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HF 1851

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/15/2021 04:55pm

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

Bill Text Versions

Engrossments
Introduction Posted on 03/04/2021

Current Version - as introduced

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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.

Definition.

new text begin(a) new text endFor purposes of this section, new text beginthe definitions in this
subdivision have the meanings given to them.
new text end

new text begin (b) 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, including 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, evaluation by the
attending physician deleted text beginand one or more physicians specializing in pain medicine or the treatment
of
deleted text endnew text begin, a physician specializing in pain medicine, or a physician treatingnew text end the area, system, or
organ of the body new text beginconfirmed or new text endperceived as the source of the new text beginintractable new text endpainnew text begin. The evaluation
must include a thorough assessment of the patient, the patient's level and severity of pain,
the patient's function, any physical disabilities related to pain, daily living activities, and
quality of life. The evaluation must also take into consideration any genetic and metabolism
factors or complications, and must be performed in accordance with the standard of care
and the level of care, skill, and treatment that would be recognized by a reasonably prudent
physician under similar conditions or circumstances
new text end; or

(2) when treating a terminally ill patient, evaluation by the attending physician 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 physician under similar conditions and
circumstances.

new text begin (c) "Palliative care" means specialized medical care for individuals living with a serious
illness or a serious diagnosis that focuses on providing relief from the symptoms and stress
of the illness or diagnosis, relieving suffering, and providing the best quality of life. Palliative
care may be provided along with curative treatment to individuals with a nonterminal
diagnosis.
new text end

new text begin (d) "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, regardless of confirmation or the perceived source
of intractable pain, and regardless of whether the intractable pain is the result of an injury,
condition, disorder, or disease 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, whether confirmed or perceived, 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 physician new text beginor advanced
practice registered nurse
new text endmay 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's new text beginor advanced
practice registered nurse's
new text endtreatment of the deleted text beginindividualdeleted text endnew text begin patientnew text end for a diagnosed condition
causing intractable pain. No physician new text beginor advanced practice registered nurse new text endshall 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
physician new text beginor advanced practice registered nurse:
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;
new text end

new text begin (2) documents in the patient's medical record the assessments performed, all elements
of the treatment program, and the rationale for why the prescribed medication and dosage
is appropriate, effective, and medically necessary to treat the patient's intractable pain;
new text end

new text begin (3) documents that the patient shows no signs of abuse, addiction, or diversion at the
time of the patient's evaluation and during any follow up visits when a prescription was
issued or subsequently refilled;
new text end

new text begin (4) documents objective assessment of the success or failure of the treatment plan and
the results of periodic monitoring and testing; and
new text end

new text begin (5) enters into a patient-provider agreement that meets the criteria in subdivision 5.
new text end

new text begin (b) No physician or advanced practice registered nurse, acting in good faith, 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,
Minnesota opioid prescribing improvement program, and Minnesota quality improvement
program established under section 256B.0638.
new text end

new text begin (c) A physician or advanced practice registered nurse treating intractable pain by
prescribing, dispensing, or administering a controlled substance in Schedules II to V in
section 152.02, including but 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 benefiting 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 or advanced practice registered nurse's decision to taper a patient's
medication dosage must be based on factors other than a morphine milligram equivalent
recommendation or threshold in order to meet criteria of a medically warranted taper.
new text end

Subd. 3.

Limits on applicability.

This section does not apply to:

(1) a physician's new text beginor an advanced practice registered nurse's new text endtreatment of deleted text beginan individualdeleted text endnew text begin a
patient
new 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 physician new text beginor advanced practice registered
nurse
new text endknows to be using the controlled substances for nontherapeutic new text beginor 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 an individual 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 physician deleted text beginshalldeleted text endnew text begin or advanced practice registered nurse mustnew text end
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's new text beginor advanced practice registered
nurse's
new text endtreatment 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's
new 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 or advanced practice registered nurse and the patient or the patient's legal
guardian, if applicable, must enter into a provider-patient agreement. The agreement must
include a description of the patient's treatment plan, required monitoring protocols, and the
prescribing details of any medication prescribed as part of the treatment plan, including the
risks associated with the medication being prescribed and any black box warnings, if
applicable, for the medication prescribed.
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 or advanced practice registered nurse, 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 or advanced practice
registered nurse annually. If there is a change in the patient's treatment plan, including a
change in medication or dosage, 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