Recent COHCA Articles


Proposed Bill Would Require Payment …

Proposed Bill Would Require Payment Disclosures to Advanced Practice Nurses and Physician Assistants

A proposed bi…
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Bill would give Ohio nurses more latitude…

Bill would give Ohio nurses more latitude in treating patients

Request to buy this photoAdam Cairns | Dispatch S…
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Nursing Shortage Not as Dire as Previously…

Nursing Shortage Not as Dire as Previously Predicted

According to a recent study, although a nursing shortage is s…
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Partial Prescription Refill Bill to be…

Partial Prescription Refill Bill to be heard next week in Senate Medicaid Committee

Sub. H. B. No. 116
Brown, Gint…
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Interprofessional Legislative Update

HPU-LogoBy Lori Herf, MA

The Ohio General Assembly has dedicated much of the winter and spring months to budget (HB 59) deliberations. With the new state fiscal year beginning on July 1st, 2013, legislative leaders will focus most of their attention not only on the fiscal operations of the state of Ohio, but also on the many policy changes made as amendments to state budget provisions.

APRNs and Physician Assistants

Language was considered that would have allowed advanced practice nurses and physician assistants to admit patients to hospitals. That provision is now being considered independently of the budget as HB 139.


A number of pharmacy provisions remain part of the budget as well. One of the provisions would require that Medicaid managed care organiza-tions provide 90 days notice to pharmacies being terminated as a network provider and extends the notice to all types of health care providers. In the case of pharmacies, similarly the budget would require that 90 days advance notice be given regarding the removal of a prescribed drug from the formulary or preferred drug list used by the organization or administrator or any change in the terms governing access to the drug. The amendment that we are opposing in the budget which is HB 59 dealt with remote dispensing.

The amendment would have allowed a pharmacy that is licensed as a terminal distributor of dangerous drugs to use a remote drug dispensing system at a nursing home or residential care facility. The pharmacist would not be required to be physically present where the system is used to dispense the drugs. COHCA has strong concerns regarding this provision and asked legislators to remove the language from the budget bill. The Ohio Senate did remove the language from the substitute version of the bill; however the bill will be amended next week and then be considered by a conference committee that could reinsert the language into the final version of the bill.

Other Bills:

House Bill 44

To require the Director of Health to develop protocols regarding the authority to administer, deliver, distribute, or dispense drugs during certain public health emergencies. This is currently pending in

House Health and Aging Committee where it has received two hearings.

Requires the Director of Health to develop one or more protocols that authorize certain licensed health professionals to administer, deliver, or distribute drugs during a public health emergency; requires the Director to develop protocols as well that authorize pharmacists and pharmacy interns to dispense limited quantities of dangerous drugs without a prescription or record of a prescription during a public health emergency; and provides that an individual who administers, delivers, distributes or dispenses a drug or dangerous drug in accordance with one or more of those protocols is not liable for, nor subject to civil damages, criminal prosecution, or professional disciplinary action, unless the individual’s acts of omissions constitute willful, wanton misconduct.

House Bill 60

To require that rules governing maternity units, newborn care nurseries, and maternity homes include certain provisions pertaining to the authority to make decisions regarding the transfer of patients to other facilities and to specify procedures for granting variances or waivers of any requirement in the rules governing operation of such facilities.

Currently pending in House Health and Aging where it has received two hearings.

The bill codifies an administrative rule that authorizes the Director of Health to grant a variance from or waiver of any of the requirements of rules regarding the operation of a maternity unit, newborn care nursery, or maternity home; requires the Director to adopt rules regarding application forms to be used and procedures to be followed in applying for a variance or waiver; requires the Director to review all applications for variances and waivers and, not later than 90 days after receipt of an application, to determine whether to grant the variance or waiver and notify the applicant of the decision.

House Bill 83

To make 14 major changes to the law that gov-erns the practice of psychology. Heard in the House Health and Aging Committee; reported out of committee; passed the House 96-1; currently pending in the Senate Medicaid, Health and Hu-man Services Committee.

House Bill 94

To require a health insuring corporation, public employee benefit plan, or sickness and accident insurer to reimburse a board of health for any services provided to an individual by the board that is covered by a plan issued to the individual by the health insuring corporation, public employee benefit plan, or sickness and accident insurer upon request submitted by the Board of Health.

Currently pending in House Insurance Committee; has received two hearings.

House Bill 123

TELEHEALTH SERVICES (Gonzales, Wachtmann)
Regarding Medicaid and health insurance coverage of telehealth services.

Currently pending in House Health and Aging Committee where it has received two hearings.

The bill authorizes health care insurers to provide coverage of telehealth services provided by health care professionals and facilities, requires the Office of Medical Assistance to adopt rules establishing standards for Medicaid reimbursement of telehealth services provided by health care professionals and facilities; specifies that coverage of a telehealth service applies only if the service involves an immediate and direct interaction with a patient, is medically appropriate and necessary, and is provided by a licensed health care provider or facility; and requires that a health care provider seeking reimbursement for telehealth service maintain documentation of providing the service as part of the patient records the provider maintains.

House Bill 131

TANNING REGULATIONS (Johnson, Stinziano)
To regulate chemical tanning and prohibit tanning facilities from allowing the use of sun lamps by certain individuals under 18 years of age.

Currently pending in House Health and Aging Committee where it has received three hearings.

Prohibits an operator or employee of a tanning facility from allowing an individual under age 18 to use the facility’s fluorescent sun lamp tanning services unless the individual presents a prescription issued by a physician; and requires the State Board of Cosmetology to regulate chemical tanning facilities.

House Bill 139

To permit certain advanced practice registered nurses and physician assistants to admit patients to hospitals.

Currently pending in House Health and Aging Committee where it has received two hearings.

Current law allows only physicians, dentists and podiatrists who are members of the medical staff to admit patients to hospitals. The bill would add clinical nurse specialists, certified nurse midwives and certified nurse practitioners who have a standard care arrangement with a physician or podiatrist who is a member of the medical staff. The bill would also allow physician’s assistants, under the supervision, control or direction of a physician or podiatrist who is a member of the medical staff, to admit patients to hospitals. The bill also would require the APRN or PA to notify the collaborating or supervising physician or podiatrist not later than 12 hours after admitting a patient to a hospital.

House Bill 147

To require a surgeon performing a mastectomy, lymph node dissection, or lumpectomy in a hospital to guide the patient and provide referrals in accordance with the standards of the National Accreditation Program for Breast Centers and to name this act the Lizzie B. Byrd Act.”

Currently pending in the House Health and Aging Committee where it has had two hearings.

The bill, in addition to the above would require the sur-geon performing a mastectomy or lumpectomy to refer a patient if breast reconstruction is appropriate, and requires the surgeon to offer the patient a preoperative referral to a reconstructive or plastic surgeon in accordance with NAPBC standards.

House Bill 159

DENTAL SERVICES (Hacket, Schuring)
To prohibit a health insurer from establishing a fee schedule for dental providers for services that are not covered by any contract or participating provider agreement between the health insurer and the dental provider.

Currently the bill is pending in the House Insurance Committee where it has had one hearing.

Prohibits a contracting entity from requiring a dental provider to provide services to plan enrollees at a fee set by or subject to approval by the contracting entity unless certain circumstances are met; makes setting or requiring the insurer’s approval of fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances are met; and makes the offering of a health benefit plan that sets fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances apply.

House Bill 165

Exempts certified hyperbaric technologists from the laws governing the practice of respiratory care.

Currently pending in the House Health and Aging Committee. Has not been heard.

House Bill 170

DRUG OVERDOSES (Johnson, Stinziano)
To provide that a licensed health professional authorized to prescribe naloxone, if acting with reasonable care, may prescribe, administer, dispense or furnish naloxone to a person who is, or a person who is in a position to assist a person who is, apparently experiencing or who is likely to experience an opioid-related overdose without being subject to administrative action or criminal prosecution, to provide that a person who is in a position to assist a person who is apparently experiencing or who is likely to experience an opiod-related overdose is not subject to actions of professional licensing boards, administrative action, or criminal prosecution for a drug offense or practicing medicine without a license if the person acting in good faith, obtains naloxone prescription from a licensed health professional and administers it to a person for an opioid-related overdose, and to provide that peace officers and licensed emergency responders who are acting in good faith are not subject to administrative action or criminal prosecution for a drug offense or practicing medicine without a license for administering naloxone to a person who is apparently experiencing an opioid-related overdose.

Currently pending in the House Health and Aging Committee. It has not yet been heard by the committee.

Senate Bill 4

NEWBORN SCREENINGS (Manning, Oelslager)
To require a pulse oximetry screening for each newborn born in a hospital or freestanding birthing center.

Received two hearings in Senate Medicaid, Health and Human Services Committee, reported out of Committee; passed the Senate 33-0; referred to House Health and Aging Committee where it has received 5 hearings.

Requires hospitals and freestanding birthing centers to conduct a pulse oximetry screening on each newborn (unless a parent objects on religious grounds) for purposes of detecting critical congenital health defects; requires the Director of Health to adopt rules establishing standards and procedures for the pulse oximetry screenings.

Senate Bill 43

Makes a number of changes to the laws governing the civil commitment of and treatment provided to mentally ill persons.

Currently pending in Senate Criminal Justice Committee. It has received one hearing.

Senate Bill 99

CANCER MEDICATIONS (Oelslager, Tavares)
Regarding insurance coverage for rarely administered cancer medications.

Pending in Senate Insurance and Financial Institutions Committee where it has not received a hearing.

Neurosurgery Physician Assistant at Akron Children’s

Combines the Best of Care and Cure

Holly Zeller, PA-C sits down with Julie Tsirambidis, CNP to go over privilege delineation forms at Akron Children’s Hospital.  This is one of their many overlapping moments where NP and PA practice comes together.  Becoming more frequent is this visibility- that NPs and PAs sit side by side with their physician counterparts to enhance patient care.  After years of working in silos, these disciplines agree the time to work together is long overdue.  Hence, the Center for Advanced Practice at Akron Children’s Hospital was formed in April 2011.  The goals are vast, but include the practice and regulatory oversight of APNs and PAs, on boarding programs, and integration with medical staff leadership to name but a few.

Zeller, who is a board certified physician assistant, works in partnership with Dr. Roger Hudgins, director of the Division of Neurosurgery at Children’s Hospital.  When she is not examining patients during office hours, Holly assists Hudgins in the operating room and shares on-call duties with him for after-hours emergencies.  Additionally, on a daily basis, Zeller rounds on all inpatients, formulates plans of care, interprets imaging, triages new patient referrals, and completes various types of different procedures in the NICU, PICU, patient floors and ER.  At the end of each day, all “Mommy Call” questions which have accumulated throughout the day are addressed by calling the parent of the patient back to address their questions. “Every day is a little bit different,” she says.  Zeller, 44, of Richfield,Ohio, is one of now 18 physician assistants (PAs) who work all across Akron Children’s Hospital.  There are over 150 advanced practice providers at Akron Children’s with a director leading the way.  The center actually oversees and brings together Advanced Practice Nurses (CRNA, CNP, and CNS) and Physician Assistants under one umbrella.  The director, Julie Tsirambidis, CNP, truly believes this is the way of the future.  “We have more in common that we have separate.  Coming together to promote our professional needs, despite our regulatory difference truly sets us apart, and brings improved understanding to our patients, families, and hospital staff.”  “Many years ago, MDs and DOs, would not even work together in the same hospital, and see how far they have come- this journey is a similar beginning, in my opinion.” Tsirambidis said.

As part of their master’s degree program, PAs can elect a surgical track that prepares them to work in the operating room.   After college, Zeller worked in the pharmaceutical field before taking a break to stay home with her children.  When she decided to return to work, she wanted a job in the medical field but didn’t want to travel anymore.  She embarked upon graduate school education and completed the PA program.  The PA education is very similar to that of the medical school model.

Zeller initially practiced with the congenital heart surgical team at Rainbow Babies and Children’s Hospital inClevelandbefore joining Akron.  When Dr. Hudgins joined Children’s two years ago, he requested a PA for his team.  He has especially relied on Zeller to share the patient load since the death this summer of the hospital’s only other neurosurgeon, Dr. Henry Bartkowski.  When Dr. Bartkowski became ill, Dr. Hudgins and Zeller formulated a plan to continue the quality care provided to the neurosurgery patients, by trying to split the evening and weekend call, thus allowing the other some “off time.” The two divide and conquer on office days, with each visiting patients and talking with families.  They frequently huddle to compare notes and examine patients’ images and other test results.  Zeller will assist in the OR on surgery days, and often performs the closing procedures.  This teamwork allows Hudgins to dictate this post-operative notes and get ready for the next patient while Zeller finishes the procedures.  “It really becomes a seamless way for getting a lot more work done than you could by yourself, plus the families love her,” Hudgins said

For information, or to join our neurosurgery team, check us out at

COHCA On Facebook

Ohio Board of Nursing releases rules update

November 24, 2015 Rules Hearing Update
On November 19, 2015, the Board of Nursing held a public rules hearing to review proposed administrative rule language. Prior to and during the hearing, the Board received comments from interested parties. The Board reviewed the comments and hearing testimony on November 20, 2015, during the public Board meeting. Following consideration of testimony at the public hearing, the Board refiled rules on November 24, 2015 as follows:

1. Rule 4723-8-04: Amended paragraph (C)(7)(a) of the Rule to state that the standard care arrangement shall be reviewed "every two years" and on an "biennial" basis; and to amend paragraph (E) to require the standard care arrangement to be retained "three" years rather than "six".

2. Rule 4723-8-05: Amend paragraph (B) of the rule to state that the standard care arrangement shall be reviewed "every two years" consistent with the proposed change discussed above regarding Rule 4723-8-04(C)(7)(a); and to amend paragraph (F) to require an APRN to verify the licensure of the collaborating physician or podiatrist "every two years" rather than annually as required currently.

3. Rule 4723-9-10: Since at least 2002, the Rule has required the Committee on Prescriptive Governance (CPG) to review the Formulary at least once per year. Historically (since 2008), the CPG has met on average 3-4 times per year. The Rule was refiled so that paragraph (B) now states that the CPG shall review the Formulary at least "twice" per year instead of "once".

A link to the copies of the three refiled rules may be found below.

All of the Rules subject to hearing on November 19 are anticipated to be effective February 1, 2016.

For questions regarding administrative rules, please email:
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4 days ago  ·  

Pharmacist Consult Bill Reported out of Senate Committee

HB188 PHARMACIST CONSULT AGREEMENTS (Manning N) To revise the laws governing pharmacist consult agreements and the laws governing the circumstances under which a pharmacist may dispense or sell a drug without a prescription.
HB188 was unanimously reported out by all members present as amended.

Two amendments were accepted without objection. One, offered by Sen. Hite, would change a number of requirements for telemedicine prescribing rules. The other, offered by Sen. Oelslager, would make a number of changes to registered nurse (RN) and limited practice nurse (LPN) license renewal procedures and timelines.

There were no witnesses.
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1 week ago  ·  

Dr. Shah is the CEO of MyMeds (, a digital health company whose medication adherence platform engages patients, physicians and pharmacists to work together.
Technology is disrupting consumer industries across the globe. In healthcare, technology is being used to improve systems, but the new disruption will be driven by people – patients and pharmacists. Like never before, patients are demanding consumer technologies to help them become more engaged on their changing health care team. The new team brings pharmacists off the bench and puts them in a starring role to help solve one of healthcare’s biggest issues – the $300 billion problem of medication non-adherence (not taking medicines properly).

Dr. Shah is the CEO of MyMeds and a Board-certified nephrologist who practices in Minneapolis. Combining his front-line experience of understanding the multiple roles (patient, provider, entrepreneur) in a rapidly-changing health environment, and his dedication to implementing digital health IT to improve health outcomes, Dr. Shah provides a unique perspective on innovation in healthcare today. He received his M.D. from the University of Minnesota Medical School, and attended Boston University, from where he graduated with a B.A. in Cognitive Psychology with a focus on memory creation. This provided the foundation on which the MyMeds adherence platform was created to improve medication-taking behaviors. He has been recognized for his work in business, medicine and philanthropy with the Virginia McKnight Binger Award in Human Service, 40 Under 40, Ten Outstanding Young Minnesotans, and Real Power.
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2 weeks ago  ·  

Proposed Bill Would Require Payment Disclosures to Advanced Practice Nurses and Physician Assistants

A proposed bill will require pharmaceutical companies and medical device manufacturers to disclose payments made to advance practice nurses and physician assistants for consulting, promotional talks, meals and other interactions. The Physician Payment Sunshine Act already requires companies to report these types of payments to doctors, dentists, chiropractors, optometrists and podiatrists, but the current law does not include payments made to nurses with advanced degrees or physician assistants, all of whom can prescribe medications. The proposed bill will expand the disclosure requirements to include physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives. If passed, the new legislation will be effective in 2017.
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1 month ago  ·  

Bill would give Ohio nurses more latitude in treating patients

Request to buy this photoAdam Cairns | Dispatch State Rep. Dorothy Pelanda, right, comments about the physical weight of House Bill 216, which she is sponsoring, while talking with Candy Rinehart, head of Ohio State University’s College of Nursing.
By Misti Crane The Columbus Dispatch • Monday October 26, 2015 5:12 AM
Nurse practitioners and other advanced-practice nurses say Ohio law makes it harder for them to do their jobs well and is forcing talent to states where they can practice without physician oversight and other challenges.
Lawmakers are expected to begin hearings in January on a sweeping “modernization” bill introduced this year by Rep. Dorothy Pelanda, a Marysville Republican.
On Wednesday, advanced-practice nurses chatted with her and lobbied her colleagues.
Although legislative wrangling over the bill is months off, interest groups already are formulating their arguments and looking for ways to temper a proposal that would free the nurses from having to enter into formal agreements with physicians.
The Ohio State Medical Association, which represents doctors, has called the proposal unreasonable, alarming and dangerous and argues that a team approach works well and leads to optimal patient care.
The group says the bill would erode protections against prescription drug abuse and fragment health care. It also stresses that doctors are better-educated and have deeper medical knowledge.
The nurses say they’re already making their own decisions in patient care and shouldn’t have to pay a physician as much as $25,000 a year for oversight that can amount to little actual collaboration or advice.
Furthermore, they say, those arrangements can be hard to find in Ohio, prompting good nurses to leave for states where oversight is not required.
Advanced-practice nurses routinely collaborate with doctors and other nurses when they’re looking for advice or feedback, and that won’t change if the law changes, said Christine Williams, a nurse practitioner in Cleveland and director of full practice authority and reimbursement for the Ohio Association of Advanced Practice Nurses.
Advanced-practice nurses include nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists and certified nurse midwives.
In Ohio, about 4,600 nurses graduate from advanced-degree programs every year and about 12,000 practice in the state, said Lori Chovanak, CEO of the Ohio Nurses Association and a nurse practitioner.
Freeing nurses to operate independently would help keep more of them here and help remove barriers to primary care that many Ohioans face, she said. Better access to primary care means healthier patients, fewer emergency visits and lower health-care costs.
“Ohio has some of the most stringent laws surrounding practice for nurse practitioners. We’re doing a good job of educating them, and then they leave the state to go practice in a state where they can confidently take care of patients and not rely on a physician’s signature,” Chovanak said.
Nurse practitioners have that ability in 21 states and the District of Columbia.
Twenty-six states allow certified nurse midwives to practice without physician oversight and 33 states allow independent nurse anesthetists.
A 2010 study paid for by the American Association of Nurse Anesthetists analyzed Medicare data from 1999 and 2005 and found no evidence that nurse anesthetists who work without physician oversight resulted in an increase in deaths or complications.
But members of the Ohio State Medical Association say the relationship with a physician is critical because doctors receive more training.
That education better prepares an anesthesiologist to figure out the root cause of a complication — such as rocketing blood pressure — and respond appropriately, said Dr. Erica Stein, an anesthesiologist at Ohio State University’s Wexner Medical Center.
Stein said she values the professional strengths of the nurse anesthetists she works with at Ohio State’s Ross Heart Hospital, but she said her role in that relationship is important because she’s better prepared to understand the complex interplay between health problems and medications.
Cathy Hoffman, a nurse anesthetist who practices in southeastern Ohio, said she collaborates with the entire surgical team when she cares for patients. If a heart-rhythm problem arises, for example, “I’m going to call the cardiologist, just like the anesthesiologist would,” she said.
Nurse anesthetists don’t have the same type of practice agreements with individual physicians that nurse practitioners do, but they have limits on their practice that would be erased with this proposed law, said Hoffman, spokeswoman for the Ohio Association of Advanced Practice Nurses.
That includes not being able to order post-surgical pain or anti-nausea drugs that she herself doesn’t administer, which serves as an obstacle to better, more expedient care for her patients, Hoffman said.
Monica Hueckel, director of government affairs for the medical association, said although her group hasn’t seen any data showing poor outcomes for patients treated by independent advanced-practice nurses in other states, it doesn’t want to wait to see what bad things could happen here.
The association is eager to work with the nurses on compromises to the legislation, she said.
Pelanda said her bill likely will change before a House committee takes it up next year.
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1 month ago  ·  


Health Care Professions…


COHCA – Partnering

in Patient Care

COHCA, a interprofessional group, are partners in patient care: better care, lower costs, a partnership that will help improve the quality, safety, and affordability of health care for all Ohioans. Nationally, healthcare initiatives are fostering partnerships in patient care.


COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST SUSTAINING ORGANIZATIONAL SPONSOR - Cleveland Clinic's Zielony Nursing Institute

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…


COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST PLATINUM ORGANIZATIONAL SPONSOR - The Southern Ohio Chapter of the American College of Nurse-Midwives 

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA PLATINUM ORGANIZATIONAL SPONSOR - Ohio Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP)


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