OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 676 Bill Analysis
135th General Assembly
Click here for H.B. 676’s Fiscal Note
Version: As Introduced
Primary Sponsors: Reps. Baker and Abrams
Effective date:
Elizabeth Molnar, Attorney
SUMMARY
▪ Recognizes prescribed pediatric extended care centers, facilities providing services to
medically or technologically dependent children, and regulates their operation, including
by requiring each center to hold a license issued by the Director of Health.
▪ Establishes eligibility conditions for licensure, including that a prescribed pediatric
extended care center (1) employ a medical director and at least one nurse manager and
(2) operate a child care center at the same address as the prescribed pediatric extended
care center.
▪ Authorizes a licensed center to provide medical, nursing, and psychosocial services and
developmental education to medically dependent or technologically dependent children
while at the center.
▪ Requires the Medicaid Director to seek approval from the federal Centers for Medicare
and Medicaid Services to cover services provided by licensed prescribed pediatric
extended care centers.
DETAILED ANALYSIS
Prescribed pediatric extended care centers
H.B. 676 recognizes prescribed pediatric extended care centers and regulates their
operation, including by requiring each center to hold a license issued by the Director of Health.1
The bill defines a prescribed pediatric extended care center to mean a facility other than a
hospital, whether operated for profit or not, that provides and delivers, or allows for the
1 R.C. Chapter 3724.
November 18, 2024
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provision of, certain services to medically dependent or technologically dependent children and
their legal guardians.2
Unauthorized operation
The bill prohibits a person, firm, organization, institution, or agency from knowingly
operating a prescribed pediatric extended care center without a license issued by the Director of
Health.3 Each violation is subject to a fine not less than $500 and not more than $10,000.4
Applying for a license; eligibility conditions
A person, firm, organization, institution, or agency seeking a license to operate a
prescribed pediatric extended care center must file an application with the Director of Health in
a manner prescribed by the Director.5
To be eligible to receive the license, an applicant must satisfy the following requirements:
▪ Hold a current, valid child care center license and operate the child care center at the
same address at which the prescribed pediatric extended care center will operate;
▪ Contract with or employ a medical director who is a physician specializing in pediatric
medicine and has at least three years of clinical experience in that specialty;
▪ Contract with or employ one or more nurse managers, with each nurse manager being a
registered nurse with clinical experience in pediatric nursing;
▪ Submit a $500 initial application fee or, in the case of a facility that already holds a
prescribed pediatric extended care center license, a $250 initial application fee.6
The bill requires the Director to review each application it receives. After receiving an
application that the Director considers complete, the Director must determine whether the
applicant meets the bill’s eligibility requirements.7
Issuing and renewing a license
If the Director of Health determines that an applicant has met the bill’s eligibility
conditions, the Director is required to issue a prescribed pediatric extended care license to the
applicant.8 Each license is valid for three years, unless revoked or suspended, expires on the date
that is three years after the date of issuance, and may be renewed for additional three-year
periods.9
2 R.C. 3724.01(F).
3 R.C. 3724.02.
4 R.C. 3724.99.
5 R.C. 3724.03(A).
6 R.C. 3724.03(B).
7 R.C. 3724.03(C).
8 R.C. 3724.04(A).
9 R.C. 3724.04(B).
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To renew a license, a center must submit a renewal application to the Director on or
before the license’s expiration date and in a manner prescribed by the Director. Each application
must be accompanied by a $500 renewal fee. The Director is required to renew the license if the
applicant continues to hold a current, valid child care license and meets any renewal
requirements established by the Director in rule.10
License holder discipline
The bill authorizes the Department of Health to refuse to issue or renew, suspend, or
revoke a license or otherwise impose discipline on a license holder for any violation of the bill’s
provisions or rules adopted under it. Discipline may include imposing a civil penalty in an amount
not more than $500 for each violation and for each day the violation occurs.11
Medically dependent or technologically dependent children –
enrollment and authorized services
The bill authorizes certain services to be provided to medically dependent or
technologically dependent children enrolled in licensed centers.12 For purposes of the bill, a
medically dependent or technologically dependent child is an individual who is less than 21 years
of age and requires, as a result of a medical condition, continuous therapeutic interventions or
skilled nursing supervision.13
Referral required for enrollment
Before a medically dependent or technologically dependent child may enroll in a licensed
center, the child’s parent or legal guardian must submit a referral from the child’s physician. The
referral must include a description of the child’s medical condition, medical stability, and the
continuous therapeutic interventions or skilled nursing supervision that the child requires. 14
Services provided by the center
A licensed center may provide and deliver at the center, for a part of the day, any of the
following services to medically dependent or technologically dependent children who are not
related to the center’s owner or operator by blood, marriage, or adoption:
▪ Medical services;
▪ Nursing services;
▪ Psychosocial services;
▪ Developmental education.
10 R.C. 3724.04(C).
11 R.C. 3724.09.
12 R.C. 3724.06.
13 R.C. 3724.01(C).
14 R.C. 3724.08(A).
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The center also may provide and deliver services to meet the caregiver training needs of
a medically dependent or technologically dependent child’s legal guardian.15
Services performed at the center but provided by other entities
A licensed center may allow for any of the following therapies, services, or supports to be
provided, for a part of the day, at the center: speech therapy; occupational therapy; physical
therapy; social work services; developmental services; child life services; psychological services;
and behavioral supports. In allowing for the foregoing therapies, services, and supports to be
provided at the center, the center may contract with another entity to provide them.16
Standards for operating a center
The bill establishes standards for operating a licensed prescribed pediatric extended care
center, including those that relate to the following topics.
Medical director duties
Once a medically dependent or technologically dependent child enrolls in a licensed
center and begins to receive its services, the child must remain under the care of a physician
other than the center’s medical director. But, the medical director, in consultation with the child’s
physician and parent or legal guardian, must develop a treatment plan that outlines the child’s
required therapeutic interventions and skilled nursing supervision.17
The bill requires the center’s medical director to be available either in person or by
electronic communication to consult with the center’s nurse manager or other nursing staff. And,
on at least a monthly basis, the medical director must review each child’s treatment plan and
medical records and must update the plan as necessary.18
Nurse duties
The bill requires a nurse manager, or nurse manager’s designee, to be present at the
center during its hours of operation.19 It also directs the nurse manager to coordinate the
implementation of a child’s treatment plan.
The bill specifies that a treatment plan’s interventions and skilled nursing are to be
administered by either a registered nurse employed by the center or a licensed practical nurse
also employed by the center and under the registered nurse’s direct supervision.20
Child-to-staff ratios
The bill sets the following medically dependent or technologically dependent child-to-
staff ratios:
15 R.C. 3724.06(A).
16 R.C. 3724.06(B).
17 R.C. 3724.08(B).
18 R.C. 3724.08(C).
19 R.C. 3724.07(B).
20 R.C. 3724.08(B).
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▪ When caring for not more than 12 children, two registered nurses;
▪ When caring for at least 13 but not more than 20 children, two registered nurses and one
licensed practical nurse;
▪ When caring for at least 21 but not more than 30 children, three registered nurses and
two licensed practical nurses.
For every 8 children added to the 30 children, the center must ensure that another
registered nurse is providing care, in addition to the other three registered nurses.21
Electronic medical records system
The bill requires the center to use an electronic medical records system to maintain
records relating to the medically dependent and technologically dependent children it enrolls.
The system must include the following records: daily assessments; medication lists; and reports
of medications administered, medication errors, and therapeutic interventions. The center is
required to ensure that the system allows for periodic audits and assists the center in
implementing internal compliance programs.22
Department of Health audits
The bill requires the center to assist the Department of Health in any audits it conducts
of the center, including those related to the center’s delivery of and billing for services.23
Director of Health rulemaking
The bill requires the Director of Health to adopt rules establishing standards and
procedures for the licensure and regulation of prescribed pediatric extended care centers. It also
authorizes the Director to adopt any other rules considered necessary to implement the bill’s
provisions.24 All rules must be adopted in accordance with Ohio’s Administrative Procedure Act.25
The required rules must establish or specify the following:
▪ License application and renewal procedures;
▪ Reasons for which the Department of Health may refuse to issue or renew, suspend, or
revoke a license or otherwise impose discipline on a license holder;
▪ Standards for providing and delivering, and for allowing for the provision of, services to
medically dependent or technologically dependent children, in particular, in a manner
that is family-centered while also individualized for each child and the child’s caregiver
and in a setting that is both integrated and inclusive;
21 R.C. 3724.07(A).
22 R.C. 3724.07(C).
23 R.C. 3724.07(D).
24 R.C. 3724.05(A).
25 R.C. 3724.05(B). See also R.C. Chapter 119, not in the bill.
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▪ Standards to ensure that a center’s conditions and physical surroundings are healthy,
safe, and sanitary;
▪ Minimum qualifications for employment as an operator, registered nurse, licensed
practical nurse, or other staff member as well as their training requirements;
▪ Methods for maintaining medical records, data, and other information relating to the
children and families receiving services;
▪ Standards and procedures for providing medical transportation services to and from
centers, including by ensuring that nursing support is available and prohibiting medical
transportation service providers who are related to center owners;
▪ Procedures and a timeline for conducting center inspections and audits.26
Medicaid coverage
The bill requires the Medicaid Director to seek approval from the federal Centers for
Medicare and Medicaid Services to cover services provided by licensed prescribed pediatric
extended care centers to medically dependent or technologically dependent children.27
To be eligible to receive Medicaid payments for those services, a center must hold a valid
license issued by the Director of Health as well as a valid Medicaid provider agreement.28
HISTORY
Action Date
Introduced 10-16-24
ANHB0676IN-135/sb
26 R.C. 3724.05(A).
27 R.C. 5164.27(B).
28 R.C. 5164.27(C).
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As Introduced