SB 36: Ohio Optometry Law

Executive Summary:

Ohio Senate Bill 36 proposes significant revisions to the state law governing the practice of optometry in Ohio. The bill amends numerous sections of the Revised Code (specifically Chapter 4725) and enacts a new section (4725.012) while repealing another (4725.131). The core themes of this bill revolve around expanding the scope of practice for licensed optometrists, clarifying definitions, updating regulatory procedures, and aligning with other relevant state laws concerning professional licensing and prescription drug databases.

Main Themes and Important Ideas/Facts:

1. Expansion of Optometric Scope of Practice:

• Non-Invasive Injectables: The bill introduces a new section, 4725.012, which grants licensed optometrists the authority to employ, apply, administer, or prescribe certain injectable procedures (excluding intravenous and intraocular injections) for the examination, diagnosis, treatment, or prevention of visual system conditions. This excludes epinephrine injections for anaphylaxis, which is already authorized.
• The specific procedures listed include:
• “Any injection, other than an intravenous or intraocular injection, of a drug or dangerous drug…” (lines 138-141)
• “The incision and curettage of a chalazion;” (line 142)
• “The removal and biopsy of a skin lesion if the lesion has a low risk of malignancy and does not involve the eyelid margin;” (lines 143-145)
• “The excision or drainage, or both, of a conjunctival cyst or concretion;” (lines 146-147)
• “Any suturing other than corneal and scleral suturing;” (line 148)
• “A laser surgery consisting of capsulotomy, trabeculoplasty, or peripheral iridotomy.” (lines 149-151)
• Rulemaking and Training Requirements: The bill mandates the State Vision Professionals Board to adopt rules governing the performance of these new procedures. These rules must specify:
• “The infection control practices to be followed…” (lines 154-156)
• “The training requirements that a licensed optometrist must satisfy in order to be eligible to perform each procedure…” (lines 157-161)
• Specifically, laser surgery training will require “at least thirty-two hours of instruction.” (lines 163-164) The board will determine the minimum hours for other procedures.
• Demonstration of Competency: To perform these expanded procedures, optometrists must “demonstrate to the state vision professionals board, in a manner prescribed by the board, that the optometrist satisfies for that procedure the training requirements established in rules adopted under division (B)(2) of this section.” (lines 167-171)
• Vision Correction Devices with Drug Delivery: The bill clarifies that optometrists can prescribe and dispense vision correction devices that also deliver therapeutic pharmaceutical agents, provided the delivered drug would otherwise be within their scope of practice (topical or oral therapeutic agents). Examples include “contact lenses that deliver such drugs or dangerous drugs; punctal plugs; ocular inserts…” (lines 124-132)

2. Amendments to the Definition of “Practice of Optometry”:

• The definition is updated to reflect the expanded scope, specifically referencing the new section 4725.012 and removing redundant language. For instance, the phrase “excluding invasive procedures” in the context of employing instruments and procedures is now qualified by exceptions related to the new section and epinephrine administration (lines 24-28).
• The order of some activities within the definition has been renumbered (lines 36-47).

3. Therapeutic Pharmaceutical Agents:

• The definition of “Therapeutic pharmaceutical agent” is refined. While the classifications of oral drugs remain largely the same (anti-infectives, anti-allergy, anti-glaucoma, analgesics, anti-inflammatories), there’s a specific condition added for methylprednisolone use: it can only be prescribed for allergy cases in individuals 18 or older, for a single episode of illness, and in an amount not exceeding a single course of therapy (lines 79-86).
• The definition explicitly states that it “does not include a controlled substance, except in the case of an analgesic controlled substance authorized by the state vision professionals board in rules adopted under section 4725.091 of the Revised Code…” (lines 73-77).
• The board, in consultation with the state board of pharmacy, will continue to adopt rules specifying other oral drugs approved for ophthalmic purposes that can be prescribed by optometrists (lines 98-104, 205-208).
• Optometrists may personally furnish a therapeutic pharmaceutical agent to a patient without charge for a supply not exceeding 72 hours (or the minimum available quantity if larger) (lines 192-198).

4. Regulatory Updates and Procedures:

• State Vision Professionals Board Authority: The bill reiterates and updates the board’s authority to adopt rules governing the practice of optometry and enforce relevant sections of the Revised Code (lines 201-204).
• Delegation of Optometric Tasks: The board must adopt rules establishing standards and procedures for optometrists to delegate optometric tasks to unlicensed individuals. These rules will cover supervision levels (on-site in healthcare facilities with potential exceptions for routine topical drug administration), patient acuity considerations, training and competency requirements, and other relevant standards (lines 209-227).
• Licensing Examination: The bill updates language regarding the licensing examination, aligning it with the “certificate of licensure” terminology and emphasizing the board’s authority to accept examinations from the National Board of Examiners in Optometry or other recognized professional testing organizations (lines 232-243).
• Licensure Requirements: Basic requirements for licensure remain (age, education, graduation from an approved school, passing the exam). The bill updates cross-references to align with the new scope (lines 282-291).
• Criminal Records Checks: The board is required to adopt rules establishing criminal records check requirements for applicants, referencing section 4776.03 of the Revised Code (lines 228-231).
• Certificate of Licensure: The bill consistently uses the term “certificate of licensure” instead of “license” in many sections related to optometry practice (e.g., issuance, renewal, suspension, revocation).
• License Renewal: Optometrists renewing their licenses who prescribe opioid analgesics must certify whether they have access to the state’s drug database (unless certain exceptions apply, such as restricted access or the database no longer existing) (lines 358-379).
• Continuing Education: The continuing education requirement remains 50 clock hours biennially, including 20 hours in pharmacology for all licensed optometrists (lines 383-388).
• Reinstatement of License: The process for reinstating an expired license is outlined, requiring application, meeting conditions deemed appropriate by the board, and potentially providing evidence of good standing in other jurisdictions (lines 474-501).
• Licensure by Endorsement: The bill details the process for issuing a certificate of licensure by endorsement to optometrists licensed in Canadian provinces with comparable standards. Specific conditions must be met (lines 503-543). It also references Chapter 4796 of the Revised Code regarding licensure for out-of-state applicants more generally (lines 563-571).

5. Disciplinary Actions and Enforcement:

• The bill updates the language regarding reasons for refusing to grant, suspending, revoking, limiting, or reprimanding a certificate of licensure or imposing monetary penalties. These reasons include fraud, immorality, unprofessional conduct, felony convictions, misdemeanor convictions in practice, violating board restrictions, practicing with a suspended license (leading to mandatory permanent revocation), being denied licensure in another jurisdiction, and departing from acceptable standards of care (lines 573-631).
• The prohibition against soliciting patients door-to-door or establishing temporary offices remains, with suspension of the certificate as the penalty (lines 642-646).
• The provisions regarding waiving deductibles or copayments as an inducement are updated, with exceptions for compliance with health benefit plans and services to other licensed optometrists (lines 647-697).
• Failure to comply with requirements related to prescribing opioid analgesics to minors (section 3719.061) is added as a cause for disciplinary action (lines 667-671).
• The process for complaints, investigations, and disciplinary hearings is outlined, referencing Chapter 119 of the Revised Code (lines 717-738, 760-770).
• The board’s authority to issue cease-and-desist orders for unlicensed practice is reaffirmed (section 4725.231, lines 826-834).
• The process for summary suspension of a license when there is clear and convincing evidence of a violation and immediate danger to the public is detailed (section 4725.24, lines 835-866).

6. Miscellaneous Provisions:

• Title Restrictions: The bill explicitly states that the law does not confer the titles of “medical doctor, physician, surgeon, oculist, ophthalmologist” on optometrists (section 4725.25, lines 867-870).
• Exemptions: The bill outlines exemptions to the law, including licensed physicians, those selling optical accessories without fitting them, nonresident instructors in approved optometry schools (without requiring an Ohio license under Chapter 4796 for their instructional duties), students in training programs under supervision, individuals authorized under other Revised Code sections, and those delegating tasks under board rules (section 4725.26, lines 871-912). A new exemption is added for nonresident optometrists volunteering at charitable events for up to seven days (lines 913-937).
• Recognition of Optometric Testimony: The bill mandates that state, county, municipal, school district, and other public boards/agencies (as well as private institutions receiving public funds) must accept the testimony and reports of licensed optometrists as competent evidence within their scope of practice and shall not interfere with an individual’s free choice of receiving services from either an optometrist or a physician (section 4725.27, lines 938-953).
• Fees: The board is authorized to charge fees for licensure and providing rosters of licensed optometrists (section 4725.34, lines 954-979).
• Telehealth Services: Licensed optometrists may provide telehealth services in accordance with section 4743.09 of the Revised Code (section 4725.35, lines 980-983).
• Dispensing Opticians: The bill makes minor updates to sections related to dispensing opticians (Chapter 4725.40-4725.59) to align terminology with “certificate of licensure” and cross-reference criminal records checks (sections 4725.501, 4725.531, 4725.59, lines 984-1029).
• Repeal of Section 4725.131: This section is repealed (lines 1038-1040), and a note indicates the board can take action to implement this repeal without altering the authority of individuals licensed under the previous definitions of optometry practice (lines 1041-1051).
• Harmonization of Amendments: The bill notes that certain sections (4725.13 and 4725.18) are presented as harmonized versions reflecting amendments from previous General Assemblies (lines 1052-1063).

Potential Impacts and Considerations:

• Increased Access to Care: Expanding the scope of practice for optometrists could potentially increase patient access to certain ophthalmic procedures, particularly in areas where ophthalmologists are less readily available.
• Training and Education: The implementation of the expanded scope will necessitate the development and approval of appropriate training programs and competency assessments by the State Vision Professionals Board.
• Collaboration and Referral Networks: Clear guidelines and protocols may be needed to ensure appropriate collaboration and referral between optometrists and ophthalmologists, especially regarding conditions falling outside the optometrist’s expanded scope.
• Patient Safety: Robust rulemaking by the board regarding infection control and training will be crucial to ensure patient safety in the performance of these new procedures.
• Impact on Ophthalmology: The ophthalmology community may have concerns regarding the expansion of optometric scope and potential impacts on their practice.

Next Steps:

Further analysis may be needed to understand the specific details of the repealed section (4725.131) and the implications of its removal. Stakeholder input from optometry professionals, ophthalmologists, and patient advocacy groups will likely be important as this bill moves through the legislative process.

This briefing document provides a preliminary overview of the key aspects of Senate Bill 36. Further details and specific implications should be examined as the legislative process unfolds.