HB 242: "An Act relating to the prescription of opioids; 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; relating to the practice of optometry; relating to the practice of pharmacy; relating to the practice of veterinary medicine; relating to the state medical examiner; relating to the controlled substance prescription database; relating to the duties of the Board of Pharmacy; and providing for an effective date."
00 HOUSE BILL NO. 242 01 "An Act relating to the prescription of opioids; relating to the practice of dentistry; 02 relating to the practice of medicine; relating to the practice of podiatry; relating to the 03 practice of osteopathy; relating to the practice of nursing; relating to the practice of 04 optometry; relating to the practice of pharmacy; relating to the practice of veterinary 05 medicine; relating to the state medical examiner; relating to the controlled substance 06 prescription database; relating to the duties of the Board of Pharmacy; and providing 07 for an effective date." 08 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 09 * Section 1. AS 08.36.070(a) 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,
01 and registered dental assistants who are in good standing; 02 (3) affiliate with the American Association of Dental Boards and pay 03 annual dues to the association; 04 (4) hold hearings and order the disciplinary sanction of a person who 05 violates this chapter, AS 08.32, or a regulation of the board; 06 (5) supply forms for applications, licenses, permits, certificates, 07 registration documents, and other papers and records; 08 (6) enforce the provisions of this chapter and AS 08.32 and adopt or 09 amend the regulations necessary to make the provisions of this chapter and AS 08.32 10 effective; 11 (7) adopt regulations ensuring that renewal of a license, registration, or 12 certificate under this chapter or a license, certificate, or endorsement under AS 08.32 13 is contingent on proof of continued professional competence; the regulations must 14 require that a licensee receive not less than two hours of education in pain 15 management and opioid use and addiction in the two years preceding an application 16 for renewal of a license, unless the licensee has demonstrated to the satisfaction of the 17 board that the licensee does not currently hold a valid federal Drug Enforcement 18 Administration registration number; 19 (8) at least annually, cause to be published on the Internet and in a 20 newspaper of general circulation in each major city in the state a summary of 21 disciplinary actions the board has taken during the preceding calendar year; 22 (9) issue permits or certificates to licensed dentists, licensed dental 23 hygienists, and dental assistants who meet standards determined by the board for 24 specific procedures that require specific education and training; 25 (10) require that a licensed dentist who has a federal Drug 26 Enforcement Administration registration number register with the controlled substance 27 prescription database under AS 17.30.200(n); 28 (11) adopt regulations that establish opioid prescription dosage 29 standards based on morphine milligram equivalents; in this paragraph, 30 "morphine milligram equivalent" means the conversion factor used to calculate 31 the strength of an opioid using morphine dosage as the comparative unit of
01 measure. 02 * Sec. 2. AS 08.64.101(a) is amended to read: 03 (a) The board shall 04 (1) except as provided in regulations adopted by the board under (b) of 05 this section, examine and issue licenses to applicants; 06 (2) develop written guidelines to ensure that licensing requirements are 07 not unreasonably burdensome and the issuance of licenses is not unreasonably 08 withheld or delayed; 09 (3) after a hearing, impose disciplinary sanctions on persons who 10 violate this chapter or the regulations or orders of the board; 11 (4) adopt regulations ensuring that renewal of licenses is contingent on 12 proof of continued competency on the part of the licensee; 13 (5) under regulations adopted by the board, contract with private 14 professional organizations to establish an impaired medical professionals program to 15 identify, confront, evaluate, and treat persons licensed under this chapter who abuse 16 alcohol, other drugs, or other substances or are mentally ill or cognitively impaired; 17 (6) adopt regulations that establish guidelines for a physician or 18 physician assistant who is rendering a diagnosis, providing treatment, or prescribing, 19 dispensing, or administering a prescription drug to a person without conducting a 20 physical examination under AS 08.64.364; the guidelines must include a nationally 21 recognized model policy for standards of care of a patient who is at a different location 22 than the physician or physician assistant; 23 (7) require that a licensee who has a federal Drug Enforcement 24 Administration registration number register with the controlled substance prescription 25 database under AS 17.30.200(n); 26 (8) adopt regulations that establish opioid prescription dosage 27 standards based on morphine milligram equivalents; in this paragraph, 28 "morphine milligram equivalent" means the conversion factor used to calculate 29 the strength of an opioid using morphine dosage as the comparative unit of 30 measure. 31 * Sec. 3. AS 08.68.100(a) is amended to read:
01 (a) The board shall 02 (1) adopt regulations necessary to implement this chapter, including 03 regulations 04 (A) pertaining to practice as an advanced practice registered 05 nurse, including requirements for an advanced practice registered nurse to 06 practice as a certified registered nurse anesthetist, certified clinical nurse 07 specialist, certified nurse practitioner, or certified nurse midwife; regulations 08 for an advanced practice registered nurse who holds a valid federal Drug 09 Enforcement Administration registration number must address training in pain 10 management and opioid use and addiction; 11 (B) necessary to implement AS 08.68.331 - 08.68.336 relating 12 to certified nurse aides in order to protect the health, safety, and welfare of 13 clients served by nurse aides; 14 (C) pertaining to retired nurse status; [AND] 15 (D) establishing criteria for approval of practical nurse 16 education programs that are not accredited by a national nursing accrediting 17 body; and 18 (E) establishing opioid prescription dosage standards based 19 on morphine milligram equivalents; in this subparagraph, "morphine 20 milligram equivalent" means the conversion factor used to calculate the 21 strength of an opioid using morphine dosage as the comparative unit of 22 measure; 23 (2) approve curricula and adopt standards for basic education programs 24 that prepare persons for licensing under AS 08.68.190; 25 (3) provide for surveys of the basic nursing education programs in the 26 state at the times it considers necessary; 27 (4) approve education programs that meet the requirements of this 28 chapter and of the board, and deny, revoke, or suspend approval of education 29 programs for failure to meet the requirements; 30 (5) examine, license, and renew the licenses of qualified applicants; 31 (6) prescribe requirements for competence before a former registered,
01 advanced practice registered, or licensed practical nurse may resume the practice of 02 nursing under this chapter; 03 (7) define by regulation the qualifications and duties of the executive 04 administrator and delegate authority to the executive administrator that is necessary to 05 conduct board business; 06 (8) develop reasonable and uniform standards for nursing practice; 07 (9) publish advisory opinions regarding whether nursing practice 08 procedures or policies comply with acceptable standards of nursing practice as defined 09 under this chapter; 10 (10) require applicants under this chapter to submit fingerprints and the 11 fees required by the Department of Public Safety under AS 12.62.160 for criminal 12 justice information and a national criminal history record check; the department shall 13 submit the fingerprints and fees to the Department of Public Safety for a report of 14 criminal justice information under AS 12.62 and a national criminal history record 15 check under AS 12.62.400; 16 (11) require that a licensed advanced practice registered nurse who has 17 a federal Drug Enforcement Administration registration number register with the 18 controlled substance prescription database under AS 17.30.200(n). 19 * Sec. 4. AS 08.72.050 is amended to read: 20 Sec. 08.72.050. Regulations. The board shall adopt regulations 21 (1) necessary for the proper performance of its duties; 22 (2) governing the applicants and applications for licensing; 23 (3) for the licensing of optometrists; 24 (4) necessary to govern the practice of optometry, including the 25 prescription and use of pharmaceutical agents for the treatment of eye disease; 26 (5) prescribing requirements that a person licensed under this chapter 27 must meet to demonstrate continued professional competency; 28 (6) developing uniform standards for the practice of optometry; 29 (7) establishing opioid prescription dosage standards based on 30 morphine milligram equivalents; in this paragraph, "morphine milligram 31 equivalent" means the conversion factor used to calculate the strength of an
01 opioid using morphine dosage as the comparative unit of measure. 02 * Sec. 5. AS 08.80.335 is amended by adding a new subsection to read: 03 (c) Before filling a prescription for and dispensing an opioid that is a schedule 04 II, III, or IV controlled substance under federal law, a pharmacist shall confirm that 05 the prescribing practitioner reviewed the patient's prescription records in the controlled 06 substance prescription database as provided in AS 17.30.200 before prescribing the 07 opioid. 08 * Sec. 6. AS 08.98.050(a) is amended to read: 09 (a) The board shall 10 (1) establish examination requirements for eligible applicants for 11 licensure to practice veterinary medicine; 12 (2) examine, or cause to be examined, eligible applicants for licensure 13 or registration; 14 (3) approve the issuance of licenses and student permits to qualified 15 applicants; 16 (4) establish standards for the practice of veterinary medicine by 17 regulation; 18 (5) conduct disciplinary proceedings in accordance with this chapter; 19 (6) adopt regulations requiring proof of continued competency before a 20 license is renewed; 21 (7) as requested by the department, monitor the standards and 22 availability of veterinary services provided in the state and report its findings to the 23 department; 24 (8) collect, or cause to be collected, data concerning the practice of 25 veterinary technology by veterinary technicians in the state and submit the data to the 26 department for maintenance; 27 (9) establish, by regulation, educational and training requirements for 28 (A) the issuance of student permits; and 29 (B) the delegation of duties by veterinarians licensed under this 30 chapter to veterinary technicians; 31 (10) require that a licensee who has a federal Drug Enforcement
01 Administration registration number register with the controlled substance prescription 02 database under AS 17.30.200(n); 03 (11) identify resources and develop educational materials to assist 04 licensees to identify an animal owner who may be at risk for abusing or misusing an 05 opioid; 06 (12) adopt regulations that establish opioid prescription dosage 07 standards based on morphine milligram equivalents; in this paragraph, 08 "morphine milligram equivalent" means the conversion factor used to calculate 09 the strength of an opioid using morphine dosage as the comparative unit of 10 measure. 11 * Sec. 7. AS 12.65.020 is amended by adding a new subsection to read: 12 (h) If the state medical examiner or deputy medical examiner determines a 13 person's death was caused by an overdose of a schedule II, III, or IV controlled 14 substance under federal law, the state medical examiner or deputy medical examiner 15 shall report to the Board of Pharmacy the person's name, address, and date of birth. 16 * Sec. 8. AS 17.30.200(c) is amended to read: 17 (c) The board shall maintain the database in an electronic file or by other 18 means established by the board to facilitate use of the database for identification of 19 (1) prescribing practices and patterns of prescribing and dispensing 20 controlled substances; 21 (2) practitioners who 22 (A) prescribe controlled substances in an unprofessional or 23 unlawful manner; or 24 (B) fail to review the information in the database to check a 25 patient's prescription records before dispensing, prescribing, or 26 administering a schedule II, III, or IV controlled substance under federal 27 law to the patient as required under this section or board regulations; 28 (3) individuals who receive prescriptions for controlled substances 29 from licensed practitioners and who subsequently obtain dispensed controlled 30 substances from a drug outlet in quantities or with a frequency inconsistent with 31 generally recognized standards of dosage for that controlled substance; [AND]
01 (4) individuals who present forged or otherwise false or altered 02 prescriptions for controlled substances to a pharmacy; and 03 (5) each occurrence for which a practitioner failed to review the 04 information in the database to check a patient's prescription records before 05 dispensing, prescribing, or administering a schedule II, III, or IV controlled 06 substance under federal law to the patient as required under this section or 07 board regulations. 08 * Sec. 9. AS 17.30.200(d) is amended to read: 09 (d) The database and the information contained within the database are 10 confidential, are not public records, are not subject to public disclosure, and may not 11 be shared with the federal government. The board shall [UNDERTAKE TO] ensure 12 the security and confidentiality of the database and the information contained within 13 the database. The board may allow access to the database only to the following 14 persons, and in accordance with the limitations provided and regulations of the board: 15 (1) personnel of the board regarding inquiries concerning licensees or 16 registrants of the board or personnel of another board or agency concerning a 17 practitioner under a search warrant, subpoena, or order issued by an administrative law 18 judge or a court; 19 (2) authorized board personnel or contractors as required for 20 operational and review purposes; 21 (3) a licensed practitioner having authority to prescribe controlled 22 substances or an agent or employee of the practitioner whom the practitioner has 23 authorized to access the database on the practitioner's behalf, to the extent the 24 information relates specifically to a current patient of the practitioner to whom the 25 practitioner is prescribing or considering prescribing a controlled substance; the agent 26 or employee must be licensed or registered under AS 08; 27 (4) a licensed or registered pharmacist having authority to dispense 28 controlled substances or an agent or employee of the pharmacist whom the pharmacist 29 has authorized to access the database on the pharmacist's behalf, to the extent the 30 information relates specifically to a current patient to whom the pharmacist is 31 dispensing or considering dispensing a controlled substance; the agent or employee
01 must be licensed or registered under AS 08; 02 (5) federal, state, and local law enforcement authorities may receive 03 printouts of information contained in the database under a search warrant or order 04 issued by a court establishing probable cause for the access and use of the information; 05 (6) an individual who is the recipient of a controlled substance 06 prescription entered into the database may receive information contained in the 07 database concerning the individual on providing evidence satisfactory to the board that 08 the individual requesting the information is in fact the person about whom the data 09 entry was made and on payment of a fee set by the board under AS 37.10.050 that 10 does not exceed $10; 11 (7) a licensed pharmacist employed by the Department of Health and 12 Social Services who is responsible for administering prescription drug coverage for 13 the medical assistance program under AS 47.07, to the extent that the information 14 relates specifically to prescription drug coverage under the program; 15 (8) a licensed pharmacist, licensed practitioner, or authorized 16 employee of the Department of Health and Social Services responsible for utilization 17 review of prescription drugs for the medical assistance program under AS 47.07, to the 18 extent that the information relates specifically to utilization review of prescription 19 drugs provided to recipients of medical assistance; 20 (9) the state medical examiner, to the extent that the information 21 relates specifically to investigating the cause and manner of a person's death; 22 (10) an authorized employee of the Department of Health and Social 23 Services may receive information from the database that does not disclose the identity 24 of a patient, prescriber, dispenser, or dispenser location, for the purpose of identifying 25 and monitoring public health issues in the state; however, the information provided 26 under this paragraph may include the region of the state in which a patient, prescriber, 27 and dispenser are located and the specialty of the prescriber; and 28 (11) a practitioner, pharmacist, or clinical staff employed by an Alaska 29 tribal health organization, including commissioned corps officers of the United States 30 Public Health Service employed under a memorandum of agreement; in this 31 paragraph, "Alaska tribal health organization" has the meaning given to "tribal health
01 program" in 25 U.S.C. 1603. 02 * Sec. 10. AS 17.30.200(e) is amended to read: 03 (e) The failure of a pharmacist-in-charge or a pharmacist to register with or 04 submit information to the database as required under this section is grounds for the 05 board to take disciplinary action against the license or registration of the pharmacy or 06 pharmacist. After a hearing, and upon a finding by a practitioner's licensing 07 board that the [THE FAILURE OF A] practitioner has failed to register with or 08 review the database as required under this section, [IS GROUNDS FOR] the 09 practitioner's licensing board shall [TO] take disciplinary action against the 10 practitioner. 11 * Sec. 11. AS 17.30.200(h) is amended to read: 12 (h) An individual who has submitted information to the database in 13 accordance with this section may not be held civilly liable for having submitted the 14 information. Dispensers or practitioners may not be held civilly liable for damages for 15 accessing [OR FAILING TO ACCESS] the information in the database. 16 * Sec. 12. AS 17.30.200(k) is amended to read: 17 (k) In the regulations adopted under this section, the board shall provide 18 (1) [THAT PRESCRIPTION INFORMATION IN THE DATABASE 19 SHALL BE PURGED FROM THE DATABASE AFTER TWO YEARS HAVE 20 ELAPSED FROM THE DATE THE PRESCRIPTION WAS DISPENSED; 21 (2)] a method for an individual to challenge information in the 22 database about the individual that the individual [PERSON] believes is incorrect or 23 was incorrectly entered by a dispenser; 24 (2) [(3)] a procedure [AND TIME FRAME] for registration with the 25 database; 26 (3) [(4)] that a practitioner review the information in the database to 27 check a patient's prescription records before dispensing, prescribing, or administering 28 a schedule II or III controlled substance under federal law to the patient; the 29 regulations must provide that a practitioner is not required to review the information in 30 the database before dispensing, prescribing, or administering 31 (A) a controlled substance to a person who is receiving
01 treatment 02 (i) in an inpatient setting; 03 (ii) at the scene of an emergency or in an ambulance; in 04 this sub-subparagraph, "ambulance" has the meaning given in 05 AS 18.08.200; 06 (iii) in an emergency room; 07 (iv) immediately before, during, or within the first 48 08 hours after surgery or a medical procedure; 09 (v) in a hospice or nursing home that has an in-house 10 pharmacy; or 11 (B) a nonrefillable prescription of a controlled substance in a 12 quantity intended to last for not more than three days. 13 * Sec. 13. AS 17.30.200(p) is amended to read: 14 (p) The board shall [IS AUTHORIZED TO] provide unsolicited notification 15 to a patient's pharmacist and practitioner, as well as the [,] practitioner's licensing 16 board, [OR PRACTITIONER] if a patient has received one or more prescriptions for 17 controlled substances in quantities or with a frequency inconsistent with generally 18 recognized standards of safe practice. An unsolicited notification to a practitioner's 19 licensing board under this section 20 (1) must be provided to the practitioner; 21 (2) is confidential; 22 (3) may not disclose information that is confidential under this section; 23 (4) may be in a summary form sufficient to provide notice of the basis 24 for the unsolicited notification. 25 * Sec. 14. AS 17.30.200(s) is amended to read: 26 (s) Notwithstanding (p) of this section, the board shall, at least once a year, 27 [MAY] issue to a practitioner periodic unsolicited reports that detail and compare the 28 practitioner's opioid prescribing practice with other practitioners of the same 29 occupation and similar specialty. The board shall simultaneously send to the 30 practitioner's licensing board and, if the practitioner is in a group practice, to a 31 director of the practice who is licensed under AS 08 a copy of the report that
01 excludes personally identifiable information of patients. A report issued under this 02 subsection is confidential and a recipient may not disclose information in the 03 report to a person who does not have access to the database under this section 04 [THE BOARD SHALL ISSUE THE REPORT ONLY TO A PRACTITIONER]. The 05 board may adopt regulations to implement this subsection. The regulations must 06 [MAY] address the types of controlled substances to be included in an unsolicited 07 report, the quantities dispensed, the medication strength, and other factors determined 08 by the board. 09 * Sec. 15. AS 17.30.200 is amended by adding a new subsection to read: 10 (v) If the board receives notice from the state medical examiner or deputy 11 medical examiner under AS 12.65.020(h) that a person's death was caused by an 12 overdose of a schedule II, III, or IV controlled substance under federal law, the board 13 shall 14 (1) review the database and identify practitioners who prescribed a 15 schedule II, III, or IV controlled substance under federal law to the person during the 16 three-month period preceding the person's death; and 17 (2) promptly notify the practitioner and the practitioner's licensing 18 board of the determination by the state medical examiner or deputy medical examiner 19 regarding the person's cause of death. 20 * Sec. 16. The uncodified law of the State of Alaska is amended by adding a new section to 21 read: 22 TRANSITION: REGULATIONS. Not later than one year after the effective date of 23 secs. 1 - 15 of this Act, 24 (1) the Board of Dental Examiners shall adopt regulations necessary to 25 implement sec. 1 of this Act; the regulations take effect under AS 44.62 (Administrative 26 Procedure Act), but not before the effective date of sec. 1 of this Act; 27 (2) the State Medical Board shall adopt regulations necessary to implement 28 sec. 2 of this Act; the regulations take effect under AS 44.62 (Administrative Procedure Act), 29 but not before the effective date of sec. 2 of this Act; 30 (3) the Board of Nursing shall adopt regulations necessary to implement sec. 3 31 of this Act; the regulations take effect under AS 44.62 (Administrative Procedure Act), but
01 not before the effective date of sec. 3 of this Act; 02 (4) the Board of Examiners in Optometry shall adopt regulations necessary to 03 implement sec. 4 of this Act; the regulations take effect under AS 44.62 (Administrative 04 Procedure Act), but not before the effective date of sec. 4 of this Act; 05 (5) the Board of Pharmacy shall adopt regulations necessary to implement 06 secs. 5 and 8 - 15 of this Act; the regulations take effect under AS 44.62 (Administrative 07 Procedure Act), but not before the effective date of secs. 5 and 8 - 15 of this Act; 08 (6) the Board of Veterinary Examiners shall adopt regulations necessary to 09 implement sec. 6 of this Act; the regulations take effect under AS 44.62 (Administrative 10 Procedure Act), but not before the effective date of sec. 6 of this Act; 11 (7) the Department of Commerce, Community, and Economic Development 12 and a board that regulates an occupation that includes a practitioner required to register with 13 the controlled substance prescription database under AS 17.30.200 shall adopt regulations to 14 implement the changes made by AS 17.30.200(c), as amended by sec. 8 of this Act, and 15 AS 17.30.200(e), as amended by sec. 10 of this Act; the regulations take effect under 16 AS 44.62 (Administrative Procedure Act), but not before the effective date of secs. 8 and 10 17 of this Act; in this paragraph, 18 (A) "board" has the meaning given in AS 08.01.110; 19 (B) "occupation" has the meaning given in AS 08.01.110; 20 (C) "practitioner" has the meaning given in AS 11.71.900. 21 * Sec. 17. Section 16 of this Act takes effect immediately under AS 01.10.070(c). 22 * Sec. 18. Except as provided in sec. 17 of this Act, this Act takes effect January 1, 2021.