OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
S.B. 81 Bill Analysis
135th General Assembly
Click here for S.B. 81’s Fiscal Note
Version: As Reported by House Health Provider Services
Primary Sponsor: Sen. Romanchuk
Effective Date:
Elizabeth Molnar, Attorney
SUMMARY
 Authorizes physician assistants, certified nurse practitioners, clinical nurse specialists,
and certified nurse midwives to sign documents related to the admission, treatment,
and discharge of psychiatric inpatients, if certain conditions are met.
 Replaces the Board of Nursing’s Substance Use Disorder Monitoring Program with the
Safe Haven Program, a program to monitor applicant and practitioner impairment
resulting from substance use or mental or physical disability.
 Requires the Safe Haven Program to be conducted by a monitoring organization under
contract with the Board and places duties on the organization, including receiving
reports of impairment, determining eligibility for program participation, and monitoring
participant treatment and compliance.
 Authorizes an insurance navigator to receive compensation from a health insurer
offering insurance through an exchange operating in Ohio so long as the compensation
is not in connection with the enrollment of employees and other individuals in a
qualified health benefit plan.
DETAILED ANALYSIS
Authority to sign documents relating to psychiatric inpatient
admission, treatment, and discharge
The bill authorizes eligible physician assistants and advanced practice registered nurses
(APRNs) who are certified nurse practitioners, clinical nurse specialists, or certified nurse-
midwives to sign certain documents relating to individuals receiving psychiatric or other
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behavioral health care services at a health care facility on an inpatient basis.1 The documents
must concern an inpatient’s admission, treatment, or discharge and may include treatment
plans and medication orders that are part of treatment plans.
Conditions on signing authority
The following conditions must be satisfied in order for a physician assistant or APRN to
be eligible to sign the documents:
 The physician assistant or APRN must either be employed, or granted appropriate
credentials, by the facility;
 The physician assistant’s supervising physician or the APRN’s collaborating physician
must either be employed by the facility or be a member of its medical staff;
 The supervising or collaborating physician must have authorized the physician assistant
or APRN to sign documents relating to the admission, treatment, or discharge of the
physician’s patients;
 In the case of a physician assistant, the facility’s policies must allow the physician
assistant to sign the documents;
 In the case of an APRN, the nurse’s standard care arrangement must specify in writing
that the nurse is authorized to sign documents for the physician’s patients.2
Physician immunity
The bill states that a supervising physician, in the case of a physician assistant, or a
collaborating physician, in the case of an APRN, who authorizes the physician assistant or APRN
to sign documents under the bill’s provisions is not subject to civil liability, administrative
action, or criminal prosecution for an act or omission that arises from the physician assistant or
APRN signing the document.3
Physician supervision and collaboration – background
Physician supervision – physician assistants
Existing law unchanged by the bill requires a physician assistant to practice only under
the supervision, control, and direction of a physician with whom the physician assistant has
entered into a supervision agreement. The physician assistant also must practice in accordance
with that agreement and if applicable, the policies of the health care facility where the
physician assistant practices.4
1 R.C. 4723.436(A) and 4730.204(A).
2 R.C. 4723.431(C), 4723.436(B), 4730.204(A) and (B).
3 R.C. 4723.436(C) and 4730.204(C).
4 R.C. 4730.08, not in the bill.
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Physician collaboration − APRNs
Current law unchanged by the bill requires an APRN who is a certified nurse
practitioner, clinical nurse specialist, or certified nurse-midwife to practice in collaboration with
a physician, meaning that the physician is continuously available to communicate with the
nurse either in person or by electronic communication.5 The APRN also must enter into a
standard care arrangement with one or more collaborating physicians and practice in
accordance with it. A standard care arrangement is a written, formal guide for planning and
evaluating a patient’s health care that is developed by one or more collaborating physician and
the APRN.
Board of Nursing – impairment monitoring
The bill requires the Board of Nursing to establish the Safe Haven Program to monitor
practitioners and applicants who are or may be impaired. In creating Safe Haven, the bill
eliminates existing law provisions establishing the Board of Nursing’s Substance Use Disorder
Monitoring Program.6 Note that, at present, the Board issues licenses or certificates to the
following types of practitioners – registered nurses, advanced practice registered nurses,
licensed practical nurses, dialysis technicians, medication aides, community health workers, and
doulas.7
Like its Substance Use Disorder Monitoring Program, the Board, through Safe Haven,
monitors impairment, but with several differences. First, while the current law program
addresses only impairment related to drug, alcohol, or other substance use, Safe Haven also
addresses impairment resulting from a mental or physical disability.8 Second, participation
extends to applicants for licensure or certification; the Board’s existing program governs only
licensed or certified practitioners.9 Third, Safe Haven must be conducted by a monitoring
organization, while under current law, the Board must administer the Substance Use
Monitoring Program or, in the alternative, may contract with a third-party vendor to do so.10
Fourth, a practitioner is no longer required to surrender the practitioner’s Board-issued
license or certificate as a condition of participation.11 Fifth, the Board is required by the bill,
rather than authorized as under current law, to abstain from taking disciplinary action against
certain impaired individuals.12
5 R.C. 4723.01 and 4723.43, not in the bill, and 4723.431.
6 R.C. 4723.35 and 4723.351; conforming change in R.C. 4723.06.
7 R.C. Chapter 4723.
8 R.C. 4723.35(A) and (B).
9 R.C. 4723.35(A) and (B).
10 R.C. 4723.35(B).
11 R.C. 4723.35(E), repealed.
12 R.C. 4723.35(F).
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Participant eligibility
To be eligible to participate in Safe Haven, a practitioner or applicant must (1) be in
need of assistance with impairment or potential impairment and (2) must hold an
unencumbered license and not be under the terms of a Board order or consent agreement for
impairment.13 Under the bill, eligibility determinations are to be made by the program’s
monitoring organization.14 Current law requires the Board’s supervising member to make the
determinations.
Monitoring organization
As noted above, the bill requires Safe Haven to be conducted by a monitoring
organization under contract with the Board. It establishes eligibility conditions that must be
met by the organization before a contract is entered into and also imposes duties on the
contracting organization.
Eligibility conditions
To be eligible to contract with the Board, an organization must meet all of the following:
(1) operate in Ohio as a professionals health program, (2) be organized as a not-for-profit entity
and exempt from federal income taxation, (3) employ or contract with a physician specializing
in addiction medicine or psychiatry to serve as its medical director, and (4) employ or contract
with one or more licensed health care professionals as necessary for the organization’s
operation.15
Duties and procedures
The bill establishes the following duties to be fulfilled by the monitoring organization:
 Conducting a review of individuals and entities providing impairment evaluation and
treatment services to determine which should be approved to serve as the program’s
evaluators and treatment providers;
 Granting or denying approval to evaluators and treatment providers and periodically
reviewing and updating the program’s list of approved evaluators and providers,
including by examining their outcomes and operations;
 Receiving reports of impairment or suspected impairment from any source, including
Board referrals;
 Notifying an applicant or practitioner who is the subject of a report or referral that the
report or referral has been made and that the applicant or practitioner may be eligible
to participate in Safe Haven;
13 R.C. 4723.35(G).
14 R.C. 4723.35(E).
15 R.C. 4723.351(A).
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 Determining whether applicants and practitioners reported or referred to the
organization are eligible to participate and notifying them of determinations;
 In the case of applicants or practitioners reported by treatment providers, notifying the
providers of eligibility determinations;
 Reporting to the Board any practitioner or applicant who is determined ineligible to
participate in Safe Haven;
 Referring participants for evaluation by a treatment provider approved by the
organization, unless the report the organization received was made by an approved
treatment provider and the applicant or practitioner has already been evaluated by the
treatment provider;
 Monitoring the evaluation of eligible applicants and practitioners;
 Referring eligible applicants and practitioners who choose to participate in Safe Haven
to approved treatment providers;
 Establishing, in consultation with treatment providers, the terms and conditions with
which individual participants must comply for continued participation in and successful
completion of the program;
 Reporting to the Board any practitioner or applicant who does not complete evaluation
or treatment or does not comply with any of the terms and conditions established by
the monitoring organization and the treatment provider;
 Performing any other activities specified in the contract with the Board or that the
organization considers necessary to comply with the bill.16
Related to the foregoing duties, the bill requires the monitoring organization to develop
procedures for performing them.17 And, in consultation with the Board, the organization must
develop procedures for reporting certain information to the Board, including the following:
(1) the total number of Safe Haven participants, (2) any applicant or practitioner that presents
an imminent danger to the public or self, (3) any applicant or practitioner who is unwilling or
unable to complete or comply with any part of the program, including evaluation, treatment, or
monitoring, and (4) any applicant or practitioner whose impairment was not substantially
alleviated by participation in the program.18
Disclosures to the Board
The bill prohibits the monitoring organization from disclosing to the Board the name of
any applicant or practitioner or any records relating to the applicant or practitioner, except
16 R.C. 4723.351(B).
17 R.C. 4723.351(D)(1).
18 R.C. 4723.351(D)(2).
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under one of the following five circumstances: (1) the applicant or practitioner is determined
ineligible for Safe Haven, (2) the applicant or practitioner requests the disclosure, (3) the
applicant or practitioner is unwilling or unable to complete or comply with any part of the
program, (4) the applicant or practitioner presents an imminent danger to the public or self, as
a result of impairment, and (5) the applicant’s or practitioner’s impairment has not been
substantially alleviated by participation in the program.19
Immunity
Under the bill, in the absence of fraud or bad faith, the monitoring organization is not
liable in damages to any person as a result of any act or omission related to its official duties. In
the event of a claim or action against the organization, the bill requires the state to provide and
pay for the monitoring organization’s defense, but only if the organization asks to be defended,
makes its request to the state in writing, and cooperates in its defense in good faith. The state
also must pay any resulting judgment or settlement, but not any part of a claim or judgment
that is for punitive or exemplary damages.20
Board duties and authority
In addition to requiring the Board to establish Safe Haven, the bill imposes other duties
on it and also grants it certain authority.
Requirement to abstain from imposing discipline
Under the bill, the Board must abstain from taking disciplinary action against an
individual whose health and effectiveness show signs of impairment or potential impairment,
but who is not currently under the terms of a consent agreement or Board-issued order for
impairment and who is participating in Safe Haven.21 Under current law, the Board may abstain
from imposing discipline against a practitioner with a substance use disorder if it finds that the
practitioner can be treated effectively and there is no impairment of the practitioner’s ability to
practice according to acceptable and prevailing standards of safe care.22
The bill also specifies that an applicant’s or practitioner’s impairment neither excuses an
applicant or practitioner who has committed other violations nor precludes the Board from
investigating or taking disciplinary action against an applicant or practitioner for other
violations.
Requirement to refer to the monitoring organization
The bill requires the Board to refer to the monitoring organization any applicant or
practitioner whose health and effectiveness show signs of impairment or potential impairment,
19 R.C. 4723.351(C).
20 R.C. 4723.021.
21 R.C. 4723.35(F).
22 R.C. 4723.35(B), repealed.
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but only if the applicant or practitioner satisfies the bill’s eligibility conditions for participation
in Safe Haven.23
Prohibition against mental or physical examinations
The bill prohibits the Board from compelling any individual who has been referred to
Safe Haven, by the Board or otherwise, to submit to a mental or physical examination.24
Authority to transfer responsibilities
After establishing Safe Haven, the Board may transfer to the monitoring organization, in
whole or in part, either or both of the following responsibilities:
 The monitoring and oversight of licensees as part of the Substance Use Disorder
Program as that program existed on or before the bill’s effective date;
 The monitoring and oversight of licensees under terms specified in a Board adjudication
order or consent agreement.
If the Board transfers the foregoing responsibilities, the monitoring organization must
provide quarterly reports to the Board regarding the compliance of transferred licensees. It also
must immediately report to the Board any licensee who is not in compliance with the terms and
conditions of monitoring.25
Rulemaking authority
The bill authorizes the Board to adopt any rules it considers necessary to implement the
bill’s Safe Haven provisions.26 The rules must be adopted in accordance with Ohio’s
Administrative Procedure Act.27
Insurance navigators