As Introduced

136th General Assembly

Regular Session H. B. No. 945

2025-2026

Representatives White, A., Roemer

To amend sections 3712.01, 3712.03, 3712.04, 3712.06, and 3712.062 and to enact sections 3712.20 and 3712.21 of the Revised Code regarding the regulation of hospice care programs.

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

Section 1. That sections 3712.01, 3712.03, 3712.04, 3712.06, and 3712.062 be amended and sections 3712.20 and 3712.21 of the Revised Code be enacted to read as follows:

Sec. 3712.01. As used in this chapter:

(A) "Hospice care program" means a coordinated program of home, outpatient, and inpatient care and services that is operated by a person or public agency and that provides the following care and services to hospice patients, including services as indicated below to hospice patients' families, through a medically directed interdisciplinary team, under interdisciplinary plans of care established pursuant to section 3712.06 of the Revised Code, in order to meet the physical, psychological, social, spiritual, and other special needs that are experienced during the final stages of illness, dying, and bereavement:

(1) Nursing care by or under the supervision of a registered nurse;

(2) Physical, occupational, or speech or language therapy, unless waived by the department of health pursuant to rules adopted under division (A) of section 3712.03 of the Revised Code;

(3) Medical social services by a social worker under the direction of a physician;

(4) Services of a home health aide;

(5) Medical supplies, including drugs and biologicals, and the use of medical appliances;

(6) Physician's services;

(7) Short-term inpatient care, including both palliative and respite care and procedures;

(8) Counseling for hospice patients and hospice patients' families;

(9) Services of volunteers under the direction of the provider of the hospice care program;

(10) Bereavement services for hospice patients' families.

"Hospice care program" does not include a pediatric respite care program or a pediatric transition care program.

(B) "Hospice patient" means a patient, other than a pediatric respite care patient, who has been diagnosed as terminally ill, has an anticipated life expectancy of six months or less, and has voluntarily requested and is receiving care from a person or public agency licensed under this chapter to provide a hospice care program.

(C) "Hospice patient's family" means a hospice patient's immediate family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

(D) "Interdisciplinary team" means a working unit composed of professional and lay persons that includes at least a physician, a registered nurse, a social worker, a member of the clergy or a counselor, and a volunteer.

(E) "Palliative care" means specialized care for a patient of any age who has been diagnosed with a serious or life-threatening illness that is provided at any stage of the illness by an interdisciplinary team working in consultation with other health care professionals, including those who may be seeking to cure the illness, and that aims to do all of the following:

(1) Relieve the symptoms, stress, and suffering resulting from the illness;

(2) Improve the quality of life of the patient and the patient's family;

(3) Address the patient's physical, emotional, social, and spiritual needs;

(4) Facilitate patient autonomy, access to information, and medical decision making.

(F) "Physician" means a person authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(G) "Attending physician" means the physician identified by the hospice patient, pediatric respite care patient, hospice patient's family, or pediatric respite care patient's family as having primary responsibility for the medical care of the hospice patient or pediatric respite care patient.

(H) "Registered nurse" means a person registered under Chapter 4723. of the Revised Code to practice professional nursing.

(I) "Social worker" means a person licensed under Chapter 4757. of the Revised Code to practice as a social worker or independent social worker.

(J) "Pediatric respite care program" means a program operated by a person or public agency that provides inpatient respite care and related services, including all of the following services, only to pediatric respite care patients and, as indicated below, pediatric respite care patients' families, in order to meet the physical, psychological, social, spiritual, and other special needs that are experienced during or leading up to the final stages of illness, dying, and bereavement:

(1) Short-term inpatient care, including both palliative and respite care and procedures;

(2) Nursing care by or under the supervision of a registered nurse;

(3) Physician's services;

(4) Medical social services by a social worker under the direction of a physician;

(5) Medical supplies, including drugs and biologicals, and the use of medical appliances;

(6) Counseling for pediatric respite care patients and pediatric respite care patients' families;

(7) Bereavement services for respite care patients' families.

"Pediatric respite care program" does not include a pediatric transition care program or hospice care program.

(K) "Pediatric transition care program" means a program operated by a person or public agency that arranges for the provision of health care and related services in a private home setting, including all of the following services, only to pediatric transition care patients, who are not related by birth or adoption to the person that arranges for the provision of health care and related services, and, as indicated below, the parents of pediatric transition care patients, in order to meet the physical, psychological, social, spiritual, and other special needs of children who have been diagnosed with life-threatening diseases and conditions:

(1) Inpatient care and procedures;

(2) Skilled nursing care;

(3) Nursing care by or under the supervision of a registered nurse;

(4) Physician's services;

(5) Medical supplies, including drugs and biologicals, and the use of medical appliances;

(6) For a pediatric transition care patients' parents, counseling, education, and visitation to promote reunification.

"Pediatric transition care program" does not include a hospice care program or a pediatric respite care program.

(L) "Pediatric respite care patient" means a patient, other than a hospice patient, who is less than twenty-seven years of age and to whom all of the following conditions apply:

(1) The patient has been diagnosed with a disease or condition that is life-threatening and is expected to shorten the life expectancy that would have applied to the patient absent the patient's diagnosis, regardless of whether the patient is terminally ill.

(2) The diagnosis described in division (L)(1) of this section occurred while the patient was less than eighteen years of age.

(3) The patient, or the parent or guardian of the patient if the patient is under eighteen years of age or under guardianship, has voluntarily requested and is receiving care from a person or public agency licensed under this chapter to provide a pediatric respite care program.

(M) "Pediatric transition care patient" means a patient, other than a hospice patient, who is less than twenty-seven years of age and to whom all of the following conditions apply:

(1) The patient has been diagnosed with a disease or condition that is life-threatening and is expected to shorten the life expectancy that would have applied to the patient absent the patient's diagnosis, regardless of whether the patient is terminally ill.

(2) The diagnosis described in division (M)(1) of this section occurred when the patient was less than eighteen years of age.

(3) The patient, or the parent or guardian of the patient if the patient is under eighteen years of age or under guardianship, has voluntarily requested and is receiving care from a person or public agency registered under this chapter to provide a pediatric transition care program.

(N) "Pediatric respite care patient's family" means a pediatric respite care patient's family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

(O) "Skilled nursing care" means procedures that require technical skills and knowledge beyond those the untrained person possesses and that are commonly employed in providing for the physical, mental, and emotional needs of the ill or otherwise incapacitated. "Skilled nursing care" includes the following:

(1) Irrigations, catheterizations, application of dressings, and supervision of special diets;

(2) Objective observation of changes in the patient's condition as a means of analyzing and determining the nursing care required and the need for further medical diagnosis and treatment;

(3) Special procedures contributing to rehabilitation;

(4) Administration of medication by any method ordered by a physician, such as hypodermically, rectally, or orally, including observation of the patient after receipt of the medication;

(5) Carrying out other treatments prescribed by the physician that involve a similar level of complexity and skill in administration.

(P) "Medical director" means the physician responsible for overseeing the clinical care, regulatory compliance, and medical quality of a hospice care program.

Sec. 3712.03. (A) In accordance with Chapter 119. of the Revised Code, the director of health shall adopt, and may amend and rescind, rules:

(1) Providing for the licensing of persons or public agencies providing hospice care programs within this state by the department of health and for the suspension and revocation of licenses;

(2) Establishing a license fee and license renewal fee for hospice care programs, neither of which shall, except as provided in division (B) of this section, exceed six hundred dollars. The fees shall cover the three-year period during which an existing license is valid as provided in division (B) of section 3712.04 of the Revised Code.

(3) Establishing an inspection fee for hospice care programs not to exceed, except as provided in division (B) of this section, one thousand seven hundred fifty dollars;

(4)(3) Establishing requirements for hospice care program facilities and services;

(5)(4) Establishing procedures a hospice care program must follow while investigating a sign of suspected diversion of controlled substances containing opioids pursuant to division (B)(5) of section 3712.062 of the Revised Code;

(6)(5) Establishing requirements for reporting to a local law enforcement agency pursuant to division (B)(6) of section 3712.062 of the Revised Code the results of an investigation of suspected diversion;

(7)(6) Providing for a waiver of the requirement for the provision of physical, occupational, or speech or language therapy contained in division (A)(2) of section 3712.01 of the Revised Code when the requirement would create a hardship because such therapy is not readily available in the geographic area served by the provider of a hospice care program;

(8)(7) Providing for the granting of licenses to provide hospice care programs to persons and public agencies that are accredited or certified to provide such programs by an entity whose standards for accreditation or certification equal or exceed those provided for licensure under this chapter and rules adopted under it;

(9)(8) Establishing interpretive guidelines for each rule adopted under this section.

(B) Subject to the approval of the controlling board, the director may establish fees in excess of the maximum amounts specified in this section, provided that the fees do not exceed those amounts by greater than fifty per centThe department of health may adopt rules exempting hospice care programs located in rural areas from the prohibition against an individual serving as the medical director for more than two hospice care programs pursuant to section 3712.20 of the Revised Code.

(C) The department of health shall:

(1) Grant, suspend, and revoke licenses for hospice care programs in accordance with this chapter and rules adopted under it;

(2) Make such inspections as are necessary to determine whether hospice care program facilities and services meet the requirements of this chapter and rules adopted under it; and

(3) Implement and enforce provisions of this chapter and rules adopted under it as such provisions apply to hospice care programs.

Sec. 3712.04. (A) Every person or public agency that proposes to provide a hospice care program shall apply to the department of health for a license. Application shall be made on forms prescribed and provided by the department, shall include such information as the department requires, and shall be accompanied by the a license fee established by rules of the director of health adopted under division (A) of section 3712.03 of the Revised Codeof seven hundred dollars. The name of the hospice care program on the application shall match the name of the program listed on any certification through the United States centers for medicare and medicaid services, and the application shall include all of the following information:

(1) The name of any person owning thirty per cent or more of the hospice care program;

(2) The name of the chief administrator of the hospice care program;

(3) The name of the medical director;

(4) Any other names the program uses;

(5) The following information pertaining to any person that owns thirty per cent or more of the hospice care program, the chief administrator, and the medical director:

(a) Professional discipline;

(b) Suspension or revocation of the health care facility license of a facility that was owned in whole or in part by the person or where the chief administrator or medical director served as an administrator or medical director;

(c) Whether the person, chief administrator, or medical director has been charged with, convicted of, or pleaded guilty to a crime pertaining to health care fraud or abuse.

(6) Evidence that a criminal records check has been requested pursuant to division (E) of this section for each person that owns thirty per cent or more of the hospice care program, the chief administrator, and the medical director.

(7) Any other information required by the department, including information described in division (F) of this section.

The department shall grant a license to the applicant if the applicant is in compliance with this chapter and rules adopted under it. The department shall not grant a license to the applicant if the department has evidence that the applicant or any person that owns thirty per cent or more of the hospice care program, the chief administrator, or the medical director has been excluded from participation in medicare or medicaid or convicted of or pleaded guilty to a crime pertaining to health care fraud or abuse.

(B) Each person or public agency applying for a hospice care program license under this section shall, upon license approval, immediately post a surety bond with the department in the amount of one hundred thousand dollars and shall maintain the bond for five years after the initial license is granted. The bond shall be for the payment of civil penalties or costs resulting from enforcement actions.

(C) A license granted under this section shall be valid for three yearsone year. Application for renewal of a license shall be accompanied by a seven hundred dollar renewal fee and shall be made at least ninety days before the expiration of the license in the same manner as for an initial license, except that, if the program provides hospice care and services in a hospice patient's home, the application for renewal shall include written evidence demonstrating that the applicant is in compliance with section 3712.062 of the Revised Code. The application for renewal shall include all information required for initial licensure under division (A) of this section. The department shall renew the license if the applicant meets the requirements of this chapter and rules adopted under it.

(C)(D) Subject to Chapter 119. of the Revised Code, the department may suspend or revoke a license if the for any of the following reasons:

(1) The licensee made any material misrepresentation in the application for the license or no longer meets the requirements of this chapter or rules adopted under it.

(2) Any person that owns thirty per cent or more of the hospice care program has been excluded from participation in medicare or medicaid or has been convicted of or pleaded guilty to a crime pertaining to health care fraud or abuse.

(3) Another hospice care program is licensed at the same business address.

(4) The hospice care program was subject to a reduced annual payment penalty by the United States centers for medicare and medicaid services for failure to meet hospice quality reporting requirements.

(5) In the preceding twelve months, the hospice care program did not provide services to any patient.

(6) The chief administrator of the hospice care program is recorded as the chief administrator for another hospice care program.

(7) Except as permitted by rule, the medical director is recorded as the medical director for more than two hospice care programs.

(8) In the preceding thirty-six months, the hospice care program reported a hospice aggregate cap utilization rate greater than eighty per cent of the hospice aggregate cap set by the United States centers for medicare and medicaid services.

(D) (E) Each person or public agency applying for a hospice care program license under this section shall request that the superintendent of the bureau of criminal identification and investigation conduct a criminal records check of each person owning thirty per cent or more of the hospice care program, the chief administrator of the hospice care program, and the medical director in the same manner as a criminal records check is requested for an applicant pursuant to section 3712.09 of the Revised Code.

(F) If the person or public agency applying for a hospice care program license under this section has a primary residence or business address that is located outside of this state, the department may require the submission of both of the following:

(1) The results of any inspection or survey conducted on a hospice care program that shares at least thirty per cent ownership with the hospice care program for which the person or public agency is seeking a license;

(2) Disclosure of negative performance history for any chief administrator of the hospice care program or medical director in the ten years preceding the date of application, including professional discipline and any charge, conviction, or guilty plea for a crime pertaining to health care fraud or abuse.

(G) A hospital, nursing home, home for the aged, county medical care facility, or other health facility or agency that provides a hospice care program shall be licensed to provide a hospice care program under this section.

(E)(H) A nursing home licensed under Chapter 3721. of the Revised Code that does not hold itself out to be a hospice, does not hold itself out as providing a hospice care program, does not use the term hospice to describe or refer to its activities or facilities, and that does not provide all of the services enumerated in division (A) of section 3712.01 of the Revised Code is not subject to the licensing provisions of this chapter.

(I)(1) A hospice care program licensed under this section shall not undergo any change in ownership for at least five years after the date the license is first issued, unless an owner is deceased. Any change in ownership of more than thirty per cent ownership interest shall be accompanied by a change in ownership application. The application shall be made on forms prescribed and provided by the department and shall include all information required for initial licensure under division (A) of this section.

(2) If the hospice care program applying for a change in ownership has a surety bond with the department pursuant to division (B) of this section, that surety bond shall be maintained for five years after the change in ownership application is approved by the department. If the hospice care program does not have a surety bond with the department, the license holder shall post a surety bond with the department in the amount of one hundred thousand dollars and shall maintain the bond for five years after the change in ownership application is approved by the department. The bond shall be for the payment of civil penalties or costs resulting from enforcement actions.

(3) Within six months after approving a change in ownership application, the department shall conduct a survey of the hospice care program for compliance with the requirements of this chapter or rules adopted under it.

Sec. 3712.06. Any person or public agency licensed under section 3712.04 of the Revised Code to provide a hospice care program shall:

(A) Provide a planned and continuous hospice care program, the medical components of which shall be under the direction of a physician;

(B) Ensure that care from a nurse licensed under Chapter 4723. of the Revised Code is available within two hours twenty-four hours a day and seven days a week;

(C) Establish an interdisciplinary plan of care for each hospice patient and the patient's family that:

(1) Is coordinated by one designated individual who shall ensure that all components of the plan of care are addressed and implemented;

(2) Addresses maintenance of patient-family participation in decision making; and

(3) Is periodically reviewed by the patient's attending physician and by the patient's interdisciplinary team.

(D) Have an interdisciplinary team or teams that provide or supervise the provision of care and establish the policies governing the provision of the care;

(E) Provide bereavement counseling for hospice patients' families;

(F) Not discontinue care because of a hospice patient's inability to pay for the care;

(G) Maintain central clinical records on all hospice patients under its care; and

(H) Provide care in individuals' homes, on an outpatient basis, and on a short-term inpatient basis.

A provider of a hospice care program may include pharmacist services among the other services that are made available to its hospice patients.

A provider of a hospice care program may arrange for another person or public agency to furnish a component or components of the hospice care program pursuant to a written contract. When a provider of a hospice care program arranges for a hospital, a home providing nursing care, or home health agency to furnish a component or components of the hospice care program to its patient, the care shall be provided by a licensed, certified, or accredited hospital, home providing nursing care, or home health agency pursuant to a written contract under which:

(1) The provider of a hospice care program furnishes to the contractor a copy of the hospice patient's interdisciplinary plan of care that is established under division (C) of this section and specifies the care that is to be furnished by the contractor;

(2) The regimen described in the established plan of care is continued while the hospice patient receives care from the contractor, subject to the patient's needs, and with approval of the coordinator of the interdisciplinary team designated pursuant to division (C)(1) of this section;

(3) All care, treatment, and services furnished by the contractor are entered into the hospice patient's medical record;

(4) The designated coordinator of the interdisciplinary team ensures conformance with the established plan of care; and

(5) A copy of the contractor's medical record and discharge summary is retained as part of the hospice patient's medical record.

Any hospital contracting for inpatient care shall be encouraged to offer temporary limited privileges to the hospice patient's attending physician while the hospice patient is receiving inpatient care from the hospital.

(I) Notify a veteran, spouse, surviving spouse, or representative on behalf of the veteran, seeking services from the hospice care agency that the veteran, spouse, or surviving spouse, may be eligible for health care or financial benefits through the United States department of veterans affairs and provide the veteran, spouse, surviving spouse, or representative with information about congressionally chartered veterans service organizations or the county veterans service office that can assist with investigating and applying for benefits through the United States department of veterans affairs. As used in this division, "veteran" has the same meaning as in section 5901.01 of the Revised Code.

(J) Maintain a commercial office independent from any other business that has both:

(1) Visible signage;

(2) Basic operational infrastructure including secure file storage and a telephone line that is answered twenty-four hours a day and seven days a week.

Sec. 3712.062. (A) Each hospice care program licensed under this chapter that provides hospice care and services in a hospice patient's home shall establish a written policy establishing procedures to be followed in preventing the diversion of controlled substances containing opioids that are prescribed to its hospice patients. The policy shall include procedures for the disposal of any such drugs prescribed to a hospice patient as part of the patient's interdisciplinary plan of care that are relinquished to the program after the patient's death or that otherwise are no longer needed by the patient. The policy shall require that the disposal be documented by a program employee and conducted in any of the following ways:

(1) Performed by a program employee and witnessed by the patient or patient's family member;

(2) Performed by the patient or patient's family member and witnessed by a program employee;

(3) Performed by a program employee and witnessed by another program employee.

(B) As part of a hospice patient's interdisciplinary plan of care required by section 3712.06 of the Revised Code, each hospice care program that provides hospice care and services in the patient's home shall do all of the following:

(1) Before providing hospice care and services, distribute a copy of the written policy established under division (A) of this section to the patient and patient's family and discuss the procedures included in the policy with the patient and patient's family;

(2) Assess the patient, the patient's family, and the care environment for any risk factors associated with diversion;

(3) Maintain records of controlled substances containing opioids prescribed to the patient and included in the patient's interdisciplinary plan of care, including accurate counts of the numbers dispensed and used;

(4) Monitor the use and consumption of controlled substances containing opioids prescribed to the patient and included in the patient's interdisciplinary plan of care, including prescription refills, for signs of diversion;

(5) Investigate any sign of suspected diversion in accordance with rules adopted under division (A)(5) of section 3712.03 of the Revised Code.

(6) Report the results of an investigation of suspected diversion to the local law enforcement agency with jurisdiction over the territory in which the hospice patient's home is located in accordance with rules adopted under division (A)(6) of section 3712.03 of the Revised Code;

(7) Before providing hospice care and services, inform the patient and the patient's family that the hospice care program will dispose of any controlled substances containing opioids that are no longer needed by the patient and were included in the patient's interdisciplinary plan of care;

(8) After the patient's death or when no longer needed by the patient, request, in writing, that the patient or patient's family relinquish to the program for disposal any remaining controlled substances containing opioids that were included in the patient's interdisciplinary plan of care to the program;

(9) Report to the local law enforcement agency with jurisdiction over the territory in which the hospice patient's home is located the quantity and type of any remaining controlled substances containing opioids that were included in the patient's interdisciplinary plan of care and were not relinquished to the program by the patient or patient's family.

(C) If a hospice care program complies with divisions (B)(8) and (9) of this section, none of the following shall be liable in damages to any person or government entity in a civil action for injury, death, or loss to person or property that allegedly arises from an action or omission relative to this section unless the action or omission constitutes willful or wanton misconduct: the program; a program employee, officer, or director; or a prescriber of controlled substances containing opioids that were included in the patient's interdisciplinary plan of care.

(D) No person who receives a written request under division (B)(8) of this section shall fail to relinquish controlled substances containing opioids that were included in a patient's interdisciplinary plan of care.

(E) Following a report from a hospice program under division (B)(9) of this section, the local law enforcement agency with jurisdiction over the territory in which the hospice patient's home is located shall investigate and dispose of the remaining controlled substances containing opioids that were reported to the agency pursuant to division (B)(9) of this section.

(F) After a review of the written evidence submitted under division (B)(C) of section 3712.04 of the Revised Code with an application for license renewal, if the department determines that the program is not in compliance with this section, the department may suspend the program's license for not more than six months and impose a fine not to exceed twenty thousand dollars.

(G) Not later than one year after the effective date of this section, the director of health shall adopt rules in accordance with Chapter 119. of the Revised Code establishing standards and procedures for the submission and review of the written evidence required by division (B)(C) of section 3712.04 of the Revised Code for renewal of a hospice care program license.

Sec. 3712.20. (A)(1) No individual shall serve as the chief administrator for more than one hospice care program licensed under section 3712.04 of the Revised Code unless each hospice care program for whom the individual serves as the chief administrator shares at least fifty per cent ownership in common.

(2) No individual shall serve as the medical director for more than two hospice care programs licensed under section 3712.04 of the Revised Code unless each hospice care program for whom the individual serves as the medical director shares at least fifty per cent ownership in common, except that the department of health may adopt rules exempting hospice care programs located in rural areas from this prohibition.

(B) Any person or public agency licensed under section 3712.04 of the Revised Code to provide a hospice care program shall notify the department of health within ten calendar days of employing a new chief administrator or medical director.

Sec. 3712.21. (A)The department of health

, in consultation with associations representing hospice care programs, shall do both of the following:

(1) Select a set of hospice care measures to be monitored by the department using data available through the United States centers for medicare and medicaid services, including measures that capture:

(a) Live discharge rates;

(b) Length of stay;

(c) Family satisfaction;

(d) Service delivery;

(e) Transitions of care.

(2) Establish thresholds for measures selected under division (A)(1) of this section that require the department to conduct a survey of the program within six months for compliance with the requirements of this chapter and rules adopted under it.

(B) On a quarterly basis, the department shall monitor the measures selected under division (A)(1) of this section for hospice care programs licensed under section 3712.04 of the Revised Code and may contract with a data management company to fulfill this requirement.

Section 2. That existing sections 3712.01, 3712.03, 3712.04, 3712.06, and 3712.062 of the Revised Code are hereby repealed.

Section 3. (A) Except as provided in division (B) of this section, the Department of Health shall not do either of the following until six months after the effective date of this section:

(1) Issue a new license under section 3712.04 of the Revised Code to a person or public agency that proposes to provide a hospice care program;

(2) Accept an application for a hospice care program change of ownership, unless an owner is deceased.

(B) The Department of Health may issue a license under section 3712.04 of the Revised Code within six months after the effective date of this section if the Department determines there is a demonstrated need in the geographic area the hospice care program would serve.

(C) Notwithstanding division (I)(3) of section 3712.04 of the Revised Code, for applications for change in ownership of a hospice care program that are filed within fifteen months after the effective date of this section, the Department of Health has until the date that is twenty-four months after the effective date of this section to complete the change of ownership survey required under that division.