Recent COHCA Articles

Issue 2

Issue 2 – Why This is Not a Good Proposition for Ohio
Issue 2  is slated for a vote on the November 2017 ballot. …
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Important Dues Process Update

At our most recent board meeting in Columbus, there was a discussion regarding… |read more|…
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2nd Ohio Pharmacy Advocacy Forum

Ohio College of Clinical Pharmacy, Ohio Colleges of Pharmacy
and Council for Ohio Health Care Advocacy
In colla…
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ZIKA VIRUS

ZIKA VIRUS
Zika virus disease (Zika) is a disease caused by Zika virus that is spread to people primarily through …
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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.

Pharmacists

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

HEALTH EMERGENCIES (McClain)
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

MATERNITY UNITS (Huffman)
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

PSYCHOLOGY LAWS (Hackett)
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

HEALTH PLANS (Gonzales)
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

HOSPITAL ADMISSIONS (Gonzales)
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

MASTECTOMY GUIDANCE (Patmon, Wachtmann)
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

HYPERBARIC TECHNOLOGISTS (Roegner)
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

CIVIL COMMITMENT (Burke)
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

https://www.akronchildrens.org/cms/careers/index.html

President’s Message

A message from our President.

At our most recent board meeting in Columbus, there was a discussion regarding…

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Pharmacist FAQ: New Limits on Prescription Opioids for Acute Pain

Updated 8/17/2017

Effective August 31, 2017, the State of Ohio will have new rules for prescribing opioid analgesics for the treatment of acute pain. Please be advised, these rules DO NOT apply to the use of opioids for the treatment of chronic pain.
In general, the rules limit the prescribing of opioid analgesics for acute pain, as follows:
1. No more than seven days of opioids can be prescribed for adults.
2. No more than five days of opioids can be prescribed for minors and only after the written consent of the parent or guardian is obtained.
3. Health care providers may prescribe opioids in excess of the day supply limits only if they provide a specific reason in the patient’s medical record.
4. Except as provided for in the rules, the total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day.
5. The new limits do not apply to opioids prescribed for cancer, palliative care, end-of-life/hospice care or medication-assisted treatment for addiction.
6. The rules apply to the first opioid analgesic prescription for the treatment of an episode of acute pain.
NOTE: The rules do not apply to veterinarians.
A guidance document and links to the rules for prescribers can be accessed here: www.pharmacy.ohio.gov/AcuteLimits
Rule 4729-5-30 – Manner of Issuance
▪ Starting December 29, 2017, rule 4729-5-30 will require prescribers to include the first four characters (ex. M16.5) of the diagnosis code (ICD-10) or the full procedure code (Current Dental Terminology – CDT) on all opioid prescriptions, which will then be entered by the pharmacy into OARRS. See MoreSee Less

3 months ago  ·  

House Votes to Override 11 Vetoes, Including MCO Tax Replacement; Medicaid Freeze Not Included

The fate of the Medicaid expansion enrollment freeze remains up in the air after the House took up veto overrides Thursday.

The House voted to override 11 of Gov. John Kasich’s 47 line-item vetoes in the biennial budget bill (HB 49), but the most watched item was not among them.

Instead, the chamber, led by a Republican supermajority, voted 87-10 to override the governor’s veto of the Medicaid managed care sales tax replacement plan alongside several other Medicaid provisions.

The provision to cut off new enrollment in the Medicaid expansion group on July 1, 2018 drew significant pushback from a variety of groups.

Speaker Cliff Rosenberger said the House’s lack of action on the Medicaid expansion freeze “does not mean we will not come back in the fall and take that back up.”

The Clarksville Republican said House Republicans are in a wait-and-see approach as efforts to repeal and replace the Affordable Care Act at the federal level work their way through Congress.

“At this juncture, we want to give the summer to allow the federal government to see if they are going to come to a conclusion in Congress before we take action on moving forward with the freeze waiver request,” he told reporters after session.

If House Republicans feel the need to override the governor’s veto later in the year, Mr. Rosenberger said he has the votes to do so.

The House designated all vetoes that were not overridden as pending. The legislature has the entirety of the current two-year session to act on the vetoes. The session ends on December 31, 2018.

The legislative rebuff of the governor’s changes to the budget marked the first time the House has voted to override multiple vetoes from a governor in forty years. ) The overrides prompted stern criticism from Gov. Kasich and warnings from administration officials who spoke afterward of their consequences. (See separate story)

Rep. Bill Seitz (R-Cincinnati) said during a floor speech that the governor’s plan for the MCO tax replacement would force counties and transit authorities to lose revenue. He said the legislature’s plan is to ask the federal government for permission to adjust rates for six years in order to help local governments transition away from the revenue.

“Why six years? They enjoyed the revenue for six years. They should enjoy it for another six years,” he said.

He said the legislature’s plan is a partial replacement and is subject to the federal Centers for Medicare and Medicaid Services approval.

Minority Leader Fred Strahorn (D-Dayton) urged support for overriding that veto, saying he feels fairly confident that there is little risk that, as the administration has warned, the request would jeopardize the current replacement plan and put hundreds of millions of dollars in Medicaid funding at risk.

The House voted 66-31 to override an item (Veto #3) limiting the amount of money the Controlling Board can appropriate.

Rep. Ryan Smith (R-Bidwell) said both chambers settled on a limit of half of a percent of GRF, about $165 million, for which the board can expend in funds not already appropriated.

Rep. Jack Cera (D-Bellaire) urged a vote against it, saying it is intended to target Medicaid expansion.

Another item (#23) the House voted 66-31 to override was one dealing with Medicaid coverage of optional eligibility groups. Rep. Smith said the legislature has no controls over who is eligible for Medicaid, and that the General Assembly needs that authority.

Rep. Emilia Sykes (D-Akron) asked members to vote against it, saying the state should ensure it can cover optional groups.

The House also voted 66-31 to override the veto of a provision it added to the budget (#25) that would give the Joint Medicaid Oversight Committee authority to oversee any increase in Medicaid rates.

Rep. Steve Huffman (R-Tipp City) said it would form a partnership between the House, Senate, Medicaid and the governor in setting rates.

Rep. Sykes said JMOC already works to control the cost of Medicaid, and that the provision would create more bureaucracy in the rate-setting process.

The chamber voted 97-0 to override a veto (#26) of a provision regarding Medicaid rates for neonatal and newborn services. That provision, Rep. Mark Romanchuk (R-Mansfield) said, would increase rates for providers who deal with unborn and newborn children.

The House voted 96-1 to override a veto (#27) of a provision dealing with Medicaid rates for nursing facilities. Rep. Seitz said the House chose to keep rates for skilled nursing facilities in statute and raise the rates for them.

“I do not see how we improve the quality of care for our grandmas and grandpas by cutting the rates for those who care for them in their last moments,” Rep. Seitz said.

The House voted 95-2 to override a veto (#30) of the legislature’s plan to delay the movement of Medicaid long-term care services into managed care. Rep. Tom Patton (R-Strongsville) said the governor’s effort to move the services to managed care without legislative authority is an effort to wrest authority from the legislature.

Rep. Nickie Antonio (D-Lakewood) urged support for override, saying the move to MLTSS should be properly vetted.

The chamber voted 95-2 to override a veto (#31) of a provision that would delay the addition of behavioral health services to managed care, part of the behavioral health redesign, until July 1, 2018. The legislature and the administration have both agreed on delaying new codes for behavioral health until Jan. 1.

Rep. Smith said the delay is important to avoid significant problems for the state’s behavioral health providers.

The House voted 66-31 to override a veto (#34) of a provision giving the legislature, not the Controlling Board more authority over the spending of funding for state Medicaid funding if the matching rate from the federal government changes.

The House also voted 66-31 to override a veto (#36) of a provision requiring the administration to again seek a waiver for the Healthy Ohio Medicaid program, which would require certain enrollees to pay into a modified health savings account.

“It actually provides skin in the game for healthy outcomes and provides a way to help people up and off of Medicaid,” Rep. Jim Butler (R-Oakwood) said.

Rep. Sykes spoke out against the override, saying much of the cost savings from similar programs has come from people who could not make the required payments and who were removed from the Medicaid program.

“It will create a less-healthy Ohio because it would create more people with less health care,” she said.

From Gongwer News Service See MoreSee Less

5 months ago  ·  

Ohio House of Representatives votes to override to override 11 of Governor Kasich’s 47 line-item vetoes in state operating budget

Notably missing from the list of 11 veto overrides today in the Ohio House was one that would have imposed a freeze on new enrollment in the Medicaid expansion group on July 1, 2018.
The house override marks the first time the House has voted to override multiple vetoes from a governor in 40 years.

Veto overrides of interest to providers include the following:

Governor Kasich’s plan to replace the MCO tax.
The house plan in place of the language would be to ask the federal government for permission to adjust rates for six years to allow local governments additional time to transition away from the revenue source used for transit projects. The vote to override the veto was bipartisan.

Limit on the amount of money that the Controlling board can appropriate.
Opponents of the language claim that the limit is meant to target Medicaid expansion.

Medicaid coverage of optional eligilbility groups.
Chaiman Ryan Smith argued for the veto override saying that the legislature needs to control who is eligible for Medicaid and that by overriding the veto, the legislature would have that authority. The vote was 65-30 with most democrats opposing the override effort.

Joint Medicaid Oversight Committee authority to oversee any increase in Medicaid rates.
The house voted 66-30 to override the veto of a provision it added to the budget that would give the Joint Medicaid Oversight Committee authority to oversee any increase in Medicaid rates.

Neonatal and Newborn Services. Unanimously the house voted to override the veto of a provision that would increase rates for providers who deal with unborn and newborn children.

Medicaid Rates for Nursing Facilities. This override was almost unanimous with one dissenting vote. The override would keep rates for skilled nursing facilities in statute and raise the rates for them.

Delay in the movement of Medicaid long-term case services into managed care. The almost unanimous vote, 95-2 would block the governor’s effort to move long-term care to Medicaid Managed Care without authority to do so given by the legislature.

Delay the the the addition of behavioral health services to managed care, part of the behavioral health redesign. Spefically the vetoed language would delay implementation until July 1, 1018. The vote was bipartisan, 95-2.

Language giving the legislature, not the Cotrolling Board, more authority over spending of funds for state Medicaid funding if the matching rate from the federal government changes.

Healthy Ohio language that would require the administration to again seek a waiver for Healthy Ohio Medicaid program, which would require certain enrollees to pay into a modified health savings account. The vote was 66-30.

It is important to note that the house may decide to override additional governor’s vetoes any time between today and December 31, 2018. The senate has not convened to override any of the 47 vetoes. They may do so up through December 31st 2018 as well. Vetoes overrides on each item in both chambers is required. See MoreSee Less

5 months ago  ·  

Alert

CNPs, CNSs, CNMs: Be Prepared to Upload a List of Collaborating Physicians When You Renew

Section 4723.42(B)(3), ORC, requires that CNPs, CNSs, and CNMs report their current collaborating physicians or podiatrists at the time they renew. CNPs, CNSs, and CNMs must upload a list of the “names and business addresses” of their current collaborating physicians and podiatrists to complete the COA renewal/APRN license issuance process.

There is no required form to use for this reporting requirement. Please upload a list of the names and business addresses of your current collaborating physicians and podiatrists in a legible format.

If you do not have a current collaborating physician or podiatrist, upload a document stating that you have no current collaborating physician or podiatrist and no standard care arrangement at the time of renewal.

Please note that current law requires you to update your current collaborating physicians or podiatrists within 30 days of any addition or deletion. There is an exception in the event of a collaborating physician or podiatrist’s death. See Section 4723.431(A) and (E)(2), ORC. See MoreSee Less

6 months 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’S FIRST GOLD SPONSOR AND A FOUNDING MEMBER - Dr. Jeri Milstead PhD, RN, NEA-BC, FAAN 

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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