OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
+++++++++ +
S.B. 144 Final Analysis
135th General Assembly
Click here for S.B. 144’s Fiscal Note
Primary Sponsor: Sen. Romanchuk
Effective date: October 24, 2024; appropriations effective July 25, 2024; includes item veto
Effective date:
Audra Tidball, Attorney
SUMMARY
Pharmacist administration of immunizations
▪ Authorizes certified pharmacy technicians and registered pharmacy technicians to
administer immunizations in the same manner that pharmacy interns are authorized to
do so under continuing law.
▪ Reduces, from age seven to age five, the youngest age group for whom pharmacists,
interns, and technicians may administer immunizations.
▪ Eliminates a requirement that most immunizations for children under age 13 be
prescribed in order to be administered by a pharmacist or pharmacy intern.
Medication aides
▪ Limits the Board of Nursing’s certification of medication aides to those practicing in
nursing homes and residential care facilities, by eliminating the Board’s authority to
certify aides practicing in intermediate care facilities for individuals with intellectual
disabilities (ICFs/IID).
▪ Revises the law governing the Board’s approval of medication aide training programs,
including by establishing a $50 application fee and reducing, from 70 to 30, the hours of
instruction that an approved program must provide.
▪ Specifies that medication aides are to be known as “certified medication aides” or
“CMAs,” and requires the Board to maintain an online CMA registry.
▪ Authorizes a medication aide to administer prescription medications to residents of
nursing homes and residential care facilities, but only pursuant to the supervision of a
registered nurse or licensed practical nurse, rather than the nurse’s delegation, as under
prior law.
August 6, 2024
Office of Research and Drafting LSC Legislative Budget Office
▪ For as-needed medications, eliminates the requirement that a nursing assessment of the
patient be completed before the medication is administered, and also authorizes a
medication aide to administer those medications regardless of whether the supervising
nurse is present at the facility.
▪ Eliminates the prohibition on a medication aide administering schedule II controlled
substances.
▪ Authorizes a medication aide to administer insulin by injection if using an insulin pen
device with a dosage indicator, but otherwise maintains the prohibition on medication
aides administering medications by injection.
Certified nurse aides
▪ Establishes an alternative condition that an individual may satisfy to be eligible for
employment as a nurse aide in a long-term care facility – that the individual has
successfully completed a Board of Nursing-approved prelicensure program of nursing
education and has passed the Board-accepted examination.
▪ Establishes an additional ground upon which an individual is to be listed on the
Department of Health’s (ODH) nurse aide registry – that the individual has successfully
completed a Board-approved prelicensure program of nursing education and has passed
the Board-accepted examination.
▪ Requires individuals listed on the nurse aide registry to be referred to as certified nurse
aides, and permits only individuals in good standing on the registry to use the designation
“certified nurse aide” or “CNA.”
▪ Eliminates the Director of Health’s authority to approve competency evaluation
programs, but retains the Director’s authority to conduct the programs.
▪ Authorizes training and competency evaluation programs to conduct competency
evaluations.
▪ Prohibits ODH rules from requiring a training and competency evaluation program
instructor to have experience in a nursing home so long as the program coordinator
supervising the program is a registered nurse with two years of nursing experience,
including at least one year providing services in a nursing home or ICF/IID.
Nursing home quality improvement projects
▪ Regarding the law that requires nursing homes to participate in at least one quality
improvement project every two years, requires priority to be given to projects that assist
with workforce, and makes it permissive instead of mandatory for nursing homes to
consider projects on a Department of Aging-developed list.
P a g e |2 S.B. 144
Final Analysis
Office of Research and Drafting LSC Legislative Budget Office
Conditional employment – nursing homes and adult day-care
programs
▪ Extends (from 30 to 60) the number of days that a nursing home or adult day-care
program may conditionally employ an applicant while the applicant’s criminal records
check results are pending.
Adult day-care grants
▪ Reappropriates all remaining funds from item 042628, Adult Day Care, at the end of
FYs 2023 and 2024 to the successive fiscal year, and requires all grants to be administered
to adult day-care providers by December 31, 2024.
Certificates of need
▪ Related to certificates of need to increase the number of long-term care beds in a county
in accordance with a county’s bed need, exempts a county with at least 60 fewer beds
than the county’s bed need from a limitation that a county is considered not to need
additional beds if its occupancy rate is less than 85%.
▪ Shortens, to every two years from every four years, the review cycle for
(1) determinations of county long-term care bed supply and need and (2) certificate of
need review.
▪ Permits the Director to approve relocation of beds from a county only if the number of
beds remaining in the county after the relocation will exceed the county’s bed need by at
least 50 beds, as opposed to 100 beds under prior law.
▪ Eliminates a stipulation that permits the Director to approve relocation of beds from a
county only if the number of beds in the facility’s service area after the relocation is at
least equal to the state bed need rate, and eliminates related provisions specifying a
facility’s service area.
▪ Regarding comparative review of certificate of need applications, eliminates a
requirement that comparative review is required if two applications submitted during the
same review period propose to relocate beds from the same service area and the number
of beds left in the service area would be less than the state bed need rate.
▪ Eliminates a requirement that for an approved certificate of need, the long-term care
facility from which beds were relocated must reduce the number of beds operated in the
facility by at least 10% of the beds relocated.
▪ Related to the changes above, creates a one-time period of acceptance and review that
begins April 24, 2025.
Nursing home change of operator
▪ Replaces references to an “applicant” for a license to operate a nursing home following a
change of operator with references to the “entering operator.”
P a g e |3 S.B. 144
Final Analysis
Office of Research and Drafting LSC Legislative Budget Office
▪ Removes a requirement that an application for a license to operate a nursing home
following a change of operator disclose the owners with at least 5% ownership of a
management firm or business employed to manage the nursing home.
▪ Specifies that the bond required as part of a nursing home change of operator license
application may be supplied by either the entering operator or the owner of the nursing
home.
▪ Establishes additional circumstances under which the Director of Health is required to
deny a nursing home change of operator license application.
▪ Removes several actions undertaken by the owner of a nursing home as actions that
constitute a change of operator of the nursing home.
▪ Requires the owner of a nursing home to provide written notice of specified information
to the Department of Medicaid before a change of owner of a nursing facility may occur.
▪ Specifies that a nursing facility that undergoes a change of owner on July 1, 2023, or later
is ineligible to receive a quality incentive payment for a specified period of time if, within
one year of the change, there is an increase in the lease payments or other financial
obligations of the operator to the owner.
▪ Requires, not later than October 24, 2025, that the identity of the operator holding a
license to operate a nursing facility and the person holding the Medicaid provider
agreement on record for the facility be the same person.
Medicaid payment rate for ICFs/IID in peer group 5
▪ Eliminates the prohibition on the per Medicaid day payment rate for intermediate care
facilities for individuals with intellectual disabilities (ICFs/IID) in peer group 5 exceeding
the payment rate for developmental centers that was in effect on July 1, 2013.
▪ Eliminates law that established fixed amounts for the (1) capital component costs,
(2) direct care costs, (3) indirect care costs, and (4) other protected costs components for
the per Medicaid day payment rate for new ICFs/IID in peer group 5.
▪ Specifies that for FY 2025, the per Medicaid day payment rate for ICFs/IID in peer group 5
is to be calculated in accordance with the act and the remaining provisions of continuing
law regarding payments made to ICFs/IID.
▪ Specifies that if an ICF/IID in peer group 5 receives a per Medicaid day payment from the
Department of Developmental Disabilities between July 1, 2024, and October 24, 2024
(the act’s effective date), the Department must make a supplemental payment to the
ICF/IID that covers the difference between the amount paid and the amount required to
be paid under the act.
Ohio Medical Quality Foundation (VETOED)
▪ Would have repealed the statute that refers to the Ohio Medical Quality Foundation,
which is organized as a nonprofit corporation, and directed the Foundation to transfer all
P a g e |4 S.B. 144
Final Analysis
Office of Research and Drafting LSC Legislative Budget Office
of its unencumbered funds to the monitoring organization under contract with the State
Medical Board.
▪ Would have required the monitoring organization to use transferred funds for purposes
of administering the confidential monitoring program for impaired practitioners licensed
by, or seeking licensure with, the Medical Board.
TABLE OF CONTENTS
Pharmacist administration of immunizations................................................................................. 6
Medication aides – certification ..................................................................................................... 6
Eligibility ...................................................................................................................................... 7
Application and renewal ............................................................................................................. 7
Training program approval .......................................................................................................... 7
Medication administration .......................................................................................................... 7
Immunity ..................................................................................................................................... 8
Rulemaking .................................................................................................................................. 8
Note on related enactment ......................................................................................................... 8
Certified nurse aides ....................................................................................................................... 8
Nursing education ....................................................................................................................... 9
Nurse aide references ................................................................................................................. 9
Competency evaluation programs and training and competency evaluation programs ........... 9
Nursing home quality improvement projects............................................................................... 10
Conditional employment – nursing homes and adult day-care programs ................................... 10
Adult day-care grants .................................................................................................................... 11
Certificates of need ....................................................................................................................... 11
Bed supply and bed need determinations; review period ........................................................ 11
Occupancy rate consideration .................................................................................................. 11
Other considerations related to certificate of need approval .................................................. 12
One-time period of acceptance and review.............................................................................. 12
Nursing home change of operator................................................................................................ 12
Department of Health change of operator application ............................................................ 13
Required disclosures............................................................................................................. 13
Bond or other financial security ........................................................................................... 14
Prior experience ................................................................................................................... 14
Issuing or denying a license .................................................................................................. 14
Department of Medicaid nursing facility change of operator or owner .................................. 15
Change of operator .............................................................................................................. 15
Change of owner .................................................................................................................. 16
P a g e |5 S.B. 144
Final Analysis
Office of Research and Drafting LSC Legislative Budget Office
Medicaid payment rate for ICFs/IID in peer group 5 .................................................................... 17
Ohio Medical Quality Foundation (VETOED) ................................................................................ 18
DETAILED ANALYSIS
Pharmacist administration of immunizations
The act makes several modifications to the authority of pharmacists and other persons
under their supervision to administer immunizations. First, it extends the authority to certified
pharmacy technicians and registered pharmacy technicians in the same manner as pharmacy
interns under preexisting law. This involves having to meet a number of conditions, including that
the technician (1) work under the direct supervision of a pharmacist, (2) complete a course in
administering immunizations that meets requirements established in rules, (3) receive and
maintain certification to perform basic life-support procedures, and (4) practice in accordance
with a protocol that meets various requirements established under continuing law.1
Second, the act makes several changes regarding immunizations for children. The act
authorizes pharmacists, interns, and technicians to administer immunizations beginning when a
child is five, as opposed to the prior law age limit of seven. For children under 13, the act
eliminates a requirement that their immunizations generally be prescribed (other than
immunizations for COVID-19 and the flu, which already did not require a prescription before the
act).2 The act also requires, for each immunization administered to a child under 18, that the
pharmacist, intern, or technician inform the child’s parent or legal guardian of the importance of
well child visits with a pediatri