1.1 	A bill for an act
1.2 	relating to human services; expanding participation in the opioid prescribing 
1.3 	improvement program;amending Minnesota Statutes 2016, section 256B.0638, 
1.4 	subdivisions 2, 4, 5.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. Minnesota Statutes 2016, section 256B.0638, subdivision 2, is amended to read:
1.7 		Subd. 2.Definitions. (a) For purposes of this section, the terms defined in this subdivision 
1.8 	have the meanings given them.
1.9 	(b) "Commissioner" means the commissioner of human services.
1.10 	(c) "Commissioners" means the commissioner of human services and the commissioner 
1.11 	of health.
1.12 	(d) "DEA" means the United States Drug Enforcement Administration.
1.13 	(e) "Minnesota health care program" means a public health care program administered 
1.14 	by the commissioner of human services under this chapter and chapter 256L, and the 
1.15 	Minnesota restricted recipient program.
1.16 	(f) "Opioid disenrollment standards" means parameters of opioid prescribing practices 
1.17 	that fall outside community standard thresholds for prescribing to such a degree that a 
1.18 	provider must be disenrolled as a medical assistance provider.
1.19 	(g) "Opioid prescriber" means a licensed health care provider who prescribes opioids to 
1.20 	medical assistance and MinnesotaCare enrollees under the fee-for-service system or under 
1.21 	a managed care or county-based purchasing plan in this state.
2.1 	(h) "Opioid quality improvement standard thresholds" means parameters of opioid 
2.2 	prescribing practices that fall outside community standards for prescribing to such a degree 
2.3 	that quality improvement is required.
2.4 	(i) "Program" means the statewide opioid prescribing improvement program established 
2.5 	under this section.
2.6 	(j) "Provider group" means a clinic, hospital, or primary or specialty practice group that 
2.7 	employs, contracts with, or is affiliated with an opioid prescriber. Provider group does not 
2.8 	include a professional association supported by dues-paying members.
2.9 	(k) "Sentinel measures" means measures of opioid use that identify variations in 
2.10 	prescribing practices during the prescribing intervals.

2.11 	Sec. 2. Minnesota Statutes 2016, section 256B.0638, subdivision 4, is amended to read:
2.12 		Subd. 4.Program components. (a) The working group shall recommend to the 
2.13 	commissioners the components of the statewide opioid prescribing improvement program, 
2.14 	including, but not limited to, the following:
2.15 	(1) developing criteria for opioid prescribing protocols, including:
2.16 	(i) prescribing for the interval of up to four days immediately after an acute painful 
2.17 	event;
2.18 	(ii) prescribing for the interval of up to 45 days after an acute painful event; and
2.19 	(iii) prescribing for chronic pain, which for purposes of this program means pain lasting 
2.20 	longer than 45 days after an acute painful event;
2.21 	(2) developing sentinel measures;
2.22 	(3) developing educational resources for opioid prescribers about communicating with 
2.23 	patients about pain management and the use of opioids to treat pain;
2.24 	(4) developing opioid quality improvement standard thresholds and opioid disenrollment 
2.25 	standards for opioid prescribers and provider groups. In developing opioid disenrollment 
2.26 	standards, the standards may be described in terms of the length of time in which prescribing 
2.27 	practices fall outside community standards and the nature and amount of opioid prescribing 
2.28 	that fall outside community standards; and
2.29 	(5) addressing other program issues as determined by the commissioners.
3.1 	(b) The opioid prescribing protocols shall not apply to opioids prescribed for patients 
3.2 	who are experiencing pain caused by a malignant condition or who are receiving hospice 
3.3 	care, or to opioids prescribed as medication-assisted therapy to treat opioid dependency.
3.4 	(c) All opioid prescribers who prescribe opioids to Minnesota health care program 
3.5 	enrollees must participate in the program in accordance with subdivision 5. Any other 
3.6 	prescriber who prescribes opioids may comply with the components of this program described 
3.7 	in paragraph (a) on a voluntary basis.

3.8 	Sec. 3. Minnesota Statutes 2016, section 256B.0638, subdivision 5, is amended to read:
3.9 		Subd. 5.Program implementation. (a) The commissioner shall implement the programs 
3.10 	within the Minnesota health care program to improve the health of and quality of care 
3.11 	provided to Minnesota health care program enrollees and to other patients. The commissioner 
3.12 	shall annually collect and report to opioid prescribers data showing the sentinel measures 
3.13 	of their opioid prescribing patterns compared to their anonymized peers.
3.14 	(b) The commissioner shall notify an opioid prescriber and all provider groups with 
3.15 	which the opioid prescriber is employed or affiliated when the opioid prescriber's prescribing 
3.16 	pattern exceeds the opioid quality improvement standard thresholds. An opioid prescriber 
3.17 	and any provider group that receives a notice under this paragraph shall submit to the 
3.18 	commissioner a quality improvement plan for review and approval by the commissioner 
3.19 	with the goal of bringing the opioid prescriber's prescribing practices into alignment with 
3.20 	community standards. A quality improvement plan must include:
3.21 	(1) components of the program described in subdivision 4, paragraph (a);
3.22 	(2) internal practice-based measures to review the prescribing practice of the opioid 
3.23 	prescriber and, where appropriate, any other opioid prescribers employed by or affiliated 
3.24 	with any of the provider groups with which the opioid prescriber is employed or affiliated; 
3.25 	and
3.26 	(3) appropriate use of the prescription monitoring program under section 152.126.
3.27 	The commissioner shall submit a copy of any quality improvement plan to the health-related 
3.28 	licensing board that licenses the opioid prescriber.
3.29 	(c) If, after a year from the commissioner's notice under paragraph (b), the opioid 
3.30 	prescriber's prescribing practices do not improve so that they are consistent with community 
3.31 	standards, the commissioner shall take one or more of the following steps:
3.32 	(1) monitor prescribing practices more frequently than annually;
4.1 	(2) monitor more aspects of the opioid prescriber's prescribing practices than the sentinel 
4.2 	measures; or
4.3 	(3) require the opioid prescriber to participate in additional quality improvement efforts, 
4.4 	including but not limited to mandatory use of the prescription monitoring program established 
4.5 	under section 152.126.
4.6 	(d) The commissioner shall terminate from Minnesota health care programs all opioid 
4.7 	prescribers and provider groups whose prescribing practices fall within the applicable opioid 
4.8 	disenrollment standards and shall submit a report to the health-related licensing board that 
4.9 	licenses the opioid prescriber.