Chapter 4723-6 | Alternative Program for Substance Use Disorder Monitoring

Rule 4723-6-01 | Definitions.

• Effective: February 1, 2024
• Promulgated Under: 119.03

As used in this chapter:

(A) "Agreement" means a voluntary, written contract between an individual and the board's alternative program for substance use disorder in which the board abstains from taking disciplinary action against the individual for violation of Chapter 4723. of the Revised Code and the individual agrees to be monitored by the board according to the terms and conditions of the program specified in section 4723.35 of the Revised Code, this chapter, and any other terms and conditions determined necessary by the program to ensure that the individual is able to practice in accordance with acceptable standards of safe care.

(B) "Approved treatment program" means an alcohol or substance use disorder treatment program which is either certified by a state agency or is accredited by a joint commission, council on Accreditation (COA), or commission on accreditation of rehabilitation facilities (CARF).

(C) "Drug of abuse" has the same meaning as in section 3719.011 of the Revised Code, and includes any controlled substance as defined in section 3719.01 of the Revised Code, any harmful intoxicant as defined in section 2925.01 of the Revised Code, or any dangerous drug as defined in section 4729.01 of the Revised Code.

(D) "Medication-assisted treatment" has the same meaning as in section 340.01 of the Revised Code.

(E) "Person" includes, without limitation, a natural person, a corporation, whether nonprofit or for profit, a partnership, a limited liability company, an unincorporated society or association, or two or more persons having a joint or common interest.

(F) "Practitioner" means a healthcare professional who is authorized by law to prescribe drugs, dangerous drugs, or drug therapy related devices in the course of the professional's practice and is licensed under Chapter 4715., 4723., 4725., 4731., or 4730., of the Revised Code and authorized by law to write prescription's for drugs or dangerous drugs.

(G) "Program" means the unit of the board responsible for administering the alternative program for substance use disorder established by section 4723.35 of the Revised Code.

(H) "Random alcohol and drug screen" means a laboratory or breathalyzer test administered at an irregular interval not known in advance by the individual to be tested to detect the presence of alcohol, drugs of abuse, or other mood altering substances in the individual's body fluids, breath, hair, or nails.

(I) "Substance use disorder" for purposes of section 4723.35 of the Revised Code and Chapter 4723-6 of the Administrative Code means either of the following:

(1) The chronic and habitual use of alcohol to the extent that the user no longer can control the use of alcohol; or the user's health, safety, or welfare or that of others is endangered; or

(2) The use of a drug of abuse, to the extent that the user becomes physically or psychologically dependent on the drug; or the user's health, safety, or welfare or that of others is endangered.

To the extent that under prior law, the term "chemical dependency" was used, the term is to be construed to hold the same meaning as "substance use disorder" for purposes of the board's monitoring program established according to section 4723.35 of the Revised Code and Chapter 4723-6 of the Administrative Code.

(J) "Support group" means individuals who hold licenses or certificates issued under Chapter 4723. of the Revised Code who meet regularly to discuss practice issues related to recovery and to provide substance use disorder support for its members.

(K) "Treatment provider" means a licensed healthcare provider, with demonstrated expertise in substance use disorder, who provides alcohol or substance use treatment in an approved treatment program to an individual participating in the alternative program for dependency.

(L) "Twelve-step meeting" means a meeting sponsored by a group such as alcoholics anonymous, narcotics anonymous, or a related organization which addresses substance use disorders and promotes sobriety and recovery through peer group support, self-help, and anonymity, and which is based on an abstinence model of recovery.

Last updated February 1, 2024 at 9:31 AM

Supplemental Information

Authorized By: 4723.35, 4723.07
Amplifies: 4723.35
Five Year Review Date: 2/1/2029
Prior Effective Dates: 2/1/2001, 2/1/2014, 2/1/2020

Rule 4723-6-02 | Eligibility requirements for participation in the alternative programfor substance use disorder.

• Effective: February 1, 2024
• Promulgated Under: 119.03

[Comment: Information regarding the availability and effective date of the materials incorporated by reference in this rule can be found in paragraph (G) of rule 4723-1-03 of the Administrative Code.]

(A) An individual may participate in the program if the board supervising member for disciplinary matters determines that all of the following conditions are met:

(1) The individual has been issued a license to practice nursing as either a registered nurse or a licensed practical nurse in Ohio, or a certificate to practice as a dialysis technician or community health worker in Ohio;

(2) The individual requests and the board provides the individual an "Alternative Program for Substance Use Disorder Admission Application," that includes an "Initial Voluntary Temporary License/Certificate Surrender" form. Within ten business days of the date the application was provided by the board to the individual, the board must receive the individual's completed "Initial Voluntary Temporary License/Certificate Surrender" form;

(3) The individual submits a completed "Alternative Program for Substance Use Disorder Admission Application" to the board within sixty days of the date the application was provided by the board to the individual. The completed application shall be accompanied by all of the following:

(a) A substance use disorder assessment performed by a licensed healthcare provider with demonstrated expertise in the treatment of substance use disorders that documents a diagnosis of substance use disorder and sets forth an organized plan for treatment.

(b) Signed waivers giving the program consent to receive and release information necessary for purposes of determining program eligibility. This includes, but is not limited to, information to and from employers, probation officers, law enforcement agencies, peer assistance programs, and any treatment providers or health care practitioners. No person with knowledge of any information disclosed by the program pursuant to this paragraph shall divulge the information to any other person. The information contained in the completed application shall indicate to the board supervising member for disciplinary matters all of the following:

(i) The individual may be effectively treated for the substance use disorder;

(ii) The individual may be effectively monitored for compliance with program requirements; and

(iii) The individual is not subject to the prohibitions in paragraph (B) of this rule.

(B) An individual may not participate in the program if the board receives information indicating that the individual's compliance with the program may not be effectively monitored while participating in the program. This information includes, but is not limited to, the following:

(1) The individual has a medical and/or psychiatric condition, diagnosis, or disorder, other than a substance use disorder, in which the manifest symptoms are not adequately controlled;

(2) The individual has attempted or completed two or more substance use disorder treatment programs as of the date of the application, not including the individual's current substance use disorder treatment plan and related treatment currently submitted for purposes of program eligibility;

(3) The individual has substituted or tampered with a substance or drug of abuse;

(4) The board has taken action against the individual's license to practice nursing as either a registered nurse or a licensed practical nurse or certificate or intern certificate to practice as a dialysis technician or community health worker;

(5) A board regulating nurses, dialysis technicians or community health workers in another jurisdiction has taken action against the individual's license to practice nursing as either a registered nurse or a licensed practical nurse in that jurisdiction or certificate or intern certificate to practice as a dialysis technician or community health worker in that jurisdiction;

(6) The individual has completed the program or a similar program in another jurisdiction;

(7) The individual has been terminated from the program or from a similar program in another jurisdiction;

(8) The individual was admitted to, but did not complete or is no longer in good standing, a similar program in another jurisdiction;

(9) The individual has been convicted of, pled guilty to (other than a plea resulting in a finding of eligibility for intervention in lieu of conviction), had a judicial finding of eligibility for diversion for, or had a judicial finding of guilt resulting from a plea of no contest to any felony or an act in another jurisdiction that would constitute a felony in Ohio;

(10) The board determines that the public may not be adequately protected from unsafe practice if the individual enters the program; or

(11) The individual has failed or refused to cooperate with a board investigation.

Last updated February 1, 2024 at 9:31 AM

Supplemental Information

Authorized By: 4723.35, 4723.07
Amplifies: 4723.35
Five Year Review Date: 2/1/2029
Prior Effective Dates: 4/1/1997, 2/1/2001, 2/1/2019, 2/1/2020

Rule 4723-6-03 | Terms and conditions a participant must meet to successfully complete the substance use disorder monitoring program.

• Effective: February 1, 2024
• Promulgated Under: 119.03

(A) The participant shall enter into an agreement with the program and shall comply with all of the terms and conditions of the participant's agreement for the time period specified in the agreement.

(B) The agreement may include the following requirements:

(1) The participant:

(a) Enter substance use disorder treatment in an approved treatment program or provide documentation of current participation in treatment or completion of treatment no later than thirty days from the execution of the agreement; and

(b) Comply with all requirements of the participant's substance use disorder treatment plan;

(2) The participant cause the treatment provider to submit documentation acceptable to the program of the participant's compliance with the participant's substance use disorder treatment plan;

(3) The participant abstain from the use of alcohol, drugs of abuse, and controlled substances, except for the participant's use of drugs of abuse and controlled substances prescribed for purposes of medication-assisted treatment in accordance with state law, or prescribed for other health purposes by a treating practitioner who has knowledge of the participant's substance use disorder and treatment plan;

(4) The participant cause all treating healthcare providers who authorize, prescribe or administer medication with respect to the participant, including but not limited to drugs of abuse, to submit documentation regarding the medication to the program, in the manner specified in the agreement;

(5) The participant inform any and all treating healthcare practitioners of the participant's substance use disorder and recovery status prior to receiving treatment and prescriptions;

(6) The participant cause any and all healthcare practitioners, substance use disorder treatment providers, and counselors to provide progress reports to the program at the intervals specified in the participant's agreement;

(7) The participant submit to random alcohol and drug screens when requested by the program, and that the participant comply with all requirements of random alcohol and drug screening as specified in the agreement;

(8) The participant attend support, peer group, or twelve-step group meetings as specified in the participant's agreement, and that the participant verify attendance at these meetings by using the meeting form provided by the program;

(9) The participant comply with the employment restrictions, for positions that require a nursing license, or dialysis technician certificate , or community health worker certificate, specified in the agreement, which may include, but are not limited to:

(a) Program approval of the employment;

(b) Work schedule restrictions;

(c) Restrictions against administering and having access to alcohol or products containing alcohol, excluding topically applied alcohol-based products used for disinfection purposes, controlled substances, and drugs of abuse; and

(d) Practice setting or patient population restrictions;

(10) The participant sign waivers required by division (E) of section 4723.35 of the Revised Code, and that the participant also sign waivers permitting the program to receive or release information necessary to properly facilitate the monitoring of the participant's progress in their recovery from substance use disorder and compliance with their program requirements. The information may be released to or received from persons, including, but not limited to, employers, probation officers, law enforcement agencies, peer assistance programs, substance use disorder treatment providers, healthcare practitioners, government agencies, or court officials. No person with knowledge of any information disclosed by the program pursuant to this paragraph shall divulge the information to any other person.

(11) The participant return to employment in a position that requires a nursing license or dialysis technician certificate , or as a community health worker, while under the terms of the agreement, and continue in that employment, or other employment requiring licensure or certification, for an aggregate period of at least one year of full-time employment, prior to being considered for release from the terms and conditions of the agreement;

(12) The participant be responsible for all costs to the participant resulting from the participant's program requirements. All costs incurred by the participant resulting from the participant's participation in the program are wholly between the participant and any person providing the services according to the program requirements. None of the costs incurred by the participant shall be charged to the program and the program assumes no liability for any costs incurred by the participant in paying all costs;

(13) The participant meet with a program representative at the intervals specified by the agreement; and

(14) The participant obey all federal, state, and local laws and rules including, but not limited to, all laws and rules regulating the practice of nursing or dialysis care in Ohio.

Last updated February 1, 2024 at 9:31 AM

Supplemental Information

Authorized By: 4723.35, 4723.07
Amplifies: 4723.35
Five Year Review Date: 2/1/2029
Prior Effective Dates: 2/1/2020

Rule 4723-6-04 | Successful completion of the alternative programfor substance use disorder.

• Effective: February 1, 2024
• Promulgated Under: 119.03

(A) A participant successfully completes the program when the participant complies with the terms and conditions of the program specified in section 4723.35 of the Revised Code, this chapter, and the participant's agreement for the time period specified in the agreement.

(B) When a participant successfully completes the program as indicated in paragraph (A) of this rule, the program shall notify the participant of such successful completion in writing. Once the participant receives this written notification of successful completion from the program, the participant shall no longer be required to comply with the terms and conditions of the program specified in section 4723.35 of the Revised Code, this chapter, and the participant's agreement.

(C) When making a decision regarding disciplinary action for violations of Chapter 4723. of the Revised Code or the rules of the board, the board will be notified by a written communication from board staff, marked as confidential according to division (F) of section 4723.35 of the Revised Code, if the individual who is the subject of proposed board action previously successfully completed the program.

(D) A participant who successfully completes the program shall not be reported to the national council of state boards of nursing's disciplinary data bank or the federally mandated national database unless the board imposes disciplinary action against the participant.

Last updated February 1, 2024 at 9:31 AM

Supplemental Information

Authorized By: 4723.35, 4723.07
Amplifies: 4723.35
Five Year Review Date: 2/1/2029
Prior Effective Dates: 4/1/1999, 2/1/2019

Rule 4723-6-05 | Causes for termination from the alternative programfor substance use disorder.

• Effective: February 1, 2024
• Promulgated Under: 119.03

Participation in the program may be terminated for any of the following reasons:

(A) The participant fails to comply with any of the terms and conditions of the program specified in section 4723.35 of the Revised Code and this chapter;

(B) The participant fails to comply with any provision of the participant's agreement;

(C) The participant is unable to practice according to acceptable and prevailing standards of safe care; or

(D) The program receives information which, after investigation, indicates that the participant may have committed an additional violation of a provision of Chapter 4723. of the Revised Code or any rules of the board.

Last updated February 1, 2024 at 9:32 AM

Supplemental Information

Authorized By: 4723.07, 4723.35
Amplifies: 4723.35
Five Year Review Date: 2/1/2029
Prior Effective Dates: 2/1/2001

Rule 4723-6-06 | Confidentiality regarding the alternative programfor substance use disorder.

• Effective: February 1, 2024
• Promulgated Under: 119.03

(A) Admission and ongoing monitoring shall be conducted in a manner that maintains the confidentiality of the individual.

(B) According to division (F)(3) of section 4723.35 of the Revised Code, all records regarding an individual's application to or participation in the program are confidential and are not public records. The records include, but are not limited to:

(1) Medical records;

(2) Substance use disorder records;

(3) Mental health records;

(4) Treatment records;

(5) Reports required by the participant's agreement;

(6) Waivers and releases required by the participant's agreement;

(7) Alcohol and drug screen results;

(8) Verification of attendance at support, peer group or twelve-step meetings; and

(9) Internal program documentation concerning participants in the program, including program assessments and recommendations;

(10) Applications submitted to the program, records related to review of program eligibility, and participant agreements.

(C) According to division (E)(4) of section 4723.35 of the Revised Code, a participant may authorize in writing the release of information regarding his or her progress in the program.

(D) All program records shall be maintained in a secure storage area for a period of two years following the participant's date of successful completion of the program, or for a period of two years following a determination that an applicant is not eligible for participation.

Last updated February 1, 2024 at 9:32 AM

Supplemental Information

Authorized By: 4723.07, 4723.35
Amplifies: 4723.35
Five Year Review Date: 2/1/2029
Prior Effective Dates: 4/1/1999, 2/1/2001