New Hampshire Nurse Practitioner Association
Nurse Practitioners, Nurse Midwives and Nurse Anesthetists working together for a healthier New Hampshire

Opioid Legislation Update: HB1423

Posted 11 months ago by Mary Bidgood-Wilson

House Bill 1423 was passed by house commitee HHS on March 3rd.  This legislation dictates the scope of rules that must be implementated by the Board of Nursing.  

http://www.gencourt.state.nh.us/bill_status/billText.aspx?v=HI&id=850&txtFormat=html

 

Amendment to HB 1423-FN

Amend the bill by replacing section 1with the following:

1 New Section; Rulemaking for Prescribing Controlled Drugs; Controlled Drug Prescription Health and Safety Program. Amend RSA 318-B by inserting after section 40 the following new section:

318-B:41 Rulemaking for Prescribing Controlled Drugs.

I.(a) Before September 1, 2016, the following boards shall submit to the joint legislative committee on administrative rules final proposed rules for prescribing schedule II, III, and IV opioids, for the management or treatment of pain:

(1) The board of medicine, concerning physicians and physician assistants.

(2) The board of dental examiners, concerning dentists.

(3) The board of nursing, concerning advanced practice registered nurses.

(4) The board of registration in optometry, concerning optometrists.

(5) The board of registration in podiatry, concerning podiatrists.

(6) The naturopathic board of examiners, concerning naturopaths.

(b) The rules required under paragraph I shall, at a minimum, contain mandatory standards for the practice components established in paragraph II.

II. The rules shall, at a minimum, contain mandatory standards for the following practice components:

(a) Standards for the use of opioids for the management or treatment of all pain:

(1) Conducting and documenting a detailed history and a physical exam in response to a complaint of pain or anticipated pain.

(2) Completing a board-approved risk assessment tool to determine whether a patient is an appropriate candidate for a schedule II, III, or IV opioid.

(3) Establishing and documenting an appropriate pain treatment plan that includes consideration of nonpharmacological modalities and non-opioid therapy.

(4)(A) Querying the program database when writing an initial schedule II, III, or IV opioid prescription for the management or treatment of a patient's pain and then periodically, at least twice a year. Such rules shall include exceptions for:

(i) Controlled substances administered to a patient in a health care setting;

(ii) The program is inaccessible or not functioning properly, due to an internal or external electronic issue; or

(iii) An emergency department is experiencing a higher than normal patient volume, and to query the program database would materially delay care.

(B) When a situation falling under exception (A)(ii) or (iii) is applicable, such exception shall be documented in the patient's medical record.

(5) Establishing procedures for informed consent outlining the risks and benefits of opioid use.

(6) Requiring the lowest effective dosage for the fewest number of days with specific dose limits be prescribed for a medical condition or specialty.

(7) Providing for the enforcement of the prescribing rules by specifying that noncompliance with the rules may constitute unprofessional conduct under the board's practice act.

(b) Standards for the use of opioids for the management or treatment of acute pain:

(1) Limiting the amount of days for an opioid prescription issued in an emergency department, urgent care setting, or walk-in clinic. This specific duration limit shall be set by each board no later than August 1, 2016 taking into consideration the recommendation from a majority vote of a policy group consisting of the chief medical officer of the department of health and human services, a physician designated by the New Hampshire chapter of the American College of Emergency Physicians, a physician designated by the New Hampshire Hospital Association, an advanced practice registered nurse designated by the New Hampshire Nurse Practitioner Association, a physician or advanced practice registered nurse designated by the governor, a board certified surgeon, designated by the New Hampshire Medical Society, and an oral surgeon, designated by the New Hampshire Dental Society. Five members of the policy group shall constitute a quorum. All policy group meetings shall be open to the public and noticed in the house and senate calendars.

(2) In settings where continuity of care is anticipated, each board shall establish finite limits considering dose and duration of opioid prescriptions for treatment of acute pain and appropriate timing of office follow up for persistent, unresolved acute pain.

(c) Standards for the use of opioids for the management or treatment of chronic pain:

(1) Mandatory use of written treatment agreements, such as the agreement developed by the American Academy of Pain Medicine. Treatment agreements shall include conduct that triggers the discontinuation or tapering of opioid prescriptions.

(2) Establishing a requirement for periodic review conducted at reasonable intervals to reevaluate treatment plans and use of opioids.

(3) Establishing a procedure for, and documenting consideration of, consultation with, or referral to a specialist for patients receiving a high morphine equivalent dose for longer than 90 days.

(4) Creating exemptions to the prescribing rules for situations in which an opioid is being prescribed for the management of chronic pain for:

(A) Patients with cancer pain;

(B) Patients with a terminal condition;

(C) Long-term, nonrehabilitative, residents of a nursing home facility.

III. Before September 1, 2016, the board of veterinary medicine shall submit to the joint legislative committee on administrative rules final proposed rules for prescribing schedule II, III, and IV opioids by veterinarians for the management or treatment of pain. For the practice components set forth in paragraph IV, the term "patient" refers to the animal being prescribed opioids for the management or treatment of pain, and the term "owner" refers to the legal owner of the animal.

IV. The prescribing rules required by paragraph III shall, at a minimum, contain mandatory standards for the following practice components.

(a) Standards for the use of opioids for the management or treatment of pain:

(1) Conducting and documenting a detailed history and a physical exam in response to a complaint of pain or anticipated pain.

(2) Completing a board-approved risk assessment tool to determine whether a patient is an appropriate candidate for a schedule II, III, or IV opioid.

(3) Establishing and documenting an appropriate pain treatment plan that includes consideration of nonpharmacological modalities and non-opioid therapy.

(4)(A) Querying the program database when writing an initial schedule II, III, or IV opioid prescription for the management or treatment of a patient's pain and then periodically, at least twice a year. The program shall be queried for the patient, its owner, and the individual bringing the patient in to see the veterinarian, if applicable. Exceptions to this requirement shall be limited to situations in which:

(i) Controlled substances are to be administered to a patient in a health care setting.

(ii) The program is inaccessible or not functioning properly, due to an internal or external electronic issue.

(B) For exception (ii), the specific reason why there was no query of the program database shall be documented in the patient's medical record.

(5) Establishing procedures for informed consent outlining the risks and benefits of opioid use.

(6) Requiring the lowest effective dosage for the fewest number of days with specific dose limits, if appropriate, be prescribed for a medical condition or specialty.

(7) Providing for the enforcement of the prescribing rules by specifying that noncompliance with the rules may constitute unprofessional conduct under the board's practice act.

(b) Standards for the use of opioids for the management or treatment of acute pain:

(1) Limiting the amount of days for an opioid prescription issued in an emergency care setting. The board shall base its recommendation on the limit established pursuant to paragraph II(b)(1).

(2) In settings where continuity of care is anticipated, establishing finite limits on dose and duration of opioid prescriptions for treatment of acute pain and appropriate timing of office follow up for persistent, unresolved acute pain.

(c) Standards for the use of opioids in the management or treatment of chronic pain.

(1) Mandatory use of written treatment agreements, such as the agreement developed by the American Academy of Pain Medicine. Treatment agreements shall include conduct that triggers the discontinuation or tapering of opioid prescriptions.

(2) Establishing a requirement for periodic review conducted at reasonable intervals to reevaluate treatment plans and use of opioids.

V. At a minimum, each board's Internet website shall include online links to board approved:

(a) Continuing education on the prescribing of opioids.

(b) Screening tools.

(c) Treatment agreements.

(d) Risks and benefits of opioid use.

(e) Proper storage of opioids.

(f) Proper disposal of unused opioids.

Amend RSA 329:9, XX as inserted by section 2 of the bill by replacing it with the following:

XX. Prescribing controlled drugs pursuant to RSA 318-B:41.

Amend RSA 317-A:12, XIII as inserted by section 3 of the bill by replacing it with the following:

XIII. Prescribing controlled drugs pursuant to RSA 318-B:41; and

Amend RSA 326-B:9, XII as inserted by section 4 of the bill by replacing it with the following:

XII. Prescribing controlled drugs pursuant to RSA 318-B:41.

Amend RSA 327:31, X as inserted by section 5 of the bill by replacing it with the following:

X. Prescribing controlled drugs pursuant to RSA 318-B:41.

Amend RSA 315:4, XII as inserted by section 6 of the bill by replacing it with the following:

XII. Prescribing controlled drugs pursuant to RSA 318-B:41.

Amend RSA 328-E:10, I(e) as inserted by section 7 of the bill by replacing it with the following:

(e) Prescribing controlled drugs pursuant to RSA 318-B:41.

Amend RSA 332-B:7-a, XV as inserted by section 8 of the bill by replacing it with the following:

XV. Prescribing controlled drugs pursuant to RSA 318-B:41.

Amend the bill by replacing section 9 with the following:

9 Repeal. RSA 318-B:39, relative to prescribers required to query the program prior to prescribing controlled substances, is repealed.

10 Effective Date.

I. RSA 318-B:41, II(a)(4), IV(a)(4), and section 9 shall take effect January 1, 2017.

II. The remainder of this act shall take effect upon its passage.