Governor Kasich recently signed into law two health care-related bills that will take effect on May 20, 2014: Ohio House Bill 123 ("HB 123") and Ohio House Bill 139 ("HB 139"). HB 123 contains new rules relating to Medicaid coverage for telemedicine and also expands Ohio’s peer review confidentiality statutes. HB 139 allows for certain advance practice nurses ("APNs") and physician assistants ("PAs") to admit patients to hospitals.

HB 123
HB 123 makes two changes to Ohio’s health care legislation:

• It expands the confidentiality protections afforded to documents prepared by or for the use of a peer review committee.
• It directs Ohio’s Medicaid program to develop rules for Medicaid coverage of "telehealth services," a.k.a. telemedicine.

Ohio law already provides that the proceedings and records of a health care entity’s peer review committee are not subject to discovery or introduction into evidence in any civil action against health care providers. And while the existing peer review statutes are fairly expansive in terms of the types of entities entitled to protection (and have been given a correspondingly expansive reading by Ohio courts), HB 123 provides some additional comfort that those statutes will not get in the way of integrated provider networks, including new models such as accountable care organizations, performing peer review activities. Specifically, by revising Ohio Revised Code ("O.R.C.") § 2305.25, HB 123 revised the definition of a "health care entity" to include accountable care organizations, as well as combinations of entities that in their own right would individually qualify as "health care entities" eligible for protection under the peer review statutes. Further, HB 123 clarifies that for purposes of the peer review statute, the term "Hospital" includes "a group of hospitals that are owned, sponsored, or managed by a single entity," thereby making it clear that hospital systems may engage in peer review activities at the system level and still enjoy the protections under the statute. By adding language to O.R.C. § 2305.252, HB 123 also limits the circumstances in which the privilege of confidentiality is considered waived. The new language specifies that the release of any document, record or piece of information protected by the privilege does not affect the confidentiality of any other such documents, records or information. "Only the information, documents, or records actually released cease to be privileged." In addition, the new language states that health care entities may share such privileged information, documents or records, so long as they are used only for peer review purposes.

HB 123 also directs the Ohio Department of Medicaid to establish standards for Medicaid payments for "telehealth services," defined as health services "delivered to a patient though the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located." In response, the Department of Medicaid issued Draft Rule 5160-1-18, which would establish Medicaid coverage for evaluation and management services and psychiatric services delivered through telemedicine. To be eligible for Medicaid coverage, services must be delivered via interactive, real-time electronic communication by a doctor or licensed psychologist at a "distant site" to a patient at an "originating site," such as a hospital or a doctor’s office. The distant site provider may submit a claim for the telemedical service but may not submit a facility claim. The originating site provider may submit a claim for a telehealth originating fee if it is not an inpatient hospital or nursing facility and if it does not submit a claim for a separately-identifiable evaluation and management service provided to the patient that same day.

HB 139
HB 139 grants certain APNs and PAs the ability to admit hospital inpatients. Prior to HB 139, only physicians, dentists or podiatrists who were members of a hospital’s medical staff could admit patients.

Now, clinical nurse specialists, certified nurse midwives and certified nurse practitioners may admit patients, so long as the following requirements are met:

• The APN has a standard care arrangement with a collaborating physician who is a member of the medical staff.
• The patient will be under the medical supervision of the collaborating physician.
• The hospital has granted the APN admitting privileges and appropriate credentials.

Prior to admitting the patient, the APN must notify the collaborating physician of the planned admission. All admitting arrangements should be documented in the APN’s standard care arrangement.

In addition, PAs may admit hospital patients, so long as the following conditions are met:

• The PA is listed on an approved supervision agreement with a physician who is a member of the hospital’s medical staff.
• The patient will be under the medical supervision of the supervising physician.
• The hospital has granted the PA admitting privileges and appropriate credentials.

Prior to admitting a patient, the PA must notify the supervising physician of the planned admission.

APNs and PAs who wish to start admitting patients must ensure that they first receive proper hospital privileges. Furthermore, the standard care arrangements for any APNs will have to be updated to allow for the admission of hospital inpatients.