Florida Senate - 2012                          SENATOR AMENDMENT
       Bill No. CS for SB 1292
       
       
       
       
       
       
                                Barcode 631584                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                                       .                                
                                       .                                
                                       .                                
                  Floor: WD            .                                
             03/09/2012 05:46 PM       .                                
       —————————————————————————————————————————————————————————————————




       —————————————————————————————————————————————————————————————————
       Senator Bogdanoff moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 302 - 407
    4  and insert:
    5         Section 8. Present paragraphs (a), (c), and (d) of
    6  subsection (1), paragraph (a) of subsection (2), and paragraph
    7  (e) of subsection (3) of section 456.44, Florida Statutes, are
    8  amended, and a new paragraph (d) is added to subsection (1) of
    9  that section, to read:
   10         456.44 Controlled substance prescribing.—
   11         (1) DEFINITIONS.—
   12         (a) “Addiction medicine specialist” means a board-certified
   13  psychiatrist physiatrist with a subspecialty certification in
   14  addiction medicine or who is eligible for such subspecialty
   15  certification in addiction medicine, an addiction medicine
   16  physician certified or eligible for certification by the
   17  American Society of Addiction Medicine, or an osteopathic
   18  physician who holds a certificate of added qualification in
   19  Addiction Medicine through the American Osteopathic Association.
   20         (c) “Board–certified pain management physician” means a
   21  physician who possesses board certification in pain medicine by
   22  the American Board of Pain Medicine, board certification by the
   23  American Board of Interventional Pain Physicians, or board
   24  certification or subcertification in pain management or pain
   25  medicine by a specialty board recognized by the American
   26  Association of Physician Specialists or the American Board of
   27  Medical Specialties or an osteopathic physician who holds a
   28  certificate in Pain Management by the American Osteopathic
   29  Association.
   30         (d) “Board eligible” means successful completion of an
   31  anesthesia, physical medicine and rehabilitation, rheumatology,
   32  or neurology residency program approved by the Accreditation
   33  Council for Graduate Medical Education or the American
   34  Osteopathic Association for a period of six years from
   35  successful completion of such residency program.
   36         (e)(d) “Chronic nonmalignant pain” means pain unrelated to
   37  cancer or rheumatoid arthritis which persists beyond the usual
   38  course of disease or the injury that is the cause of the pain or
   39  more than 90 days after surgery.
   40         (2) REGISTRATION.—Effective January 1, 2012, a physician
   41  licensed under chapter 458, chapter 459, chapter 461, or chapter
   42  466 who prescribes any controlled substance, listed in Schedule
   43  II, Schedule III, or Schedule IV as defined in s. 893.03, for
   44  the treatment of chronic nonmalignant pain, must:
   45         (a) Designate himself or herself as a controlled substance
   46  prescribing practitioner on the physician’s practitioner
   47  profile.
   48         (3) STANDARDS OF PRACTICE.—The standards of practice in
   49  this section do not supersede the level of care, skill, and
   50  treatment recognized in general law related to health care
   51  licensure.
   52         (e) The physician shall refer the patient as necessary for
   53  additional evaluation and treatment in order to achieve
   54  treatment objectives. Special attention shall be given to those
   55  patients who are at risk for misusing their medications and
   56  those whose living arrangements pose a risk for medication
   57  misuse or diversion. The management of pain in patients with a
   58  history of substance abuse or with a comorbid psychiatric
   59  disorder requires extra care, monitoring, and documentation and
   60  requires consultation with or referral to an addiction medicine
   61  specialist or psychiatrist addictionologist or physiatrist.
   62  
   63  This subsection does not apply to a board-eligible or board
   64  certified anesthesiologist, physiatrist, rheumatologist, or
   65  neurologist, or to a board-certified physician who has surgical
   66  privileges at a hospital or ambulatory surgery center and
   67  primarily provides surgical services. This subsection does not
   68  apply to a board-eligible or board-certified medical specialist
   69  who has also completed a fellowship in pain medicine approved by
   70  the Accreditation Council for Graduate Medical Education or the
   71  American Osteopathic Association, or who is board eligible or
   72  board certified in pain medicine by the American Board of Pain
   73  Medicine or a board approved by the American Board of Medical
   74  Specialties or the American Osteopathic Association and performs
   75  interventional pain procedures of the type routinely billed
   76  using surgical codes.
   77         Section 9. Paragraph (a) of subsection (1) of section
   78  458.3265, Florida Statutes, is amended to read:
   79         458.3265 Pain-management clinics.—
   80         (1) REGISTRATION.—
   81         (a)1. As used in this section, the term:
   82         a. “Board eligible” means successful completion of an
   83  anesthesia, physical medicine and rehabilitation, rheumatology,
   84  or neurology residency program approved by the Accreditation
   85  Council for Graduate Medical Education or the American
   86  Osteopathic Association for a period of six years from
   87  successful completion of such residency program.
   88         b.a. “Chronic nonmalignant pain” means pain unrelated to
   89  cancer or rheumatoid arthritis which persists beyond the usual
   90  course of disease or the injury that is the cause of the pain or
   91  more than 90 days after surgery.
   92         c.b. “Pain-management clinic” or “clinic” means any
   93  publicly or privately owned facility:
   94         (I) That advertises in any medium for any type of pain
   95  management services; or
   96         (II) Where in any month a majority of patients are
   97  prescribed opioids, benzodiazepines, barbiturates, or
   98  carisoprodol for the treatment of chronic nonmalignant pain.
   99         2. Each pain-management clinic must register with the
  100  department unless:
  101         a. That clinic is licensed as a facility pursuant to
  102  chapter 395;
  103         b. The majority of the physicians who provide services in
  104  the clinic primarily provide surgical services;
  105         c. The clinic is owned by a publicly held corporation whose
  106  shares are traded on a national exchange or on the over-the
  107  counter market and whose total assets at the end of the
  108  corporation’s most recent fiscal quarter exceeded $50 million;
  109         d. The clinic is affiliated with an accredited medical
  110  school at which training is provided for medical students,
  111  residents, or fellows;
  112         e. The clinic does not prescribe controlled substances for
  113  the treatment of pain;
  114         f. The clinic is owned by a corporate entity exempt from
  115  federal taxation under 26 U.S.C. s. 501(c)(3);
  116         g. The clinic is wholly owned and operated by one or more
  117  board-eligible or board-certified anesthesiologists,
  118  physiatrists, rheumatologists, or neurologists; or
  119         h. The clinic is wholly owned and operated by a physician
  120  multispecialty practice where one or more board-eligible or
  121  board-certified medical specialists who have also completed
  122  fellowships in pain medicine approved by the Accreditation
  123  Council for Graduate Medical Education, or who are also board
  124  certified in pain medicine by the American Board of Pain
  125  Medicine or a board approved by the American Board of Medical
  126  Specialties, the American Association of Physician Specialists,
  127  or the American Osteopathic Association and perform
  128  interventional pain procedures of the type routinely billed
  129  using surgical codes.
  130         Section 10. Paragraph (a) of subsection (1) of section
  131  459.0137, Florida Statutes, is amended to read:
  132         459.0137 Pain-management clinics.—
  133         (1) REGISTRATION.—
  134         (a)1. As used in this section, the term:
  135         a. “Board eligible” means successful completion of an
  136  anesthesia, physical medicine and rehabilitation, rheumatology,
  137  or neurology residency program approved by the Accreditation
  138  Council for Graduate Medical Education or the American
  139  Osteopathic Association for a period of six years from
  140  successful completion of such residency program.
  141         b.a. “Chronic nonmalignant pain” means pain unrelated to
  142  cancer or rheumatoid arthritis which persists beyond the usual
  143  course of disease or the injury that is the cause of the pain or
  144  more than 90 days after surgery.
  145         c.b. “Pain-management clinic” or “clinic” means any
  146  publicly or privately owned facility:
  147         (I) That advertises in any medium for any type of pain
  148  management services; or
  149         (II) Where in any month a majority of patients are
  150  prescribed opioids, benzodiazepines, barbiturates, or
  151  carisoprodol for the treatment of chronic nonmalignant pain.
  152         2. Each pain-management clinic must register with the
  153  department unless:
  154         a. That clinic is licensed as a facility pursuant to
  155  chapter 395;
  156         b. The majority of the physicians who provide services in
  157  the clinic primarily provide surgical services;
  158         c. The clinic is owned by a publicly held corporation whose
  159  shares are traded on a national exchange or on the over-the
  160  counter market and whose total assets at the end of the
  161  corporation’s most recent fiscal quarter exceeded $50 million;
  162         d. The clinic is affiliated with an accredited medical
  163  school at which training is provided for medical students,
  164  residents, or fellows;
  165         e. The clinic does not prescribe controlled substances for
  166  the treatment of pain;
  167         f. The clinic is owned by a corporate entity exempt from
  168  federal taxation under 26 U.S.C. s. 501(c)(3);
  169         g. The clinic is wholly owned and operated by one or more
  170  board-eligible or board-certified anesthesiologists,
  171  physiatrists, rheumatologists, or neurologists; or
  172         h. The clinic is wholly owned and operated by a physician
  173  multispecialty practice where one or more board-eligible or
  174  board-certified medical specialists who have also completed
  175  fellowships in pain medicine approved by the Accreditation
  176  Council for Graduate Medical Education or the American
  177  Osteopathic Association, or who are also board-certified in pain
  178  medicine by the American Board of Pain Medicine or a board
  179  approved by the American Board of Medical Specialties, the
  180  American Association of Physician Specialists, or the American
  181  Osteopathic Association and perform interventional pain
  182  procedures of the type routinely billed using surgical codes.
  183  
  184  ================= T I T L E  A M E N D M E N T ================
  185         And the title is amended as follows:
  186         Delete lines 32 - 42
  187  and insert:
  188         are not residents; amending s. 456.44, F.S.; revising
  189         the definition of the term “addiction medicine
  190         specialist” to include board-certified psychiatrists;
  191         defining the term “board eligible”; excluding a board
  192         certified physiatrist as an addiction medicine
  193         specialist; including the American Board of Medical
  194         Specialties as a recognized certification entity;
  195         revising the definition of the term “chronic
  196         nonmalignant pain” to exclude reference to rheumatoid
  197         arthritis; exempting specified board-eligible health
  198         care providers from application of certain provisions;
  199         adding the American Board of Pain Medicine as a
  200         recognized board-certification entity for purposes of
  201         exemption from application of certain provisions;
  202         amending s. 458.3265, F.S.; defining the term “board
  203         eligible”; revising the definition of the term
  204         “chronic nonmalignant pain” to exclude reference to
  205         rheumatoid arthritis; permitting specified board
  206         eligible physicians to own a pain-management clinic
  207         without registering the clinic; permitting a
  208         rheumatologist to own a pain-management clinic without
  209         registering the clinic; including a physician
  210         multispecialty practice to permitted ownership forms
  211         of pain-management clinics; requiring at least one
  212         specialist in multispecialty practice to be board
  213         eligible; recognizing the American Board of Pain
  214         Medicine, the American Association of Physician
  215         Specialists, and the American Osteopathic Association
  216         as board-certification organizations for purposes of
  217         determining a board-certified pain medicine specialist
  218         as an owner of a pain-management clinic; amending s.
  219         459.0137, F.S.; defining the term “board eligible”;
  220         revising the definition of the term “chronic
  221         nonmalignant pain” to exclude reference to rheumatoid
  222         arthritis; permitting a board-eligible rheumatologist
  223         to own a pain-management clinic; including a physician
  224         multispecialty practice to permitted ownership forms
  225         of pain-management clinics; permitting specified
  226         board-eligible physicians to own a pain-management
  227         clinic without registering the clinic; permitting a
  228         rheumatologist to own a pain-management clinic without
  229         registering the clinic; adding multispecialty practice
  230         to permitted ownership forms of pain-management
  231         clinics; requiring at least one specialist in
  232         multispecialty practice to be board-eligible;
  233         recognizing the American Board of Pain Medicine and
  234         the American Association of Physician Specialists as
  235         board-certification organizations for purposes of
  236         determining a board-certified pain medicine specialist
  237         as owner of a pain-management clinic; amending