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CSSSHB 268(HSS): "An Act relating to the prescription of opioids; relating to the Department of Health and Social Services; relating to the practice of dentistry; relating to the practice of medicine; relating to the practice of podiatry; relating to the practice of osteopathy; relating to the practice of nursing; and relating to the practice of optometry."

00            CS FOR SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 268(HSS)                                                        
01 "An Act relating to the prescription of opioids; relating to the Department of Health and                               
02 Social Services; relating to the practice of dentistry; relating to the practice of medicine;                           
03 relating to the practice of podiatry; relating to the practice of osteopathy; relating to the                           
04 practice of nursing; and relating to the practice of optometry."                                                        
05 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
06    * Section 1. The uncodified law of the State of Alaska is amended by adding a new section                          
07 to read:                                                                                                                
08       SHORT TITLE. This Act may be known as the Consumer Advisory on Potential                                          
09 Heroin Addiction from Opioid Use Act.                                                                                   
10    * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to                          
11 read:                                                                                                                   
12       OPIOID ADDICTION: LEGISLATIVE FINDINGS. The legislature finds that                                                
13            (1)  the state has a considerable moral, public health, and financial interest in                            
14 reducing opioid and heroin addiction in the state;                                                                      
01            (2)  it is medically documented that opioid prescription drugs are addictive and                             
02 that opioid addiction is harmful and expensive to address;                                                              
03            (3)  as of 2017, accepted evidence shows that a significant percentage of                                    
04 people who become addicted to heroin were initially addicted to opioid prescription drugs;                              
05            (4)  opioid prescription drug and heroin addiction interferes with an addict's                               
06 ability to work and provide for a stable and healthy family;                                                            
07            (5)  the state's opioid epidemic damages the health of families and children and                             
08 affects the chances that a child will receive a healthy upbringing;                                                     
09            (6)  the opioid epidemic increases crime in the state, and the presence of heroin                            
10 dealers in the state poses a public safety threat;                                                                      
11 (7)  the opioid epidemic costs the state and other entities excessive amounts of                                        
12 money, which is especially problematic in lean budget times;                                                            
13 (8)  policies that reduce the number of people who become addicted to opioids                                           
14 and heroin will better serve citizens of the state and foster healthier families;                                       
15 (9)  patients are not always advised of the addictive effects of opioid                                                 
16 prescription drug use or that opioid prescription drug use may lead to opioid prescription drug                         
17 and heroin addiction; and                                                                                               
18 (10)  requiring medical providers to inform patients of the risks associated with                                       
19 opioid prescription drug use can help to reduce opioid prescription drug and heroin addictions                          
20 in the state.                                                                                                           
21    * Sec. 3. AS 08.36.315 is amended to read:                                                                         
22 Sec. 08.36.315. Grounds for discipline, suspension, or revocation of license.                                         
23 The board may revoke or suspend the license of a dentist, or may reprimand, censure,                                    
24       or discipline a dentist, or both, if the board finds, after a hearing, that the dentist                           
25 (1)  used or knowingly cooperated in deceit, fraud, or intentional                                                      
26       misrepresentation to obtain a license;                                                                            
27 (2)  engaged in deceit, fraud, or intentional misrepresentation in the                                                  
28 course of providing or billing for professional dental services or engaging in                                          
29       professional activities;                                                                                          
30 (3)  advertised professional dental services in a false or misleading                                                   
31       manner;                                                                                                           
01                 (4)  received compensation for referring a person to another dentist or                                 
02       dental practice;                                                                                                  
03                 (5)  has been convicted of a felony or other crime that affects the                                     
04       dentist's ability to continue to practice dentistry competently and safely;                                       
05                 (6)  engaged in the performance of patient care, or permitted the                                       
06       performance of patient care by persons under the dentist's supervision, regardless of                             
07       whether actual injury to the patient occurred,                                                                    
08                      (A)  that did not conform to minimum professional standards of                                     
09            dentistry; or                                                                                                
10 (B)  when the dentist, or a person under the supervision of the                                                         
11 dentist, did not have the permit, registration, or certificate required under                                           
12            AS 08.32 or this chapter;                                                                                    
13 (7)  failed to comply with this chapter, with a regulation adopted under                                                
14       this chapter, or with an order of the board;                                                                      
15                 (8)  continued to practice after becoming unfit due to                                                  
16                      (A)  professional incompetence;                                                                    
17 (B)  addiction or dependence on alcohol or other drugs that                                                             
18            impair the dentist's ability to practice safely;                                                             
19                      (C)  physical or mental disability;                                                                
20 (9)  engaged in lewd or immoral conduct in connection with the                                                          
21       delivery of professional service to patients;                                                                     
22 (10)  permitted a dental hygienist or dental assistant who is employed                                                  
23 by the dentist or working under the dentist's supervision to perform a dental procedure                                 
24       in violation of AS 08.32.110 or AS 08.36.346;                                                                     
25 (11)  failed to report to the board a death that occurred on the premises                                               
26       used for the practice of dentistry within 48 hours;                                                               
27 (12)  falsified or destroyed patient or facility records or failed to                                                   
28 maintain a patient or facility record for at least seven years after the date the record                                
29       was created;                                                                                                      
30 (13)  prescribed or dispensed an opioid in excess of the maximum                                                        
31       dosage authorized under AS 08.36.355; [OR]                                                                        
01                 (14)  procured, sold, prescribed, or dispensed drugs in violation of a                                  
02       law, regardless of whether there has been a criminal action or harm to the patient; or                        
03                 (15)  habitually and without good cause failed to provide oral and                                  
04       written information on opioids under AS 08.36.357 before initially prescribing an                             
05       outpatient supply of an opioid to patients.                                                                   
06    * Sec. 4. AS 08.36 is amended by adding a new section to read:                                                     
07 Sec. 08.36.357. Opioid prescription information; relationship to causes of                                            
08 action. (a) Before a licensee initially prescribes an outpatient supply of an opioid to a                             
09 patient, the licensee or an agent of the licensee shall provide to the patient or the                                   
10       person authorized to make health care decisions for the patient                                                   
11 (1)  an oral statement which, in the licensee's or agent's own words,                                                   
12       includes                                                                                                          
13                      (A)  the licensee's reasons for prescribing the opioid;                                            
14                      (B)  any reasonable non-opioid alternatives to the prescription;                                   
15                      (C)  information that                                                                              
16 (i)  the prescription could potentially lead to opioid                                                                  
17                 addiction;                                                                                              
18 (ii)  the danger of opioid addiction can begin to increase                                                              
19                 if a prescription is extended over longer periods of time; and                                          
20 (iii)  opioid addiction may pose potentially life-                                                                      
21                 threatening health risks; and                                                                           
22 (2)  a written statement, which may include graphics, prepared by the                                                   
23 Department of Health and Social Services that provides appropriate information                                          
24       conveying the potential addictive and health risks of opioids.                                                    
25 (b)  The requirements under (a) of this section do not apply to a patient                                               
26       receiving                                                                                                         
27                 (1)  hospice care from a licensed provider or facility; and                                             
28                 (2)  substance abuse or opioid dependence treatment.                                                    
29 (c)  The Department of Health and Social Services shall provide access on the                                           
30 department's Internet website to a printable version of the written statement a licensee                                
31       is required to distribute under (a)(2) of this section.                                                           
01            (d)  Nothing in this section creates a new cause of action or affects an existing                            
02       cause of action.                                                                                                  
03    * Sec. 5. AS 08.64.326(a) is amended to read:                                                                      
04            (a)  The board may impose a sanction if the board finds after a hearing that a                               
05       licensee                                                                                                          
06                 (1)  secured a license through deceit, fraud, or intentional                                            
07       misrepresentation;                                                                                                
08                 (2)  engaged in deceit, fraud, or intentional misrepresentation while                                   
09       providing professional services or engaging in professional activities;                                           
10                 (3)  advertised professional services in a false or misleading manner;                                  
11 (4)  has been convicted, including conviction based on a guilty plea or                                                 
12       plea of nolo contendere, of                                                                                       
13 (A)  a class A or unclassified felony or a crime in another                                                             
14 jurisdiction with elements similar to a class A or unclassified felony in this                                          
15            jurisdiction;                                                                                                
16 (B)  a class B or class C felony or a crime in another jurisdiction                                                     
17 with elements similar to a class B or class C felony in this jurisdiction if the                                        
18 felony or other crime is substantially related to the qualifications, functions, or                                     
19            duties of the licensee; or                                                                                   
20 (C)  a crime involving the unlawful procurement, sale,                                                                  
21            prescription, or dispensing of drugs;                                                                        
22 (5)  has procured, sold, prescribed, or dispensed drugs in violation of a                                               
23       law regardless of whether there has been a criminal action or harm to the patient;                                
24 (6)  intentionally or negligently permitted the performance of patient                                                  
25 care by persons under the licensee's supervision that does not conform to minimum                                       
26       professional standards even if the patient was not injured;                                                       
27 (7)  failed to comply with this chapter, a regulation adopted under this                                                
28       chapter, or an order of the board;                                                                                
29                 (8)  has demonstrated                                                                                   
30 (A)  professional incompetence, gross negligence, or repeated                                                           
31 negligent conduct; the board may not base a finding of professional                                                     
01            incompetence solely on the basis that a licensee's practice is unconventional or                             
02            experimental in the absence of demonstrable physical harm to a patient;                                      
03                      (B)  addiction to, severe dependency on, or habitual overuse of                                    
04            alcohol or other drugs that impairs the licensee's ability to practice safely;                               
05                      (C)  unfitness because of physical or mental disability;                                           
06 (9)  engaged in unprofessional conduct, in sexual misconduct, or in                                                     
07 lewd or immoral conduct in connection with the delivery of professional services to                                     
08 patients; in this paragraph, "sexual misconduct" includes sexual contact, as defined by                                 
09 the board in regulations adopted under this chapter, or attempted sexual contact with a                                 
10 patient outside the scope of generally accepted methods of examination or treatment of                                  
11 the patient, regardless of the patient's consent or lack of consent, during the term of the                             
12 physician-patient relationship, as defined by the board in regulations adopted under                                    
13 this chapter, unless the patient was the licensee's spouse at the time of the contact or,                               
14 immediately preceding the physician-patient relationship, was in a dating, courtship,                                   
15       or engagement relationship with the licensee;                                                                     
16                 (10)  has violated AS 18.16.010;                                                                        
17 (11)  has violated any code of ethics adopted by regulation by the                                                      
18       board;                                                                                                            
19 (12)  has denied care or treatment to a patient or person seeking                                                       
20 assistance from the physician if the only reason for the denial is the failure or refusal                               
21       of the patient to agree to arbitrate as provided in AS 09.55.535(a);                                              
22 (13)  has had a license or certificate to practice medicine in another                                                  
23 state or territory of the United States, or a province or territory of Canada, denied,                                  
24 suspended, revoked, surrendered while under investigation for an alleged violation,                                     
25 restricted, limited, conditioned, or placed on probation unless the denial, suspension,                                 
26 revocation, or other action was caused by the failure of the licensee to pay fees to that                               
27       state, territory, or province; [OR]                                                                               
28 (14)  prescribed or dispensed an opioid in excess of the maximum                                                        
29       dosage authorized under AS 08.64.363; or                                                                      
30 (15)  habitually and without good cause failed to provide oral and                                                  
31 written information on opioids under AS 08.64.371 before initially prescribing an                                   
01       outpatient supply of an opioid to patients.                                                                   
02    * Sec. 6. AS 08.64 is amended by adding a new section to read:                                                     
03 Sec. 08.64.371. Opioid prescription information; relationship to causes of                                            
04 action. (a) Before a licensee initially prescribes an outpatient supply of an opioid to a                             
05 patient, the licensee or an agent of the licensee shall provide to the patient or the                                   
06       person authorized to make health care decisions for the patient                                                   
07                 (1)  an oral statement which, in the licensee's or agent's own words,                                   
08       includes                                                                                                          
09                      (A)  the licensee's reasons for prescribing the opioid;                                            
10 (B)  any reasonable non-opioid alternatives to the prescription;                                                        
11            and                                                                                                          
12                      (C)  information that                                                                              
13 (i)  the prescription could potentially lead to opioid                                                                  
14                 addiction;                                                                                              
15 (ii)  the danger of opioid addiction can begin to increase                                                              
16                 if a prescription is extended over longer periods of time;                                              
17 (iii)  opioid addiction may pose potentially life-                                                                      
18                 threatening health risks; and                                                                           
19 (2)  a written statement, which may include graphics, prepared by the                                                   
20 Department of Health and Social Services that provides appropriate information                                          
21       conveying the potential addictive and health risks of opioids.                                                    
22 (b)  The requirements under (a) of this section do not apply to a patient                                               
23       receiving                                                                                                         
24                 (1)  hospice care from a licensed provider or facility; and                                             
25                 (2)  substance abuse or opioid dependence treatment.                                                    
26 (c)  The Department of Health and Social Services shall provide access on the                                           
27 department's Internet website to a printable version of the written statement a licensee                                
28       is required to distribute under (a)(2) of this section.                                                           
29 (d)  Nothing in this section creates a new cause of action or affects an existing                                       
30       cause of action.                                                                                                  
31    * Sec. 7. AS 08.68.270 is amended to read:                                                                         
01            Sec. 08.68.270. Grounds for denial, suspension, or revocation. The board                                   
02       may deny, suspend, or revoke the license of a person who                                                          
03                 (1)  has obtained or attempted to obtain a license to practice nursing by                               
04       fraud or deceit;                                                                                                  
05                 (2)  has been convicted of a felony or other crime if the felony or other                               
06 crime is substantially related to the qualifications, functions, or duties of the licensee;                             
07 (3)  habitually abuses alcoholic beverages, or illegally uses controlled                                                
08       substances;                                                                                                       
09                 (4)  has impersonated a registered, advanced practice registered, or                                    
10       practical nurse;                                                                                                  
11 (5)  has intentionally or negligently engaged in conduct that has                                                       
12       resulted in a significant risk to the health or safety of a client or in injury to a client;                      
13 (6)  practices or attempts to practice nursing while afflicted with                                                     
14 physical or mental illness, deterioration, or disability that interferes with the                                       
15       individual's performance of nursing functions;                                                                    
16 (7)  is guilty of unprofessional conduct as defined by regulations                                                      
17       adopted by the board;                                                                                             
18 (8)  has wilfully or repeatedly violated a provision of this chapter or                                                 
19       regulations adopted under this chapter or AS 08.01;                                                               
20                 (9)  is professionally incompetent;                                                                     
21 (10)  denies care or treatment to a patient or person seeking assistance                                                
22 if the sole reason for the denial is the failure or refusal of the patient or person seeking                            
23       assistance to agree to arbitrate as provided in AS 09.55.535(a);                                                  
24 (11)  has prescribed or dispensed an opioid in excess of the maximum                                                    
25       dosage authorized under AS 08.68.705; [OR]                                                                        
26 (12)  has procured, sold, prescribed, or dispensed drugs in violation of a                                              
27       law, regardless of whether there has been a criminal action or harm to the patient; or                        
28 (13)  has habitually and without good cause failed to provide oral                                                  
29 and written information on opioids under AS 08.68.710 before initially                                              
30       prescribing an outpatient supply of an opioid to patients.                                                    
31    * Sec. 8. AS 08.68 is amended by adding a new section to article 6 to read:                                        
01 Sec. 08.68.710. Opioid prescription information; relationship to causes of                                            
02 action. (a) Before an advanced practice registered nurse initially prescribes an                                      
03 outpatient supply of an opioid to a patient, the advanced practice registered nurse or an                               
04 agent of the advanced practice registered nurse shall provide to the patient or the                                     
05       person authorized to make health care decisions for the patient                                                   
06                 (1)  an oral statement which, in the advanced practice registered nurse's                               
07       or agent's own words, includes                                                                                    
08                      (A)  the advanced practice registered nurse's reasons for                                          
09            prescribing the opioid;                                                                                      
10 (B)  any reasonable non-opioid alternatives to the prescription;                                                        
11            and                                                                                                          
12                      (C)  information that                                                                              
13 (i)  the prescription could potentially lead to opioid                                                                  
14                 addiction;                                                                                              
15 (ii)  the danger of opioid addiction can begin to increase                                                              
16                 if a prescription is extended over longer periods of time;                                              
17                           (iii)  opioid addiction may pose potentially life-                                            
18                 threatening health risks; and                                                                           
19 (2)  a written statement, which may include graphics, prepared by the                                                   
20 Department of Health and Social Services that provides appropriate information                                          
21       conveying the potential addictive and health risks of opioids.                                                    
22 (b)  The requirements under (a) of this section do not apply to a patient                                               
23       receiving                                                                                                         
24                 (1)  hospice care from a licensed provider or facility; and                                             
25                 (2)  substance abuse or opioid dependence treatment.                                                    
26 (c)  The Department of Health and Social Services shall provide access on the                                           
27 department's Internet website to a printable version of the written statement an                                        
28       advanced practice registered nurse is required to distribute under (a)(2) of this section.                        
29 (d)  Nothing in this section creates a new cause of action or affects an existing                                       
30       cause of action.                                                                                                  
31    * Sec. 9. AS 08.72.240 is amended to read:                                                                         
01            Sec. 08.72.240. Grounds for imposition of disciplinary sanctions. The board                                
02 may impose disciplinary sanctions when the board finds after a hearing that a licensee                                  
03 (1)  secured a license through deceit, fraud, or intentional                                                            
04       misrepresentation;                                                                                                
05                 (2)  engaged in deceit, fraud, or intentional misrepresentation in the                                  
06       course of providing professional services or engaging in professional activities;                                 
07                 (3)  advertised professional services in a false or misleading manner;                                  
08                 (4)  has been convicted of a felony or other crime that affects the                                     
09       licensee's ability to continue to practice competently and safely;                                                
10 (5)  intentionally or negligently engaged in or permitted the                                                           
11 performance of patient care by persons under the licensee's supervision that does not                                   
12 conform to minimum professional standards regardless of whether actual injury to the                                    
13       patient occurred;                                                                                                 
14 (6)  failed to comply with this chapter, with a regulation adopted under                                                
15       this chapter, or with an order of the board;                                                                      
16                 (7)  continued to practice after becoming unfit due to                                                  
17                      (A)  professional incompetence;                                                                    
18 (B)  failure to keep informed of or use current professional                                                            
19            theories or practices;                                                                                       
20 (C)  addiction or severe dependency on alcohol or other drugs                                                           
21            that impairs the licensee's ability to practice safely;                                                      
22                      (D)  physical or mental disability;                                                                
23 (8)  engaged in lewd or immoral conduct in connection with the                                                          
24       delivery of professional service to patients;                                                                     
25 (9)  failed to refer a patient to a physician after ascertaining the                                                    
26       presence of ocular or systemic conditions requiring management by a physician;                                    
27 (10)  prescribed or dispensed an opioid in excess of the maximum                                                        
28       dosage authorized under AS 08.72.276;                                                                             
29 (11)  procured, sold, prescribed, or dispensed drugs in violation of a                                                  
30       law, regardless of whether there has been a criminal action or harm to the patient; or                        
31 (12)  habitually and without good cause failed to provide oral and                                                  
01       written information on opioids under AS 08.72.277 before initially prescribing an                             
02       outpatient supply of an opioid to patients.                                                                   
03    * Sec. 10. AS 08.72 is amended by adding a new section to read:                                                    
04 Sec. 08.72.277. Opioid prescription information; relationship to causes of                                            
05 action. (a) Before a licensee initially prescribes an outpatient supply of an opioid to a                             
06 patient, the licensee or an agent of the licensee shall provide to the patient or the                                   
07       person authorized to make health care decisions for the patient                                                   
08                 (1)  an oral statement which, in the licensee's or agent's own words,                                   
09       includes                                                                                                          
10                      (A)  the licensee's reasons for prescribing the opioid;                                            
11 (B)  any reasonable non-opioid alternatives to the prescription;                                                        
12            and                                                                                                          
13                      (C)  information that                                                                              
14 (i)  the prescription could potentially lead to opioid                                                                  
15                 addiction;                                                                                              
16 (ii)  the danger of opioid addiction can begin to increase                                                              
17                 if a prescription is extended over longer periods of time;                                              
18 (iii)  opioid addiction may pose potentially life-                                                                      
19                 threatening health risks; and                                                                           
20 (2)  a written statement, which may include graphics, prepared by the                                                   
21 Department of Health and Social Services that provides appropriate information                                          
22       conveying the potential addictive and health risks of opioids.                                                    
23 (b)  The requirements under (a) of this section do not apply to a patient                                               
24       receiving                                                                                                         
25                 (1)  hospice care from a licensed provider or facility; and                                             
26                 (2)  substance abuse or opioid dependence treatment.                                                    
27 (c)  The Department of Health and Social Services shall provide access on the                                           
28 department's Internet website to a printable version of the written statement a licensee                                
29       is required to distribute under (a)(2) of this section.                                                           
30 (d)  Nothing in this section creates a new cause of action or affects an existing                                       
31       cause of action.                                                                                                  
01    * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to                         
02 read:                                                                                                                   
03 TRANSITION: REGULATIONS. The Department of Health and Social Services may                                               
04 adopt regulations necessary to implement the changes made by secs. 4, 6, 8, and 10 of this                              
05 Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not                                 
06 before the effective date of the relevant provision of this Act implemented by the regulation.