txt

CSHB 159(FIN) am: "An Act relating to the prescription of opioids; relating to voluntary nonopioid directives; relating to the controlled substance prescription database; relating to the practice of dentistry; relating to the practice of pharmacy; relating to the practice of medicine; relating to the practice of podiatry; relating to the practice of osteopathy; relating to the practice of nursing; relating to the practice of optometry; relating to the practice of veterinary medicine; relating to the duties of the Board of Pharmacy; relating to pharmacists; providing for an effective date by repealing the effective date of sec. 73, ch. 25, SLA 2016; and providing for an effective date."

00                      CS FOR HOUSE BILL NO. 159(FIN) am                                                                  
01 "An Act relating to the prescription of opioids; relating to voluntary nonopioid                                        
02 directives; relating to the controlled substance prescription database; relating to the                                 
03 practice of dentistry; relating to the practice of pharmacy; relating to the practice of                                
04 medicine; relating to the practice of podiatry; relating to the practice of osteopathy;                                 
05 relating to the practice of nursing; relating to the practice of optometry; relating to the                             
06 practice of veterinary medicine; relating to the duties of the Board of Pharmacy;                                       
07 relating to pharmacists; providing for an effective date by repealing the effective date of                             
08 sec. 73, ch. 25, SLA 2016; and providing for an effective date."                                                        
09 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
10    * Section 1. The uncodified law of the State of Alaska is amended by adding a new section                          
11 to read:                                                                                                                
12       LEGISLATIVE INTENT. It is the intent of the legislature that the seven-day supply                                 
01 limit for an initial opioid prescription under secs. 5, 16, and 22 of this Act may not be                               
02 considered as a minimum length of time appropriate for an initial prescription. The United                              
03 States Centers for Disease Control and Prevention guidelines state that a three-day initial                             
04 prescription of an opioid is sufficient for most cases of acute pain. The United States Centers                         
05 for Disease Control and Prevention reported in its March 17, 2017, weekly report that the                               
06 likelihood of a person's chronic opioid use increases with each additional day of medication                            
07 supplied after the second day. Practitioners should use their professional judgment in each                             
08 case and not interpret the seven-day limit as a direction to prescribe the full seven days.                             
09    * Sec. 2. AS 08.36.070(a), as amended by sec. 5, ch. 25, SLA 2016, is amended to read:                             
10            (a)  The board shall                                                                                         
11 (1)  provide for the examination of applicants and the credentialing,                                                   
12       registration, and licensure of those applicants it finds qualified;                                               
13 (2)  maintain a registry of licensed dentists, licensed dental hygienists,                                              
14       and registered dental assistants who are in good standing;                                                        
15 (3)  affiliate with the American Association of Dental Boards and pay                                                   
16       annual dues to the association;                                                                                   
17 (4)  hold hearings and order the disciplinary sanction of a person who                                                  
18       violates this chapter, AS 08.32, or a regulation of the board;                                                    
19 (5)  supply forms for applications, licenses, permits, certificates,                                                    
20       registration documents, and other papers and records;                                                             
21 (6)  enforce the provisions of this chapter and AS 08.32 and adopt or                                                   
22 amend the regulations necessary to make the provisions of this chapter and AS 08.32                                     
23       effective;                                                                                                        
24 (7)  adopt regulations ensuring that renewal of a license, registration, or                                             
25 certificate under this chapter or a license, certificate, or endorsement under AS 08.32                                 
26 is contingent on [UPON] proof of continued professional competence; the                                         
27 regulations must require that a licensee receive not less than two hours of                                         
28 education in pain management and opioid use and addiction in the two years                                          
29 preceding an application for renewal of a license, unless the licensee has                                          
30 demonstrated to the satisfaction of the board that the licensee does not currently                                  
31       hold a valid federal Drug Enforcement Administration registration number;                                     
01                 (8)  at least annually, cause to be published on the Internet and in a                                  
02       newspaper of general circulation in each major city in the state a summary of                                     
03       disciplinary actions the board has taken during the preceding calendar year;                                      
04                 (9)  issue permits or certificates to licensed dentists, licensed dental                                
05       hygienists, and dental assistants who meet standards determined by the board for                                  
06       specific procedures that require specific education and training;                                                 
07                 (10)  require that a licensed dentist who has a federal Drug                                            
08       Enforcement Administration registration number register with the controlled substance                             
09       prescription database under AS 17.30.200(o).                                                                      
10    * Sec. 3. AS 08.36.110(a) is amended to read:                                                                      
11            (a)  An applicant for a license to practice dentistry shall                                                  
12                 (1)  provide certification to the board that the applicant                                              
13 (A)  is a graduate of a dental school that, at the time of                                                              
14            graduation, is approved by the board;                                                                        
15 (B)  has successfully passed a written examination approved by                                                          
16            the board;                                                                                                   
17 (C)  has not had a license to practice dentistry revoked,                                                               
18            suspended, or voluntarily surrendered in this state or another state;                                        
19 (D)  is not the subject of an adverse decision based on [UPON]                                                      
20 a complaint, investigation, review procedure, or other disciplinary proceeding                                          
21 within the five years immediately preceding application, or of an unresolved                                            
22 complaint, investigation, review procedure, or other disciplinary proceeding,                                           
23            undertaken by a state, territorial, local, or federal dental licensing jurisdiction;                         
24 (E)  is not the subject of an unresolved or an adverse decision                                                         
25 based on [UPON] a complaint, investigation, review procedure, or other                                              
26 disciplinary proceeding, undertaken by a state, territorial, local, or federal                                          
27 dental licensing jurisdiction or law enforcement agency that relates to criminal                                        
28 or fraudulent activity, dental malpractice, or negligent dental care and that                                           
29 adversely reflects on the applicant's ability or competence to practice dentistry                                       
30            or on the safety or well-being of patients;                                                                  
31 (F)  is not the subject of an adverse report from the National                                                          
01            Practitioner Data Bank or the American Association of Dental Boards                                          
02            Clearinghouse for Board Actions that relates to criminal or fraudulent activity,                             
03            or dental malpractice;                                                                                       
04                      (G)  is not impaired to an extent that affects the applicant's                                     
05            ability to practice dentistry;                                                                               
06                      (H)  has not been convicted of a crime that adversely reflects on                                  
07            the applicant's ability or competency to practice dentistry or that jeopardizes                              
08            the safety or well-being of a patient;                                                                       
09                 (2)  pass, to the satisfaction of the board, written, clinical, and other                               
10       examinations administered or approved by the board; and                                                           
11 (3)  meet the other qualifications for a license established by the board                                               
12 by regulation, including education in pain management and opioid use and                                            
13 addiction in the two years preceding the application for a license, unless the                                      
14 applicant has demonstrated to the satisfaction of the board that the applicant                                      
15 does not currently hold a valid federal Drug Enforcement Administration                                             
16       registration number; approved education may include dental school coursework.                                 
17    * Sec. 4. AS 08.36.315 is amended to read:                                                                         
18 Sec. 08.36.315. Grounds for discipline, suspension, or revocation of license.                                         
19 The board may revoke or suspend the license of a dentist, or may reprimand, censure,                                    
20       or discipline a dentist, or both, if the board finds, after a hearing, that the dentist                   
21 (1)  used or knowingly cooperated in deceit, fraud, or intentional                                                      
22       misrepresentation to obtain a license;                                                                            
23 (2)  engaged in deceit, fraud, or intentional misrepresentation in the                                                  
24 course of providing or billing for professional dental services or engaging in                                          
25       professional activities;                                                                                          
26 (3)  advertised professional dental services in a false or misleading                                                   
27       manner;                                                                                                           
28 (4)  received compensation for referring a person to another dentist or                                                 
29       dental practice;                                                                                                  
30 (5)  has been convicted of a felony or other crime that affects the                                                     
31       dentist's ability to continue to practice dentistry competently and safely;                                       
01                 (6)  engaged in the performance of patient care, or permitted the                                       
02       performance of patient care by persons under the dentist's supervision, regardless of                             
03       whether actual injury to the patient occurred,                                                                    
04                      (A)  that did not conform to minimum professional standards of                                     
05            dentistry; or                                                                                                
06                      (B)  when the dentist, or a person under the supervision of the                                    
07            dentist, did not have the permit, registration, or certificate required under                                
08            AS 08.32 or this chapter;                                                                                    
09                 (7)  failed to comply with this chapter, with a regulation adopted under                                
10       this chapter, or with an order of the board;                                                                      
11                 (8)  continued to practice after becoming unfit due to                                                  
12                      (A)  professional incompetence;                                                                    
13 (B)  addiction or dependence on alcohol or other drugs that                                                             
14            impair the dentist's ability to practice safely;                                                             
15                      (C)  physical or mental disability;                                                                
16 (9)  engaged in lewd or immoral conduct in connection with the                                                          
17       delivery of professional service to patients;                                                                     
18 (10)  permitted a dental hygienist or dental assistant who is employed                                                  
19 by the dentist or working under the dentist's supervision to perform a dental procedure                                 
20       in violation of AS 08.32.110 or AS 08.36.346;                                                                     
21 (11)  failed to report to the board a death that occurred on the premises                                               
22       used for the practice of dentistry within 48 hours;                                                               
23 (12)  falsified or destroyed patient or facility records or failed to                                                   
24 maintain a patient or facility record for at least seven years after the date the record                                
25       was created;                                                                                                  
26 (13)  prescribed or dispensed an opioid in excess of the maximum                                                    
27       dosage authorized under AS 08.36.355; or                                                                      
28 (14)  procured, sold, prescribed, or dispensed drugs in violation of                                                
29 a law, regardless of whether there has been a criminal action or harm to the                                        
30       patient.                                                                                                      
31    * Sec. 5. AS 08.36 is amended by adding a new section to read:                                                     
01            Sec. 08.36.355. Maximum dosage for opioid prescriptions. (a) A licensee                                    
02       may not issue                                                                                                     
03                 (1)  an initial prescription for an opioid that exceeds a seven-day supply                              
04       to an adult patient for outpatient use;                                                                           
05 (2)  a prescription for an opioid that exceeds a seven-day supply to a                                                  
06 minor; at the time a licensee writes a prescription for an opioid for a minor, the                                      
07 licensee shall discuss with the parent or guardian of the minor why the prescription is                                 
08       necessary and the risks associated with opioid use.                                                               
09            (b)  Notwithstanding (a) of this section, a licensee may issue a prescription for                            
10 an opioid that exceeds a seven-day supply to an adult or minor patient if, in the                                       
11 professional judgment of the licensee, more than a seven-day supply of an opioid is                                     
12       necessary for                                                                                                     
13 (1)  the patient's chronic pain management; the licensee may write a                                                    
14 prescription for an opioid for the quantity needed to treat the patient's medical                                       
15 condition or chronic pain; the licensee shall document in the patient's medical record                                  
16 the condition triggering the prescription of an opioid in a quantity that exceeds a                                     
17 seven-day supply and indicate that a nonopioid alternative was not appropriate to                                       
18       address the medical condition; or                                                                                 
19 (2)  a patient who is unable to access a practitioner within the time                                                   
20 necessary for a refill of the seven-day supply because of a logistical or travel barrier;                               
21 the licensee may write a prescription for an opioid for the quantity needed to treat the                                
22 patient for the time that the patient is unable to access a practitioner; the licensee shall                            
23 document in the patient's medical record the reason for the prescription of an opioid in                                
24 a quantity that exceeds a seven-day supply and indicate that a nonopioid alternative                                    
25 was not appropriate to address the medical condition; in this paragraph, "practitioner"                                 
26       has the meaning given in AS 11.71.900.                                                                            
27            (c)  In this section,                                                                                        
28                 (1)  "adult" means                                                                                      
29                      (A)  a individual who has reached 18 years of age; or                                              
30                      (B)  an emancipated minor;                                                                         
31 (2)  "emancipated minor" means a minor whose disabilities have been                                                     
01       removed for general purposes under AS 09.55.590;                                                                  
02                 (3)  "minor" means an individual under 18 years of age who is not an                                    
03       emancipated minor.                                                                                                
04    * Sec. 6. AS 08.36.370 is amended by adding a new paragraph to read:                                               
05                 (10)  "opioid" includes the opium and opiate substances and opium and                                   
06       opiate derivatives listed in AS 11.71.140.                                                                        
07    * Sec. 7. AS 08.64.107 is amended to read:                                                                         
08            Sec. 08.64.107. Regulation of physician assistants and intensive care                                      
09       paramedics. The board shall adopt regulations regarding the licensure of physician                              
10 assistants and registration of mobile intensive care paramedics, and the medical                                        
11       services that they may perform, including the                                                                     
12 (1)  educational and other qualifications, including education in pain                                              
13       management and opioid use and addiction;                                                                      
14                 (2)  application and registration procedures;                                                           
15                 (3)  scope of activities authorized; and                                                                
16                 (4)  responsibilities of the supervising or training physician.                                         
17    * Sec. 8. AS 08.64.200(a) is amended to read:                                                                      
18 (a)  Except for foreign medical graduates as specified in AS 08.64.225, each                                            
19       physician applicant shall                                                                                         
20 (1)  submit a certificate of graduation from a legally chartered medical                                                
21 school accredited by the Association of American Medical Colleges and the Council                                       
22       on Medical Education of the American Medical Association;                                                         
23 (2)  submit a certificate from a recognized hospital or hospitals                                                       
24 certifying that the applicant has satisfactorily performed the duties of resident                                       
25       physician or intern for a period of                                                                               
26 (A)  one year if the applicant graduated from medical school                                                            
27 before January 1, 1995, as evidenced by a certificate of completion of the first                                        
28 year of postgraduate training from the facility where the applicant completed                                           
29            the first year of internship or residency; and                                                               
30 (B)  two years if the applicant graduated from medical school                                                           
31 on or after January 1, 1995, as evidenced by a certificate of completion of the                                         
01 first year of postgraduate training from the facility where the applicant                                               
02 completed the first year of internship or residency and a certificate of                                                
03 successful completion of one additional year of postgraduate training at a                                              
04            recognized hospital;                                                                                         
05 (3)  submit a list of negotiated settlements or judgments in claims or                                                  
06 civil actions alleging medical malpractice against the applicant, including an                                          
07       explanation of the basis for each claim or action; [AND]                                                          
08 (4)  not have a license to practice medicine in another state, country,                                                 
09 province, or territory that is currently suspended or revoked for disciplinary reasons;                             
10       and                                                                                                           
11 (5)  receive education in pain management and opioid use and                                                        
12 addiction, unless the applicant has demonstrated to the satisfaction of the board                                   
13 that the applicant does not currently hold a valid federal Drug Enforcement                                         
14 Administration registration number; an applicant may include past professional                                      
15       experience or professional education as proof of professional competence.                                     
16    * Sec. 9. AS 08.64.205 is amended to read:                                                                         
17 Sec. 08.64.205. Qualifications for osteopath applicants. Each osteopath                                               
18 applicant shall meet the qualifications prescribed in AS 08.64.200(a)(3) - (5)                                      
19       [AS 08.64.200(a)(3) AND (4)] and shall                                                                            
20 (1)  submit a certificate of graduation from the legally chartered school                                               
21       of osteopathy approved by the board;                                                                              
22 (2)  submit a certificate from a hospital approved by the American                                                      
23 Medical Association or the American Osteopathic Association that certifies that the                                     
24 osteopath has satisfactorily completed and performed the duties of intern or resident                                   
25       physician for                                                                                                     
26 (A)  one year if the applicant graduated from a school of                                                               
27 osteopathy before January 1, 1995, as evidenced by a certificate of completion                                          
28 of the first year of postgraduate training from the facility where the applicant                                        
29            completed the first year of internship or residency; or                                                      
30 (B)  two years if the applicant graduated from a school of                                                              
31 osteopathy on or after January 1, 1995, as evidenced by a certificate of                                                
01 completion of the first year of postgraduate training from the facility where the                                       
02 applicant completed the first year of internship or residency and a certificate of                                      
03 successful completion of one additional year of postgraduate training at a                                              
04            recognized hospital;                                                                                         
05 (3)  take the examination required by AS 08.64.210 or be certified to                                                   
06 practice by the National Board of Examiners for Osteopathic Physicians and Surgeons                                     
07       or by the National Board of Osteopathic Medical Examiners;                                                    
08 (4)  receive education in pain management and opioid use and                                                        
09 addiction, unless the applicant has demonstrated to the satisfaction of the board                                   
10 that the applicant does not currently hold a valid federal Drug Enforcement                                         
11 Administration registration number; an applicant may include past professional                                      
12       experience or professional education as proof of professional competence.                                     
13    * Sec. 10. AS 08.64.209(a) is amended to read:                                                                     
14 (a)  Each applicant who desires to practice podiatry shall meet the                                                     
15 qualifications prescribed in AS 08.64.200(a)(3) - (5) [AS 08.64.200(a)(3) AND (4)]                                  
16       and shall                                                                                                         
17 (1)  submit a certificate of graduation from a legally chartered school of                                              
18       podiatry approved by the board;                                                                                   
19 (2)  take the examination required by AS 08.64.210; the State Medical                                                   
20 Board shall call to its aid a podiatrist of known ability who is licensed to practice                                   
21 podiatry to assist in the examination and licensure of applicants for a license to                                      
22       practice podiatry;                                                                                                
23 (3)  receive education in pain management and opioid use and                                                        
24 addiction, unless the applicant has demonstrated to the satisfaction of the board                                   
25 that the applicant does not currently hold a valid federal Drug Enforcement                                         
26 Administration registration number; an applicant may include past professional                                      
27       experience or professional education as proof of professional competence;                                     
28 (4)  meet other qualifications of experience or education which the                                                 
29       board may require.                                                                                                
30    * Sec. 11. AS 08.64.225(a) is amended to read:                                                                     
31 (a)  Applicants who are graduates of medical colleges not accredited by the                                             
01       Association of American Medical Colleges and the Council on Medical Education of                                  
02       the American Medical Association shall                                                                            
03                 (1)  meet the requirements of AS 08.64.200(a)(3) - (5)                                              
04       [AS 08.64.200(a)(3) AND (4)] and 08.64.255;                                                                       
05                 (2)  have successfully completed                                                                        
06 (A)  three years of postgraduate training as evidenced by a                                                             
07 certificate of completion of the first year of postgraduate training from the                                           
08 facility where the applicant completed the first year of internship or residency                                        
09 and a certificate of successful completion of two additional years of                                                   
10            postgraduate training at a recognized hospital; or                                                           
11 (B)  other requirements establishing proof of competency and                                                            
12 professional qualifications as the board considers necessary to ensure the                                              
13 continued protection of the public adopted at the discretion of the board by                                            
14 regulation, including education in pain management and opioid use and                                               
15 addiction, unless the applicant has demonstrated to the satisfaction of the                                         
16 board that the applicant does not currently hold a valid federal Drug                                               
17 Enforcement Administration registration number; an applicant may                                                    
18 include past professional experience or professional education as proof of                                          
19            professional competence; and                                                                             
20                 (3)  have passed examinations as specified by the board in regulations.                                 
21    * Sec. 12. AS 08.64.250 is amended to read:                                                                        
22 Sec. 08.64.250. License by credentials. The board may waive the examination                                           
23 requirement and license by credentials if the physician, osteopath, or podiatry                                     
24 applicant meets the requirements of AS 08.64.200, 08.64.205, or 08.64.209, submits                                  
25 proof of continued competence as required by regulation, pays the required fee, and                                 
26       has                                                                                                               
27 (1)  an active license from a board of medical examiners established                                                    
28 under the laws of a state or territory of the United States or a province or territory of                               
29       Canada issued after thorough examination; or                                                                      
30                 (2)  passed an examination as specified by the board in regulations.                                    
31    * Sec. 13. AS 08.64.250 is amended by adding a new subsection to read:                                             
01 (b)  The board shall adopt regulations under (a) of this section that require an                                        
02 applicant demonstrate professional competence in pain management and addiction                                          
03 disorders. An applicant may include past professional experience or professional                                        
04       education as proof of professional competence.                                                                    
05    * Sec. 14. AS 08.64.312 is amended to read:                                                                        
06 Sec. 08.64.312. Continuing education requirements. (a) The board shall                                                
07 promote a high degree of competence in the practice of medicine, osteopathy, and                                    
08 podiatry by requiring every licensee of medicine, osteopathy, and podiatry                                      
09       [PHYSICIAN LICENSED] in the state to fulfill continuing education requirements.                                   
10 (b)  Before a license may be renewed, the licensee shall submit evidence to the                                         
11 board or its designee that continuing education requirements prescribed by regulations                                  
12 adopted by the board have been met. Continuing education requirements must                                          
13 include not less than two hours of education in pain management and opioid use                                      
14 and addiction in the two years preceding an application for renewal of a license,                                   
15 unless the licensee demonstrates to the satisfaction of the board that the licensee's                               
16       practice does not include pain management and opioid treatment or prescribing.                                
17 (c)  The board or its designee may exempt a physician, osteopath, or                                                
18 podiatrist from the requirements of (b) of this section upon an application by the                                  
19 physician, osteopath, or podiatrist giving evidence satisfactory to the board or its                                
20 designee that the physician, osteopath, or podiatrist is unable to comply with the                                  
21 requirements because of extenuating circumstances. However, a person may not be                                         
22 exempted from more than 15 hours of continuing education in a five-year period; a                                   
23 person may not be exempted from the requirement to receive at least two hours                                       
24 of education in pain management and opioid use and addiction unless the person                                      
25 has demonstrated to the satisfaction of the board that the person does not                                          
26 currently hold a valid federal Drug Enforcement Administration registration                                         
27       number.                                                                                                       
28    * Sec. 15. AS 08.64.326(a) is amended to read:                                                                     
29 (a)  The board may impose a sanction if the board finds after a hearing that a                                          
30       licensee                                                                                                          
31 (1)  secured a license through deceit, fraud, or intentional                                                            
01       misrepresentation;                                                                                                
02                 (2)  engaged in deceit, fraud, or intentional misrepresentation while                                   
03       providing professional services or engaging in professional activities;                                           
04                 (3)  advertised professional services in a false or misleading manner;                                  
05                 (4)  has been convicted, including conviction based on a guilty plea or                                 
06       plea of nolo contendere, of                                                                                       
07                      (A)  a class A or unclassified felony or a crime in another                                        
08            jurisdiction with elements similar to a class A or unclassified felony in this                               
09            jurisdiction;                                                                                                
10 (B)  a class B or class C felony or a crime in another jurisdiction                                                     
11 with elements similar to a class B or class C felony in this jurisdiction if the                                        
12 felony or other crime is substantially related to the qualifications, functions, or                                     
13            duties of the licensee; or                                                                                   
14 (C)  a crime involving the unlawful procurement, sale,                                                                  
15            prescription, or dispensing of drugs;                                                                        
16 (5)  has procured, sold, prescribed, or dispensed drugs in violation of a                                               
17       law regardless of whether there has been a criminal action or harm to the patient;                            
18 (6)  intentionally or negligently permitted the performance of patient                                                  
19 care by persons under the licensee's supervision that does not conform to minimum                                       
20       professional standards even if the patient was not injured;                                                       
21 (7)  failed to comply with this chapter, a regulation adopted under this                                                
22       chapter, or an order of the board;                                                                                
23                 (8)  has demonstrated                                                                                   
24 (A)  professional incompetence, gross negligence, or repeated                                                           
25 negligent conduct; the board may not base a finding of professional                                                     
26 incompetence solely on the basis that a licensee's practice is unconventional or                                        
27            experimental in the absence of demonstrable physical harm to a patient;                                      
28 (B)  addiction to, severe dependency on, or habitual overuse of                                                         
29            alcohol or other drugs that impairs the licensee's ability to practice safely;                               
30                      (C)  unfitness because of physical or mental disability;                                           
31 (9)  engaged in unprofessional conduct, in sexual misconduct, or in                                                     
01 lewd or immoral conduct in connection with the delivery of professional services to                                     
02 patients; in this paragraph, "sexual misconduct" includes sexual contact, as defined by                                 
03 the board in regulations adopted under this chapter, or attempted sexual contact with a                                 
04 patient outside the scope of generally accepted methods of examination or treatment of                                  
05 the patient, regardless of the patient's consent or lack of consent, during the term of the                             
06 physician-patient relationship, as defined by the board in regulations adopted under                                    
07 this chapter, unless the patient was the licensee's spouse at the time of the contact or,                               
08 immediately preceding the physician-patient relationship, was in a dating, courtship,                                   
09       or engagement relationship with the licensee;                                                                     
10                 (10)  has violated AS 18.16.010;                                                                        
11 (11)  has violated any code of ethics adopted by regulation by the                                                      
12       board;                                                                                                            
13 (12)  has denied care or treatment to a patient or person seeking                                                       
14 assistance from the physician if the only reason for the denial is the failure or refusal                               
15       of the patient to agree to arbitrate as provided in AS 09.55.535(a); [OR]                                         
16 (13)  has had a license or certificate to practice medicine in another                                                  
17 state or territory of the United States, or a province or territory of Canada, denied,                                  
18 suspended, revoked, surrendered while under investigation for an alleged violation,                                     
19 restricted, limited, conditioned, or placed on probation unless the denial, suspension,                                 
20 revocation, or other action was caused by the failure of the licensee to pay fees to that                               
21       state, territory, or province; or                                                                             
22 (14)  prescribed or dispensed an opioid in excess of the maximum                                                    
23       dosage authorized under AS 08.64.363.                                                                         
24    * Sec. 16. AS 08.64 is amended by adding a new section to article 3 to read:                                       
25 Sec. 08.64.363. Maximum dosage for opioid prescriptions. (a) A licensee                                               
26       may not issue                                                                                                     
27 (1)  an initial prescription for an opioid that exceeds a seven-day supply                                              
28       to an adult patient for outpatient use;                                                                           
29 (2)  a prescription for an opioid that exceeds a seven-day supply to a                                                  
30 minor; at the time a licensee writes a prescription for an opioid for a minor, the                                      
31 licensee shall discuss with the parent or guardian of the minor why the prescription is                                 
01       necessary and the risks associated with opioid use.                                                               
02 (b)  Notwithstanding (a) of this section, a licensee may issue a prescription for                                       
03 an opioid that exceeds a seven-day supply to an adult or minor patient if, in the                                       
04 professional medical judgment of the licensee, more than a seven-day supply of an                                       
05       opioid is necessary for                                                                                           
06 (1)  the patient's acute medical condition, chronic pain management,                                                    
07 pain associated with cancer, or pain experienced while the patient is in palliative care;                               
08 the licensee may write a prescription for an opioid for the quantity needed to treat the                                
09 patient's medical condition, chronic pain, pain associated with cancer, or pain                                         
10 experienced while the patient is in palliative care; the licensee shall document in the                                 
11 patient's medical record the condition triggering the prescription of an opioid in a                                    
12 quantity that exceeds a seven-day supply and indicate that a nonopioid alternative was                                  
13       not appropriate to address the medical condition;                                                                 
14 (2)  a patient who is unable to access a practitioner within the time                                                   
15 necessary for a refill of the seven-day supply because of a logistical or travel barrier;                               
16 the licensee may write a prescription for an opioid for the quantity needed to treat the                                
17 patient for the time that the patient is unable to access a practitioner; the licensee shall                            
18 document in the patient's medical record the reason for the prescription of an opioid in                                
19 a quantity that exceeds a seven-day supply and indicate that a nonopioid alternative                                    
20 was not appropriate to address the medical condition; in this paragraph, "practitioner"                                 
21       has the meaning given in AS 11.71.900; or                                                                         
22 (3)  the treatment of a patient's substance abuse or opioid dependence;                                                 
23 the licensee may write a prescription for an opioid approved for the treatment of                                       
24 substance abuse or opioid dependence for the quantity needed to treat the patient's                                     
25 substance abuse or opioid dependence; the licensee shall document in the patient's                                      
26 medical record the reason for the prescription of an opioid approved for the treatment                                  
27 of substance abuse or opioid dependence in a quantity that exceeds a seven-day supply                                   
28 and indicate that a nonopioid alternative was not appropriate for the treatment of                                      
29       substance abuse or opioid dependence.                                                                             
30            (c)  In this section,                                                                                        
31                 (1)  "adult" means                                                                                      
01                      (A)  an individual who has reached 18 years of age; or                                             
02                      (B)  an emancipated minor;                                                                         
03                 (2)  "emancipated minor" means a minor whose disabilities have been                                     
04       removed for general purposes under AS 09.55.590;                                                                  
05                 (3)  "minor" means a individual under 18 years of age who is not an                                     
06       emancipated minor.                                                                                                
07    * Sec. 17. AS 08.64.364(c) is amended to read:                                                                     
08            (c)  The board may not impose disciplinary sanctions on a physician for                                      
09       prescribing, dispensing, or administering a prescription drug that is a controlled                                
10 substance or botulinum toxin if the requirements under (a) of this section and                                      
11 AS 08.64.363 are met and the physician prescribes, dispenses, or administers the                                    
12 controlled substance or botulinum toxin when an appropriate licensed health care                                        
13 provider is present with the patient to assist the physician with examination, diagnosis,                               
14       and treatment.                                                                                                    
15    * Sec. 18. AS 08.64.380 is amended by adding a new paragraph to read:                                              
16 (7)  "opioid" includes the opium and opiate substances and opium and                                                    
17       opiate derivatives listed in AS 11.71.140.                                                                        
18    * Sec. 19. AS 08.68.100(a), as amended by sec. 10, ch. 25, SLA 2016, is amended to read:                           
19            (a)  The board shall                                                                                         
20 (1)  adopt regulations necessary to implement this chapter, including                                                   
21       regulations                                                                                                       
22 (A)  pertaining to practice as an advanced practice registered                                                          
23 nurse, including requirements for an advanced practice registered nurse to                                              
24 practice as a certified registered nurse anesthetist, certified clinical nurse                                          
25 specialist, certified nurse practitioner, or certified nurse midwife; regulations                                   
26 for an advanced practice registered nurse who holds a valid federal Drug                                            
27 Enforcement Administration registration number must address training                                                
28            in pain management and opioid use and addiction;                                                         
29 (B)  necessary to implement AS 08.68.331 - 08.68.336 relating                                                           
30 to certified nurse aides in order to protect the health, safety, and welfare of                                         
31            clients served by nurse aides;                                                                               
01                      (C)  pertaining to retired nurse status; and                                                       
02                      (D)  establishing criteria for approval of practical nurse                                         
03            education programs that are not accredited by a national nursing accrediting                                 
04            body;                                                                                                        
05                 (2)  approve curricula and adopt standards for basic education programs                                 
06       that prepare persons for licensing under AS 08.68.190;                                                            
07                 (3)  provide for surveys of the basic nursing education programs in the                                 
08       state at the times it considers necessary;                                                                        
09                 (4)  approve education programs that meet the requirements of this                                      
10 chapter and of the board, and deny, revoke, or suspend approval of education                                            
11       programs for failure to meet the requirements;                                                                    
12                 (5)  examine, license, and renew the licenses of qualified applicants;                                  
13 (6)  prescribe requirements for competence before a former registered,                                                  
14 advanced practice registered, or licensed practical nurse may resume the practice of                                    
15       nursing under this chapter;                                                                                       
16 (7)  define by regulation the qualifications and duties of the executive                                                
17 administrator and delegate authority to the executive administrator that is necessary to                                
18       conduct board business;                                                                                           
19                 (8)  develop reasonable and uniform standards for nursing practice;                                     
20 (9)  publish advisory opinions regarding whether nursing practice                                                       
21 procedures or policies comply with acceptable standards of nursing practice as defined                                  
22       under this chapter;                                                                                               
23 (10)  require applicants under this chapter to submit fingerprints and the                                              
24 fees required by the Department of Public Safety under AS 12.62.160 for criminal                                        
25 justice information and a national criminal history record check; the department shall                                  
26 submit the fingerprints and fees to the Department of Public Safety for a report of                                     
27 criminal justice information under AS 12.62 and a national criminal history record                                      
28       check under AS 12.62.400;                                                                                         
29 (11)  require that a licensed advanced practice registered nurse                                                    
30 [PRACTITIONER] who has a federal Drug Enforcement Administration registration                                           
31 number register with the controlled substance prescription database under                                               
01       AS 17.30.200(o).                                                                                                  
02    * Sec. 20. AS 08.68.270 is amended to read:                                                                        
03            Sec. 08.68.270. Grounds for denial, suspension, or revocation. The board                                   
04       may deny, suspend, or revoke the license of a person who                                                          
05                 (1)  has obtained or attempted to obtain a license to practice nursing by                               
06       fraud or deceit;                                                                                                  
07                 (2)  has been convicted of a felony or other crime if the felony or other                               
08 crime is substantially related to the qualifications, functions, or duties of the licensee;                             
09 (3)  habitually abuses alcoholic beverages, or illegally uses controlled                                                
10       substances;                                                                                                       
11 (4)  has impersonated a registered, advanced practice registered, or                                                    
12       practical nurse;                                                                                                  
13 (5)  has intentionally or negligently engaged in conduct that has                                                       
14       resulted in a significant risk to the health or safety of a client or in injury to a client;                      
15 (6)  practices or attempts to practice nursing while afflicted with                                                     
16 physical or mental illness, deterioration, or disability that interferes with the                                       
17       individual's performance of nursing functions;                                                                    
18 (7)  is guilty of unprofessional conduct as defined by regulations                                                      
19       adopted by the board;                                                                                             
20 (8)  has wilfully or repeatedly violated a provision of this chapter or                                                 
21       regulations adopted under this chapter or AS 08.01;                                                               
22                 (9)  is professionally incompetent;                                                                     
23 (10)  denies care or treatment to a patient or person seeking assistance                                                
24 if the sole reason for the denial is the failure or refusal of the patient or person seeking                            
25       assistance to agree to arbitrate as provided in AS 09.55.535(a);                                              
26 (11)  has prescribed or dispensed an opioid in excess of the                                                        
27       maximum dosage authorized under AS 08.68.705; or                                                              
28 (12)  has procured, sold, prescribed, or dispensed drugs in violation                                               
29 of a law, regardless of whether there has been a criminal action or harm to the                                     
30       patient.                                                                                                      
31    * Sec. 21. AS 08.68.276 is amended to read:                                                                        
01 Sec. 08.68.276. Continuing competence required. A license to practice                                                 
02 nursing may not be renewed unless the nurse has complied with continuing                                                
03 competence requirements established by the board by regulation. The board shall                                     
04 adopt regulations for renewal of a license of an advanced practice registered                                       
05 nurse. The regulations must require that a licensee receive not less than two                                       
06 hours of education in pain management and opioid use and addiction in the two                                       
07 years preceding an application for renewal of a license unless the licensee has                                     
08 demonstrated to the satisfaction of the board that the licensee does not currently                                  
09       hold a valid federal Drug Enforcement Administration registration number.                                     
10    * Sec. 22. AS 08.68 is amended by adding a new section to article 6 to read:                                       
11 Sec. 08.68.705. Maximum dosage for opioid prescriptions. (a) An advanced                                              
12       practice registered nurse may not issue                                                                           
13 (1)  an initial prescription for an opioid that exceeds a seven-day supply                                              
14       to an adult patient for outpatient use;                                                                           
15 (2)  a prescription for an opioid that exceeds a seven-day supply to a                                                  
16 minor; at the time an advanced practice registered nurse writes a prescription for an                                   
17 opioid for a minor, the advanced practice registered nurse shall discuss with the parent                                
18 or guardian of the minor why the prescription is necessary and the risks associated                                     
19       with opioid use.                                                                                                  
20 (b)  Notwithstanding (a) of this section, an advanced practice registered nurse                                         
21 may issue a prescription for an opioid that exceeds a seven-day supply to an adult or                                   
22 minor patient if, in the professional judgment of the advanced practice registered                                      
23       nurse, more than a seven-day supply of an opioid is necessary for                                                 
24 (1)  the patient's acute medical condition, chronic pain management,                                                    
25 pain associated with cancer, or pain experienced while the patient is in palliative care;                               
26 the advanced practice registered nurse may write a prescription for an opioid for the                                   
27 quantity needed to treat the patient's medical condition, chronic pain, pain associated                                 
28 with cancer, or pain experienced while the patient is in palliative care; the advanced                                  
29 practice registered nurse shall document in the patient's medical record the condition                                  
30 triggering the prescription of an opioid in a quantity that exceeds a seven-day supply                                  
31 and indicate that a nonopioid alternative was not appropriate to address the medical                                    
01       condition; or                                                                                                     
02 (2)  a patient who is unable to access a practitioner within the time                                                   
03 necessary for a refill of the seven-day supply because of a logistical or travel barrier;                               
04 the advanced practice registered nurse may write a prescription for an opioid for the                                   
05 quantity needed to treat the patient for the time that the patient is unable to access a                                
06 practitioner; the advanced practice registered nurse shall document in the patient's                                    
07 medical record the reason for the prescription of an opioid in a quantity that exceeds a                                
08 seven-day supply and indicate that a nonopioid alternative was not appropriate to                                       
09 address the medical condition; in this paragraph, "practitioner" has the meaning given                                  
10       in AS 11.71.900.                                                                                                  
11 (c)  This section does not authorize an advanced practice registered nurse to                                           
12 prescribe a controlled substance if the advanced practice registered nurse is not                                       
13 otherwise authorized to prescribe a controlled substance under policies, procedures, or                                 
14       regulations issued or adopted by the board.                                                                       
15            (d)  In this section,                                                                                        
16                 (1)  "adult" means                                                                                      
17                      (A)  an individual who has reached 18 years of age; or                                             
18                      (B)  an emancipated minor;                                                                         
19 (2)  "emancipated minor" means a minor whose disabilities have been                                                     
20       removed for general purposes under AS 09.55.590;                                                                  
21 (3)  "minor" means an individual under 18 years of age who is not an                                                    
22       emancipated minor.                                                                                                
23    * Sec. 23. AS 08.68.850 is amended by adding a new paragraph to read:                                              
24 (12)  "opioid" includes the opium and opiate substances and opium and                                                   
25       opiate derivatives listed in AS 11.71.140.                                                                        
26    * Sec. 24. AS 08.72.140 is amended to read:                                                                        
27 Sec. 08.72.140. Qualifications for licensure. An applicant for licensure as an                                        
28       optometrist                                                                                                       
29 (1)  shall be a graduate of a school or college of optometry recognized                                                 
30       by the board;                                                                                                     
31 (2)  may not have committed an act in any jurisdiction that would have                                                  
01       constituted a violation of this chapter or regulations adopted under this chapter at the                          
02       time the act was committed;                                                                                       
03 (3)  may not have been disciplined by an optometry licensing entity in                                                  
04 another jurisdiction and may not be the subject of a pending disciplinary proceeding                                    
05 conducted by an optometry licensing entity in another jurisdiction; however, the board                                  
06 may consider the disciplinary action and, in the board's discretion, determine if the                                   
07       person is qualified for licensure;                                                                                
08                 (4)  shall have successfully completed                                                                  
09                      (A)  the written and practical portions of an examination on                                       
10 ocular pharmacology approved by the board that tests the licensee's or                                                  
11 applicant's knowledge of the characteristics, pharmacological effects,                                                  
12 indications, contraindications, and emergency care associated with the                                                  
13            prescription and use of pharmaceutical agents;                                                               
14 (B)  a nontopical therapeutic pharmaceutical agent course of at                                                         
15 least 23 hours approved by the board or an examination approved by the board                                            
16            on the treatment and management of ocular disease; and                                                       
17 (C)  an optometry and nontopical therapeutic pharmaceutical                                                             
18 agent injection course of at least seven hours approved by the board or                                                 
19            equivalent training acceptable to the board; and                                                             
20 (5)  shall meet other qualifications for licensure as established under                                                 
21 this chapter and regulations adopted by the board under AS 08.72.050; the                                           
22 regulations must include qualifications for licensees who hold a valid federal                                      
23 Drug Enforcement Administration registration number that address training in                                        
24       pain management and opioid use and addiction.                                                                 
25    * Sec. 25. AS 08.72.170 is amended to read:                                                                        
26 Sec. 08.72.170. Licensure by credentials. The board shall issue a license by                                          
27       credentials to an applicant who                                                                                   
28 (1)  is a graduate of a school or college of optometry recognized by the                                                
29       board;                                                                                                            
30 (2)  has passed a written examination approved by the board that is                                                     
31 designed to test the applicant's knowledge of the laws of Alaska governing the practice                                 
01       of optometry and the regulations adopted under those laws;                                                        
02 (3)  holds a current license to practice optometry in another state or                                                  
03 territory of the United States or in a province of Canada that has licensure                                            
04 requirements that the board determines are equivalent to those established under this                                   
05       chapter;                                                                                                          
06 (4)  at some time in the past, received a license to practice optometry                                                 
07 from another state or territory of the United States or from a province of Canada that                                  
08 required the person to have passed the National Board of Examiners in Optometry                                         
09       examination to qualify for licensure;                                                                             
10 (5)  was engaged in the active licensed clinical practice of optometry in                                               
11 a state or territory of the United States or in a province of Canada for at least 3,120                                 
12       hours during the 36 months preceding the date of application under this section;                                  
13 (6)  has not committed an act in any jurisdiction that would have                                                       
14 constituted a violation of this chapter or regulations adopted under this chapter at the                                
15       time the act was committed; [AND]                                                                                 
16 (7)  has not been disciplined by an optometry licensing entity in another                                               
17 jurisdiction and is not the subject of a pending disciplinary proceeding conducted by                                   
18 an optometry licensing entity in another jurisdiction; however, the board may consider                                  
19 the disciplinary action and, in the board's discretion, determine whether [IF] the                                  
20       person is qualified for licensure; and                                                                        
21 (8)  has received education in pain management and opioid use and                                                   
22 addiction adequate for the practice of optometry, unless the applicant has                                          
23 demonstrated to the satisfaction of the board that the applicant does not                                           
24 currently hold a valid federal Drug Enforcement Administration registration                                         
25 number; an applicant may include past professional experience or professional                                       
26       education as proof of professional competence.                                                                
27    * Sec. 26. AS 08.72.181(d) is amended to read:                                                                     
28 (d)  Before a license may be renewed, the licensee shall submit to the board                                            
29       evidence that, in the four years preceding the application for renewal, the licensee has                          
30 (1)  completed eight hours of continuing education, approved by the                                                     
31       board, concerning the use and prescription of pharmaceutical agents;                                              
01                 (2)  completed seven hours of continuing education, approved by the                                     
02       board, concerning the injection of nontopical therapeutic pharmaceutical agents;                                  
03       [AND]                                                                                                             
04 (3)  completed at least two hours of education in pain management                                                   
05 and opioid use and addiction, unless the applicant has demonstrated to the                                          
06 satisfaction of the board that the applicant does not currently hold a valid federal                                
07       Drug Enforcement Administration registration number; and                                                      
08                 (4)  met other continuing education requirements as may be prescribed                               
09       by regulations of the board to ensure the continued protection of the public.                                     
10    * Sec. 27. AS 08.72.240 is amended to read:                                                                        
11 Sec. 08.72.240. Grounds for imposition of disciplinary sanctions. The board                                           
12       may impose disciplinary sanctions when the board finds after a hearing that a licensee                            
13 (1)  secured a license through deceit, fraud, or intentional                                                            
14       misrepresentation;                                                                                                
15 (2)  engaged in deceit, fraud, or intentional misrepresentation in the                                                  
16       course of providing professional services or engaging in professional activities;                                 
17                 (3)  advertised professional services in a false or misleading manner;                                  
18 (4)  has been convicted of a felony or other crime that [WHICH]                                                     
19       affects the licensee's ability to continue to practice competently and safely;                                    
20 (5)  intentionally or negligently engaged in or permitted the                                                           
21 performance of patient care by persons under the licensee's supervision that [WHICH]                                
22 does not conform to minimum professional standards regardless of whether actual                                         
23       injury to the patient occurred;                                                                                   
24 (6)  failed to comply with this chapter, with a regulation adopted under                                                
25       this chapter, or with an order of the board;                                                                      
26                 (7)  continued to practice after becoming unfit due to                                                  
27                      (A)  professional incompetence;                                                                    
28 (B)  failure to keep informed of or use current professional                                                            
29            theories or practices;                                                                                       
30 (C)  addiction or severe dependency on alcohol or other drugs                                                           
31            that [WHICH] impairs the licensee's ability to practice safely;                                          
01                      (D)  physical or mental disability;                                                                
02                 (8)  engaged in lewd or immoral conduct in connection with the                                          
03       delivery of professional service to patients;                                                                     
04                 (9)  failed to refer a patient to a physician after ascertaining the                                    
05       presence of ocular or systemic conditions requiring management by a physician;                                
06                 (10)  procured, sold, prescribed, or dispensed drugs in violation of                                
07       a law, regardless of whether there has been a criminal action or harm to the                                  
08       patient.                                                                                                      
09    * Sec. 28. AS 08.80.030(b), as amended by sec. 12, ch. 25, SLA 2016, is amended to read:                           
10 (b)  In order to fulfill its responsibilities, the board has the powers necessary                                       
11       for implementation and enforcement of this chapter, including the power to                                        
12 (1)  elect a president and secretary from its membership and adopt rules                                                
13       for the conduct of its business;                                                                                  
14 (2)  license by examination or by license transfer the applicants who are                                               
15       qualified to engage in the practice of pharmacy;                                                                  
16 (3)  assist the department in inspections and investigations for                                                        
17 violations of this chapter, or of any other state or federal statute relating to the practice                           
18       of pharmacy;                                                                                                      
19                 (4)  adopt regulations to carry out the purposes of this chapter;                                       
20 (5)  establish and enforce compliance with professional standards and                                                   
21       rules of conduct for pharmacists engaged in the practice of pharmacy;                                             
22 (6)  determine standards for recognition and approval of degree                                                         
23 programs of schools and colleges of pharmacy whose graduates shall be eligible for                                      
24 licensure in this state, including the specification and enforcement of requirements for                                
25       practical training, including internships;                                                                        
26 (7)  establish for pharmacists and pharmacies minimum specifications                                                    
27 for the physical facilities, technical equipment, personnel, and procedures for the                                     
28 storage, compounding, and dispensing of drugs or related devices, and for the                                           
29       monitoring of drug therapy;                                                                                       
30 (8)  enforce the provisions of this chapter relating to the conduct or                                                  
31 competence of pharmacists practicing in the state, and the suspension, revocation, or                                   
01       restriction of licenses to engage in the practice of pharmacy;                                                    
02                 (9)  license and regulate the training, qualifications, and employment of                               
03       pharmacy interns and pharmacy technicians;                                                                        
04                 (10)  issue licenses to persons engaged in the manufacture and                                          
05       distribution of drugs and related devices;                                                                        
06                 (11)  establish and maintain a controlled substance prescription                                        
07       database as provided in AS 17.30.200;                                                                             
08                 (12)  establish standards for the independent administration by a                                       
09       pharmacist of vaccines and related emergency medications under AS 08.80.168,                                      
10 including the completion of an immunization training program approved by the board;                                     
11 (13)  establish standards for the independent dispensing by a                                                           
12 pharmacist of an opioid overdose drug under AS 17.20.085, including the completion                                      
13       of an opioid overdose training program approved by the board;                                                     
14 (14)  require that a licensed pharmacist [WHO HAS A FEDERAL                                                             
15 DRUG ENFORCEMENT ADMINISTRATION REGISTRATION NUMBER]                                                                    
16       register with the controlled substance prescription database under AS 17.30.200(o).                               
17    * Sec. 29. AS 08.80 is amended by adding a new section to article 3 to read:                                       
18 Sec. 08.80.345. Prescription for an opioid; voluntary request for lesser                                            
19 quantity. (a) A pharmacist filling a prescription for an opioid that is a schedule II or                              
20 III controlled substance under federal law may, at the request of the individual for                                    
21 whom the prescription is written, dispense the prescribed opioid in a lesser quantity                                   
22       than prescribed.                                                                                                  
23 (b)  Nothing in this section shall be construed to prevent substitution of an                                           
24       equivalent drug under AS 08.80.295.                                                                               
25    * Sec. 30. AS 08.98.050(a) is amended to read:                                                                     
26            (a)  The board shall                                                                                         
27 (1)  establish examination requirements for eligible applicants for                                                     
28       licensure to practice veterinary medicine;                                                                        
29 (2)  examine, or cause to be examined, eligible applicants for licensure                                                
30       or registration;                                                                                                  
31 (3)  approve the issuance of licenses and student permits to qualified                                                  
01       applicants;                                                                                                       
02                 (4)  establish standards for the practice of veterinary medicine by                                     
03       regulation;                                                                                                       
04                 (5)  conduct disciplinary proceedings in accordance with this chapter;                                  
05                 (6)  adopt regulations requiring proof of continued competency before a                                 
06       license is renewed;                                                                                               
07                 (7)  as requested by the department, monitor the standards and                                          
08       availability of veterinary services provided in the state and report its findings to the                          
09       department;                                                                                                       
10 (8)  collect, or cause to be collected, data concerning the practice of                                                 
11 veterinary technology by veterinary technicians in the state and submit the data to the                                 
12       department for maintenance;                                                                                       
13                 (9)  establish, by regulation, educational and training requirements for                                
14                      (A)  the issuance of student permits; and                                                          
15 (B)  the delegation of duties by veterinarians licensed under this                                                      
16            chapter to veterinary technicians;                                                                       
17 (10)  require that a licensee who has a federal Drug Enforcement                                                    
18 Administration registration number register with the controlled substance                                           
19       prescription database under AS 17.30.200(o);                                                                  
20 (11)  identify resources and develop educational materials to assist                                                
21 licensees to identify an animal owner who may be at risk for abusing or misusing                                    
22       an opioid.                                                                                                    
23    * Sec. 31. AS 08.98.235 is amended to read:                                                                        
24 Sec. 08.98.235. Grounds for imposition of disciplinary sanctions. After a                                             
25 hearing, the board may impose a disciplinary sanction on a person licensed under this                                   
26       chapter when the board finds that the person                                                                      
27 (1)  secured a license through deceit, fraud, or intentional                                                            
28       misrepresentation;                                                                                                
29 (2)  engaged in deceit, fraud, or intentional misrepresentation in the                                                  
30       course of providing professional services or engaging in professional activities;                                 
31                 (3)  advertised professional services in a false or misleading manner;                                  
01                 (4)  has been convicted of a felony or other crime which affects the                                    
02       person's ability to continue to practice competently and safely;                                                  
03 (5)  intentionally or negligently engaged in or permitted the                                                           
04 performance of animal care by the person's supervisees which does not conform to                                        
05 minimum professional standards regardless of whether actual injury to the animal                                        
06       occurred;                                                                                                         
07                 (6)  failed to comply with this chapter, with a regulation adopted under                                
08       this chapter, or with an order of the board;                                                                      
09                 (7)  continued to practice after becoming unfit due to                                                  
10                      (A)  professional incompetence;                                                                    
11 (B)  addiction or severe dependency on alcohol or other drugs                                                           
12            which impairs the person's ability to practice safely;                                                       
13                      (C)  physical or mental disability;                                                                
14 (8)  engaged in lewd or immoral conduct in connection with the                                                          
15       delivery of professional service;                                                                             
16 (9)  procured, sold, prescribed, or dispensed drugs in violation of a                                               
17       law, regardless of whether there has been a criminal action.                                                  
18    * Sec. 32. AS 13 is amended by adding a new chapter to read:                                                       
19                 Chapter 55. Voluntary Nonopioid Directive Act.                                                        
20 Sec. 13.55.010. Nonopioid directive; revocation; other requirements. (a)                                              
21 An individual who is 18 years of age or older or an emancipated minor, a parent or                                      
22 legal guardian of a minor, or an individual's guardian or other person appointed by the                                 
23 individual or a court to manage the individual's health care may execute a voluntary                                    
24 nonopioid directive stating that an opioid may not be administered or prescribed to the                                 
25 individual or the minor. The directive must be in a format prescribed by the                                            
26       department and available in an electronic format.                                                                 
27 (b)  The commissioner of health and social services shall adopt regulations to                                          
28       implement this chapter. The regulations must                                                                      
29 (1)  include verification by a health care provider and comply with the                                                 
30       written consent requirements under 42 U.S.C. 290dd-2(b);                                                          
31 (2)  provide standard procedures for an individual, a parent or legal                                                   
01       guardian of a minor, or an individual's guardian or other person appointed by the                                 
02       individual or a court to manage the individual's health care to submit a voluntary                                
03       nonopioid directive to a health care provider or hospital;                                                        
04                 (3)  include appropriate exemptions for emergency medical personnel;                                    
05                 (4)  ensure the confidentiality of a voluntary nonopioid directive;                                     
06                 (5)  ensure exemptions for an opioid used for treatment of substance                                    
07       abuse or opioid dependence.                                                                                       
08            (c)  An individual who is 18 years of age or older or an emancipated minor, a                                
09       parent or legal guardian of a minor, or an individual's guardian or other person                                  
10 appointed by the individual or a court to manage the individual's health care may                                       
11       revoke a voluntary nonopioid directive at any time in writing or orally.                                          
12 (d)  An individual, a parent or legal guardian of a minor, or an individual's                                           
13 guardian or other person appointed by the individual or a court to manage the                                           
14 individual's health care may submit a voluntary nonopioid directive to a health care                                    
15       provider or a hospital.                                                                                           
16 Sec. 13.55.020. Obligations of health care providers and hospitals. A health                                          
17 care provider, a hospital, or an employee of a health care provider or hospital may not                                 
18 be subject to disciplinary action by the health care provider's or the employee's                                       
19 professional licensing board or held civilly or criminally liable for failure to                                        
20 administer, prescribe, or dispense an opioid, or for inadvertent administration of an                                   
21       opioid, to an individual or a minor who has a voluntary nonopioid directive.                                      
22 Sec. 13.55.030. Prescriptions presumed valid. A prescription presented to a                                           
23 pharmacy is presumed to be valid, and a pharmacist may not be subject to disciplinary                                   
24 action by the pharmacist's professional licensing board or held civilly or criminally                                   
25 liable for dispensing an opioid in contradiction to an individual's or a minor's                                        
26       voluntary nonopioid directive.                                                                                    
27 Sec. 13.55.040. Effect of this chapter. Nothing in this chapter shall be                                              
28       construed to                                                                                                    
29 (1)  alter an advance health care directive under AS 13.52 (Health Care                                                 
30       Decisions Act);                                                                                                   
31 (2)  limit the prescribing, dispensing, or administering of an opioid                                                   
01       overdose drug;                                                                                                    
02                 (3)  limit an authorized health care provider or pharmacist from                                        
03       prescribing, dispensing, or administering an opioid for the treatment of substance                                
04       abuse or opioid dependence.                                                                                       
05            Sec. 13.55.100. Definitions. In this chapter, unless the context otherwise                                 
06       requires,                                                                                                         
07                 (1)  "department" means the Department of Health and Social Services;                                   
08                 (2)  "emancipated minor" means a minor whose disabilities have been                                     
09       removed for general purposes under AS 09.55.590;                                                                  
10                 (3)  "health care provider" has the meaning given in AS 09.65.340;                                      
11                 (4)  "hospital" has the meaning given in AS 13.52.268;                                                  
12 (5)  "minor" means an individual under 18 years of age who is not an                                                    
13       emancipated minor;                                                                                                
14 (6)  "opioid" includes the opium and opiate substances and opium and                                                    
15       opiate derivatives listed in AS 11.71.140;                                                                        
16                 (7)  "opioid overdose drug" has the meaning given in AS 09.65.340.                                      
17 Sec. 13.55.110. Short title. This chapter may be known as the Voluntary                                               
18       Nonopioid Directive Act.                                                                                          
19    * Sec. 33. AS 17.30.200(a), as amended by sec. 21, ch. 25, SLA 2016, is amended to read:                           
20 (a)  The controlled substance prescription database is established in the Board                                         
21 of Pharmacy. The purpose of the database is to contain data as described in this                                        
22 section regarding every prescription for a schedule II, III, or IV controlled substance                                 
23 under federal law dispensed in the state to a person other than under the                                           
24 circumstances described in (u) of this section [THOSE ADMINISTERED TO A                                             
25       PATIENT AT A HEALTH CARE FACILITY].                                                                               
26    * Sec. 34. AS 17.30.200(b), as amended by sec. 23, ch. 25, SLA 2016, is amended to read:                           
27 (b)  The pharmacist-in-charge of each licensed or registered pharmacy,                                                  
28 regarding each schedule II, III, or IV controlled substance under federal law dispensed                                 
29 by a pharmacist under the supervision of the pharmacist-in-charge, and each                                             
30 practitioner who directly dispenses a schedule II, III, or IV controlled substance under                                
31 federal law other than those dispensed or administered under the circumstances                                      
01 described in (u) of this section [ADMINISTERED TO A PATIENT AT A HEALTH                                             
02 CARE FACILITY], shall submit to the board, by a procedure and in a format                                               
03 established by the board, the following information for inclusion in the database on at                                 
04       least a weekly basis:                                                                                             
05                 (1)  the name of the prescribing practitioner and the practitioner's                                    
06       federal Drug Enforcement Administration registration number or other appropriate                                  
07       identifier;                                                                                                       
08                 (2)  the date of the prescription;                                                                      
09                 (3)  the date the prescription was filled and the method of payment; this                               
10 paragraph does not authorize the board to include individual credit card or other                                       
11       account numbers in the database;                                                                                  
12 (4)  the name, address, and date of birth of the person for whom the                                                    
13       prescription was written;                                                                                         
14                 (5)  the name and national drug code of the controlled substance;                                       
15                 (6)  the quantity and strength of the controlled substance dispensed;                                   
16 (7)  the name of the drug outlet dispensing the controlled substance;                                                   
17       and                                                                                                               
18 (8)  the name of the pharmacist or practitioner dispensing the controlled                                               
19       substance and other appropriate identifying information.                                                          
20    * Sec. 35. AS 17.30.200(b), as amended by sec. 34 of this Act, is amended to read:                                 
21 (b)  The pharmacist-in-charge of each licensed or registered pharmacy,                                                  
22 regarding each schedule II, III, or IV controlled substance under federal law dispensed                                 
23 by a pharmacist under the supervision of the pharmacist-in-charge, and each                                             
24 practitioner who directly dispenses a schedule II, III, or IV controlled substance under                                
25 federal law other than those dispensed or administered under the circumstances                                          
26 described in (u) of this section, shall submit to the board, by a procedure and in a                                    
27 format established by the board, the following information for inclusion in the                                         
28       database on at least a daily [WEEKLY] basis:                                                                  
29 (1)  the name of the prescribing practitioner and the practitioner's                                                    
30 federal Drug Enforcement Administration registration number or other appropriate                                        
31       identifier;                                                                                                       
01                 (2)  the date of the prescription;                                                                      
02                 (3)  the date the prescription was filled and the method of payment; this                               
03       paragraph does not authorize the board to include individual credit card or other                                 
04       account numbers in the database;                                                                                  
05                 (4)  the name, address, and date of birth of the person for whom the                                    
06       prescription was written;                                                                                         
07                 (5)  the name and national drug code of the controlled substance;                                       
08                 (6)  the quantity and strength of the controlled substance dispensed;                                   
09                 (7)  the name of the drug outlet dispensing the controlled substance;                                   
10       and                                                                                                               
11 (8)  the name of the pharmacist or practitioner dispensing the controlled                                               
12       substance and other appropriate identifying information.                                                          
13    * Sec. 36. AS 17.30.200(d), as amended by sec. 25, ch. 25, SLA 2016, is amended to read:                           
14 (d)  The database and the information contained within the database are                                                 
15 confidential, are not public records, are not subject to public disclosure, and may not                                 
16 be shared with the federal government. The board shall undertake to ensure the                                          
17 security and confidentiality of the database and the information contained within the                                   
18 database. The board may allow access to the database only to the following persons,                                     
19       and in accordance with the limitations provided and regulations of the board:                                     
20 (1)  personnel of the board regarding inquiries concerning licensees or                                                 
21 registrants of the board or personnel of another board or agency concerning a                                           
22 practitioner under a search warrant, subpoena, or order issued by an administrative law                                 
23       judge or a court;                                                                                                 
24 (2)  authorized board personnel or contractors as required for                                                          
25       operational and review purposes;                                                                                  
26 (3)  a licensed practitioner having authority to prescribe controlled                                                   
27 substances or an agent or employee of the practitioner whom the practitioner has                                        
28 authorized to access the database on the practitioner's behalf, to the extent the                                       
29 information relates specifically to a current patient of the practitioner to whom the                                   
30 practitioner is prescribing or considering prescribing a controlled substance; the agent                                
31       or employee must be licensed or registered under AS 08;                                                           
01 (4)  a licensed or registered pharmacist having authority to dispense                                                   
02 controlled substances or an agent or employee of the pharmacist whom the pharmacist                                     
03 has authorized to access the database on the pharmacist's behalf, to the extent the                                     
04 information relates specifically to a current patient to whom the pharmacist is                                         
05 dispensing or considering dispensing a controlled substance; the agent or employee                                      
06       must be licensed or registered under AS 08;                                                                       
07 (5)  federal, state, and local law enforcement authorities may receive                                          
08 printouts of information contained in the database under a search warrant or order                                      
09 issued by a court establishing probable cause for the access and use of the information;                                
10 (6)  an individual who is the recipient of a controlled substance                                                       
11 prescription entered into the database may receive information contained in the                                         
12 database concerning the individual on providing evidence satisfactory to the board that                                 
13 the individual requesting the information is in fact the person about whom the data                                     
14 entry was made and on payment of a fee set by the board under AS 37.10.050 that                                         
15       does not exceed $10;                                                                                              
16 (7)  a licensed pharmacist employed by the Department of Health and                                                     
17 Social Services who is responsible for administering prescription drug coverage for                                     
18 the medical assistance program under AS 47.07, to the extent that the information                                       
19       relates specifically to prescription drug coverage under the program;                                             
20 (8)  a licensed pharmacist, licensed practitioner, or authorized                                                        
21 employee of the Department of Health and Social Services responsible for utilization                                    
22 review of prescription drugs for the medical assistance program under AS 47.07, to the                                  
23 extent that the information relates specifically to utilization review of prescription                                  
24       drugs provided to recipients of medical assistance;                                                               
25 (9)  the state medical examiner, to the extent that the information                                                     
26       relates specifically to investigating the cause and manner of a person's death;                                   
27 (10)  an authorized employee of the Department of Health and Social                                                     
28 Services may receive information from the database that does not disclose the identity                                  
29 of a patient, prescriber, dispenser, or dispenser location, for the purpose of identifying                              
30 and monitoring public health issues in the state; however, the information provided                                     
31 under this paragraph may include the region of the state in which a patient, prescriber,                                
01       and dispenser are located and the specialty of the prescriber; and                                                
02 (11)  a practitioner, pharmacist, or clinical staff employed by an Alaska                                               
03 tribal health organization, including commissioned corps officers of the United States                                  
04 Public Health Service employed under a memorandum of agreement; in this                                                 
05 paragraph, "Alaska tribal health organization" has the meaning given to "tribal health                                  
06       program" in 25 U.S.C. 1603.                                                                                       
07    * Sec. 37. AS 17.30.200(e), as amended by sec. 27, ch. 25, SLA 2016, is amended to read:                           
08            (e)  The failure of a pharmacist-in-charge or a [,] pharmacist [, OR                                     
09       PRACTITIONER] to register or submit information to the database as required under                                 
10 this section is grounds for the board to take disciplinary action against the license or                                
11 registration of the pharmacy or pharmacist. The failure of a practitioner to register                               
12 or review the database as required under this section is grounds for the                                            
13 practitioner's [OR FOR ANOTHER] licensing board to take disciplinary action                                         
14       against the [A] practitioner.                                                                                 
15    * Sec. 38. AS 17.30.200(p), enacted by sec. 34, ch. 25, SLA 2016, is amended to read:                              
16 (p)  The board shall promptly notify the State Medical Board, the Board of                                              
17 Nursing, the Board of Dental Examiners, [AND] the Board of Examiners in                                                 
18 Optometry, and the Board of Veterinary Examiners when a practitioner registers                                      
19       with the database under (o) of this section.                                                                      
20    * Sec. 39. AS 17.30.200(q), enacted by sec. 34, ch. 25, SLA 2016, is amended to read:                              
21 (q)  The board is authorized to provide unsolicited notification to a pharmacist,                                   
22 practitioner's licensing board, or practitioner if a patient has received one or more                               
23 prescriptions for controlled substances in quantities or with a frequency inconsistent                                  
24 with generally recognized standards of safe practice. An unsolicited notification to a                              
25       practitioner's licensing board under this section                                                             
26                 (1)  must be provided to the practitioner;                                                          
27                 (2)  is confidential;                                                                               
28 (3)  may not disclose information that is confidential under this                                                   
29       section;                                                                                                      
30 (4)  may be in a summary form sufficient to provide notice of the                                                   
31       basis for the unsolicited notification.                                                                       
01    * Sec. 40. AS 17.30.200(r), enacted by sec. 34, ch. 25, SLA 2016, is amended to read:                              
02            (r)  The board shall update the database on at least a daily [WEEKLY] basis                              
03       with the information submitted to the board under (b) of this section.                                            
04    * Sec. 41. AS 17.30.200(n) is amended by adding a new paragraph to read:                                           
05                 (5)  "opioid" includes the opium and opiate substances and opium and                                    
06       opiate derivatives listed in AS 11.71.140.                                                                        
07    * Sec. 42. AS 17.30.200 is amended by adding new subsections to read:                                              
08            (t)  Notwithstanding (q) of this section, the board may issue to a practitioner                              
09       periodic unsolicited reports that detail and compare the practitioner's opioid                                    
10 prescribing practice with other practitioners of the same occupation and similar                                        
11 specialty. A report issued under this subsection is confidential and the board shall                                    
12 issue the report only to a practitioner. The board may adopt regulations to implement                                   
13 this subsection. The regulations may address the types of controlled substances to be                                   
14 included in an unsolicited report, the quantities dispensed, the medication strength,                                   
15       and other factors determined by the board.                                                                        
16 (u)  A practitioner or a pharmacist is not required to comply with the                                                  
17       requirements of (a) and (b) of this section if a controlled substance is                                          
18                 (1)  administered to a patient at                                                                       
19                      (A)  a health care facility; or                                                                    
20                      (B)  a correctional facility;                                                                      
21 (2)  dispensed to a patient for an outpatient supply of 24 hours or less at                                             
22       a hospital                                                                                                        
23                      (A)  inpatient pharmacy; or                                                                        
24                      (B)  emergency department.                                                                         
25    * Sec. 43. AS 18.05.040(a) is amended to read:                                                                     
26            (a)  The commissioner shall adopt regulations consistent with existing law for                               
27 (1)  the time, manner, information to be reported, and persons                                                          
28 responsible for reporting for each disease or other condition of public health                                          
29       importance on the list developed under AS 18.15.370;                                                              
30                 (2)  cooperation with local boards of health and health officers;                                       
31 (3)  protection and promotion of the public health and prevention of                                                    
01       disability and mortality;                                                                                         
02 (4)  the transportation of dead bodies, except that the commissioner                                                    
03 may not require that a dead body be embalmed unless the body is known to carry a                                        
04 communicable disease or embalmment is otherwise required for the protection of the                                      
05       public health or for compliance with federal law;                                                                 
06                 (5)  carrying out the purposes of this chapter;                                                         
07                 (6)  the conduct of its business and for carrying out the provisions of                                 
08       laws of the United States and the state relating to public health;                                                
09                 (7)  establishing the divisions and local offices and advisory groups                                   
10 necessary or considered expedient to carry out or assist in carrying out a duty or power                                
11       assigned to it;                                                                                                   
12 (8)  the voluntary certification of laboratories to perform diagnostic,                                                 
13 quality control, or enforcement analyses or examinations based on recognized or                                         
14 tentative standards of performance relating to analysis and examination of food,                                        
15 including seafood, milk, water, and specimens from human beings submitted by                                            
16       licensed physicians and nurses for analysis;                                                                      
17 (9)  the regulation of quality and purity of commercially compressed                                                    
18       oxygen sold for human respiration;                                                                                
19 (10)  establishing confidentiality and security standards for information                                               
20       and records received under AS 18.15.355 - 18.15.395;                                                          
21 (11)  implementation of AS 13.55 (Voluntary Nonopioid Directive                                                     
22       Act).                                                                                                         
23    * Sec. 44. Sections 22, 24, 26, 28, 30, 32, 52, and 73, ch. 25, SLA 2016, are repealed.                            
24    * Sec. 45. The uncodified law of the State of Alaska is amended by adding a new section to                         
25 read:                                                                                                                   
26 TRANSITION: REGULATIONS. (a) The Department of Health and Social Services                                               
27 may adopt regulations necessary to implement the changes made by secs. 32 and 43 of this                                
28 Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not                                 
29 before the effective date of the relevant provision of this Act implemented by the regulation.                          
30 (b)  The Department of Commerce, Community, and Economic Development and a                                              
31 board that regulates an occupation that includes a practitioner required to register with the                           
01 controlled substance prescription database under AS 17.30.200 shall adopt regulations to                                
02 implement the changes made by AS 17.30.200(b), as amended by sec. 35 of this Act, and                                   
03 AS 17.30.200(r), as amended by sec. 40 of this Act. The regulations take effect under                                   
04 AS 44.62 (Administrative Procedure Act), but not before the effective date of the relevant                              
05 provision of secs. 35 and 40 of this Act implemented by the regulation. In this subsection,                             
06            (1)  "board" has the meaning given in AS 08.01.110;                                                          
07            (2)  "occupation" has the meaning given in AS 08.01.110;                                                     
08            (3)  "practitioner" has the meaning given in AS 11.71.900.                                                   
09       (c)  The Board of Dental Examiners may adopt regulations necessary to implement the                               
10 changes made by secs. 2 and 3 of this Act. The regulations take effect under AS 44.62                                   
11 (Administrative Procedure Act), but not before the effective date of the relevant provision of                          
12 secs. 2 and 3 of this Act implemented by the regulation.                                                                
13 (d)  The State Medical Board may adopt regulations necessary to implement the                                           
14 changes made by secs. 7 - 14 of this Act. The regulations take effect under AS 44.62                                    
15 (Administrative Procedure Act), but not before the effective date of the relevant provision of                          
16 secs. 7 - 14 of this Act implemented by the regulation.                                                                 
17 (e)  The Board of Nursing may adopt regulations necessary to implement the changes                                      
18 made by secs. 19 and 21 of this Act. The regulations take effect under AS 44.62                                         
19 (Administrative Procedure Act), but not before the effective date of the relevant provision of                          
20 secs. 19 and 21 of this Act implemented by the regulation.                                                              
21 (f)  The Board of Examiners in Optometry may adopt regulations necessary to                                             
22 implement the changes made by secs. 24 - 26 of this Act. The regulations take effect under                              
23 AS 44.62 (Administrative Procedure Act), but not before the effective date of the relevant                              
24 provision of secs. 24 - 26 of this Act implemented by the regulation.                                                   
25    * Sec. 46. Section 28 of this Act takes effect on the effective date of sec. 12, ch. 25, SLA                       
26 2016.                                                                                                                   
27    * Sec. 47. Section 33 of this Act takes effect on the effective date of sec. 21, ch. 25, SLA                       
28 2016.                                                                                                                   
29    * Sec. 48. Section 34 of this Act takes effect on the effective date of sec. 23, ch. 25, SLA                       
30 2016.                                                                                                                   
31    * Sec. 49. Section 36 of this Act takes effect on the effective date of sec. 25, ch. 25, SLA                       
01 2016.                                                                                                                   
02    * Sec. 50. Section 37 of this Act takes effect on the effective date of sec. 27, ch. 25, SLA                       
03 2016.                                                                                                                   
04    * Sec. 51. Sections 38 and 39 of this Act take effect on the effective date of sec. 34, ch. 25,                    
05 SLA 2016.                                                                                                               
06    * Sec. 52. Section 42 of this Act takes effect on the effective date of secs. 21 and 23, ch. 25,                   
07 SLA 2016.                                                                                                               
08    * Sec. 53. Sections 2, 3, 7 - 14, 19, 21, 24 - 26, 35, and 40 of this Act take effect July 1,                      
09 2018.                                                                                                                   
10    * Sec. 54. Sections 32 and 43 of this Act take effect July 1, 2019.                                                
11    * Sec. 55. Except as provided in secs. 46 - 54 of this Act, this Act takes effect immediately                      
12 under AS 01.10.070(c).