As Introduced

136th General Assembly

Regular Session H. B. No. 535

2025-2026

Representative Lorenz

To amend sections 3727.50, 3727.51, 3727.52, 3727.54, 3727.55, and 3727.56; to enact new section 3727.53 and section 4123.293; and to repeal section 3727.53 of the Revised Code to revise the law governing hospital-wide nursing care committees and hospital nursing services staffing plans.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 3727.50, 3727.51, 3727.52, 3727.54, 3727.55, and 3727.56 be amended and new section 3727.53 and section 4123.293 of the Revised Code be enacted to read as follows:

Sec. 3727.50. As used in this section and sections 3727.51 to 3727.57 of the Revised Code:

(A) "Direct patient care" means care provided by a nurse with direct responsibility to carry out medical regimens or nursing care for one or more patients.

(B) "Hospital" means a facility or institution licensed under Chapter 3722. of the Revised Code.

(B) "Hospital administrator" means an individual who is both of the following:

(1) Employed by or under contract with a hospital in an executive, managerial, or supervisory capacity;

(2) Authorized by the hospital to direct, discipline, evaluate, fire, or hire nursing staff or to establish one or more hospital-wide policies affecting nursing practice, staffing levels, or patient care operations.

"Hospital administrator" includes a hospital's chief executive officer, chief nursing officer, or chief operating officer, the director of a hospital department, or the manager of a hospital unit.

(C) "Inpatient care unit" means a hospital unit, including an operating room or other inpatient care area, in which nursing care is provided to patients who have been admitted to the hospital.

(C) "Nurse" means a person who is licensed to practice as a registered nurse under Chapter 4723. of the Revised Code or, if the hospital employs licensed practical nurses, a person who is licensed to practice as a licensed practical nurse under that chapter.

(D) "Licensed practical nurse" and "registered nurse" have the same meanings as in section 4723.01 of the Revised Code.

(E) "Unit-specific minimum staffing level" means the minimum number of registered nurses and licensed practical nurses assigned to provide direct patient care in a specific inpatient care unit of a hospital during an employment shift.

Sec. 3727.51. (A) Each hospital shall convene a hospital-wide nursing care committee not Not later than ninety days after the effective date of this section or, if the hospital is not treating patients on the effective date of this section, ninety days after the hospital begins to treat patientsamendment, each hospital shall convene a hospital-wide nursing care committee. The In the case of a hospital that begins operation after the effective date of this amendment, the hospital shall convene such a committee not later than ninety days after the hospital begins operation.

The hospital shall select the members of the committee, subject to all of the following:

(1) The hospital's chief nursing officer shall be included as a member of the committee and other hospital administrators also may be included as members, but only if the total number of hospital administrator members does not exceed thirty per cent of the committee's membership.

(2) At Subject to division (B) of this section, at least fifty fifty-one per cent of the committee's membership shall consist of registered nurses who provide direct patient care in the hospital.

(3) The number of registered nurses included as members of the committee shall be sufficient to provide adequate representation of all types of nursing care services provided in the hospital.

(B) The committee member who is the hospital's chief nursing officer shall establish a mechanism for obtaining input from nurses in all inpatient care units who provide direct patient care regarding what the nursing services staffing plan recommendations described in division (B) of section 3727.52 of the Revised Code should includeIn the case of a hospital that has bargained collectively with the registered nurses who are employed by or under contract with the hospital, the hospital shall not select all of the members of the committee described in division (A)(2) of this section. In such a case, the collective bargaining representative for the hospital's registered nurses shall select a majority of the members described in division (A)(2) of this section, with the hospital being responsible for selecting the remainder of those members.

Sec. 3727.52. A (A) Not later than ninety days after a hospital-wide nursing care committee is convened pursuant to section 3727.51 of the Revised Code, and then every two years thereafter, the hospital-wide nursing care committee shall do both all of the following:

(A) If one exists, evaluate the hospital's current (1) Review the hospital's nursing services staffing plan in effect at the time of the review;

(B) Recommend a nursing services staffing plan that is, at a minimum, consistent with current standards established by private accreditation organizations or governmental entities and addresses (2) Consider all of the following factors related to nursing services staffing:

(1)(a) The selection, implementation, and evaluation of minimum staffing levels that ensure, for all inpatient care units that ensure, that the hospital has a staff of competent nurses with the specialized skills needed to meet patient needs in accordance with evidence-based safe nurse staffing standards;

(2)(b) The complexity of complete care,; the requirements for assessment of patients on patient admission,; the volume of patient admissions, discharges, and transfers,; the evaluation of the progress of a patient's problems,; and the amount of time needed for patient education, ongoing physical patient assessments, planning for a patient's discharge, assessment after a change in patient condition, and assessment of the need for patient referrals;

(3)(c) Patient acuity and the number of patients for whom care is being provided;

(4)(d) The need for ongoing assessments of a unit's patients and its nursing staff levels relative to its patients;

(5)(e) The hospital's policy for identifying additional nurses who can provide direct patient care when patients' unexpected needs exceed the planned workload for direct care staff.

(3) Following the review of a nursing services staffing plan under division (A)(1) of this section, develop a replacement plan that establishes for a two-year period unit-specific minimum staffing levels for each inpatient care unit, ensuring that the hospital has a staff of competent nurses with the specialized skills needed to meet patient needs in accordance with evidence-based safe nurse staffing standards.

(B) In developing one or more nursing services staffing plans under this section, in particular such a plan's unit-specific minimum staffing levels, the hospital-wide nursing care committee shall express those minimum staffing levels in either of the following terms:

(1) A fixed nurse-to-patient ratio;

(2) A ratio range that specifies a permissible minimum and maximum number of patients per nurse, provided that such a range ensures safe patient care and meets evidence-based safe nurse staffing standards.

(C) As soon as practicable after the development of a nursing services staffing plan, the hospital-wide nursing care committee shall hold a vote to determine if the committee should approve the plan. Such a plan may be approved only by a majority vote of the committee.

Sec. 3727.53. (A) Except as provided in division (B) of this section, as soon as practicable after a hospital-wide nursing care committee develops and approves a nursing services staffing plan under section 3727.52 of the Revised Code, the hospital shall adopt and implement the staffing plan for the two-year period that begins on the date of the plan's adoption.

(B) Subject to division (C) of this section, during the two-year period in which a nursing services staffing plan is in effect, a hospital may adjust the plan's unit-specific minimum staffing levels, but only in either the following circumstances:

(1) When patient care needs exceed the plan's unit-specific minimum staffing levels, but only if staffing levels are adjusted with the assistance of the model identified in section 3727.55 of the Revised Code and the patient acuity assessment tool adopted under that section;

(2) When a public health emergency has been declared for a time period not exceeding ninety days, for the geographic area in which the hospital is located, and in response to a health threat that poses a significant risk to the area's population.

(C) Any adjustment to the nursing staffing services plan as described in division (B) of this section takes effect only on approval by a majority vote of the hospital-wide nursing care committee.

(D) A hospital shall file with the department of health a nursing services staffing plan in accordance with the following schedule:

(1) Not later than thirty days after any such plan is adopted under division (A) of this section;

(2) Not later than thirty days after an adjusted plan is approved under division (C) of this section.

(E) Each calendar quarter, a hospital shall make a prompt and diligent effort to adhere to its nursing services staffing plan at least eighty per cent of the time in each inpatient unit, except that during a public health emergency as described in division (B)(2) of this section, a hospital shall make a prompt and diligent effort to adhere to its nursing services staffing plan at least sixty per cent of the time in each hospital unit.

(F)(1) A hospital shall submit to the department of health on a quarterly basis compliance reports for the hospital. Each report shall include the following information: compliance rates organized by unit-level; approved variances; and a summary of corrective actions taken when the percentages described in division (E) of this section were not met.

(2) Before a report is submitted under division (F)(1) of this section, the report shall be certified by the hospital's chief nursing officer and a direct care nurse who serves as a co-chairperson for the hospital's hospital-wide nursing care committee.

(3) Not later than thirty days after receiving a compliance report submitted under division (F)(1) of this section, the department of health shall make the report publicly available on the internet web site maintained by the department.

(4) When making reports publicly available under division (F)(3) of this section, the department shall use a format that is accessible to the public and searchable by hospital name, location, and reporting period. The department also shall ensure that such reports include the information described in division (F)(1) of this section.

(G) The department of health may audit a hospital if either of the following circumstances occurs:

(1) A compliance report submitted by a hospital as required by division (F) of this section indicates that the hospital's compliance rate for any unit falls below the percentages described in division (E) of this section;

(2) The department receives three or more complaints about the hospital's compliance rates that the department determines are credible and substantiated.

(H) If the department of health determines that a hospital has not made a prompt and diligent effort to adhere to the hospital's nursing services staffing plan at the percentages described in division (E) of this section, the department shall assess a fine on the hospital in an amount that is equal to five times the average hourly wage for each hour of staffing under the staffing percentages. The department shall deposit any fines collected under this division to the credit of the nurse education grant program fund created under section 4723.063 of the Revised Code.

Sec. 3727.54. (A) At least once every two years, the hospital-wide nursing care committee convened pursuant to section 3727.51 of the Revised Code shall do both of the following:

(1) Review how the nursing services staffing plan in effect at the time of the review does all of the following:

(a) Affects inpatient care outcomes;

(b) Affects clinical management;

(c) Facilitates a delivery system that provides, on a cost-effective basis, quality nursing care consistent with acceptable and prevailing standards of safe nursing care and evidence-based guidelines established by national nursing organizations.

(2) Make recommendations, based on the review conducted under division (A)(1) of this section, regarding how the nursing services staffing plan should be revised, if at all.

(B) For the purpose of maintaining a repository for public access, beginning in 2018, a hospital shall submit to the department of health, by March 1 of each even-numbered year, a copy of the hospital's nursing services staffing plan in effect at that time. The copy of the plan is a public record under section 149.43 of the Revised Code.

Sec. 3727.55. To provide staffing flexibility to meet patient needs, every hospital hospital-wide nursing care committee shall identify a model for adjusting the a nursing services staffing plan created adopted under section 3727.53 of the Revised Code for each inpatient care unit.

Every hospital-wide nursing care committee also shall adopt a standardized, evidence-based patient acuity assessment tool for use in adjusting a nursing services staffing plan.

Sec. 3727.56. (A) A hospital shall provide copies of its nursing services staffing plan created adopted under section 3727.53 of the Revised Code, in accordance with both of the following:

(1) Free of charge, a copy of the staffing plan and subsequent changes to the plan shall be provided to each member of the hospital's nursing staff.

(2) For a fee not to exceed actual copying costs, a copy of the staffing plan shall be provided to any person who requests it.

(B) In a conspicuous location in the hospital, a notice shall be posted informing the public of the availability of the staffing plan. The notice shall specify the appropriate person, office, or department to be contacted to review or obtain a copy of the staffing plan.

Sec. 4123.293. (A) As used in this section, "hospital" has the same meaning as in section 3727.50 of the Revised Code.

(B) The administrator of workers' compensation, subject to the approval of the bureau of workers' compensation board of directors, shall establish a program to encourage a hospital to adhere to its nursing services staffing plan adopted under section 3727.53 of the Revised Code. The administrator, in consultation with the director of health, shall establish all of the following:

(1) A discount on premium rates for a hospital that adheres to a staffing plan at least eighty per cent of the time in each inpatient unit in a calendar year during normal operations and at least sixty per cent of the time in each hospital unit during a public health emergency as described in division (B)(2) of section 3727.53 of the Revised Code;

(2) Procedures for verifying eligibility for a discount under the program;

(3) A process for resolving disputes related to the amount of a discount and the eligibility for a discount.

Section 2. That existing sections 3727.50, 3727.51, 3727.52, 3727.54, 3727.55, and 3727.56 of the Revised Code are hereby repealed.

Section 3. That section 3727.53 of the Revised Code is hereby repealed.