Minnesota Legislature
HF 3786
1st Engrossment - 92nd Legislature (2021 - 2022) Posted on 04/07/2022 12:25pm
Bill Text Versions
| Engrossments | ||
|---|---|---|
| Introduction | Posted on 02/28/2022 | |
| 1st Engrossment | Posted on 04/07/2022 |
Current Version - 1st Engrossment
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A bill for an act
relating to health care; modifying the definition of intractable pain; modifying the
criteria for prescribing controlled substance for the treatment of intractable pain;
amending Minnesota Statutes 2020, section 152.125.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2020, section 152.125, is amended to read:
152.125 INTRACTABLE PAIN.
Subdivision 1.
deleted text begin Definitiondeleted text end new text begin Definitionsnew text end .
new text begin (a) new text end For purposes of this section, new text begin the terms in this
subdivision have the meanings given.
new text end
new text begin
(b) "Drug diversion" means the unlawful transfer of prescription drugs from their licit
medical purpose to the illicit marketplace.
new text end
new text begin (c) new text end "Intractable pain" means a pain state in which the cause of the pain cannot be removed
or otherwise treated with the consent of the patient and in which, in the generally accepted
course of medical practice, no relief or cure of the cause of the pain is possible, or none has
been found after reasonable efforts. new text begin Conditions associated with intractable pain include but
are not limited to cancer and the recovery period, sickle cell disease, noncancer pain, rare
diseases, orphan diseases, severe injuries, and health conditions requiring the provision of
palliative care or hospice care. new text end Reasonable efforts for relieving or curing the cause of the
pain may be determined on the basis of, but are not limited to, the following:
(1) when treating a nonterminally ill patient for intractable pain, new text begin an new text end evaluation new text begin conducted
new text end by the attending physician and one or more physicians specializing in pain medicine or the
treatment of the area, system, or organ of the body new text begin confirmed or new text end perceived as the source of
the new text begin intractable new text end pain; or
(2) when treating a terminally ill patient, new text begin an new text end evaluation new text begin conducted new text end by the attending
physician who does so in accordance with new text begin the standard of care and new text end the level of care, skill,
and treatment that would be recognized by a reasonably prudent physician under similar
conditions and circumstances.
new text begin
(d) "Palliative care" has the meaning provided in section 144A.75, subdivision 12.
new text end
new text begin
(e) "Rare disease" means a disease, disorder, or condition that affects fewer than 200,000
individuals in the United States and is chronic, serious, life altering, or life threatening.
new text end
new text begin Subd. 1a. new text end
new text begin Criteria for the evaluation and treatment of intractable pain. new text end
new text begin
The evaluation
and treatment of intractable pain when treating a nonterminally ill patient is governed by
the following criteria:
new text end
new text begin
(1) a diagnosis of intractable pain by the treating physician and either by a physician
specializing in pain medicine or a physician treating the area, system, or organ of the body
that is the source of the pain is sufficient to meet the definition of intractable pain; and
new text end
new text begin
(2) the cause of the diagnosis of intractable pain must not interfere with medically
necessary treatment including but not limited to prescribing or administering a controlled
substance in Schedules II to V of section 152.02.
new text end
Subd. 2.
Prescription and administration of controlled substances for intractable
pain.
new text begin (a) new text end Notwithstanding any other provision of this chapter, a physiciannew text begin , advanced practice
registered nurse, or physician assistantnew text end may prescribe or administer a controlled substance
in Schedules II to V of section 152.02 to deleted text begin an individualdeleted text end new text begin a patientnew text end in the course of the
physician'snew text begin , advanced practice registered nurse's, or physician assistant'snew text end treatment of the
deleted text begin individualdeleted text end new text begin patientnew text end for a diagnosed condition causing intractable pain. No physiciannew text begin , advanced
practice registered nurse, or physician assistantnew text end shall be subject to disciplinary action by
the Board of Medical Practice new text begin or Board of Nursing new text end for appropriately prescribing or
administering a controlled substance in Schedules II to V of section 152.02 in the course
of treatment of deleted text begin an individualdeleted text end new text begin a patientnew text end for intractable pain, provided the physiciannew text begin , advanced
practice registered nurse, or physician assistant:
new text end
new text begin (1) new text end keeps accurate records of the purpose, use, prescription, and disposal of controlled
substances, writes accurate prescriptions, and prescribes medications in conformance with
chapter 147deleted text begin .deleted text end new text begin or 148 or in accordance with the current standard of care; and
new text end
new text begin
(2) enters into a patient-provider agreement that meets the criteria in subdivision 5.
new text end
new text begin
(b) No physician, advanced practice registered nurse, or physician assistant, acting in
good faith and based on the needs of the patient, shall be subject to any civil or criminal
action or investigation, disenrollment, or termination by the commissioner of health or
human services solely for prescribing a dosage that equates to an upward deviation from
morphine milligram equivalent dosage recommendations or thresholds specified in state or
federal opioid prescribing guidelines or policies, including but not limited to the Guideline
for Prescribing Opioids for Chronic Pain issued by the Centers for Disease Control and
Prevention, Minnesota opioid prescribing guidelines, the Minnesota opioid prescribing
improvement program, and the Minnesota quality improvement program established under
section 256B.0638.
new text end
new text begin
(c) A physician, advanced practice registered nurse, or physician assistant treating
intractable pain by prescribing, dispensing, or administering a controlled substance in
Schedules II to V of section 152.02 that includes but is not opioid analgesics must not taper
a patient's medication dosage solely to meet a predetermined morphine milligram equivalent
dosage recommendation or threshold if the patient is stable and compliant with the treatment
plan, is experiencing no serious harm from the level of medication currently being prescribed
or previously prescribed, and is in compliance with the patient-provider agreement as
described in subdivision 5.
new text end
new text begin
(d) A physician's, advanced practice registered nurse's, or physician assistant's decision
to taper a patient's medication dosage must be based on factors other than a morphine
milligram equivalent recommendation or threshold.
new text end
new text begin
(e) No pharmacist, health plan company, or pharmacy benefit manager shall refuse to
fill a prescription for an opiate issued by a licensed practitioner with the authority to prescribe
opiates solely based on the prescription exceeding a predetermined morphine milligram
equivalent dosage recommendation or threshold.
new text end
Subd. 3.
Limits on applicability.
This section does not apply to:
(1) a physician'snew text begin , advanced practice registered nurse's, or physician assistant'snew text end treatment
of deleted text begin an individualdeleted text end new text begin a patientnew text end for chemical dependency resulting from the use of controlled
substances in Schedules II to V of section 152.02;
(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to deleted text begin an individualdeleted text end new text begin a patientnew text end whom the physiciannew text begin , advanced practice registered
nurse, or physician assistantnew text end knows to be using the controlled substances for nontherapeutic
new text begin or drug diversion new text end purposes;
(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of deleted text begin an individualdeleted text end new text begin a patientnew text end having
intractable pain; or
(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain relief.
Subd. 4.
Notice of risks.
Prior to treating deleted text begin an individualdeleted text end new text begin a patientnew text end for intractable pain in
accordance with subdivision 2, a physiciannew text begin , advanced practice registered nurse, or physician
assistantnew text end shall discuss with the deleted text begin individualdeleted text end new text begin patient or the patient's legal guardian, if applicable,new text end
the risks associated with the controlled substances in Schedules II to V of section 152.02
to be prescribed or administered in the course of the physician'snew text begin , advanced practice registered
nurse's, or physician assistant'snew text end treatment of deleted text begin an individualdeleted text end new text begin a patientnew text end , and document the
discussion in the deleted text begin individual'sdeleted text end new text begin patient'snew text end recordnew text begin as required in the patient-provider agreement
described in subdivision 5new text end .
new text begin Subd. 5. new text end
new text begin Patient-provider agreement. new text end
new text begin
(a) Before treating a patient for intractable pain,
a physician, advanced practice registered nurse, or physician assistant and the patient or the
patient's legal guardian, if applicable, must mutually agree to the treatment and enter into
a provider-patient agreement. The agreement must include a description of the prescriber's
and the patient's expectations, responsibilities, and rights according to best practices and
current standards of care.
new text end
new text begin
(b) The agreement must be signed by the patient or the patient's legal guardian, if
applicable, and the physician, advanced practice registered nurse, or physician assistant and
included in the patient's medical records. A copy of the signed agreement must be provided
to the patient.
new text end
new text begin
(c) The agreement must be reviewed by the patient and the physician, advanced practice
registered nurse, or physician assistant annually. If there is a change in the patient's treatment
plan, the agreement must be updated and a revised agreement must be signed by the patient
or the patient's legal guardian. A copy of the revised agreement must be included in the
patient's medical record and a copy must be provided to the patient.
new text end
new text begin
(d) A patient-provider agreement is not required in an emergency or inpatient hospital
setting.
new text end