OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 102 Bill Analysis
135th General Assembly
Click here for H.B. 102’s Fiscal Note
Version: As Reported by House Health Provider Services
Primary Sponsors: Reps. T. Young and John
Effective date:
Audra Tidball, Attorney
SUMMARY
Recognizes and regulates the practice of advanced practice respiratory therapists, who
are individuals that perform services – pursuant to a supervision agreement with a
physician – for the diagnosis and treatment of cardiopulmonary diseases or conditions.
Requires an advanced practice respiratory therapist to hold a license issued by the State
Medical Board and establishes criminal penalties for violators.
Allows the holder of an advanced practice respiratory therapist license to perform
certain services authorized by the supervising physician, which may include ordering,
prescribing, and administering drugs and medical devices.
Coordinates the State Medical Board’s licensing and regulatory procedures for advanced
practice respiratory therapists with those for respiratory therapists and other health
care professionals also regulated by the Board.
TABLE OF CONTENTS
Practice of advanced practice respiratory therapists ..................................................................... 2
Authorized services ..................................................................................................................... 2
Prescriptive authority ............................................................................................................. 3
Other provisions related to prescribing ................................................................................. 4
Orders for respiratory care; supervision and delegation ....................................................... 4
Telehealth services ................................................................................................................. 5
Care during disasters or emergencies .................................................................................... 5
Physician supervision .................................................................................................................. 5
Supervision agreement........................................................................................................... 6
Quality assurance system ....................................................................................................... 7
Supervising physician liability...................................................................................................... 7
July 8, 2024
Office of Research and Drafting LSC Legislative Budget Office
Liability related to health care facilities ...................................................................................... 7
Unauthorized practice and criminal penalties ............................................................................ 8
Eligibility for licensure ..................................................................................................................... 9
Application .................................................................................................................................. 9
Renewal ..................................................................................................................................... 10
Failure to maintain qualifications or to complete continuing education ............................ 10
Licensure fees ............................................................................................................................ 11
Discipline by the Medical Board ................................................................................................... 11
Against advanced practice and other respiratory therapists .................................................... 11
Against a supervising physician ................................................................................................. 12
Other health professionals ........................................................................................................ 12
Respiratory Care Advisory Council ................................................................................................ 12
Medical Board and Advisory Council liability ............................................................................... 13
Rulemaking.................................................................................................................................... 13
Miscellaneous provisions .............................................................................................................. 13
Interpretation of bill ..................................................................................................................... 14
DETAILED ANALYSIS
Practice of advanced practice respiratory therapists
The bill recognizes and regulates the practice of respiratory care as an advanced practice
respiratory therapist, which means performing services delegated by a supervising physician in
the diagnosis and treatment of patients with cardiopulmonary diseases or conditions, including
prescribing, ordering, and administering drugs and medical devices.1 The bill establishes a
process by which an individual may obtain a license to practice as an advanced practice
respiratory therapist through the State Medical Board and specifies the services a license
holder may perform under the delegation of a supervising physician.
Authorized services
A holder of a license to practice as an advanced practice respiratory therapist is
authorized to practice only under the supervision, control, and direction of a physician with
whom the advanced practice respiratory therapist has entered into a supervision agreement as
set forth in the bill. An advanced practice respiratory therapist must practice in accordance with
the supervision agreement, as well as the policies of the health care facility in which the
advanced practice respiratory therapist is practicing.2
1 R.C. 4761.01(J).
2 R.C. 4761.36(A); see also R.C. 4761.38(B).
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The bill defines “health care facility” as a hospital and any other hospital-based facility
designated by the Medical Board in rules.3 Advanced practice respiratory therapists are
authorized to practice in any “health care facility” within which their supervising physician has
supervision, control, and direction of the advanced practice respiratory therapist.4
Under the bill, a licensed advanced practice respiratory therapist may perform any of
the following services authorized by a supervising physician if the services are part of the
physician’s normal course of practice and expertise:
Ordering diagnostic, therapeutic, and other medical services;
Prescribing physical therapy or referring a patient for physical therapy;5
Ordering occupational therapy or referring a patient for occupational therapy;
If the advanced practice respiratory therapist has been granted physician-delegated
prescriptive authority, ordering, prescribing, and administering drugs and medical
devices;
Any other services that are part of the supervising physician’s normal course of practice
and expertise.6
The bill specifically prohibits a supervising physician from authorizing an advanced
practice respiratory therapist to perform any service that is beyond the physician’s or
therapist’s normal course of practice and expertise. It also limits the supervising physician’s
authorization to services the physician is satisfied that the advanced practice respiratory
therapist is capable of competently performing.7
In a health care facility with an emergency department, the bill authorizes a supervising
physician to, on occasion, send an advanced practice respiratory therapist to the emergency
department to assess a patient. The supervising physician must be available to go to the
emergency department to personally evaluate the patient.8
Prescriptive authority
A licensed advanced practice respiratory therapist may exercise physician-delegated
prescriptive authority, which includes prescribing drugs and therapeutic devices. 9 In exercising
3 R.C. 4761.01(K) and 4761.36(B).
4 R.C. 4761.39(A).
5 R.C. 4755.48.
6 R.C. 4761.38(A).
7 R.C. 4761.39(C).
8 R.C. 4761.39(D).
9 R.C. 4761.41 and 4761.44.
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this authority, an advanced practice respiratory therapist is subject to the following conditions
or limitations:10
The respiratory therapist may exercise prescriptive authority only to the extent that the
supervising physician has granted that authority;
The respiratory therapist must comply with all conditions the supervising physician
places on the therapist’s exercise of prescriptive authority (see below);
The respiratory therapist is prohibited from prescribing a controlled substance;
The respiratory therapist is prohibited from personally furnishing any drug;
The respiratory therapist is prohibited from prescribing any drug in violation of state or
federal law;
The respiratory therapist is prohibited from furnishing sample drugs.11
Regarding conditions that may be placed on physician-delegated prescriptive authority,
any such conditions must be in writing. Possible conditions include:12
Identifying specific classes of drugs and therapeutic devices that cannot be prescribed;
Limitations on dosages and refills;
Specifying circumstances under which referral to a physician is required;
Responsibilities to be fulfilled by the supervising physician that are not otherwise
specified in the supervision agreement.
Other provisions related to prescribing
The bill includes corresponding changes to Ohio’s criminal drug laws and pharmacy laws
related to the authority being granted to advanced practice respiratory therapists to possess,
prescribe, and administer drugs. Accordingly, advanced practice respiratory therapists are
included in those provisions in the same manner as other prescribers.13
Orders for respiratory care; supervision and delegation
Under the bill, an advanced practice respiratory therapist may order respiratory care
services and delegate the performance of those services, including the administration of drugs,
to another respiratory care professional. Advanced practice respiratory therapists also may
supervise respiratory care professionals.14
10 R.C. 4761.44.
11 R.C. 3719.81.
12 R.C. 4761.45.
13 R.C. 2925.01, 2925.23, 2925.55, 2925.56, 3719.13, 4729.01, and 4729.51.
14 R.C. 4761.17.
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Further, the bill authorizes an advanced practice respiratory therapist to delegate
performance of a task or the administration of a drug to any other person if certain conditions
are met.15 These include the following:
The advanced practice respiratory therapist must be physically present at the location
where the task is performed or the drug administered;
The advanced practice respiratory therapist, prior to delegating a task or the
administration of a drug, must determine that the task or drug is appropriate for the
patient and that the person to whom delegation is made may safely perform the task or
administer the drug;
With respect to drug administration, the advanced practice respiratory therapist must
have been granted physician-delegated prescriptive authority and must be authorized
to prescribe the drug, the drug cannot be a controlled substance, the drug cannot be
administered intravenously, and the drug cannot be administered in a hospital inpatient
care unit or emergency department or a freestanding emergency department or
ambulatory surgical facility.
Telehealth services
The bill authorizes an advanced practice respiratory therapist to provide telehealth
services. The bill maintains current law’s authorization for respiratory care professionals to
practice telehealth.16
Care during disasters or emergencies
The bill specifies that an advanced practice respiratory therapist is not prohibited from
providing medical care in response to a disaster or emergency. In such a circumstance, the
advanced practice respiratory therapist’s supervising physician is not required to meet the
supervision requirements established by the bill. Instead, the physician designated as the
medical director of the disaster or emergency may supervise the advanced practice respiratory
therapist.17
Physician supervision
The bill prohibits an advanced practice respiratory therapist from practicing without the
supervision, control, and direction of a supervising physician who specializes in pulmonology,
anesthesiology, critical care, or sleep medicine.18 However, before initiating supervision of an
15 R.C. 4761.381.
16 R.C. 4761.25 and 4743.09; see also R.C. 5164.95, regarding standards for Medicaid payments for
telehealth services provided by advanced practice respiratory therapists.
17 R.C. 4761.35.
18 R.C. 4761.33.
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advanced practice respiratory therapist, a physician must enter into a supervision agreement
with the respiratory therapist who will be supervised.19
Supervision agreement
Under the bill, a supervision agreement may not apply to more than one advanced
practice respiratory therapist and only a physician specializing in pulmonology, anesthesiology,
critical care, or sleep medicine may enter into the agreement. The agreement must specify that
the physician agrees to supervise the advanced practice respiratory therapist and that the
respiratory therapist agrees to practice under that physician’s supervision.20
The agreement also must include the following components:21
Terms that require the advanced practice respiratory therapist to practice in accordance
with the policies of the health care facility in which the respiratory therapist practices;
Any limitations on the responsibilities to be fulfilled by the advanced practice
respiratory therapist;
The circumstances under which the advanced practice respiratory therapist is required
to refer a patient to the supervising physician;
If the supervising physician chooses to designate physicians to act as alternate
supervising physicians, the names, business addresses, and business telephone numbers
of the physicians who have agreed to act in that capacity.
Upon entering into a supervision agreement, the supervising physician and advanced
practice respiratory therapist must each retain a copy of it in their respective records.22 If the
Medical Board finds a failure to comply with this requirement, the Board may take disciplinary
action, impose a civil penalty, or both. Alternatively, the Board may permit the individual to
agree in writing to update the records and pay a civil penalty. Any civil penalty cannot exceed
$5,000.23
In supervising an advanced practice respiratory therapist, all of the following conditions
must be met:24
The supervising physician must provide only on-site supervision, consisting of being
physically present at the location where the respiratory therapist is practicing and being
continuously available for direct communication with the respiratory therapist;
19 R.C. 4761.37.
20 R.C. 4761.37(A).
21 R.C. 4761.37(B).
22 R.C. 4761.37(C).
23 R.C. 4761.37(D)(2) and (4).
24 R.C. 4761.39(A).
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The supervising physician must personally and actively review the advanced practice
respiratory therapist’s professional activities;
The supervising