12/04/2025

House Bill 521 Raises Questions for Providers With Post-Acute Units

A new proposal in the Ohio General Assembly, House Bill 521, titled the Ohio Nurse Workforce and Safe Patient Act, would create mandatory registered nurse staffing ratios in hospitals and introduce a new statewide nurse staffing committee structure. While the legislation is designed primarily for acute care settings, several provisions reference units that include long-term care beds, skilled nursing beds, and special skilled nursing beds, prompting questions about whether any LeadingAge Ohio members could be subject to the bill.

The bill applies to any facility that meets the statutory definition of a hospital, which is an institution providing inpatient medical or surgical services for more than 24 hours. It also expressly includes long-term acute care hospitals and hospital units that hold skilled nursing or long-term care beds. Facilities excluded from the bill’s staffing mandates include freestanding inpatient rehabilitation facilities, freestanding birthing centers, and psychiatric hospitals operated by the Department of Behavioral Health.

Based on this structure, the bill does not appear to apply to traditional nursing homes, residential care facilities, or assisted living communities. However, it may affect hospital-based post-acute units, including hospital-owned skilled nursing, transitional care, or swing-bed units that are licensed or designated as hospital beds. The references to skilled nursing beds appear limited to settings operated under a hospital license. At this time, the bill does not appear to extend its staffing ratios to freestanding long-term care providers.

For providers that operate hospital-based skilled nursing units—particularly those within rural hospitals, which receive extended implementation timelines—the proposal creates new ratios for these units. The bill establishes a 1:5 registered nurse–to–patient ratio for any unit identified as skilled nursing. Hospitals would be prohibited from counting charge nurses or other supervisory nurses toward this ratio and would be required to maintain shift-by-shift staffing documentation accessible to staff and the public. Compliance would be monitored through semi-annual audits conducted by the Ohio Department of Health.

If you have questions about how your licensure status may interact with the bill language, contact Eli Faes at efaes@leadingageohio.org.