00 SENATE CS FOR CS FOR HOUSE BILL NO. 159(FIN) 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; relating to the definition of 'practitioner'; providing for an 08 effective date by repealing the effective date of sec. 73, ch. 25, SLA 2016; and providing 09 for an effective date." 10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 11  * Section 1. The uncodified law of the State of Alaska is amended by adding a new section 12 to read: 01 LEGISLATIVE INTENT. It is the intent of the legislature that the seven-day supply 02 limit for an initial opioid prescription under secs. 5, 16, 22, and 33 of this Act and the four- 03 day supply limit for an initial opioid prescription under sec. 28 of this Act may not be 04 considered as a minimum length of time appropriate for an initial prescription. The United 05 States Centers for Disease Control and Prevention guidelines state that a three-day initial 06 prescription of an opioid is sufficient for most cases of acute pain. The United States Centers 07 for Disease Control and Prevention reported in its March 17, 2017, weekly report that the 08 likelihood of a person's chronic opioid use increases with each additional day of medication 09 supplied after the second day. Practitioners should use their professional judgment in each 10 case and not interpret the seven-day limit as a direction to prescribe the full seven days or the 11 four-day limit as a direction to prescribe the full four days. 12  * Sec. 2. AS 08.36.070(a), as amended by sec. 5, ch. 25, SLA 2016, is amended to read: 13 (a) The board shall 14 (1) provide for the examination of applicants and the credentialing, 15 registration, and licensure of those applicants it finds qualified; 16 (2) maintain a registry of licensed dentists, licensed dental hygienists, 17 and registered dental assistants who are in good standing; 18 (3) affiliate with the American Association of Dental Boards and pay 19 annual dues to the association; 20 (4) hold hearings and order the disciplinary sanction of a person who 21 violates this chapter, AS 08.32, or a regulation of the board; 22 (5) supply forms for applications, licenses, permits, certificates, 23 registration documents, and other papers and records; 24 (6) enforce the provisions of this chapter and AS 08.32 and adopt or 25 amend the regulations necessary to make the provisions of this chapter and AS 08.32 26 effective; 27 (7) adopt regulations ensuring that renewal of a license, registration, or 28 certificate under this chapter or a license, certificate, or endorsement under AS 08.32 29 is contingent on [UPON] proof of continued professional competence; the  30 regulations must require that a licensee receive not less than two hours of  31 education in pain management and opioid use and addiction in the two years  01 preceding an application for renewal of a license, unless the licensee has  02 demonstrated to the satisfaction of the board that the licensee does not currently  03 hold a valid federal Drug Enforcement Administration registration number; 04 (8) at least annually, cause to be published on the Internet and in a 05 newspaper of general circulation in each major city in the state a summary of 06 disciplinary actions the board has taken during the preceding calendar year; 07 (9) issue permits or certificates to licensed dentists, licensed dental 08 hygienists, and dental assistants who meet standards determined by the board for 09 specific procedures that require specific education and training; 10 (10) require that a licensed dentist who has a federal Drug 11 Enforcement Administration registration number register with the controlled substance 12 prescription database under AS 17.30.200(o). 13  * Sec. 3. AS 08.36.110(a) is amended to read: 14 (a) An applicant for a license to practice dentistry shall 15 (1) provide certification to the board that the applicant 16 (A) is a graduate of a dental school that, at the time of 17 graduation, is approved by the board; 18 (B) has successfully passed a written examination approved by 19 the board; 20 (C) has not had a license to practice dentistry revoked, 21 suspended, or voluntarily surrendered in this state or another state; 22 (D) is not the subject of an adverse decision based on [UPON] 23 a complaint, investigation, review procedure, or other disciplinary proceeding 24 within the five years immediately preceding application, or of an unresolved 25 complaint, investigation, review procedure, or other disciplinary proceeding, 26 undertaken by a state, territorial, local, or federal dental licensing jurisdiction; 27 (E) is not the subject of an unresolved or an adverse decision 28 based on [UPON] a complaint, investigation, review procedure, or other 29 disciplinary proceeding, undertaken by a state, territorial, local, or federal 30 dental licensing jurisdiction or law enforcement agency that relates to criminal 31 or fraudulent activity, dental malpractice, or negligent dental care and that 01 adversely reflects on the applicant's ability or competence to practice dentistry 02 or on the safety or well-being of patients; 03 (F) is not the subject of an adverse report from the National 04 Practitioner Data Bank or the American Association of Dental Boards 05 Clearinghouse for Board Actions that relates to criminal or fraudulent activity, 06 or dental malpractice; 07 (G) is not impaired to an extent that affects the applicant's 08 ability to practice dentistry; 09 (H) has not been convicted of a crime that adversely reflects on 10 the applicant's ability or competency to practice dentistry or that jeopardizes 11 the safety or well-being of a patient; 12 (2) pass, to the satisfaction of the board, written, clinical, and other 13 examinations administered or approved by the board; and 14 (3) meet the other qualifications for a license established by the board 15 by regulation, including education in pain management and opioid use and  16 addiction in the two years preceding the application for a license, unless the  17 applicant has demonstrated to the satisfaction of the board that the applicant  18 does not currently hold a valid federal Drug Enforcement Administration  19 registration number; approved education may include dental school coursework. 20  * Sec. 4. AS 08.36.315 is amended to read: 21 Sec. 08.36.315. Grounds for discipline, suspension, or revocation of license. 22 The board may revoke or suspend the license of a dentist, or may reprimand, censure, 23 or discipline a dentist, or both, if the board finds, after a hearing, that the dentist 24 (1) used or knowingly cooperated in deceit, fraud, or intentional 25 misrepresentation to obtain a license; 26 (2) engaged in deceit, fraud, or intentional misrepresentation in the 27 course of providing or billing for professional dental services or engaging in 28 professional activities; 29 (3) advertised professional dental services in a false or misleading 30 manner; 31 (4) received compensation for referring a person to another dentist or 01 dental practice; 02 (5) has been convicted of a felony or other crime that affects the 03 dentist's ability to continue to practice dentistry competently and safely; 04 (6) engaged in the performance of patient care, or permitted the 05 performance of patient care by persons under the dentist's supervision, regardless of 06 whether actual injury to the patient occurred, 07 (A) that did not conform to minimum professional standards of 08 dentistry; or 09 (B) when the dentist, or a person under the supervision of the 10 dentist, did not have the permit, registration, or certificate required under 11 AS 08.32 or this chapter; 12 (7) failed to comply with this chapter, with a regulation adopted under 13 this chapter, or with an order of the board; 14 (8) continued to practice after becoming unfit due to 15 (A) professional incompetence; 16 (B) addiction or dependence on alcohol or other drugs that 17 impair the dentist's ability to practice safely; 18 (C) physical or mental disability; 19 (9) engaged in lewd or immoral conduct in connection with the 20 delivery of professional service to patients; 21 (10) permitted a dental hygienist or dental assistant who is employed 22 by the dentist or working under the dentist's supervision to perform a dental procedure 23 in violation of AS 08.32.110 or AS 08.36.346; 24 (11) failed to report to the board a death that occurred on the premises 25 used for the practice of dentistry within 48 hours; 26 (12) falsified or destroyed patient or facility records or failed to 27 maintain a patient or facility record for at least seven years after the date the record 28 was created;  29 (13) prescribed or dispensed an opioid in excess of the maximum  30 dosage authorized under AS 08.36.355; or  31 (14) procured, sold, prescribed, or dispensed drugs in violation of  01 a law, regardless of whether there has been a criminal action or harm to the  02 patient. 03  * Sec. 5. AS 08.36 is amended by adding a new section to read: 04 Sec. 08.36.355. Maximum dosage for opioid prescriptions. (a) A licensee 05 may not issue 06 (1) an initial prescription for an opioid that exceeds a seven-day supply 07 to an adult patient for outpatient use; 08 (2) a prescription for an opioid that exceeds a seven-day supply to a 09 minor; at the time a licensee writes a prescription for an opioid for a minor, the 10 licensee shall discuss with the parent or guardian of the minor why the prescription is 11 necessary and the risks associated with opioid use. 12 (b) Notwithstanding (a) of this section, a licensee may issue a prescription for 13 an opioid that exceeds a seven-day supply to an adult or minor patient if, in the 14 professional judgment of the licensee, more than a seven-day supply of an opioid is 15 necessary for 16 (1) the patient's chronic pain management; the licensee may write a 17 prescription for an opioid for the quantity needed to treat the patient's medical 18 condition or chronic pain; the licensee shall document in the patient's medical record 19 the condition triggering the prescription of an opioid in a quantity that exceeds a 20 seven-day supply and indicate that a nonopioid alternative was not appropriate to 21 address the medical condition; or 22 (2) a patient who is unable to access a practitioner within the time 23 necessary for a refill of the seven-day supply because of a logistical or travel barrier; 24 the licensee may write a prescription for an opioid for the quantity needed to treat the 25 patient for the time that the patient is unable to access a practitioner; the licensee shall 26 document in the patient's medical record the reason for the prescription of an opioid in 27 a quantity that exceeds a seven-day supply and indicate that a nonopioid alternative 28 was not appropriate to address the medical condition; in this paragraph, "practitioner" 29 has the meaning given in AS 11.71.900. 30 (c) In this section, 31 (1) "adult" means 01 (A) a 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 an individual under 18 years of age who is not an 06 emancipated minor. 07  * Sec. 6. AS 08.36.370 is amended by adding a new paragraph to read: 08 (10) "opioid" includes the opium and opiate substances and opium and 09 opiate derivatives listed in AS 11.71.140 and 11.71.160. 10  * Sec. 7. AS 08.64.107 is amended to read: 11 Sec. 08.64.107. Regulation of physician assistants and intensive care  12 paramedics. The board shall adopt regulations regarding the licensure of physician 13 assistants and registration of mobile intensive care paramedics, and the medical 14 services that they may perform, including the 15 (1) educational and other qualifications, including education in pain  16 management and opioid use and addiction; 17 (2) application and registration procedures; 18 (3) scope of activities authorized; and 19 (4) responsibilities of the supervising or training physician. 20  * Sec. 8. AS 08.64.200(a) is amended to read: 21 (a) Except for foreign medical graduates as specified in AS 08.64.225, each 22 physician applicant shall 23 (1) submit a certificate of graduation from a legally chartered medical 24 school accredited by the Association of American Medical Colleges and the Council 25 on Medical Education of the American Medical Association; 26 (2) submit a certificate from a recognized hospital or hospitals 27 certifying that the applicant has satisfactorily performed the duties of resident 28 physician or intern for a period of 29 (A) one year if the applicant graduated from medical school 30 before January 1, 1995, as evidenced by a certificate of completion of the first 31 year of postgraduate training from the facility where the applicant completed 01 the first year of internship or residency; and 02 (B) two years if the applicant graduated from medical school 03 on or after January 1, 1995, as evidenced by a certificate of completion of the 04 first year of postgraduate training from the facility where the applicant 05 completed the first year of internship or residency and a certificate of 06 successful completion of one additional year of postgraduate training at a 07 recognized hospital; 08 (3) submit a list of negotiated settlements or judgments in claims or 09 civil actions alleging medical malpractice against the applicant, including an 10 explanation of the basis for each claim or action; [AND] 11 (4) not have a license to practice medicine in another state, country, 12 province, or territory that is currently suspended or revoked for disciplinary reasons;  13 and  14 (5) receive education in pain management and opioid use and  15 addiction, unless the applicant has demonstrated to the satisfaction of the board  16 that the applicant does not currently hold a valid federal Drug Enforcement  17 Administration registration number; an applicant may include past professional  18 experience or professional education as proof of professional competence. 19  * Sec. 9. AS 08.64.205 is amended to read: 20 Sec. 08.64.205. Qualifications for osteopath applicants. Each osteopath 21 applicant shall meet the qualifications prescribed in AS 08.64.200(a)(3) - (5) 22 [AS 08.64.200(a)(3) AND (4)] and shall 23 (1) submit a certificate of graduation from the legally chartered school 24 of osteopathy approved by the board; 25 (2) submit a certificate from a hospital approved by the American 26 Medical Association or the American Osteopathic Association that certifies that the 27 osteopath has satisfactorily completed and performed the duties of intern or resident 28 physician for 29 (A) one year if the applicant graduated from a school of 30 osteopathy before January 1, 1995, as evidenced by a certificate of completion 31 of the first year of postgraduate training from the facility where the applicant 01 completed the first year of internship or residency; or 02 (B) two years if the applicant graduated from a school of 03 osteopathy on or after January 1, 1995, as evidenced by a certificate of 04 completion of the first year of postgraduate training from the facility where the 05 applicant completed the first year of internship or residency and a certificate of 06 successful completion of one additional year of postgraduate training at a 07 recognized hospital; 08 (3) take the examination required by AS 08.64.210 or be certified to 09 practice by the National Board of Examiners for Osteopathic Physicians and Surgeons 10 or by the National Board of Osteopathic Medical Examiners;  11 (4) 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. 10. AS 08.64.209(a) is amended to read: 17 (a) Each applicant who desires to practice podiatry shall meet the 18 qualifications prescribed in AS 08.64.200(a)(3) - (5) [AS 08.64.200(a)(3) AND (4)] 19 and shall 20 (1) submit a certificate of graduation from a legally chartered school of 21 podiatry approved by the board; 22 (2) take the examination required by AS 08.64.210; the State Medical 23 Board shall call to its aid a podiatrist of known ability who is licensed to practice 24 podiatry to assist in the examination and licensure of applicants for a license to 25 practice podiatry; 26 (3) receive education in pain management and opioid use and  27 addiction, unless the applicant has demonstrated to the satisfaction of the board  28 that the applicant does not currently hold a valid federal Drug Enforcement  29 Administration registration number; an applicant may include past professional  30 experience or professional education as proof of professional competence;  31 (4) meet other qualifications of experience or education which the 01 board may require. 02  * Sec. 11. AS 08.64.225(a) is amended to read: 03 (a) Applicants who are graduates of medical colleges not accredited by the 04 Association of American Medical Colleges and the Council on Medical Education of 05 the American Medical Association shall 06 (1) meet the requirements of AS 08.64.200(a)(3) - (5) 07 [AS 08.64.200(a)(3) AND (4)] and 08.64.255; 08 (2) have successfully completed 09 (A) three years of postgraduate training as evidenced by a 10 certificate of completion of the first year of postgraduate training from the 11 facility where the applicant completed the first year of internship or residency 12 and a certificate of successful completion of two additional years of 13 postgraduate training at a recognized hospital; or 14 (B) other requirements establishing proof of competency and 15 professional qualifications as the board considers necessary to ensure the 16 continued protection of the public adopted at the discretion of the board by 17 regulation, including education in pain management and opioid use and  18 addiction, unless the applicant has demonstrated to the satisfaction of the  19 board that the applicant does not currently hold a valid federal Drug  20 Enforcement Administration registration number; an applicant may  21 include past professional experience or professional education as proof of  22 professional competence; and 23 (3) have passed examinations as specified by the board in regulations. 24  * Sec. 12. AS 08.64.250 is amended to read: 25 Sec. 08.64.250. License by credentials. The board may waive the examination 26 requirement and license by credentials if the physician, osteopath, or podiatry 27 applicant meets the requirements of AS 08.64.200, 08.64.205, or 08.64.209, submits 28 proof of continued competence as required by regulation, pays the required fee, and 29 has 30 (1) an active license from a board of medical examiners established 31 under the laws of a state or territory of the United States or a province or territory of 01 Canada issued after thorough examination; or 02 (2) passed an examination as specified by the board in regulations. 03  * Sec. 13. AS 08.64.250 is amended by adding a new subsection to read: 04 (b) The board shall adopt regulations under (a) of this section that require an 05 applicant demonstrate professional competence in pain management and addiction 06 disorders. An applicant may include past professional experience or professional 07 education as proof of professional competence. 08  * Sec. 14. AS 08.64.312 is amended to read: 09 Sec. 08.64.312. Continuing education requirements. (a) The board shall 10 promote a high degree of competence in the practice of medicine, osteopathy, and  11 podiatry by requiring every licensee of medicine, osteopathy, and podiatry 12 [PHYSICIAN LICENSED] in the state to fulfill continuing education requirements. 13 (b) Before a license may be renewed, the licensee shall submit evidence to the 14 board or its designee that continuing education requirements prescribed by regulations 15 adopted by the board have been met. Continuing education requirements must  16 include not less than two hours of education in pain management and opioid use  17 and addiction in the two years preceding an application for renewal of a license,  18 unless the licensee demonstrates to the satisfaction of the board that the licensee's  19 practice does not include pain management and opioid treatment or prescribing. 20 (c) The board or its designee may exempt a physician, osteopath, or  21 podiatrist from the requirements of (b) of this section upon an application by the 22 physician, osteopath, or podiatrist giving evidence satisfactory to the board or its 23 designee that the physician, osteopath, or podiatrist is unable to comply with the 24 requirements because of extenuating circumstances. However, a person may not be 25 exempted from more than 15 hours of continuing education in a five-year period; a  26 person may not be exempted from the requirement to receive at least two hours  27 of education in pain management and opioid use and addiction unless the person  28 has demonstrated to the satisfaction of the board that the person does not  29 currently hold a valid federal Drug Enforcement Administration registration  30 number. 31  * Sec. 15. AS 08.64.326(a) is amended to read: 01 (a) The board may impose a sanction if the board finds after a hearing that a 02 licensee 03 (1) secured a license through deceit, fraud, or intentional 04 misrepresentation; 05 (2) engaged in deceit, fraud, or intentional misrepresentation while 06 providing professional services or engaging in professional activities; 07 (3) advertised professional services in a false or misleading manner; 08 (4) has been convicted, including conviction based on a guilty plea or 09 plea of nolo contendere, of 10 (A) a class A or unclassified felony or a crime in another 11 jurisdiction with elements similar to a class A or unclassified felony in this 12 jurisdiction; 13 (B) a class B or class C felony or a crime in another jurisdiction 14 with elements similar to a class B or class C felony in this jurisdiction if the 15 felony or other crime is substantially related to the qualifications, functions, or 16 duties of the licensee; or 17 (C) a crime involving the unlawful procurement, sale, 18 prescription, or dispensing of drugs; 19 (5) has procured, sold, prescribed, or dispensed drugs in violation of a 20 law regardless of whether there has been a criminal action or harm to the patient; 21 (6) intentionally or negligently permitted the performance of patient 22 care by persons under the licensee's supervision that does not conform to minimum 23 professional standards even if the patient was not injured; 24 (7) failed to comply with this chapter, a regulation adopted under this 25 chapter, or an order of the board; 26 (8) has demonstrated 27 (A) professional incompetence, gross negligence, or repeated 28 negligent conduct; the board may not base a finding of professional 29 incompetence solely on the basis that a licensee's practice is unconventional or 30 experimental in the absence of demonstrable physical harm to a patient; 31 (B) addiction to, severe dependency on, or habitual overuse of 01 alcohol or other drugs that impairs the licensee's ability to practice safely; 02 (C) unfitness because of physical or mental disability; 03 (9) engaged in unprofessional conduct, in sexual misconduct, or in 04 lewd or immoral conduct in connection with the delivery of professional services to 05 patients; in this paragraph, "sexual misconduct" includes sexual contact, as defined by 06 the board in regulations adopted under this chapter, or attempted sexual contact with a 07 patient outside the scope of generally accepted methods of examination or treatment of 08 the patient, regardless of the patient's consent or lack of consent, during the term of the 09 physician-patient relationship, as defined by the board in regulations adopted under 10 this chapter, unless the patient was the licensee's spouse at the time of the contact or, 11 immediately preceding the physician-patient relationship, was in a dating, courtship, 12 or engagement relationship with the licensee; 13 (10) has violated AS 18.16.010; 14 (11) has violated any code of ethics adopted by regulation by the 15 board; 16 (12) has denied care or treatment to a patient or person seeking 17 assistance from the physician if the only reason for the denial is the failure or refusal 18 of the patient to agree to arbitrate as provided in AS 09.55.535(a); [OR] 19 (13) has had a license or certificate to practice medicine in another 20 state or territory of the United States, or a province or territory of Canada, denied, 21 suspended, revoked, surrendered while under investigation for an alleged violation, 22 restricted, limited, conditioned, or placed on probation unless the denial, suspension, 23 revocation, or other action was caused by the failure of the licensee to pay fees to that 24 state, territory, or province; or  25 (14) prescribed or dispensed an opioid in excess of the maximum  26 dosage authorized under AS 08.64.363. 27  * Sec. 16. AS 08.64 is amended by adding a new section to article 3 to read: 28 Sec. 08.64.363. Maximum dosage for opioid prescriptions. (a) A licensee 29 may not issue 30 (1) an initial prescription for an opioid that exceeds a seven-day supply 31 to an adult patient for outpatient use; 01 (2) a prescription for an opioid that exceeds a seven-day supply to a 02 minor; at the time a licensee writes a prescription for an opioid for a minor, the 03 licensee shall discuss with the parent or guardian of the minor why the prescription is 04 necessary and the risks associated with opioid use. 05 (b) Notwithstanding (a) of this section, a licensee may issue a prescription for 06 an opioid that exceeds a seven-day supply to an adult or minor patient if, in the 07 professional medical judgment of the licensee, more than a seven-day supply of an 08 opioid is necessary for 09 (1) the patient's acute medical condition, chronic pain management, 10 pain associated with cancer, or pain experienced while the patient is in palliative care; 11 the licensee may write a prescription for an opioid for the quantity needed to treat the 12 patient's medical condition, chronic pain, pain associated with cancer, or pain 13 experienced while the patient is in palliative care; the licensee shall document in the 14 patient's medical record the condition triggering the prescription of an opioid in a 15 quantity that exceeds a seven-day supply and indicate that a nonopioid alternative was 16 not appropriate to address the medical condition; 17 (2) a patient who is unable to access a practitioner within the time 18 necessary for a refill of the seven-day supply because of a logistical or travel barrier; 19 the licensee may write a prescription for an opioid for the quantity needed to treat the 20 patient for the time that the patient is unable to access a practitioner; the licensee shall 21 document in the patient's medical record the reason for the prescription of an opioid in 22 a quantity that exceeds a seven-day supply and indicate that a nonopioid alternative 23 was not appropriate to address the medical condition; in this paragraph, "practitioner" 24 has the meaning given in AS 11.71.900; or 25 (3) the treatment of a patient's substance abuse or opioid dependence; 26 the licensee may write a prescription for an opioid approved for the treatment of 27 substance abuse or opioid dependence for the quantity needed to treat the patient's 28 substance abuse or opioid dependence; the licensee shall document in the patient's 29 medical record the reason for the prescription of an opioid approved for the treatment 30 of substance abuse or opioid dependence in a quantity that exceeds a seven-day supply 31 and indicate that a nonopioid alternative was not appropriate for the treatment of 01 substance abuse or opioid dependence. 02 (c) In this section, 03 (1) "adult" means 04 (A) an individual who has reached 18 years of age; or 05 (B) an emancipated minor; 06 (2) "emancipated minor" means a minor whose disabilities have been 07 removed for general purposes under AS 09.55.590; 08 (3) "minor" means a individual under 18 years of age who is not an 09 emancipated minor. 10  * Sec. 17. AS 08.64.364(c) is amended to read: 11 (c) The board may not impose disciplinary sanctions on a physician for 12 prescribing, dispensing, or administering a prescription drug that is a controlled 13 substance or botulinum toxin if the requirements under (a) of this section and  14 AS 08.64.363 are met and the physician prescribes, dispenses, or administers the 15 controlled substance or botulinum toxin when an appropriate licensed health care 16 provider is present with the patient to assist the physician with examination, diagnosis, 17 and treatment. 18  * Sec. 18. AS 08.64.380 is amended by adding a new paragraph to read: 19 (7) "opioid" includes the opium and opiate substances and opium and 20 opiate derivatives listed in AS 11.71.140 and 11.71.160. 21  * Sec. 19. AS 08.68.100(a), as amended by sec. 10, ch. 25, SLA 2016, is amended to read: 22 (a) The board shall 23 (1) adopt regulations necessary to implement this chapter, including 24 regulations 25 (A) pertaining to practice as an advanced practice registered 26 nurse, including requirements for an advanced practice registered nurse to 27 practice as a certified registered nurse anesthetist, certified clinical nurse 28 specialist, certified nurse practitioner, or certified nurse midwife; regulations  29 for an advanced practice registered nurse who holds a valid federal Drug  30 Enforcement Administration registration number must address training  31 in pain management and opioid use and addiction; 01 (B) necessary to implement AS 08.68.331 - 08.68.336 relating 02 to certified nurse aides in order to protect the health, safety, and welfare of 03 clients served by nurse aides; 04 (C) pertaining to retired nurse status; and 05 (D) establishing criteria for approval of practical nurse 06 education programs that are not accredited by a national nursing accrediting 07 body; 08 (2) approve curricula and adopt standards for basic education programs 09 that prepare persons for licensing under AS 08.68.190; 10 (3) provide for surveys of the basic nursing education programs in the 11 state at the times it considers necessary; 12 (4) approve education programs that meet the requirements of this 13 chapter and of the board, and deny, revoke, or suspend approval of education 14 programs for failure to meet the requirements; 15 (5) examine, license, and renew the licenses of qualified applicants; 16 (6) prescribe requirements for competence before a former registered, 17 advanced practice registered, or licensed practical nurse may resume the practice of 18 nursing under this chapter; 19 (7) define by regulation the qualifications and duties of the executive 20 administrator and delegate authority to the executive administrator that is necessary to 21 conduct board business; 22 (8) develop reasonable and uniform standards for nursing practice; 23 (9) publish advisory opinions regarding whether nursing practice 24 procedures or policies comply with acceptable standards of nursing practice as defined 25 under this chapter; 26 (10) require applicants under this chapter to submit fingerprints and the 27 fees required by the Department of Public Safety under AS 12.62.160 for criminal 28 justice information and a national criminal history record check; the department shall 29 submit the fingerprints and fees to the Department of Public Safety for a report of 30 criminal justice information under AS 12.62 and a national criminal history record 31 check under AS 12.62.400; 01 (11) require that a licensed advanced practice registered nurse 02 [PRACTITIONER] who has a federal Drug Enforcement Administration registration 03 number register with the controlled substance prescription database under 04 AS 17.30.200(o). 05  * Sec. 20. AS 08.68.270 is amended to read: 06 Sec. 08.68.270. Grounds for denial, suspension, or revocation. The board 07 may deny, suspend, or revoke the license of a person who 08 (1) has obtained or attempted to obtain a license to practice nursing by 09 fraud or deceit; 10 (2) has been convicted of a felony or other crime if the felony or other 11 crime is substantially related to the qualifications, functions, or duties of the licensee; 12 (3) habitually abuses alcoholic beverages, or illegally uses controlled 13 substances; 14 (4) has impersonated a registered, advanced practice registered, or 15 practical nurse; 16 (5) has intentionally or negligently engaged in conduct that has 17 resulted in a significant risk to the health or safety of a client or in injury to a client; 18 (6) practices or attempts to practice nursing while afflicted with 19 physical or mental illness, deterioration, or disability that interferes with the 20 individual's performance of nursing functions; 21 (7) is guilty of unprofessional conduct as defined by regulations 22 adopted by the board; 23 (8) has wilfully or repeatedly violated a provision of this chapter or 24 regulations adopted under this chapter or AS 08.01; 25 (9) is professionally incompetent; 26 (10) denies care or treatment to a patient or person seeking assistance 27 if the sole reason for the denial is the failure or refusal of the patient or person seeking 28 assistance to agree to arbitrate as provided in AS 09.55.535(a);  29 (11) has prescribed or dispensed an opioid in excess of the  30 maximum dosage authorized under AS 08.68.705; or  31 (12) has procured, sold, prescribed, or dispensed drugs in violation  01 of a law, regardless of whether there has been a criminal action or harm to the  02 patient. 03  * Sec. 21. AS 08.68.276 is amended to read: 04 Sec. 08.68.276. Continuing competence required. A license to practice 05 nursing may not be renewed unless the nurse has complied with continuing 06 competence requirements established by the board by regulation. The board shall  07 adopt regulations for renewal of a license of an advanced practice registered  08 nurse. The regulations must require that a licensee receive not less than two  09 hours of education in pain management and opioid use and addiction in the two  10 years preceding an application for renewal of a license unless the licensee has  11 demonstrated to the satisfaction of the board that the licensee does not currently  12 hold a valid federal Drug Enforcement Administration registration number. 13  * Sec. 22. AS 08.68 is amended by adding a new section to article 6 to read: 14 Sec. 08.68.705. Maximum dosage for opioid prescriptions. (a) An advanced 15 practice registered nurse may not issue 16 (1) an initial prescription for an opioid that exceeds a seven-day supply 17 to an adult patient for outpatient use; 18 (2) a prescription for an opioid that exceeds a seven-day supply to a 19 minor; at the time an advanced practice registered nurse writes a prescription for an 20 opioid for a minor, the advanced practice registered nurse shall discuss with the parent 21 or guardian of the minor why the prescription is necessary and the risks associated 22 with opioid use. 23 (b) Notwithstanding (a) of this section, an advanced practice registered nurse 24 may issue a prescription for an opioid that exceeds a seven-day supply to an adult or 25 minor patient if, in the professional judgment of the advanced practice registered 26 nurse, more than a seven-day supply of an opioid is necessary for 27 (1) the patient's acute medical condition, chronic pain management, 28 pain associated with cancer, or pain experienced while the patient is in palliative care; 29 the advanced practice registered nurse may write a prescription for an opioid for the 30 quantity needed to treat the patient's medical condition, chronic pain, pain associated 31 with cancer, or pain experienced while the patient is in palliative care; the advanced 01 practice registered nurse shall document in the patient's medical record the condition 02 triggering the prescription of an opioid in a quantity that exceeds a seven-day supply 03 and indicate that a nonopioid alternative was not appropriate to address the medical 04 condition; or 05 (2) a patient who is unable to access a practitioner within the time 06 necessary for a refill of the seven-day supply because of a logistical or travel barrier; 07 the advanced practice registered nurse may write a prescription for an opioid for the 08 quantity needed to treat the patient for the time that the patient is unable to access a 09 practitioner; the advanced practice registered nurse shall document in the patient's 10 medical record the reason for the prescription of an opioid in a quantity that exceeds a 11 seven-day supply and indicate that a nonopioid alternative was not appropriate to 12 address the medical condition; in this paragraph, "practitioner" has the meaning given 13 in AS 11.71.900. 14 (c) This section does not authorize an advanced practice registered nurse to 15 prescribe a controlled substance if the advanced practice registered nurse is not 16 otherwise authorized to prescribe a controlled substance under policies, procedures, or 17 regulations issued or adopted by the board. 18 (d) In this section, 19 (1) "adult" means 20 (A) an individual who has reached 18 years of age; or 21 (B) an emancipated minor; 22 (2) "emancipated minor" means a minor whose disabilities have been 23 removed for general purposes under AS 09.55.590; 24 (3) "minor" means an individual under 18 years of age who is not an 25 emancipated minor. 26  * Sec. 23. AS 08.68.850 is amended by adding a new paragraph to read: 27 (12) "opioid" includes the opium and opiate substances and opium and 28 opiate derivatives listed in AS 11.71.140 and 11.71.160. 29  * Sec. 24. AS 08.72.140 is amended to read: 30 Sec. 08.72.140. Qualifications for licensure. An applicant for licensure as an 31 optometrist 01 (1) shall be a graduate of a school or college of optometry recognized 02 by the board; 03 (2) may not have committed an act in any jurisdiction that would have 04 constituted a violation of this chapter or regulations adopted under this chapter at the 05 time the act was committed; 06 (3) may not have been disciplined by an optometry licensing entity in 07 another jurisdiction and may not be the subject of a pending disciplinary proceeding 08 conducted by an optometry licensing entity in another jurisdiction; however, the board 09 may consider the disciplinary action and, in the board's discretion, determine if the 10 person is qualified for licensure; 11 (4) shall have successfully completed 12 (A) the written and practical portions of an examination on 13 ocular pharmacology approved by the board that tests the licensee's or 14 applicant's knowledge of the characteristics, pharmacological effects, 15 indications, contraindications, and emergency care associated with the 16 prescription and use of pharmaceutical agents; 17 (B) a nontopical therapeutic pharmaceutical agent course of at 18 least 23 hours approved by the board or an examination approved by the board 19 on the treatment and management of ocular disease; and 20 (C) an optometry and nontopical therapeutic pharmaceutical 21 agent injection course of at least seven hours approved by the board or 22 equivalent training acceptable to the board; and 23 (5) shall meet other qualifications for licensure as established under 24 this chapter and regulations adopted by the board under AS 08.72.050; the  25 regulations must include qualifications for licensees who hold a valid federal  26 Drug Enforcement Administration registration number that address training in  27 pain management and opioid use and addiction. 28  * Sec. 25. AS 08.72.170 is amended to read: 29 Sec. 08.72.170. Licensure by credentials. The board shall issue a license by 30 credentials to an applicant who 31 (1) is a graduate of a school or college of optometry recognized by the 01 board; 02 (2) has passed a written examination approved by the board that is 03 designed to test the applicant's knowledge of the laws of Alaska governing the practice 04 of optometry and the regulations adopted under those laws; 05 (3) holds a current license to practice optometry in another state or 06 territory of the United States or in a province of Canada that has licensure 07 requirements that the board determines are equivalent to those established under this 08 chapter; 09 (4) at some time in the past, received a license to practice optometry 10 from another state or territory of the United States or from a province of Canada that 11 required the person to have passed the National Board of Examiners in Optometry 12 examination to qualify for licensure; 13 (5) was engaged in the active licensed clinical practice of optometry in 14 a state or territory of the United States or in a province of Canada for at least 3,120 15 hours during the 36 months preceding the date of application under this section; 16 (6) has not committed an act in any jurisdiction that would have 17 constituted a violation of this chapter or regulations adopted under this chapter at the 18 time the act was committed; [AND] 19 (7) has not been disciplined by an optometry licensing entity in another 20 jurisdiction and is not the subject of a pending disciplinary proceeding conducted by 21 an optometry licensing entity in another jurisdiction; however, the board may consider 22 the disciplinary action and, in the board's discretion, determine whether [IF] the 23 person is qualified for licensure; and  24 (8) has received education in pain management and opioid use and  25 addiction adequate for the practice of optometry, unless the applicant has  26 demonstrated to the satisfaction of the board that the applicant does not  27 currently hold a valid federal Drug Enforcement Administration registration  28 number; an applicant may include past professional experience or professional  29 education as proof of professional competence. 30  * Sec. 26. AS 08.72.181(d) is amended to read:  31 (d) Before a license may be renewed, the licensee shall submit to the board 01 evidence that, 02 (1) in the four years preceding the application for renewal, the licensee 03 has [(1)] completed [EIGHT HOURS OF] continuing education requirements  04 prescribed [, APPROVED] by the board by regulation [,] concerning 05 (A) the use and prescription of pharmaceutical agents; 06 (B) [(2) COMPLETED SEVEN HOURS OF CONTINUING 07 EDUCATION, APPROVED BY THE BOARD, CONCERNING] the 08 injection of nontopical therapeutic pharmaceutical agents; and 09 (C) [(3) MET] other continuing education requirements as 10 may be necessary [PRESCRIBED BY REGULATIONS OF THE BOARD] to 11 ensure the continued protection of the public; and  12 (2) in the two years preceding the application for renewal, the  13 licensee has completed at least two hours of education in pain management and  14 opioid use and addiction, unless the applicant demonstrates to the satisfaction of  15 the board that the applicant does not currently hold a valid federal Drug  16 Enforcement Administration registration number. 17  * Sec. 27. AS 08.72.240 is amended to read: 18 Sec. 08.72.240. Grounds for imposition of disciplinary sanctions. The board 19 may impose disciplinary sanctions when the board finds after a hearing that a licensee 20 (1) secured a license through deceit, fraud, or intentional 21 misrepresentation; 22 (2) engaged in deceit, fraud, or intentional misrepresentation in the 23 course of providing professional services or engaging in professional activities; 24 (3) advertised professional services in a false or misleading manner; 25 (4) has been convicted of a felony or other crime that [WHICH] 26 affects the licensee's ability to continue to practice competently and safely; 27 (5) intentionally or negligently engaged in or permitted the 28 performance of patient care by persons under the licensee's supervision that [WHICH] 29 does not conform to minimum professional standards regardless of whether actual 30 injury to the patient occurred; 31 (6) failed to comply with this chapter, with a regulation adopted under 01 this chapter, or with an order of the board; 02 (7) continued to practice after becoming unfit due to 03 (A) professional incompetence; 04 (B) failure to keep informed of or use current professional 05 theories or practices; 06 (C) addiction or severe dependency on alcohol or other drugs 07 that [WHICH] impairs the licensee's ability to practice safely; 08 (D) physical or mental disability; 09 (8) engaged in lewd or immoral conduct in connection with the 10 delivery of professional service to patients; 11 (9) failed to refer a patient to a physician after ascertaining the 12 presence of ocular or systemic conditions requiring management by a physician;  13 (10) prescribed or dispensed an opioid in excess of the maximum  14 dosage authorized under AS 08.72.276;  15 (11) procured, sold, prescribed, or dispensed drugs in violation of  16 a law, regardless of whether there has been a criminal action or harm to the  17 patient. 18  * Sec. 28. AS 08.72 is amended by adding a new section to read: 19 Sec. 08.72.276. Maximum dosage for opioid prescriptions. (a) A licensee 20 may not issue 21 (1) an initial prescription for an opioid that exceeds a four-day supply 22 to an adult patient for outpatient use; 23 (2) a prescription for an opioid that exceeds a four-day supply to a 24 minor; upon issuance of a prescription for an opioid to a minor, the licensee shall 25 discuss with the parent or guardian of the minor why the prescription is necessary and 26 the risks associated with opioid use. 27 (b) Notwithstanding (a) of this section, a licensee may issue a prescription for 28 an opioid that exceeds a four-day supply to an adult or minor patient if the licensee 29 determines that more than a four-day supply of an opioid is necessary 30 (1) to treat the patient's medical condition or for chronic pain 31 management; the licensee may write a prescription for an opioid for the quantity 01 needed to treat the patient's medical condition or chronic pain; the licensee shall 02 document in the patient's medical record the condition triggering the prescription of an 03 opioid in a quantity that exceeds a four-day supply and indicate that a nonopioid 04 alternative was not appropriate to address the medical condition; or 05 (2) for a patient who is unable to access a practitioner within the time 06 necessary for a refill of the four-day supply because of a logistical or travel barrier; the 07 licensee may write a prescription for an opioid for the quantity needed to treat the 08 patient for the time that the patient is unable to access a practitioner; the licensee shall 09 document in the patient's medical record the reason for the prescription of an opioid in 10 a quantity that exceeds a four-day supply and indicate that a nonopioid alternative was 11 not appropriate to address the medical condition; in this paragraph, "practitioner" has 12 the meaning given in AS 11.71.900. 13  * Sec. 29. AS 08.80.030(b), as amended by sec. 12, ch. 25, SLA 2016, is amended to read: 14 (b) In order to fulfill its responsibilities, the board has the powers necessary 15 for implementation and enforcement of this chapter, including the power to 16 (1) elect a president and secretary from its membership and adopt rules 17 for the conduct of its business; 18 (2) license by examination or by license transfer the applicants who are 19 qualified to engage in the practice of pharmacy; 20 (3) assist the department in inspections and investigations for 21 violations of this chapter, or of any other state or federal statute relating to the practice 22 of pharmacy; 23 (4) adopt regulations to carry out the purposes of this chapter; 24 (5) establish and enforce compliance with professional standards and 25 rules of conduct for pharmacists engaged in the practice of pharmacy; 26 (6) determine standards for recognition and approval of degree 27 programs of schools and colleges of pharmacy whose graduates shall be eligible for 28 licensure in this state, including the specification and enforcement of requirements for 29 practical training, including internships; 30 (7) establish for pharmacists and pharmacies minimum specifications 31 for the physical facilities, technical equipment, personnel, and procedures for the 01 storage, compounding, and dispensing of drugs or related devices, and for the 02 monitoring of drug therapy; 03 (8) enforce the provisions of this chapter relating to the conduct or 04 competence of pharmacists practicing in the state, and the suspension, revocation, or 05 restriction of licenses to engage in the practice of pharmacy; 06 (9) license and regulate the training, qualifications, and employment of 07 pharmacy interns and pharmacy technicians; 08 (10) issue licenses to persons engaged in the manufacture and 09 distribution of drugs and related devices; 10 (11) establish and maintain a controlled substance prescription 11 database as provided in AS 17.30.200; 12 (12) establish standards for the independent administration by a 13 pharmacist of vaccines and related emergency medications under AS 08.80.168, 14 including the completion of an immunization training program approved by the board; 15 (13) establish standards for the independent dispensing by a 16 pharmacist of an opioid overdose drug under AS 17.20.085, including the completion 17 of an opioid overdose training program approved by the board; 18 (14) require that a licensed pharmacist [WHO HAS A FEDERAL 19 DRUG ENFORCEMENT ADMINISTRATION REGISTRATION NUMBER] 20 register with the controlled substance prescription database under AS 17.30.200(o). 21  * Sec. 30. AS 08.80 is amended by adding a new section to article 3 to read: 22 Sec. 08.80.345. Prescription for an opioid; voluntary request for lesser  23 quantity. (a) A pharmacist filling a prescription for an opioid that is a schedule II or 24 III controlled substance under federal law may, at the request of the individual for 25 whom the prescription is written, dispense the prescribed opioid in a lesser quantity 26 than prescribed. 27 (b) Nothing in this section shall be construed to prevent substitution of an 28 equivalent drug under AS 08.80.295. 29  * Sec. 31. AS 08.98.050(a) is amended to read: 30 (a) The board shall 31 (1) establish examination requirements for eligible applicants for 01 licensure to practice veterinary medicine; 02 (2) examine, or cause to be examined, eligible applicants for licensure 03 or registration; 04 (3) approve the issuance of licenses and student permits to qualified 05 applicants; 06 (4) establish standards for the practice of veterinary medicine by 07 regulation; 08 (5) conduct disciplinary proceedings in accordance with this chapter; 09 (6) adopt regulations requiring proof of continued competency before a 10 license is renewed; 11 (7) as requested by the department, monitor the standards and 12 availability of veterinary services provided in the state and report its findings to the 13 department; 14 (8) collect, or cause to be collected, data concerning the practice of 15 veterinary technology by veterinary technicians in the state and submit the data to the 16 department for maintenance; 17 (9) establish, by regulation, educational and training requirements for 18 (A) the issuance of student permits; and 19 (B) the delegation of duties by veterinarians licensed under this 20 chapter to veterinary technicians;  21 (10) require that a licensee who has a federal Drug Enforcement  22 Administration registration number register with the controlled substance  23 prescription database under AS 17.30.200(o);  24 (11) identify resources and develop educational materials to assist  25 licensees to identify an animal owner who may be at risk for abusing or misusing  26 an opioid. 27  * Sec. 32. AS 08.98.235 is amended to read: 28 Sec. 08.98.235. Grounds for imposition of disciplinary sanctions. After a 29 hearing, the board may impose a disciplinary sanction on a person licensed under this 30 chapter when the board finds that the person 31 (1) secured a license through deceit, fraud, or intentional 01 misrepresentation; 02 (2) engaged in deceit, fraud, or intentional misrepresentation in the 03 course of providing professional services or engaging in professional activities; 04 (3) advertised professional services in a false or misleading manner; 05 (4) has been convicted of a felony or other crime which affects the 06 person's ability to continue to practice competently and safely; 07 (5) intentionally or negligently engaged in or permitted the 08 performance of animal care by the person's supervisees which does not conform to 09 minimum professional standards regardless of whether actual injury to the animal 10 occurred; 11 (6) failed to comply with this chapter, with a regulation adopted under 12 this chapter, or with an order of the board; 13 (7) continued to practice after becoming unfit due to 14 (A) professional incompetence; 15 (B) addiction or severe dependency on alcohol or other drugs 16 which impairs the person's ability to practice safely; 17 (C) physical or mental disability; 18 (8) engaged in lewd or immoral conduct in connection with the 19 delivery of professional service;  20 (9) prescribed or dispensed an opioid in excess of the maximum  21 dosage authorized under AS 08.98.245;  22 (10) procured, sold, prescribed, or dispensed drugs in violation of  23 a law, regardless of whether there has been a criminal action. 24  * Sec. 33. AS 08.98 is amended by adding a new section to article 3 to read: 25 Sec. 08.98.245. Maximum dosage for opioid prescriptions. (a) A 26 veterinarian may not issue an initial prescription for an opioid that exceeds a seven- 27 day supply to the owner of an animal patient for outpatient use. 28 (b) Notwithstanding (a) of this section, a veterinarian may issue a prescription 29 for an opioid that exceeds a seven-day supply to the owner of an animal if the 30 veterinarian determines that more than a seven-day supply of an opioid is necessary 31 (1) to treat the animal's medical condition or for chronic pain 01 management; the veterinarian may write a prescription for an opioid for the quantity 02 needed to treat the animal's medical condition or chronic pain; the veterinarian shall 03 document in the animal's medical record the condition triggering the prescription of an 04 opioid in a quantity that exceeds a seven-day supply and indicate that a nonopioid 05 alternative was not appropriate to address the medical condition; or 06 (2) for an owner who is unable to access a veterinarian or pharmacist 07 within the time necessary for a refill of the seven-day supply because of a logistical or 08 travel barrier; the veterinarian may write a prescription for an opioid for the quantity 09 needed to treat the animal for the time that the owner is unable to access a veterinarian 10 or pharmacist; the veterinarian shall document in the animal's medical record the 11 reason for the prescription of an opioid in a quantity that exceeds a seven-day supply 12 and indicate that a nonopioid alternative was not appropriate to address the medical 13 condition. 14  * Sec. 34. AS 11.71.900(19) is amended to read: 15 (19) "practitioner" means 16 (A) a physician, dentist, advanced practice registered nurse,  17 optometrist, veterinarian, scientific investigator, or other person licensed, 18 registered, or otherwise permitted to distribute, dispense, conduct research with 19 respect to, or to administer or use in teaching or chemical analysis a controlled 20 substance in the course of professional practice or research in the state; 21 (B) a pharmacy, hospital, or other institution licensed, 22 registered, or otherwise permitted to distribute, dispense, conduct research with 23 respect to, or to administer a controlled substance in the course of professional 24 practice or research in the state; 25  * Sec. 35. AS 13 is amended by adding a new chapter to read: 26 Chapter 55. Voluntary Nonopioid Directive Act.  27 Sec. 13.55.010. Nonopioid directive; revocation; other requirements. (a) 28 An individual who is 18 years of age or older or an emancipated minor, a parent or 29 legal guardian of a minor, or an individual's guardian or other person appointed by the 30 individual or a court to manage the individual's health care may execute a voluntary 31 nonopioid directive stating that an opioid may not be administered or prescribed to the 01 individual or the minor. The directive must be in a format prescribed by the 02 department and available in an electronic format. 03 (b) The commissioner of health and social services shall adopt regulations to 04 implement this chapter. The regulations must 05 (1) include verification by a health care provider and comply with the 06 written consent requirements under 42 U.S.C. 290dd-2(b); 07 (2) provide standard procedures for an individual, a parent or legal 08 guardian of a minor, or an individual's guardian or other person appointed by the 09 individual or a court to manage the individual's health care to submit a voluntary 10 nonopioid directive to a health care provider or hospital; 11 (3) include appropriate exemptions for emergency medical personnel; 12 (4) ensure the confidentiality of a voluntary nonopioid directive; 13 (5) ensure exemptions for an opioid used for treatment of substance 14 abuse or opioid dependence. 15 (c) An individual who is 18 years of age or older or an emancipated minor, a 16 parent or legal guardian of a minor, or an individual's guardian or other person 17 appointed by the individual or a court to manage the individual's health care may 18 revoke a voluntary nonopioid directive at any time in writing or orally. 19 (d) An individual, a parent or legal guardian of a minor, or an individual's 20 guardian or other person appointed by the individual or a court to manage the 21 individual's health care may submit a voluntary nonopioid directive to a health care 22 provider or a hospital. 23 Sec. 13.55.020. Obligations of health care providers and hospitals. A health 24 care provider, a hospital, or an employee of a health care provider or hospital may not 25 be subject to disciplinary action by the health care provider's or the employee's 26 professional licensing board or held civilly or criminally liable for failure to 27 administer, prescribe, or dispense an opioid, or for inadvertent administration of an 28 opioid, to an individual or a minor who has a voluntary nonopioid directive. 29 Sec. 13.55.030. Prescriptions presumed valid. A prescription presented to a 30 pharmacy is presumed to be valid, and a pharmacist may not be subject to disciplinary 31 action by the pharmacist's professional licensing board or held civilly or criminally 01 liable for dispensing an opioid in contradiction to an individual's or a minor's 02 voluntary nonopioid directive. 03 Sec. 13.55.040. Effect of this chapter. Nothing in this chapter shall be 04 construed to  05 (1) alter an advance health care directive under AS 13.52 (Health Care 06 Decisions Act); 07 (2) limit the prescribing, dispensing, or administering of an opioid 08 overdose drug; 09 (3) limit an authorized health care provider or pharmacist from 10 prescribing, dispensing, or administering an opioid for the treatment of substance 11 abuse or opioid dependence. 12 Sec. 13.55.100. Definitions. In this chapter, unless the context otherwise 13 requires, 14 (1) "department" means the Department of Health and Social Services; 15 (2) "emancipated minor" means a minor whose disabilities have been 16 removed for general purposes under AS 09.55.590; 17 (3) "health care provider" has the meaning given in AS 09.65.340; 18 (4) "hospital" has the meaning given in AS 13.52.268; 19 (5) "minor" means an individual under 18 years of age who is not an 20 emancipated minor; 21 (6) "opioid" includes the opium and opiate substances and opium and 22 opiate derivatives listed in AS 11.71.140 and 11.71.160; 23 (7) "opioid overdose drug" has the meaning given in AS 09.65.340. 24 Sec. 13.55.110. Short title. This chapter may be known as the Voluntary 25 Nonopioid Directive Act. 26  * Sec. 36. AS 17.30.200(a), as amended by sec. 21, ch. 25, SLA 2016, is amended to read: 27 (a) The controlled substance prescription database is established in the Board 28 of Pharmacy. The purpose of the database is to contain data as described in this 29 section regarding every prescription for a schedule II, III, or IV controlled substance 30 under federal law dispensed in the state to a person other than under the  31 circumstances described in (u) of this section [THOSE ADMINISTERED TO A 01 PATIENT AT A HEALTH CARE FACILITY]. 02  * Sec. 37. AS 17.30.200(b), as amended by sec. 23, ch. 25, SLA 2016, is amended to read: 03 (b) The pharmacist-in-charge of each licensed or registered pharmacy, 04 regarding each schedule II, III, or IV controlled substance under federal law dispensed 05 by a pharmacist under the supervision of the pharmacist-in-charge, and each 06 practitioner who directly dispenses a schedule II, III, or IV controlled substance under 07 federal law other than those dispensed or administered under the circumstances  08 described in (u) of this section [ADMINISTERED TO A PATIENT AT A HEALTH 09 CARE FACILITY], shall submit to the board, by a procedure and in a format 10 established by the board, the following information for inclusion in the database on at 11 least a weekly basis: 12 (1) the name of the prescribing practitioner and the practitioner's 13 federal Drug Enforcement Administration registration number or other appropriate 14 identifier; 15 (2) the date of the prescription; 16 (3) the date the prescription was filled and the method of payment; this 17 paragraph does not authorize the board to include individual credit card or other 18 account numbers in the database; 19 (4) the name, address, and date of birth of the person for whom the 20 prescription was written; 21 (5) the name and national drug code of the controlled substance; 22 (6) the quantity and strength of the controlled substance dispensed; 23 (7) the name of the drug outlet dispensing the controlled substance; 24 and 25 (8) the name of the pharmacist or practitioner dispensing the controlled 26 substance and other appropriate identifying information. 27  * Sec. 38. AS 17.30.200(b), as amended by sec. 37 of this Act, is amended to read: 28 (b) The pharmacist-in-charge of each licensed or registered pharmacy, 29 regarding each schedule II, III, or IV controlled substance under federal law dispensed 30 by a pharmacist under the supervision of the pharmacist-in-charge, and each 31 practitioner who directly dispenses a schedule II, III, or IV controlled substance under 01 federal law other than those dispensed or administered under the circumstances 02 described in (u) of this section, shall submit to the board, by a procedure and in a 03 format established by the board, the following information for inclusion in the 04 database on at least a daily [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. 39. AS 17.30.200(d), as amended by sec. 25, ch. 25, SLA 2016, is amended to read: 21 (d) The database and the information contained within the database are 22 confidential, are not public records, are not subject to public disclosure, and may not 23 be shared with the federal government. The board shall undertake to ensure the 24 security and confidentiality of the database and the information contained within the 25 database. The board may allow access to the database only to the following persons, 26 and in accordance with the limitations provided and regulations of the board: 27 (1) personnel of the board regarding inquiries concerning licensees or 28 registrants of the board or personnel of another board or agency concerning a 29 practitioner under a search warrant, subpoena, or order issued by an administrative law 30 judge or a court; 31 (2) authorized board personnel or contractors as required for 01 operational and review purposes; 02 (3) a licensed practitioner having authority to prescribe controlled 03 substances or an agent or employee of the practitioner whom the practitioner has 04 authorized to access the database on the practitioner's behalf, to the extent the 05 information relates specifically to a current patient of the practitioner to whom the 06 practitioner is prescribing or considering prescribing a controlled substance; the agent 07 or employee must be licensed or registered under AS 08; 08 (4) a licensed or registered pharmacist having authority to dispense 09 controlled substances or an agent or employee of the pharmacist whom the pharmacist 10 has authorized to access the database on the pharmacist's behalf, to the extent the 11 information relates specifically to a current patient to whom the pharmacist is 12 dispensing or considering dispensing a controlled substance; the agent or employee 13 must be licensed or registered under AS 08; 14 (5) federal, state, and local law enforcement authorities may receive 15 printouts of information contained in the database under a search warrant or order 16 issued by a court establishing probable cause for the access and use of the information; 17 (6) an individual who is the recipient of a controlled substance 18 prescription entered into the database may receive information contained in the 19 database concerning the individual on providing evidence satisfactory to the board that 20 the individual requesting the information is in fact the person about whom the data 21 entry was made and on payment of a fee set by the board under AS 37.10.050 that 22 does not exceed $10; 23 (7) a licensed pharmacist employed by the Department of Health and 24 Social Services who is responsible for administering prescription drug coverage for 25 the medical assistance program under AS 47.07, to the extent that the information 26 relates specifically to prescription drug coverage under the program; 27 (8) a licensed pharmacist, licensed practitioner, or authorized 28 employee of the Department of Health and Social Services responsible for utilization 29 review of prescription drugs for the medical assistance program under AS 47.07, to the 30 extent that the information relates specifically to utilization review of prescription 31 drugs provided to recipients of medical assistance; 01 (9) the state medical examiner, to the extent that the information 02 relates specifically to investigating the cause and manner of a person's death; 03 (10) an authorized employee of the Department of Health and Social 04 Services may receive information from the database that does not disclose the identity 05 of a patient, prescriber, dispenser, or dispenser location, for the purpose of identifying 06 and monitoring public health issues in the state; however, the information provided 07 under this paragraph may include the region of the state in which a patient, prescriber, 08 and dispenser are located and the specialty of the prescriber; and 09 (11) a practitioner, pharmacist, or clinical staff employed by an Alaska 10 tribal health organization, including commissioned corps officers of the United States 11 Public Health Service employed under a memorandum of agreement; in this 12 paragraph, "Alaska tribal health organization" has the meaning given to "tribal health 13 program" in 25 U.S.C. 1603. 14  * Sec. 40. AS 17.30.200(e), as amended by sec. 27, ch. 25, SLA 2016, is amended to read: 15 (e) The failure of a pharmacist-in-charge or a [,] pharmacist [, OR 16 PRACTITIONER] to register or submit information to the database as required under 17 this section is grounds for the board to take disciplinary action against the license or 18 registration of the pharmacy or pharmacist. The failure of a practitioner to register  19 or review the database as required under this section is grounds for the  20 practitioner's [OR FOR ANOTHER] licensing board to take disciplinary action 21 against the [A] practitioner. 22  * Sec. 41. AS 17.30.200(p), enacted by sec. 34, ch. 25, SLA 2016, is amended to read: 23 (p) The board shall promptly notify the State Medical Board, the Board of 24 Nursing, the Board of Dental Examiners, [AND] the Board of Examiners in 25 Optometry, and the Board of Veterinary Examiners when a practitioner registers 26 with the database under (o) of this section. 27  * Sec. 42. AS 17.30.200(q), enacted by sec. 34, ch. 25, SLA 2016, is amended to read: 28 (q) The board is authorized to provide unsolicited notification to a pharmacist,  29 practitioner's licensing board, or practitioner if a patient has received one or more 30 prescriptions for controlled substances in quantities or with a frequency inconsistent 31 with generally recognized standards of safe practice. An unsolicited notification to a  01 practitioner's licensing board under this section  02 (1) must be provided to the practitioner;  03 (2) is confidential;  04 (3) may not disclose information that is confidential under this  05 section;  06 (4) may be in a summary form sufficient to provide notice of the  07 basis for the unsolicited notification.  08  * Sec. 43. AS 17.30.200(r), enacted by sec. 34, ch. 25, SLA 2016, is amended to read: 09 (r) The board shall update the database on at least a daily [WEEKLY] basis 10 with the information submitted to the board under (b) of this section. 11  * Sec. 44. AS 17.30.200(n) is amended by adding a new paragraph to read: 12 (5) "opioid" includes the opium and opiate substances and opium and 13 opiate derivatives listed in AS 11.71.140 and 11.71.160. 14  * Sec. 45. AS 17.30.200 is amended by adding new subsections to read: 15 (t) Notwithstanding (q) of this section, the board may issue to a practitioner 16 periodic unsolicited reports that detail and compare the practitioner's opioid 17 prescribing practice with other practitioners of the same occupation and similar 18 specialty. A report issued under this subsection is confidential and the board shall 19 issue the report only to a practitioner. The board may adopt regulations to implement 20 this subsection. The regulations may address the types of controlled substances to be 21 included in an unsolicited report, the quantities dispensed, the medication strength, 22 and other factors determined by the board. 23 (u) A practitioner or a pharmacist is not required to comply with the 24 requirements of (a) and (b) of this section if a controlled substance is 25 (1) administered to a patient at 26 (A) a health care facility; or 27 (B) a correctional facility; 28 (2) dispensed to a patient for an outpatient supply of 24 hours or less at 29 a hospital 30 (A) inpatient pharmacy; or 31 (B) emergency department. 01  * Sec. 46. AS 18.05.040(a) is amended to read: 02 (a) The commissioner shall adopt regulations consistent with existing law for 03 (1) the time, manner, information to be reported, and persons 04 responsible for reporting for each disease or other condition of public health 05 importance on the list developed under AS 18.15.370; 06 (2) cooperation with local boards of health and health officers; 07 (3) protection and promotion of the public health and prevention of 08 disability and mortality; 09 (4) the transportation of dead bodies, except that the commissioner 10 may not require that a dead body be embalmed unless the body is known to carry a 11 communicable disease or embalmment is otherwise required for the protection of the 12 public health or for compliance with federal law; 13 (5) carrying out the purposes of this chapter; 14 (6) the conduct of its business and for carrying out the provisions of 15 laws of the United States and the state relating to public health; 16 (7) establishing the divisions and local offices and advisory groups 17 necessary or considered expedient to carry out or assist in carrying out a duty or power 18 assigned to it; 19 (8) the voluntary certification of laboratories to perform diagnostic, 20 quality control, or enforcement analyses or examinations based on recognized or 21 tentative standards of performance relating to analysis and examination of food, 22 including seafood, milk, water, and specimens from human beings submitted by 23 licensed physicians and nurses for analysis; 24 (9) the regulation of quality and purity of commercially compressed 25 oxygen sold for human respiration; 26 (10) establishing confidentiality and security standards for information 27 and records received under AS 18.15.355 - 18.15.395;  28 (11) implementation of AS 13.55 (Voluntary Nonopioid Directive  29 Act). 30  * Sec. 47. Sections 22, 24, 26, 28, 30, 32, 52, and 73, ch. 25, SLA 2016, are repealed. 31  * Sec. 48. The uncodified law of the State of Alaska is amended by adding a new section to 01 read: 02 TRANSITION: REGULATIONS. (a) The Department of Health and Social Services 03 may adopt regulations necessary to implement the changes made by secs. 35 and 46 of this 04 Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not 05 before the effective date of the relevant provision of this Act implemented by the regulation. 06 (b) The Department of Commerce, Community, and Economic Development and a 07 board that regulates an occupation that includes a practitioner required to register with the 08 controlled substance prescription database under AS 17.30.200 shall adopt regulations to 09 implement the changes made by AS 17.30.200(b), as amended by sec. 38 of this Act, and 10 AS 17.30.200(r), as amended by sec. 43 of this Act. The regulations take effect under 11 AS 44.62 (Administrative Procedure Act), but not before the effective date of the relevant 12 provision of secs. 38 and 43 of this Act implemented by the regulation. In this subsection, 13 (1) "board" has the meaning given in AS 08.01.110; 14 (2) "occupation" has the meaning given in AS 08.01.110; 15 (3) "practitioner" has the meaning given in AS 11.71.900. 16 (c) The Board of Dental Examiners may adopt regulations necessary to implement the 17 changes made by secs. 2 and 3 of this Act. The regulations take effect under AS 44.62 18 (Administrative Procedure Act), but not before the effective date of the relevant provision of 19 secs. 2 and 3 of this Act implemented by the regulation. 20 (d) The State Medical Board may adopt regulations necessary to implement the 21 changes made by secs. 7 - 14 of this Act. The regulations take effect under AS 44.62 22 (Administrative Procedure Act), but not before the effective date of the relevant provision of 23 secs. 7 - 14 of this Act implemented by the regulation. 24 (e) The Board of Nursing may adopt regulations necessary to implement the changes 25 made by secs. 19 and 21 of this Act. The regulations take effect under AS 44.62 26 (Administrative Procedure Act), but not before the effective date of the relevant provision of 27 secs. 19 and 21 of this Act implemented by the regulation. 28 (f) The Board of Examiners in Optometry may adopt regulations necessary to 29 implement the changes made by secs. 24 - 26 of this Act. The regulations take effect under 30 AS 44.62 (Administrative Procedure Act), but not before the effective date of the relevant 31 provision of secs. 24 - 26 of this Act implemented by the regulation. 01  * Sec. 49. The uncodified law of the State of Alaska is amended by adding a new section to 02 read: 03 CONDITIONAL EFFECT. AS 08.72.240(10), enacted by sec. 27 of this Act, and sec. 04 28 of this Act take effect only if CSHB 103(FIN), as passed by the Thirtieth Alaska State 05 Legislature, is enacted into law. 06  * Sec. 50. If AS 08.72.240(10), enacted by sec. 27 of this Act, and sec. 28 of this Act take 07 effect under sec. 49 of this Act, they take effect on the effective date of sec. 4 of CSHB 08 103(FIN) as passed by the Thirtieth Alaska State Legislature and enacted into law. 09  * Sec. 51. Section 29 of this Act takes effect on the effective date of sec. 12, ch. 25, SLA 10 2016. 11  * Sec. 52. Section 36 of this Act takes effect on the effective date of sec. 21, ch. 25, SLA 12 2016. 13  * Sec. 53. Section 37 of this Act takes effect on the effective date of sec. 23, ch. 25, SLA 14 2016. 15  * Sec. 54. Section 39 of this Act takes effect on the effective date of sec. 25, ch. 25, SLA 16 2016. 17  * Sec. 55. Section 40 of this Act takes effect on the effective date of sec. 27, ch. 25, SLA 18 2016. 19  * Sec. 56. Sections 41 and 42 of this Act take effect on the effective date of sec. 34, ch. 25, 20 SLA 2016. 21  * Sec. 57. Section 45 of this Act takes effect on the effective date of secs. 21 and 23, ch. 25, 22 SLA 2016. 23  * Sec. 58. Sections 2, 3, 7 - 14, 19, 21, 24 - 26, 38, and 43 of this Act take effect July 1, 24 2018. 25  * Sec. 59. Sections 35 and 46 of this Act take effect July 1, 2019. 26  * Sec. 60. Except as provided in secs. 50 - 59 of this Act, this Act takes effect immediately 27 under AS 01.10.070(c).