board an advisory committee to advise the Board and the
Department of Higher Education regarding CMHA education programs.
 Authorizes the Medical Board to discipline CMHAs in a manner similar to that of other
Board licensees.
 Prohibits an individual from claiming to be able to function as a CMHA if that
individual does not hold a CMHA license, and imposes criminal penalties for
violations of that and other related prohibitions.
TABLE OF CONTENTS
Certified mental health assistant licensure .................................................................................... 2
Services that may be performed by a CMHA .............................................................................. 3
Delegation of tasks ...................................................................................................................... 3
Prohibited services ...................................................................................................................... 4
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Supervision agreements .............................................................................................................. 4
Supervision requirements ........................................................................................................... 5
Communication ...................................................................................................................... 5
Diagnosis and reevaluation .................................................................................................... 5
Quality assurance and review ................................................................................................ 5
Limit on the number of CMHAs that may be supervised at one time ................................... 6
Liability – termination of agreement...................................................................................... 6
Physician-delegated prescriptive authority ................................................................................ 6
Controlled substances ............................................................................................................ 6
Controlled substances that may be prescribed...................................................................... 6
Compliance with OARRS ......................................................................................................... 7
Other provisions related to prescribing ................................................................................. 8
License issuance and renewal ..................................................................................................... 8
Application and education requirements............................................................................... 8
Renewal .................................................................................................................................. 9
Continuing education ............................................................................................................. 9
Requirements ......................................................................................................................... 9
Reductions and extensions ..................................................................................................... 9
Investigating compliance ........................................................................................................ 9
Duplicate license................................................................................................................... 10
CMHA education programs ....................................................................................................... 10
Discipline ................................................................................................................................... 11
Against CMHAs ..................................................................................................................... 11
Against supervising physicians ............................................................................................. 12
Criminal penalties ...................................................................................................................... 12
Prohibited conduct ............................................................................................................... 12
Penalties ............................................................................................................................... 13
Rulemaking ................................................................................................................................ 13
Miscellaneous provisions applicable to the Medical Board...................................................... 13
Bill interpretation ...................................................................................................................... 13
Medicaid coverage .................................................................................................................... 14
Miscellaneous provisions .......................................................................................................... 14
DETAILED ANALYSIS
Certified mental health assistant licensure
The bill establishes licensure for a new type of mental health professional. Under the
bill, a certified mental health assistant (CMHA) is an individual who provides mental health care
under the supervision, control, and direction of a physician with whom the CMHA has entered
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into a supervision agreement. A CMHA may practice in any setting within which a supervising
physician has supervision, control, and direction of the CMHA.1 A supervising physician may be
a physician authorized to practice medicine and surgery or osteopathic medicine and surgery. 2
Services that may be performed by a CMHA
The bill authorizes a CMHA to perform the following services authorized by the
supervising physician that are part of the supervising physician’s normal course of practice and
expertise:3
1. Ordering diagnostic, therapeutic, and other medical services as appropriate based on
the patient’s diagnosis that has been made by the supervising physician;
2. Ordering, prescribing, personally furnishing, and administering drugs and medical
devices as provided in the bill and discussed below;
3. Ordering occupational therapy or referring a patient to occupational therapy, if related
to the patient’s diagnosis; and
4. Referring a patient to emergency medical services for acute safety concerns, so long as
the CMHA consults with the supervising physician as soon as practicable thereafter.
Additionally, a CMHA may provide telehealth services in accordance with existing law
that establishes standards for telehealth services for various health care professionals. 4
Delegation of tasks
The bill authorizes CMHAs to delegate the performance of a task to implement a
patient’s care plan and, if certain conditions are met, delegate administration of a drug. The
CMHA must be physically present at the location where the task is performed or the drug is
administered. Before making such a delegation, the CMHA must determine that the task or
drug is appropriate for the patient and the person to whom the delegation is made may safely
perform the task or administer the drug. Generally, the delegation may be to any person. 5
There are certain conditions that must be met for a CMHA to delegate administration of
a drug, as follows:6
 The CMHA is granted physician-delegated prescriptive authority by the supervising
physician and be authorized to prescribe the drug to be administered;
 The drug is not a controlled substance;
 The drug is not administered intravenously; and
1 R.C. 4772.01(A), 4772.09(A) and (B), 4772.11(A).
2 R.C. 4772.01(E).
3 R.C. 4772.09(C).
4 R.C. 4772.091 and 4743.09; see also R.C. 5164.95.
5 R.C. 4772.092(A), (B), and (D).
6 R.C. 4772.092(C).
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 The drug is not administered in a hospital inpatient care unit, hospital emergency
department, freestanding emergency department, or ambulatory surgical facility.
Prohibited services
A CMHA is prohibited from doing any of the following:7
1. Making an initial diagnosis;
2. Treating a patient for any diagnosis or condition not found in the most recent version of
the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the
American Psychiatric Association, or a similar publication if designated by the Medical
Board; and
3. Engaging in electroconvulsive therapy, transcranial magnetic stimulation, or any other
intervention designated as invasive by Medical Board rules.
Supervision agreements
The bill requires a physician to enter into a supervision agreement with each CMHA who
will be supervised by the physician. A supervision agreement can apply to one or more CMHAs,
but generally may not apply to more than one physician, unless the physician chooses to
designate in the supervision agreement other physicians to act as alternate supervising
physicians. The supervision agreement must clearly state that the supervising physician is
legally responsible and assumes legal liability for the services provided by the CMHA. It must be
signed by the supervising physician and the CMHA. A supervision agreement may be amended.8
A supervision agreement must include the following terms:9
1. The responsibilities to be fulfilled by the supervising physician and the CMHA;
2. Any limitations on the responsibilities to be fulfilled by the CMHA; and
3. The circumstances under which the CMHA is required to refer a patient to the
supervising physician.
The Medical Board, pursuant to an adjudication conducted in accordance with the
Administrative Procedure Act, may take disciplinary action and impose a civil penalty against a
CMHA that practices, or a supervising physician that supervises, in a manner that departs from,
or fails to conform to, the terms of a supervision agreement, or otherwise fails to comply with
the requirements for supervision agreements discussed above. If the Board finds that a CMHA
or supervising physician has failed to keep a copy of the supervision agreement in their records,
the Board may take disciplinary action and impose a civil penalty or may permit the individual
to agree in writing to update the records and pay a civil penalty. Any civil penalty cannot be
7 R.C. 4772.09(D); see also R.C. 4772.11(A)(2).
8 R.C. 4772.10(A) and (B)(5) and (C); see also R.C. 4772.11(E).
9 R.C. 4772.10(B).
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more than $5,000 and must be deposited into the State Treasury to the credit of the State
Medical Board operating fund.10
Supervision requirements
Communication
Generally, the bill requires that a supervising physician must be continuously available
for direct communication with a CMHA, either by being physically present where the CMHA is
practicing or being readily available through telecommunication and being located within a
distance of where a CMHA is practicing such that the physician can reasonably assure proper
care of patients. During the first 1,000 hours of practice, however, the supervising physician
must be physically present at the location where the CMHA is practicing. This does not require
the physician to be in the same room as the CMHA.11
Diagnosis and reevaluation
As discussed above, the supervising physician must initially diagnose a patient with a
diagnosis or condition found in the DSM prior to a CMHA providing services to a patient. After
the initial diagnosis, the supervising physician must personally and actively review the CMHA’s
professional activities at least weekly.12 A patient must be reevaluated by the supervising
physician at least every two years, or sooner if there is a significant change in the patient’s
condition or possible change in diagnosis. Additionally, annual reevaluation is required if the
CMHA prescribes a controlled substance to the patient.13
Quality assurance and review
The supervising physician must comply with the quality assurance standards established
by the Medical Board in rules, which are discussed in greater detail below. The supervising
physician may perform other quality assurance activities that the physician considers
appropriate. Additionally, the supervising physician must regularly perform other reviews of the
CMHA that the supervising physician considers necessary.14
A supervising physician can authorize a CMHA to perform a service only if the physician
is satisfied that the CMHA is capable of competently performing the service. A supervising
physician is prohibited from authorizing performance of any service that is beyond the
physician’s or CMHA’s normal course of practice and expertise.15
10 R.C. 4772.10(D) and (E) and 4731.24.
11 R.C. 4772.11(A)(1).
12 R.C. 4772.11(A)(2) and (3)(a).
13 R.C. 4772.11(A)(3)(b).
14 R.C. 4772.11(A)(4) and (5).
15 R.C. 4772.11(C).
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The bill requires the Medical Board to adopt rules establishing quality assurance
standards, including a process for all of the following:16
 Routine review by the supervising physician of selected patient record entries and
medical orders made by the CMHA;
 Discussion of complex cases;
 Discussion of new medical developments relevant to the practice of the supervising
physician and CMHA; and
 Performance of any other quality assurance activities the Medical Board considers
necessary.
Limit on the number of CMHAs that may be supervised at one time
While a physician may enter into supervision agreements with unlimited CMHAs, a
physician can only supervise up to five CMHAs at one time.17
Liability – termination of agreement
The bill states that a supervising physician assumes liability for the services provided by
a CMHA while the supervision agreement is pending. A supervising physician is not liable for
any services provided by a CMHA after the supervision agreement expires or is terminated.18
Physician-delegated prescriptive authority
A licensed CMHA is authorized to prescribe and personally furnish drugs and therapeutic
devices in the exercise of physician-delegated prescriptive authority. The prescriptive authority
may be exercised only to the extent that that it is granted by the supervising physician. A CMHA
must comply with all conditions placed on the prescriptive authority by the supervising
physician. Examples of conditions that may be placed on the prescriptive authority include
(1) identifying drugs and therapeutic devices that the physician chooses not to permit the
CMHA to prescribe, (2) limits on dosage units and refills that may be prescribed,
(3) circumstances for required physician referral, and (4) any other r