OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
S.B. 196 Bill Analysis
135th General Assembly
Click here for S.B. 196’s Fiscal Note
Version: As Reported by H. Health Provider Services
Primary Sponsor: Sen. Roegner
Effective date:
Elizabeth Molnar, Attorney
SUMMARY
▪ Makes changes to various provisions of the Revised Code, often, to include references to
certain advanced practice registered nurses.
TABLE OF CONTENTS
Standard care arrangements and physician collaboration ............................................................. 2
Scope of practice – certified nurse-midwives................................................................................. 3
Nursing practice .............................................................................................................................. 4
Education ........................................................................................................................................ 4
Elections .......................................................................................................................................... 5
Health care facilities........................................................................................................................ 5
Health care professionals ............................................................................................................... 6
Human services ............................................................................................................................... 6
Insurance......................................................................................................................................... 6
Labor and employment; workers’ compensation .......................................................................... 7
Legal ................................................................................................................................................ 7
Motor vehicles ................................................................................................................................ 9
Public health ................................................................................................................................... 9
Rehabilitation and correction ....................................................................................................... 12
State and local government .......................................................................................................... 12
Taxation......................................................................................................................................... 14
 This analysis was prepared before the report of the House Health Provider Services Committee appeared
in the House Journal. Note that the legislative history may be incomplete.
December 10, 2024
Office of Research and Drafting LSC Legislative Budget Office
DETAILED ANALYSIS
S.B. 196, a bill regarding the authority of advanced practice registered nurses (APRNs), in
particular, certified nurse-midwives, clinical nurse specialists, and certified nurse practitioners,
revises various provisions of the Revised Code, often, to include references to such APRNs. The
bill addresses many topics, with changes to each topic described briefly below. Note that many
of the bill’s changes fall under more than one topic.
Before highlighting by topic area the revisions made by the bill, this analysis focuses first
on two of the bill’s main changes to the law governing APRNs.
Standard care arrangements and physician collaboration
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 or
podiatrist, meaning that the physician or podiatrist is continuously available to communicate
with the nurse either in person or by electronic communication. The APRN also must enter into
a standard care arrangement with one or more collaborating physicians or podiatrists 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
physicians or podiatrists and the APRN.1
Psychiatric-mental health APRNs
Under existing law, a nurse’s collaborating physician or podiatrist must practice in a
specialty that is the same as or similar to the nurse’s nursing specialty.2 However, for an APRN
certified as a psychiatric-mental health clinical nurse specialist or psychiatric-mental health nurse
practitioner, the collaborating physician must practice psychiatry, pediatrics, or primary care or
family practice. The bill revises the existing law provision specifying the organization under which
a nurse practitioner may be certified as a psychiatric-mental health nurse practitioner. At
present, that certifying organization is limited to the American Nurses Credentialing Center. The
bill recognizes the American Academy of Nurse Practitioners Certification Board as an additional
psychiatric-mental health certifying organization.3
Additional APRN actions – prohibitions and authorizations
The bill states that it does not prohibit a standard care arrangement from also specifying
actions that a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner is
authorized to take, or is prohibited from taking, as part of the nurse’s practice in collaboration
with a physician or podiatrist. In specifying such actions, the standard care arrangement must
1 R.C. 4723.01 and 4723.43, not in the bill, and 4723.431.
2 R.C. 4723.431(A)(2)(b).
3 R.C. 4723.431(A)(2)(c).
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not authorize the nurse to take any action that is otherwise prohibited by statutory law or
through rules adopted by the Ohio Board of Nursing.4
Scope of practice – certified nurse-midwives
Several of the bill’s provisions authorize an APRN to sign certain documents and take
related actions. Under some of those provisions, however, an APRN who is a certified
nurse-midwife is permitted to sign and take the related action only if the nurse-midwife’s scope
of practice, as determined in accordance with statutory law outlining that scope of practice and
standards established by the Ohio Board of Nursing, allows the nurse-midwife to practice in the
manner described in those provisions.5 The provisions at issue relate to the following subjects:
▪ Determining and documenting medical conditions for purposes of Home First
components of the PASSPORT Program and Assisted Living Program, each administered
by the Ohio Department of Aging;6
▪ Receiving diphtheria antitoxin without charge for use in treating indigent persons;7
▪ Providing instructions necessary for the preparation of special diets for residents of
nursing homes and residential care facilities;8
▪ Determining whether a residential care facility resident is capable of self-administering
medication;9
▪ Determining whether vaccination against influenza or pneumococcal pneumonia is
medically inappropriate for a hospital patient or nursing home or residential care facility
resident;10
▪ Examining lead abatement workers and reporting lead poisoning;11
▪ Approving care provided in a setting other than a hospital for purposes of the law
governing kidney dialysis benefits provided by sickness and accident insurers; 12
4 R.C. 4723.431.
5 R.C. 4723.438. See also R.C. 4723.43(A), not in the bill.
6 R.C. 173.521 and 173.542.
7 R.C. 3701.162.
8 R.C. 3721.01.
9 R.C. 3721.011.
10 R.C. 3721.041 and 3727.19.
11 R.C. 3742.03, 3742.04, and 3742.07.
12 R.C. 3923.25.
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▪ Providing statements regarding the medical conditions of applicants for commercial
driver’s licenses, driver’s licenses, hearing-impaired identification cards, identification
cards, and probationary driver’s licenses.13
Nursing practice
▪ For purposes of the law governing anatomical gifts, prohibits a certified nurse-midwife,
clinical nurse specialist, or certified nurse practitioner who attends the decedent at death
or determines the time of death from participating in removal and transplant procedures
(mirrors physicians under current law) (R.C. 2108.16).
▪ Removes the current law conditions on a certified nurse practitioner or clinical nurse
specialist determining and pronouncing death, including that the nurse may do so only
for deaths occurring in a nursing home, residential care facility, or hospice or palliative
care program. Also, authorizes a certified nurse-midwife to determine and pronounce
death, regardless of the decedent’s location (R.C. 4723.36).
▪ Requires a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist
to provide certain information to a woman experiencing a fetal death who presents
herself to the nurse outside of a hospital setting (R.C. 4723.437). (Mirrors a provision that
applies to physicians under current law (R.C. 4731.82, not in the bill).)
▪ Allows a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist
to authorize one or more pharmacists to dispense nicotine replacement therapy under a
protocol established by the nurse (R.C. 4723.4812(A) and 4729.284). (Mirrors physicians’
current law (R.C. 4731.90, not in the bill).)
▪ Allows a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist
to authorize a pharmacist or pharmacy intern to dispense epinephrine under a protocol
developed by the nurse (R.C. 4723.4812(D) and 4729.47). (Mirrors physicians’ current law
(R.C. 4731.961, not in the bill).)
Education
▪ With respect to the law granting a child with a medical condition that may require
emergency medical attention the right to attend school in the district in which either of
the child’s parents is employed, specifies that – for purposes of the requirement that the
child’s parent submit certification of the child’s medical condition – the certification may
be from a physician (current law) or a certified nurse-midwife, clinical nurse specialist, or
certified nurse practitioner (R.C. 3313.64).
▪ With respect to the law authorizing a student to possess and use an asthma inhaler in
school if the student’s physician approves, also allows for the student’s clinical nurse
specialist or certified nurse practitioner to approve inhaler possession and use
(R.C. 3313.716).
13 R.C. 4506.07, 4507.06, 4507.08, 4507.081, and 4507.141.
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▪ Includes a specific reference to a clinical nurse specialist or certified nurse practitioner in
the law authorizing a school district to enter into a contract with a health district for the
purpose of providing the services of a school physician, dentist, or nurse (R.C. 3313.72).
▪ Permits clinical nurse specialists and certified nurse practitioners to certify a child’s
physical or mental condition under the law governing excuses for attendance, in the same
manner that current law permits physicians and certain mental health professionals to
provide the certification (R.C. 3321.04).
Elections
▪ For purposes of the law governing voter disability, including the inability to sign election
documents, provides for attestations from not only physicians (current law), but also
clinical nurse specialists and certified nurse practitioners (R.C. 3501.382).
Health care facilities
▪ Adds specific references to APRNs in the law authorizing patient access to medical records
(R.C. 3701.74).
▪ When special diets are provided in nursing homes and residential care facilities as a type
of personal care service, permits certified nurse-midwives, clinical nurse specialists, and
certified nurse practitioners, in addition to the currently authorized physicians and
dietitians, to provide the instructions necessary for preparing the diets (R.C. 3721.01).
▪ Adds certified nurse-midwives, clinical nurse specialists, and certified nurse practitioners
to the law governing the circumstances when medication administration and skilled
nursing care may be provided in residential care facilities, including provisions relating to
a physician’s (current law) or nurse’s written determination that an individual is capable
of self-administering medications (R.C. 3721.011).
▪ With respect to the law requiring a nursing home, residential care facility, and hospital to
offer each resident and patient vaccination against influenza and pneumococcal
pneumonia unless the resident’s or patient’s physician determines it medically
inappropriate, also allows for a certified nurse-midwife, clinical nurse specialist, or
certified nurse practitioner to make that determination (R.C. 3721.041 and 3727.19).
▪ Adds specific references to APRNs to the definitions for the law governing (1) mandatory
reporters of abuse, neglect, exploitation, or misappropriation occurring in long-term care
facilities and (2) certification of nurse aides (R.C. 3721.21; see also R.C. 3721.22(A)(1), not
in the bill).
▪ Includes references to certified nurse-midwives, clinical nurse specialists, and certified
nurse practitioners in the law governing hospital trauma care protocols. Also, when
hospitals develop trauma care protocols, requires them to consider guidelines established
by the American Academy of Emergency Nurse Practitioners, in addition to those
established by other entities that are currently specified (R.C. 3727.09).
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Health care professionals
▪ Authorizes a pharmacist to administer certain vaccines under a protocol established by a
certified nurse-midwife, clinical nurse specialist, or certified nurse practitioner (mirrors
existing law for physicians) (R.C. 4729.41).
▪ Authorizes a pharmacist to administer a specified drug by injection as long as the drug
has been prescribed by a certified nurse-midwife, clinical nurse specialist, or certified
nurse practitioner and the patient has an ongoing nurse-patient relationship with the
nurse (R.C. 4723.4812(C) and 4729.45). (Mirrors existing law for physicians, except for the
adoption of rules (see also R.C. 4731.057, not in the bill).)
Human services
▪ Adds certified nurse-midwives, clinical nurse specialists, and certified nurse practitioners
as permitted recipients of referrals from a rape crisis program for purposes of the law
governing the Rape Crisis Program Trust Fund, which is administered by the Ohio Attorney
General (mirrors physicians) (R.C. 109.921).
▪ Adds clinical nurse specialists and certified nurse practitioners to the law governing
eligibility for the Ohio Department of Aging’s Home First component of the PASSPORT
Program, in particular, in determining and documenting certain aspects of an individual’s
medical condition (mirrors physicians) (R.C. 173.521).
▪ Adds certified nurse-midwives, clinical nurse specialists, and certified nurse practitioners
to the law governing eligibility for the Ohio Department of Aging’s Home First component
of the Assisted Living Program, in particular, in determining and documenting certain
aspects of an individual’s medical condition (mirrors physicians) (R.C. 173.542).
Insurance
▪ Includes APRNs as permitted members of the pharmacy and therapeutics committees
that consult with health insuring corporations when developing prescription drug
formularies, thereby potentially reducing the number of physician members who must be
included under current law (R.C. 1753.21).
▪ For purposes of the law governing wellness or health improvement programs offered by
health insurers, when an insured is required to provide verification of a medical condition,
specifies that the verification may include a statement from the insured’s certified nurse-
midwife, clinical nurse specialist, or certified nurse