Managing Healthcare Compliance in Ohio

Sarah Jones
Outline of Ohio over a healthcare photo

Managing healthcare compliance in Ohio presents a unique set of challenges for compliance officers, healthcare professionals, and administrators. Just like all states, Ohio has its own regulations and requirements. Organizations need to successfully navigate the regulatory landscape in order to provide efficient and ethical healthcare services, and to avoid consequences for non-compliance.

For successful healthcare compliance management, facilities in Ohio need to have comprehensive compliance programs in place. These programs should help to achieve organizational compliance through education, tracking, and reporting initiatives, just to name a few. This article outlines some of the key compliance aspects specific to Ohio, so you know what’s needed to establish a sufficient compliance program.

Ohio Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

  • The Ohio Department of Health (ODH) is key to safeguarding and enhancing the health of Ohio residents. With a wide range of departments, including the Office of Compliance, ODH focuses on promoting public health, preventing diseases, and ensuring access to quality healthcare services through monitoring and enforcement of regulations and policies.
  • The Ohio Hospital Association (OHA), founded in 1915 as the nation’s first state-level hospital association, stands as a unified voice for Ohio’s hospitals, utilizing data and expertise to lead health policy, quality improvement, and economic sustainability for its members. For over a century, OHA has been dedicated to assisting member hospitals in addressing community health needs.
  • The Ohio Department of Medicaid is responsible for administering the state’s Medicaid, a comprehensive healthcare program that provides medical coverage to low-income individuals and families in Ohio. This department focuses on ensuring access to quality healthcare services while managing the state’s Medicaid budget and policies.
  • The State Medical Board of Ohio provides licensing and regulatory guidelines for medical providers in Ohio State. It ensures that practitioners meet the necessary standards and undergo proper training.
  • The Counselor, Social Worker, and Marriage and Family Therapist Board oversees regulatory adherence and licensing for mental/behavioral health providers and social workers. 

These licensing agencies play a vital role in regulating the qualifications, competencies, and ethical standards of healthcare professionals. By ensuring that practitioners meet the necessary standards and undergo proper training, these licensing bodies uphold the quality of medical and mental/behavioral health services provided in the state.

These agencies help maintain the integrity and quality of healthcare services in Ohio, protecting the public and promoting patient safety. The resources provided by these Ohio state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of Ohio.

Regulations Unique to Ohio

To meet the standards of healthcare compliance in Ohio, there are a few additional regulations. 

Hospital Licensure

Effective September 30, 2024, Ohio hospitals must obtain licensure from the Ohio Department of Health (ODH). To be eligible, hospitals must submit a complete application, be certified or accredited by the Centers for Medicare and Medicaid Services (CMS), demonstrate compliance with ODH standards, and specify bed numbers. The license is valid for three years unless revoked. Additionally, when a hospital is assigned, sold, or transferred, the law requires a license transfer application to be submitted to ODH within 30 days of the transfer. The law also requires licensed hospitals to report contagious, environmental, or infectious diseases and unusual infectious agents or biological toxins to ODH, along with any cases of opioid-dependent newborns in maternity units or newborn nurseries.

Medical Marijuana and Cannabis Regulations

In 2023, Ohio’s medical marijuana regulations underwent significant updates with the Am.Sub.H.B.33 bill, leading to the centralization of the Medical Marijuana Control Program (MMCP) under the Division of Marijuana Control (DMC) within the Department of Commerce. This transition includes the transfer of responsibilities and oversight from the Department of Commerce and the State Board of Pharmacy to the DMC. The DMC is also tasked with adopting new rules and standards for the MMCP, with a focus on reviewing and revising regulations related to medical marijuana retail dispensaries. Providers are responsible for staying up to date with these regulatory changes to maintain compliance.

Tips To Manage Healthcare Compliance in Ohio

Effectively managing healthcare compliance in Ohio is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

  • Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers Ohio-approved training.
  • Organize Policies By Requirement: Including “OH” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
  • Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
  • Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in Ohio

In Ohio, the medical credentialing process is governed by specific standards to ensure the evaluation of healthcare providers seeking contracts or participation agreements with the Ohio Department of Medicaid (ODM). This process, aligned with federal credentialing standards, involves a comprehensive evaluation of qualifications, including verification of licensing, board certification, education, clinical privileges, malpractice insurance, DEA certification, and a history of any sanctions or limitations on licensure. Additionally, providers must submit a minimum five-year work history for initial credentialing. Facilities seeking credentialing must provide similar information, including certification from accrediting bodies and verification of good standing with state and federal entities. Recredentialing is mandated every 36 months for both providers and facilities, and a credentialing committee oversees the review and appeals process, ensuring compliance with requirements​​​​​​.

Meet Ohio Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in Ohio

MedTrainer’s all-in-one compliance platform can streamline management of Ohio healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!