Chapter 3701-59 | Hospitals

Rule 3701-59-01 | Definitions.

• Effective: January 20, 2020
• Promulgated Under: 119.03

As used in this chapter:

(A) "Active medical staff" means staff with clinical privileges who are designated as active pursuant to the bylaws or other governing prescript of the hospital.

(B) "Alcohol and drug hospital" means a hospital engaged primarily in providing specialized care to inpatients with alcoholism or chemical dependency rehabilitative service needs.

(C) "Alcohol or drug abuse rehabilitation bed" means a hospital bed that is staffed and equipped for care of inpatients whose primary diagnosis is alcoholism or other chemical dependency.

(D) "Associate medical staff" means staff with clinical privileges who are designated as associate pursuant to the bylaws or other governing prescript of the hospital.

(E) "Average daily census" means total patient days for a given calendar year divided by the number of days in the year.

(F) "Beds in use" means the sum of the number of beds staffed and available for patient care on the last day of each month of the calendar year, divided by twelve.

(G) "Board certified physician" means an individual licensed under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery who has passed an examination given by a medical specialty board and has been certified by that board as a specialist. "Board certified" does not include board eligible physicians. For physicians certified by more than one board, "board certified" includes only the primary certification board.

(H) "Burn care bed" means a hospital bed that is staffed and equipped for care of inpatients whose primary diagnosis is burn-related.

(I) "Burn care hospital" means a hospital engaged primarily in providing inpatient care to patients requiring specialized burn-related diagnostic or therapeutic services.

(J) "Cancer hospital" means a hospital that is classified as a cancer hospital under 42 C.F.R. 412.23(f) (1985) and is organized primarily for treatment and research on cancer.

(K) "Cardiac catheterization" means all anatomic or physiological studies including electrophysiology procedures, of interventions, both diagnostic and therapeutic, in which the heart or coronary arteries are entered via a systemic vein or artery using a catheter that is manipulated under fluoroscopic visualization. This definition does not include studies of cardiac function performed using flow directed catheters that are positioned without the use of fluoroscopy.

(L) "Critical access hospital" means a hospital that is certified by the federal government as meeting the conditions of participation in the medicare program under 42 C.F.R. part 485, subpart F (1993).

(M) "Department" means the department of health of the state of Ohio.

(N) "Direct care services" means any in-person patient contact where health care or personal care is provided in the hospital.

(O) "Director" means the director of health or the director's designated representative.

(P) "Discharge" means a patient who is formally released from a hospital including deaths. Discharge does not include temporary transfers to other settings.

(Q) "Full-time equivalent" means at least one thousand eight hundred and twenty hours per calendar year.

(R) "General hospital" means a hospital that primarily functions to furnish the array of diagnostic and therapeutic services needed to provide care for a variety of medical conditions, such as diagnostic X-ray, clinical laboratory, and operating room services.

(S) "Heart hospital" means a hospital primarily engaged in providing inpatient care to patients requiring specialized cardiac diagnostic or therapeutic services.

(T) "Hospice beds" means the inpatient beds of a hospice care program as defined in division (A) of section 3712.01 of the Revised Code.

(U) "Hospital" means an institution located at a single site engaged primarily in providing to inpatients, by or under the supervision of an organized medical staff of physicians licensed under Chapter 4731. of the Revised Code, diagnostic services and therapeutic services for medical diagnosis and treatment or rehabilitation of injured, disabled, or sick persons. "Hospital" also means an inpatient facility, located at the same site as another institution required to register under section 3701.07 of the Revised Code, that is medicare certified as a separate hospital, or operated by or on behalf of another hospital. "Hospital" does not mean an institution that is operated by the United States government or by the Ohio department of mental health.

(V) "Hospital bed" or "bed" means a bed in a hospital with the attendant physical space, fixtures, and equipment for use in caring primarily for inpatients. "Hospital bed" includes beds used in caring for patients who stay for less than twenty-four hours, but the primary use of such beds is for care of inpatients.

(W) "House staff" means interns, residents, and fellows receiving stipends from the hospital who are in training positions approved by the accreditation council of graduate medical education, the American osteopathic association, or the American dental association.

(X) "Inpatient" means a patient whose length of stay is twenty-four hours or more.

(Y) "Inpatient surgical operating room" means a room in a hospital used to perform any operative or manual procedure undertaken for the diagnosis or treatment of a disease or other disorder.

(Z) "Long term acute care hospital", or LTACH, means a hospital that is classified as a long-term care hospital under 42 C.F.R. 412.23(e) (1985), that is engaged primarily in providing medically necessary specialized acute hospital care for medically complex patients who are critically ill or have multi-system complications or failures, and that has an average length of stay of forty-five days or less.

(AA) "Long term acute care hospital bed" means a bed in a long term acute care hospital.

(BB) "Maternity unit" means a distinct portion of a hospital in which inpatient care is provided to women during all or part of the maternity cycle.

(CC) "Medical/surgical bed" means a hospital bed in a medical or surgical unit where general medical/surgical services are provided.

(DD) "Multi-hospital system" means two or more hospitals that are subject to the control and direction of one common owner responsible for the operational decisions of the entire system or that have integrated administrative functions and medical staff that report to one governing body as the result of a formal legal or contractual obligation.

(EE) "Number of admissions" means the number of patients accepted for inpatient service of twenty-four hours or more, including transfers by a service within the hospital.

(FF) "Number of inpatient surgical cases" means number of patients treated on an inpatient basis after surgery in an operating room.

(GG) "Open heart surgery" means any surgery performed on the heart muscle, valves, arteries, or other structures in which the chest is opened and a cardiopulmonary bypass is performed using extracorporeal circulation (heart-lung machine).

(HH) "Outpatient" means a patient who is not admitted as an inpatient and whose length of stay is less than twenty-four hours.

(II) "Outpatient surgical operating room" means a room in a hospital designed to perform an operative or manual procedure undertaken for the diagnosis or treatment of a disease or other disorder on non-inpatients.

(JJ) "Patient" means an individual who receives diagnostic or therapeutic services for medical diagnosis treatment, or rehabilitation. "Patient" also includes an individual receiving palliative care.

(KK) "Patient days of care" means annual total number of inpatients in a hospital on a daily count at a specific uniform time of day.

(LL) "Pediatric cardiovascular surgery" means any open or closed heart surgical procedures performed on a pediatric patient, including surgical procedures on the heart muscle, valves, arteries, or other structures, and surgical correction of both congenital and acquired heart conditions such as ventricular septal defects (VSD), atrial septal defects (ASD), patent ductus arteriosus (excluding neonates) and valve defects. "Pediatric cardiovascular surgery" does not mean heart transplantation.

(MM) "Pediatric patient" means any patient less than twenty-two years of age.

(NN) "Physical rehabilitation bed" means a hospital bed that is staffed and equipped for care of inpatients requiring intensive, multi-disciplinary physical restorative services.

(OO) "Physical rehabilitation hospital" means a hospital engaged primarily in providing specialized care to inpatients with intensive, multi-disciplinary physical restorative service needs.

(PP) "Psychiatric care bed" means a hospital bed that is staffed and equipped for care of inpatients whose primary diagnosis in mental illness.

(QQ) "Psychiatric hospital" means a hospital engaged primarily in providing specialized care to inpatients diagnosed with mental illness.

(RR) "Register" means to report to the department on an annual basis information required under section 3701.07 of the Revised Code and rule 3701-59-05 of the Administrative Code.

(SS) "Satellite unit" means a unit owned and operated by a hospital that is providing diagnostic, therapeutic, or rehabilitative services on an outpatient basis at a geographically separate location from the hospital that owns and operates it. "Satellite unit" does not include facilities that are licensed under section 3702.30 of the Revised Code, inpatient facilities at the same geographic location that are certified as a separate hospital, or facilities providing inpatient services at a different location or different street address from the hospital that owns and operates it.

(TT) "Special care bed" means a hospital bed in which special medical/surgical services, beyond general medical/surgical care and including intensive care or coronary care, are provided.

(UU) "Total number of beds" means the total number of beds in which patient care may be provided, whether or not the bed is staffed and available. Beds in temporarily closed units are included in the total. Beds that are temporarily unavailable as the result of building renovations are included in the total. A temporary increase in the number of beds in use that is caused by unusually high volumes of admissions is not included in the total, where "temporary increase" means the average daily census exceeds registered capacity for less than forty-five days in any six month period.

Supplemental Information

Authorized By: 3701.07
Amplifies: 3701.07
Five Year Review Date: 1/20/2025
Prior Effective Dates: 7/24/1978, 6/21/2004, 6/20/2010, 3/22/2015

Rule 3701-59-03 | Operation of hospitals.

• Effective: March 22, 2015
• Promulgated Under: 119.03

(A) No person and no political subdivision, agency, or instrumentality of this state shall operate a hospital as defined in section 3727.01 of the Revised Code unless it is certified under Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981) or is accredited by a national accrediting organization approved by the centers for medicare and medicaid services.

(B) Each hospital defined in section 3727.01 of the Revised Code shall annually report to the department its accreditation and certification status on a form or in a format prescribed by the director.

(C) Any hospital defined in section 3727.01 of the Revised Code that voluntarily withdraws or is involuntarily terminated from certification or accreditation as required in paragraph (A) of this rule shall notify the director of health in writing within ten days after the effective date of such withdrawal or termination.

Supplemental Information

Authorized By: 3727.03
Amplifies: 3727.03
Five Year Review Date: 1/20/2025
Prior Effective Dates: 12/3/1983

Rule 3701-59-04 | Enforcement proceedings.

• Effective: March 25, 2010
• Promulgated Under: 119.03

(A) The director shall make an investigation of any hospital or health facility to determine if there is a violation of section 3727.02 of the Revised Code and rule 3701-59-03 of the Administrative Code whenever the director has reason to believe that there may be a violation of section 3727.02 of the Revised Code or rule 3701-59-03 of the Administrative Code.

(B) If the director ascertains that there is a violation of section 3727.02 of the Revised Code or rule 3701-59-03 of the Administrative Code, the director shall petition the court of common pleas of the county in which the hospital or health facility is located for an order enjoining such violation or shall institute legal proceedings under section 3727.99 of the Revised Code, or both, as appropriate.

Supplemental Information

Authorized By: 3727.03
Amplifies: 3727.03
Five Year Review Date: 1/20/2025
Prior Effective Dates: 12/3/1983

Rule 3701-59-05 | Hospital registration and reporting requirements.

• Effective: January 20, 2020
• Promulgated Under: 119.03

Every hospital, public or private, shall, by the first of March of each year, register with and report to the department of health the following information for the previous calendar year in a manner prescribed by the director. A facility providing inpatient services at a geographically separate location that is not part of the main hospital or is located at a different street address from the hospital that owns and operates it, and a facility that is certified by the centers for medicare and medicaid services independently from the hospital in which it is located, shall register with and report to the department of health separately.

(A) Information needed to identify and classify the hospital, include the following:

(1) Hospital identifying information, including:

(a) The name of the hospital;

(b) The hospital number assigned by the department;

(c) The name the hospital uses for medicare, if different than the hospital name in paragraph (A)(1)(a) of this rule, the hospital's national provider identifier, and centers for medicare and medicaid services certification number;

(d) The hospital's address, mailing address if different than the address, and the county in which the hospital is located; and

(e) The telephone number, e-mail address, and legal name of the business entity that controls the operation of the hospital, if different than the hospital name in paragraph (A)(1)(a) of this rule;

(2) The name and title of president/chief executive officer;

(3) The name, title, and telephone number of individual responsible for submitting hospital registration information to the department;

(4) Accreditation/certification status (accrediting organization name; medicare deemed status, if applicable; and date of most current accrediting organization survey);

(5) Name, address, county, and zip code of satellite units;

(6) Type of entity that controls operation of the hospital, such as not-for-profit, for profit, government, or other;

(7) Name of multi-hospital system of which the hospital is a part, if applicable and names and addresses of other Ohio hospitals within the multi-hospital system;

(8) If applicable, the hospital's medicare provider type classification, as specified in the hospital's provider agreement with the centers for medicare and medicaid services, from one of the following categories:

(a) Short term acute care hospital;

(b) Psychiatric hospital;

(c) Rehabilitation hospital;

(d) Critical access hospital;

(e) Long-term acute care hospital; or

(f) Children's hospital.

(9) The hospital's specialty or primary classification from one of the following categories if different from the medicare provider type classification, or if the hospital is not medicare certified:

(a) General hospital;

(b) Alcohol and drug hospital;

(c) Burn care hospital;

(d) Cancer hospital;

(e) Heart hospital;

(f) Children's hospital as defined in division (B)(1) of section 3727.01 of the Revised Code;

(g) Rehabilitation hospital;

(h) Psychiatric hospital; or

(i) Other.

(10) The business name, and medicare certification number or state licensure number, or both, of the following entities contained within the hospital, as applicable:

(a) Distinct part psychiatric unit;

(b) Distinct part rehabilitation unit;

(c) Transplant center; or

(d) Maternity unit and newborn care nursery.

(B) Information on the type and volume of services provided by the hospital including, but not limited, to the following:

(1) Number of inpatient surgical cases;

(2) Number of outpatient surgical cases;

(3) Number of pediatric and adult cardiac catheterizations performed;

(4) Number of adult open heart surgical procedures and the number of pediatric cardiovascular surgery procedures performed;

(5) Number of surgical operating rooms in the following categories;

(a) Inpatient;

(b) Outpatient; and

(c) Dual purpose (inpatient and outpatient);

(6) Number of patients treated in the emergency room and released;

(7) Number of patients treated in the emergency room who were admitted to the hospital;

(8) Level designation, if institution is a trauma center verified by the American college of surgeons;

(9) Level designation, if institution is a pediatric trauma center verified by the American college of surgeons;

(10) Level designation of obstetric service, if applicable; and

(11) Level designation of newborn service, if applicable.

(12) Information on the location, type and volume of services provided by satellite units, including the following:

(a) Types of services provided; and

(b) Total number of patients treated (on an outpatient basis) for each type of service provided.

(C) The total number of beds listed by category of inpatient care provided. Report number of admissions (including individuals transferred from another unit within the hospital), number of patient days of care, and number of beds in use for each category of care listed in this paragraph. Beds shall be reported in the following categories:

(1) Alcohol or drug abuse rehabilitation;

(2) Burn care;

(3) Hospice;

(4) Level I neonatal care service;

(5) Level II neonatal care service;

(6) Level III neonatal care service;

(7) Level I obstetric care service;

(8) Level II obstetric care service;

(9) Level III obstetric care service;

(10) Long term acute care;

(11) Long term, reported in the following categories;

(a) Skilled nursing facility beds certified under Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981) and which are not licensed under Chapter 3721. of the Revised Code;

(b) Nursing facility beds certified under Title XIX of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981) and which are not licensed under Chapter 3721. of the Revised Code;

(c) Nursing facility beds certified under Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981) and Title XIX of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981) and which are not licensed under Chapter 3721. of the Revised Code; or

(d) Special skilled nursing beds certified as skilled nursing facility beds under Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981) that were originally authorized by and are operated in accordance with section 3702.521 of the Revised Code or its predecessor;

(12) Medical/surgical - general;

(13) Pediatric intensive care (beds in a separate and distinct pediatric intensive care unit where pediatric patients suffering from critical illness receive care);

(14) Pediatric - general (services for patients less than twenty-two years of age are provided);

(15) Physical rehabilitation;

(16) Psychiatric care;

(17) Special care.

(D) The number of inpatient discharges for each of the following categories:

(1) Discharges to home, without referral to home care or hospice services;

(2) Discharges to home, with a referral to home care services;

(3) Discharges to home, with a referral to hospice care program;

(4) Transfers to inpatient service of a hospice care program;

(5) Transfers to other hospitals;

(6) Transfers to a home licensed as a nursing home under Chapter 3721. of the Revised Code or a facility certified under Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981);

(7) Total patients expired in the hospital; and

(8) Total patients discharged.

(E) The number of employees, including contract employees and employees shared with another hospital within the same hospital system, by employee type within each of the hospital service categories listed below. Report the number of employees in each type providing patient care services. Report the number of employees as total number of employees and total full-time equivalents.

(1) Physician services including interns, residents, salaried physicians, and contracted physicians;

(2) Dental services including dentists and dental residents;

(3) Nursing services including registered nurses, certified nurse practitioners, clinical nurse specialists, certified nurse midwives, certified registered nurse anesthetists (CRNA), licensed practical nurses, and nursing assistants;

(4) Pharmacy services including pharmacists and pharmacy technicians;

(5) Clinical laboratory including medical technologists, medical technicians and other licensed or certified laboratory personnel;

(6) Dietary services including registered or licensed dietitians and dietetic technicians;

(7) Radiological services including technologists, technicians, and other licensed or certified radiological personnel;

(8) Therapeutic services including occupational therapists, physical therapists, physician assistants, respiratory therapists, speech/audiology therapists, and medical social workers;

(9) Mental health services including psychologists and psychiatric social workers; and

(10) All other services to include certified or licensed health professional and technical personnel.

(F) Numbers of medical staff delineated by primary area of specialization and category as follows:

(1) Area of specialization:

(a) Medical: allergy/immunology, anesthesiology, cardiology, dentistry, dermatology, emergency medicine, family practice, gastroenterology, internal medicine, general practice, hematology, neonatology neurology, nuclear medicine, obstetrics and gynecology, oncology, ophthalmology, otorhinolaryngology, pathology, pediatrics, physical medicine, podiatry, psychiatry, radiology, rheumatology, urology, general medicine rotation program, and any other medical specialty; or

(b) Surgical: cardiovascular, colon and rectal, general neurological, orthopedic, plastic, thoracic, surgery rotation program, and any other surgical specialty.

(2) Categories:

(a) Active and associate medical staff;

(b) Active and associate medical staff who are board certified;

(c) House staff;

(d) House staff who are in training positions approved by the accreditation council of graduate medical education or the American osteopathic association; and

(e) House staff who are in training positions approved by the American dental association.

(G) County (or state if other than Ohio) of residence of patients at the time of admission, reported in the aggregate.

Supplemental Information

Authorized By: 3701.07
Amplifies: 3701.07
Five Year Review Date: 1/20/2025
Prior Effective Dates: 1/13/1988 (Emer.), 6/21/2004

Rule 3701-59-06 | Hospital quality standards for gender reassignment surgery and genital gender reassigment surgery for minors.

• Effective: January 5, 2024
• Promulgated Under: 119.03

(A) As used in this rule:

(1) "Biological sex," "Birth sex," and "sex" mean the biological indication of male and female, including sex chromosomes, naturally occurring sex hormones, gonads, and nonambiguous internal and external genitalia present at birth, without regard to an individual's psychological, chosen, or subjective experience of gender.

(2) "Gender reassignment surgery" means any surgery performed for the purpose of assisting an individual with gender transition that seeks to surgically alter or remove healthy physical or anatomical characteristics or features that are typical for the individual's biological sex, in order to instill or create physiological or anatomical characteristics that resemble a sex different from the individual's birth sex, including genital or non-genital gender reassignment surgery.

(3) "Gender transition" means the process in which an individual goes from identifying with and living as a gender that corresponds to his or her biological sex to identifying with and living as a gender different from his or her biological sex, including social, legal, or physical changes.

(4) "Genital gender reassignment surgery" means surgery performed for the purpose of assisting an individual with gender transition and includes both of the following:

(a) Surgeries that sterilize, such as castration, vasectomy, hysterectomy, oophorectomy, orchiectomy, and penectomy; or

(b) Surgeries that artificially construct tissue with the appearance of genitalia that differs from the individual's biological sex, such as metoidiplasty, phalloplasty, and vaginoplasty.

(B) It is impermissible for gender reassignment surgery or genital gender reassignment surgery or any direct or indirect referral for such procedures to be provided at a hospital to any minor individual.

(1) "Direct or indirect referral" includes, but is not limited to, in any way facilitating such care at another facility or providing any resources or information on where or how to receive such care.

(C) This rule does not prohibit a physician from treating, including by performing surgery on or prescribing drugs or hormones for, a minor individual who meets any of the following:

(1) Was born with a medically verifiable disorder of sex development, including an individual with external biological sex characteristics that are irresolvably ambiguous, such an as individual born with forty-six XX chromosomes with virilization, forty-six XY chromosomes with undervirilization, or having both ovarian and testicular tissue;

(2) Received a diagnosis of a disorder of sexual development, in which a physician has determined through genetic or biochemical testing that the individual does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action for a biological male or biological female;

(3) Needs treatment for any infection, injury, disease, or disorder that has been caused or exacerbated by the performance of gender transition services, whether or not the services were performed in accordance with state or federal law.

Last updated April 22, 2024 at 2:14 PM

Supplemental Information

Authorized By: 3701.13, 3722.06
Amplifies: 3701.13, 3722.06
Five Year Review Date: 5/3/2029