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SF 3566

1st Engrossment - 92nd Legislature (2021 - 2022) Posted on 06/27/2022 08:22am

KEY: stricken = removed, old language.
underscored = added, new language.

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 beginDefinitiondeleted text endnew text begin Definitionsnew text end.

new text begin(a) new text endFor purposes of this section, new text beginthe 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 beginConditions 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 endReasonable 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 beginan new text endevaluation new text beginconducted
new text end by the attending physiciannew text begin, advanced practice registered nurse, or physician assistantnew text end and
one or more physiciansnew text begin, advanced practice registered nurses, or physician assistantsnew text end
specializing in pain medicine or the treatment of the area, system, or organ of the body
new text begin confirmed or new text endperceived as the source of the new text beginintractable new text endpain; or

(2) when treating a terminally ill patient, new text beginan new text endevaluation new text beginconducted new text endby the attending
physiciannew text begin, advanced practice registered nurse, or physician assistantnew text end who does so in
accordance with new text beginthe standard of care and new text endthe level of care, skill, and treatment that would
be recognized by a reasonably prudent physiciannew text begin, advanced practice registered nurse, or
physician assistant
new text end 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, advanced practice registered
nurse, or physician assistant and either by a physician, advanced practice registered nurse,
or physician assistant specializing in pain medicine or a physician, advanced practice
registered nurse, or physician assistant 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 endNotwithstanding any other provision of this chapter, a physiciannew text begin, advanced practice
registered nurse, or physician assistant
new text end may prescribe or administer a controlled substance
in Schedules II to V of section 152.02 to deleted text beginan individualdeleted text endnew 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 endnew text begin patientnew text end for a diagnosed condition causing intractable pain. No physiciannew text begin, advanced
practice registered nurse, or physician assistant
new text end shall be subject to disciplinary action by
the Board of Medical Practice new text beginor Board of Nursing new text endfor appropriately prescribing or
administering a controlled substance in Schedules II to V of section 152.02 in the course
of treatment of deleted text beginan individualdeleted text endnew 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 endkeeps 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 endnew 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 limited to 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 beginan individualdeleted text endnew 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 beginan individualdeleted text endnew text begin a patientnew text end whom the physiciannew text begin, advanced practice registered
nurse, or physician assistant
new text end knows to be using the controlled substances for nontherapeutic
new text begin or drug diversion new text endpurposes;

(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 beginan individualdeleted text endnew 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 beginan individualdeleted text endnew text begin a patientnew text end for intractable pain in
accordance with subdivision 2, a physiciannew text begin, advanced practice registered nurse, or physician
assistant
new text end shall discuss with the deleted text beginindividualdeleted text endnew 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's
new text end treatment of deleted text beginan individualdeleted text endnew text begin a patientnew text end, and document the
discussion in the deleted text beginindividual'sdeleted text endnew text begin patient'snew text end recordnew text begin as required in the patient-provider agreement
described in subdivision 5
new 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