Source: http://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdoc=hb4003%20intr.htm&yr=2018&sesstype=RS&i=4003
Timestamp: 2020-01-28 05:35:18
Document Index: 498073393

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.WEST virginia Legislature
By Delegates Hollen, Romine, C., Moore, Rohrbach, Summers, Phillips, Hamilton, Storch, Sobonya, Sypolt and Capito)
A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new article, designated §16-54-1, §16-54-2, §16-54-3, §16-54-4, §16-54-5, §16-54-6, §16-54-7, §16-54-8, and §16-54-9; to amend and reenact §30-3-14 of said code; to amend and reenact §30-3A-1, §30-3A-2, §30-3A-3, and §30-3A-4 of said code; to amend and reenact §30-4-19 of said code; to amend and reenact §30-5-6 of said code; to amend and reenact §30-7-11 of said code; to amend and reenact §30-8-18 of said code to amend and reenact §30-14-12a of said code; to amend and reenact §30-36-2 of said code; to amend and reenact §60A-2-204, §60A-2-206, and §60A-2-210 of said code; and to amend and reenact §60A-9-4, §60A-9-5, and §60A-9-5a of said code, all relating to reducing the use of certain prescription drugs; limiting the amount of opioid prescription, requiring certain health care procedures be followed by health care practitioners relating to prescriptions for opioids; requiring reports to licensing boards regarding abnormal prescribing practices; relating to requiring the Board of Pharmacy to report quarterly to various licensing boards; permitting the investigation and discipline for abnormal prescribing and dispensing of prescription drugs, updating the schedule of controlled substances; allowing licensing boards who regulate prescribers to investigate abnormal prescribing and dispensing of prescription drugs based upon information.
“Acute pain” means a time limited pain cause by a specific disease of injury.
“Chronic pain” means a noncancer nonend of life pain lasting more than three months or longer than the duration of normal tissue healing.
(A) A physician licensed pursuant to §30-3-1 et seq. or §30-14-1 et seq. of this code;
(B) A physician assistant with prescriptive authority as set forth in §30-3E-1 et seq. of this code;
(C) An advanced practice registered nurse with prescriptive authority as set forth in §30-7-15a of this code;
(D) A dentist licensed pursuant to §30-4-1 et seq. of this code; and
(E) An optometrist licensed pursuant to §30-8-1 et seq. of this code.
§16-54-2. Voluntary Nonopiate Advanced Directive Form.
The office shall establish a voluntary nonopiate advanced directive form. The form shall be available on the office’s web site. The form shall indicate to a health care practitioner that an individual may not be administered or offered a prescription or medication order for an opiate. The form may be submitted to the Board of Pharmacy and the board shall make a notation of the directive on the controlled substance monitoring database. The indication may also be added to the individual’s electronic health record. An individual may revoke the voluntary nonopiate advanced directive form for any reason and may do so by written or oral means.
(1) Take and document the results of a thorough medical history, including the patient’s experience with nonopioid medication and nonpharmacological pain management approaches and substance abuse history;
(b) Prior to issuing the subsequent prescription of the course of treatment, a practitioner shall discuss with the patient, or the patient’s parent or guardian if the patient is under eighteen years of age, the risks associated with the drug being prescribed. This discussion shall include:
§16-54-6. Ongoing treatment; referral to chronic pain clinic.
(a) At the time of the issuance of the third prescription for a prescription opiate, the practitioner shall refer the patient to a chronic pain clinic.
(4) Review the Controlled Substance Monitoring Database as required by §60A-9-1 et seq. of this code.
(b) An insurance provider, Medicaid and PEIA shall provide coverage for twelve visits over one hundred twenty days of physical therapy, occupational therapy, and chiropractic care when ordered by a health care practitioner to treat conditions that cause chronic pain.
(b) Upon request of the board, any medical peer review committee in this state shall report any information that may relate to the practice or performance of any physician or podiatrist known to that medical peer review committee. Copies of the requests for information from a medical peer review committee may be provided to the subject physician or podiatrist if, in the discretion of the board, the provision of such copies will not jeopardize the board’s investigation. In the event that If copies are provided, the subject physician or podiatrist is allowed fifteen days to comment on the requested information and such comments must be considered by the board.
Upon a determination of the board that there is probable cause to believe that any person, partnership, corporation, association, insurance company, professional society or other organization has failed or refused to make a report required by this subsection, the board shall provide written notice to the alleged violator stating the nature of the alleged violation and the time and place at which the alleged violator shall appear to show good cause why a civil penalty should not be imposed. The hearing shall be conducted in accordance with §29A-5-1 et seq. of this code. After reviewing the record of the hearing, if the board determines that a violation of this subsection has occurred, the board shall assess a civil penalty of not less than $1,000 nor more than $10,000 against the violator. The board shall notify any person so assessed of the assessment in writing and the notice shall specify the reasons for the assessment. If the violator fails to pay the amount of the assessment to the board within thirty days, the Attorney General may institute a civil action in the circuit court of Kanawha County to recover the amount of the assessment. In any civil action, the court’s review of the board’s action shall be conducted in accordance with §29A-5-4 of this code. Notwithstanding any other provision of this article to the contrary, when there are conflicting views by recognized experts as to whether any alleged conduct breaches an applicable standard of care, the evidence must be clear and convincing before the board may find that the physician or podiatrist has demonstrated a lack of professional competence to practice with a reasonable degree of skill and safety for patients
(h) In every disciplinary or licensure denial action, the board shall furnish the physician or podiatrist or applicant with written notice setting out with particularity the reasons for its action. Disciplinary and licensure denial hearings shall be conducted in accordance with article five, chapter twenty-nine-a of this code. However, hearings shall be heard upon sworn testimony and the rules of evidence for trial courts of record in this state shall apply to all hearings. A transcript of all hearings under this section shall be made, and the respondent may obtain a copy of the transcript at his or her expense. The physician or podiatrist has the right to defend against any charge by the introduction of evidence, the right to be represented by counsel, the right to present and cross-examine witnesses and the right to have subpoenas and subpoenas duces tecum issued on his or her behalf for the attendance of witnesses and the production of documents. The board shall determine by a preponderance of the evidence that a violation of this code or the legislative rules promulgated occurred. The board shall make all its final actions public. The order shall contain the terms of all action taken by the board.
(k) Notwithstanding the provisions of §30-1-8 of this code, if the board determines the evidence in its possession indicates that a physician’s or podiatrist’s continuation in practice or unrestricted practice constitutes an immediate danger to the public, the board may take any of the actions provided in subsection (j) of this section on a temporary basis and without a hearing if institution of proceedings for a hearing before the board are initiated simultaneously with the temporary action and begin within fifteen days of the action. The board shall render its decision within five days of the conclusion of a hearing under this subsection.
(2) “Board” or “licensing board” means the West Virginia Board of Medicine, the West Virginia Board of Osteopathy, the West Virginia Board of Registered Nurses or the West Virginia Board of Pharmacy, the West Virginia Board of Optometry or the West Virginia Board of Dentistry.
(7) “Physician” means a physician licensed in the State of West Virginia pursuant to the provisions of article three or article fourteen of this chapter
(7) “Prescriber” means:
(B) An advanced practice registered nurse with prescriptive authority as set forth in §30-7-15a of this code;
(C) A dentist licensed pursuant to §30-4-1 et seq. of this code; and
(D) An optometrist licensed pursuant to §30-8-1 et seq. of this code.
(b) A health care provider, as defined in §55-7B-2 of this code, with prescriptive authority is not subject to disciplinary sanctions by a licensing board or criminal punishment by the state for declining to prescribe, or declining to continue to prescribe, any controlled substance to a patient which the health care provider with prescriptive authority is treating if the health care provider with prescriptive authority in the exercise of reasonable prudent judgment believes the patient is misusing the controlled substance in an abusive manner or unlawfully diverting a controlled substance legally prescribed for their use. (c) A licensed registered professional nurse is not subject to disciplinary sanctions by a licensing board or criminal punishment by the state for administering pain-relieving controlled substances to alleviate or control pain, if administered in accordance with the orders of a licensed physician.
(4) Diverting controlled substances prescribed for a patient to the physician's own personal use; or
(5) Abnormal prescribing or dispensing patterns as identified by the controlled substance monitoring program set forth in §60A-9-1 et seq. of this code. These prescribing and dispensing patterns may be discovered either in the report filed with the appropriate board as required by §60A-9-4(d) of this code following notice as set forth in §30-3A-4(a) of this code or, through an inquiry of the controlled substances monitoring database by the appropriate licensing board.
(b) Nothing in this article shall may prohibit disciplinary action or criminal prosecution of a nurse or pharmacist for:
§30-3A-4. Construction of article Abnormal prescribing practices.
(a) Upon receipt of the quarterly report set forth in §60A-9-1 et seq. of this code, the licensing board shall notify the prescriber that they have been identified as a potentially abnormal prescriber. The board may take no disciplinary action based upon the first notice.
(b) Upon receipt of a second consecutive quarterly report containing the same or substantially similar prescribing patterns the licensing board shall commence an investigating into the alleged abnormal prescribing practices of the prescriber.
(d) A licensing board may upon receipt of credible and reliable information independent of the quarterly report as set forth in §60A-9-1 et seq. of this code initiate an investigation into any alleged abnormal prescribing or dispensing practices of a licensee.
(e)The licensing boards and prescribers have all rights and responsibilities in their practice acts.
(a) The board may initiate a complaint upon receipt of the quarterly report of from the Board of Pharmacy as required by §60A-9-1 et seq. of this code or upon receipt of credible information and shall, upon the receipt of a written complaint of any person, cause an investigation to be made to determine whether grounds exist for disciplinary action under this article or the legislative rules promulgated pursuant to this article.
(a) (1) The board has all the powers and duties set forth in this article, by rule, in article one of this chapter and elsewhere in law, including the power to:
(r) (19) Propose rules in accordance with the provisions of article three, chapter twenty-nine-a of this code to implement the provisions of this article;
(a) The board shall have the power to may deny, revoke or suspend any license to practice registered professional nursing issued or applied for in accordance with the provisions of this article, or to otherwise discipline a licensee or applicant upon proof that he or she:
(a) The board may upon its own motion based on credible information or based upon the quarterly report of from the Board of Pharmacy as required by §60A-9-1 et seq. of this code, and shall upon the written complaint of any person cause an investigation to be made to determine whether grounds exist for disciplinary action under this article or the legislative rules of the board.
(d) Upon a finding that probable cause exists that the licensee or permittee has violated subsection (g) of this section or rules promulgated pursuant to this article, the board may enter into a consent decree or hold a hearing for the suspension or revocation of the license, certificate or permit or the imposition of sanctions against the licensee, certificate holder or permittee. Any hearing shall be held in accordance with the provisions of this article, and the provisions of §29A-5-1 et seq. and §29A-6-1 et seq. of this code.
(a) The board may independently initiate suspension or revocation proceedings as well as initiate suspension or revocation proceedings based on information received from any person including, but not limited to, the Board of Pharmacy as required by §60A-9-1 et seq. of this code.
Upon a determination of the board that there is probable cause to believe that any person, partnership, corporation, association, insurance company, professional society or other organization has failed or refused to make a report required by this subsection, the board shall provide written notice to the alleged violator stating the nature of the alleged violation and the time and place at which the alleged violator shall appear to show good cause why a civil penalty should not be imposed. The hearing shall be conducted in accordance with the provisions of article five, chapter twenty-nine-a of this code. After reviewing the record of such hearing, if the board determines that a violation of this subsection has occurred, the board shall assess a civil penalty of not less than $1,000 nor more than $10,000 against such violator. The board shall notify anyone assessed of the assessment in writing and the notice shall specify the reasons for the assessment. If the violator fails to pay the amount of the assessment to the board within thirty days, the Attorney General may institute a civil action in the circuit court of Kanawha County to recover the amount of the assessment. In any such civil action, the court’s review of the board’s action shall be conducted in accordance with the provisions of §29A-5-4 of this code.
(c) In every case considered by the board under this article regarding suspension, revocation or issuance of a license whether initiated by the board or upon complaint or information from any person or organization, the board shall make a preliminary determination as to whether probable cause exists to substantiate charges of cause to suspend, revoke or refuse to issue a license as set forth in §30-14-11(a) of this code. If such probable cause is found to exist, all proceedings on such charges shall be open to the public who are entitled to all reports, records, and nondeliberative materials introduced at such hearing, including the record of the final action taken: Provided, That any medical records, which were introduced at such hearing and which pertain to a person who has not expressly waived his or her right to the confidentiality of such records, shall not be open to the public nor is the public entitled to such records. If a finding is made that probable cause does not exist, the public has a right of access to the complaint or other document setting forth the charges, the findings of fact and conclusions supporting such finding that probable cause does not exist, if the subject osteopathic physician consents to such access.
(a)(1) The information required by this article to be kept by the Board of Pharmacy is confidential and not subject to the provisions of §29B-1-1 et seq. of this code or obtainable as discovery in civil matters absent a court order and is open to inspection only by inspectors and agents of the Board of Pharmacy, members of the West Virginia State Police expressly authorized by the superintendent of the West Virginia State Police to have access to the information, authorized agents of local law-enforcement agencies as members of a federally affiliated drug task force, authorized agents of the federal Drug Enforcement Administration, duly authorized agents of the Bureau for Medical Services, duly authorized agents of the Office of the Chief Medical Examiner for use in post-mortem examinations, duly authorized agents of the Office of Health Facility Licensure and Certification for use in certification, licensure and regulation of health facilities, duly authorized agents of licensing boards of practitioners in this state and other states authorized to prescribe Schedules II, III and IV controlled substances, prescribing practitioners and pharmacists, a dean of any medical school or his or her designee located in this state to access prescriber level data to monitor prescribing practices of faculty members, prescribers and residents enrolled in a degree program at the school where he or she serves as dean, a physician reviewer designated by an employer of medical providers to monitor prescriber level information of prescribing practices of physicians, advance practice registered nurses or physician assistant in their employ, and a chief medical officer of a hospital or a physician designated by the chief executive officer of a hospital who does not have a chief medical officer, for prescribers who have admitting privileges to the hospital or prescriber level information, and persons with an enforceable court order or regulatory agency administrative subpoena. All law-enforcement personnel who have access to the Controlled Substances Monitoring Program database shall be granted access in accordance with applicable state laws and the Board of Pharmacy’s rules, shall be certified as a West Virginia law-enforcement officer and shall have successfully completed training approved by the Board of Pharmacy. All information released by the Board of Pharmacy must be related to a specific patient or a specific individual or entity under investigation by any of the above parties except that practitioners who prescribe or dispense controlled substances may request specific data related to their Drug Enforcement Administration controlled substance registration number or for the purpose of providing treatment to a patient: Provided, That the West Virginia Controlled Substances Monitoring Program Database Review Committee established in subsection (b) of this section is authorized to query the database to comply with said subsection.
(b) The Board of Pharmacy shall create a West Virginia Controlled Substances Monitoring Program Database Review Committee of individuals consisting of two prosecuting attorneys from West Virginia counties, two physicians with specialties which require extensive use of controlled substances and a pharmacist who is trained in the use and abuse of controlled substances. The review committee may determine that an additional physician who is an expert in the field under investigation be added to the team when the facts of a case indicate that the additional expertise is required. The review committee, working independently, may query the database based on parameters established by the advisory committee. The review committee may make determinations on a case-by-case basis on specific unusual prescribing or dispensing patterns indicated by outliers in the system or abnormal or unusual usage patterns of controlled substances by patients which the review committee has reasonable cause to believe necessitates further action by law enforcement or the licensing board having jurisdiction over the practitioners or dispensers under consideration. The licensing board having jurisdiction over the practitioner or dispenser under consideration shall report back to the Board of Pharmacy regarding any findings, investigation or discipline resulting from the findings of the review committee within thirty days of resolution of any action taken by the licensing board resulting from the information provided by the Board of Pharmacy. The review committee shall also review notices provided by the chief medical examiner pursuant to §61-12-10(h) of this code and determine on a case-by-case basis whether a practitioner who prescribed or dispensed a controlled substance resulting in or contributing to the drug overdose may have breached professional or occupational standards or committed a criminal act when prescribing the controlled substance at issue to the decedent. Only in those cases in which there is reasonable cause to believe a breach of professional or occupational standards or a criminal act may have occurred, the review committee shall notify the appropriate professional licensing agency having jurisdiction over the applicable practitioner or dispenser and appropriate law-enforcement agencies and provide pertinent information from the database for their consideration. The number of cases identified shall be determined by the review committee based on a number that can be adequately reviewed by the review committee. The information obtained and developed may not be shared except as provided in this article and is not subject to the provisions of §29B-1-1 et seq. of this code or obtainable as discovering in civil matters absent a court order.
(d) The Board of Pharmacy shall promulgate rules with advice and consent of the advisory committee, in accordance with §29A-3-1 et seq. of this code. The legislative rules must include, but shall not be limited to, the following matters:
(A) The West Virginia Board of Medicine codified at §30-3-1 et seq. of this code;
(B) The West Virginia Board of Osteopathic Medicine codified at §30-14-1 et seq. of this code;
(C) The West Virginia Board of Examiners for Registered Professional Nurses codified at §30-7-1 et seq. of this code;
(D) The West Virginia Board of Dentistry codified at §30-4-1 et seq. of this code; and
(E) The West Virginia Board of Optometry codified at §30-8-1 et seq. of this code.
(g) A prescribing or dispensing practitioner may notify law enforcement of a patient who, in the prescribing or dispensing practitioner’s judgment, may be in violation of §60A-4-410 of this code, based on information obtained and reviewed from the controlled substances monitoring database. A prescribing or dispensing practitioner who makes a notification pursuant to this subsection is immune from any civil, administrative or criminal liability that otherwise might be incurred or imposed because of the notification if the notification is made in good faith.
§60A-9-5a. Practitioner requirements to access database and conduct annual search of the database; search by licensing boards for investigative purposes required rulemaking.
(a) All practitioners, as that term is defined in §60-2-101 of this code who prescribe or dispense Schedule II, III or IV controlled substances shall register with the West Virginia Controlled Substances Monitoring Program and obtain and maintain online or other electronic access to the program database: Provided, That compliance with the provisions of this subsection must be accomplished within thirty days of the practitioner obtaining a new license: Provided, however, That the Board of Pharmacy may renew a practitioner’s license without proof that the practitioner meet the requirements of this subsection.
(b) Upon initially prescribing or dispensing any pain-relieving controlled substance for a patient for whom they are providing pain-relieving controlled substances as part of a course of treatment for chronic, nonmalignant pain but who are not suffering from a terminal illness and at least annually thereafter should the practitioner or dispenser continue to treat the patient with controlled substances, all persons with prescriptive or dispensing authority and in possession of a valid Drug Enforcement Administration registration identification number and, who are licensed by the board of Medicine as set forth in §30-3-1 et seq. of this code, the board of Registered Professional Nurses as set forth in §30-7-1 et seq. of this code, the board of Dental Examiners as set forth in §30-4-1 et seq. of this code, and the board of Osteopathic Medicine as set forth in §30-14-1 et seq. of this code and the West Virginia Board of Optometrists as set forth in §30-8-1 et seq. of this code shall access the West Virginia Controlled Substances Monitoring Program database for information regarding specific patients. The information obtained from accessing the West Virginia Controlled Substances Monitoring Program database for the patient shall be documented in the patient’s medical record maintained by a private prescriber or any inpatient facility licensed pursuant to the provisions of chapter sixteen of this code. A pain-relieving controlled substance shall be defined as set forth in §30-3A-1 of this code.
(c) The licensing boards mentioned in subsection (b) of this section shall have access to the program monitoring database to search and query the database for purposes of investigating the prescribing practices of any prescriber for whom the board has issued a license. Any information obtained by the board shall be kept confidential and is subject to the same disclosure requirements as set forth in §60A-9-5 of this code.
(c) (d) The various boards mentioned in subsection (b) of this section shall promulgate both emergency and legislative rules pursuant to the provisions of article three, chapter twenty-nine-a of this code to effectuate the provisions of this section.
NOTE: The purpose of this bill is to reduce prescription drugs. The bill requires that reports be provided to licensing boards regarding abnormal prescribing practices and requires the Board of Pharmacy to report quarterly to various licensing boards. It permits the investigation and discipline for abnormal prescribing and dispensing of prescription drugs and allows licensing boards who regulate prescribers to investigate abnormal prescribing and dispensing of prescription drugs based upon information. The bill also adds substances to Schedule I, II and IV of the Uniform Controlled Substances Act.