Florida Senate - 2015 SENATOR AMENDMENT Bill No. CS for SB 816 Ì455740"Î455740 LEGISLATIVE ACTION Senate . House . . . Floor: NC/2R . 04/23/2015 10:50 AM . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Senator Bradley moved the following: 1 Senate Amendment (with title amendment) 2 3 Between lines 85 and 86 4 insert: 5 Section 3. Subsection (3) of section 456.44, Florida 6 Statutes, is amended to read: 7 456.44 Controlled substance prescribing.— 8 (3) STANDARDS OF PRACTICE.—The standards of practice in 9 this section do not supersede the level of care, skill, and 10 treatment recognized in general law related to health care 11 licensure. 12 (a) A complete medical history and a physical examination 13 must be conducted before beginning any treatment and must be 14 documented in the medical record. The exact components of the 15 physical examination shall be left to the judgment of the 16 clinician who is expected to perform a physical examination 17 proportionate to the diagnosis that justifies a treatment. The 18 medical record must, at a minimum, document the nature and 19 intensity of the pain, current and past treatments for pain, 20 underlying or coexisting diseases or conditions, the effect of 21 the pain on physical and psychological function, a review of 22 previous medical records, previous diagnostic studies, and 23 history of alcohol and substance abuse. The medical record shall 24 also document the presence of one or more recognized medical 25 indications for the use of a controlled substance. Each 26 registrant must develop a written plan for assessing each 27 patient’s risk of aberrant drug-related behavior, which may 28 include patient drug testing. Registrants must assess each 29 patient’s risk for aberrant drug-related behavior and monitor 30 that risk on an ongoing basis in accordance with the plan. 31 (b) Each registrant must develop a written individualized 32 treatment plan for each patient. The treatment plan shall state 33 objectives that will be used to determine treatment success, 34 such as pain relief and improved physical and psychosocial 35 function, and shall indicate if any further diagnostic 36 evaluations or other treatments are planned. After treatment 37 begins, the physician shall adjust drug therapy to the 38 individual medical needs of each patient. Other treatment 39 modalities, including a rehabilitation program, shall be 40 considered depending on the etiology of the pain and the extent 41 to which the pain is associated with physical and psychosocial 42 impairment. The interdisciplinary nature of the treatment plan 43 shall be documented. 44 (c) The physician shall discuss the risks and benefits of 45 the use of controlled substances, including the risks of abuse 46 and addiction, as well as physical dependence and its 47 consequences, with the patient, persons designated by the 48 patient, or the patient’s surrogate or guardian if the patient 49 is incompetent. The physician shall use a written controlled 50 substance agreement between the physician and the patient 51 outlining the patient’s responsibilities, including, but not 52 limited to: 53 1. Number and frequency of controlled substance 54 prescriptions and refills. 55 2. Patient compliance and reasons for which drug therapy 56 may be discontinued, such as a violation of the agreement. 57 3. An agreement that controlled substances for the 58 treatment of chronic nonmalignant pain shall be prescribed by a 59 single treating physician unless otherwise authorized by the 60 treating physician and documented in the medical record. 61 (d) The patient shall be seen by the physician at regular 62 intervals, not to exceed 3 months, to assess the efficacy of 63 treatment, ensure that controlled substance therapy remains 64 indicated, evaluate the patient’s progress toward treatment 65 objectives, consider adverse drug effects, and review the 66 etiology of the pain. Continuation or modification of therapy 67 shall depend on the physician’s evaluation of the patient’s 68 progress. If treatment goals are not being achieved, despite 69 medication adjustments, the physician shall reevaluate the 70 appropriateness of continued treatment. The physician shall 71 monitor patient compliance in medication usage, related 72 treatment plans, controlled substance agreements, and 73 indications of substance abuse or diversion at a minimum of 3 74 month intervals. 75 (e) The physician shall refer the patient as necessary for 76 additional evaluation and treatment in order to achieve 77 treatment objectives. Special attention shall be given to those 78 patients who are at risk for misusing their medications and 79 those whose living arrangements pose a risk for medication 80 misuse or diversion. The management of pain in patients with a 81 history of substance abuse or with a comorbid psychiatric 82 disorder requires extra care, monitoring, and documentation and 83 requires consultation with or referral to an addiction medicine 84 specialist or psychiatrist. 85 (f) A physician registered under this section must maintain 86 accurate, current, and complete records that are accessible and 87 readily available for review and comply with the requirements of 88 this section, the applicable practice act, and applicable board 89 rules. The medical records must include, but are not limited to: 90 1. The complete medical history and a physical examination, 91 including history of drug abuse or dependence. 92 2. Diagnostic, therapeutic, and laboratory results. 93 3. Evaluations and consultations. 94 4. Treatment objectives. 95 5. Discussion of risks and benefits. 96 6. Treatments. 97 7. Medications, including date, type, dosage, and quantity 98 prescribed. 99 8. Instructions and agreements. 100 9. Periodic reviews. 101 10. Results of any drug testing. 102 11. A photocopy of the patient’s government-issued photo 103 identification. 104 12. If a written prescription for a controlled substance is 105 given to the patient, a duplicate of the prescription. 106 13. The physician’s full name presented in a legible 107 manner. 108 (g) Patients with signs or symptoms of substance abuse 109 shall be immediately referred to a board-certified pain 110 management physician, an addiction medicine specialist, or a 111 mental health addiction facility as it pertains to drug abuse or 112 addiction unless the physician is board-certified or board 113 eligible in pain management. Throughout the period of time 114 before receiving the consultant’s report, a prescribing 115 physician shall clearly and completely document medical 116 justification for continued treatment with controlled substances 117 and those steps taken to ensure medically appropriate use of 118 controlled substances by the patient. Upon receipt of the 119 consultant’s written report, the prescribing physician shall 120 incorporate the consultant’s recommendations for continuing, 121 modifying, or discontinuing controlled substance therapy. The 122 resulting changes in treatment shall be specifically documented 123 in the patient’s medical record. Evidence or behavioral 124 indications of diversion shall be followed by discontinuation of 125 controlled substance therapy, and the patient shall be 126 discharged, and all results of testing and actions taken by the 127 physician shall be documented in the patient’s medical record. 128 129 This subsection does not apply to a board-eligible or board 130 certified anesthesiologist, physiatrist, rheumatologist, or 131 neurologist, or to a board-certified physician who has surgical 132 privileges at a hospital or ambulatory surgery center and 133 primarily provides surgical services. This subsection does not 134 apply to a board-eligible or board-certified medical specialist 135 who has also completed a fellowship in pain medicine approved by 136 the Accreditation Council for Graduate Medical Education or the 137 American Osteopathic Association, or who is board eligible or 138 board certified in pain medicine by the American Board of Pain 139 Medicine or a board approved by the American Board of Medical 140 Specialties or the American Osteopathic Association and performs 141 interventional pain procedures of the type routinely billed 142 using surgical codes. This subsection does not apply to a 143 physician who prescribes medically necessary controlled 144 substances for a patient during an inpatient stay in a hospital 145 licensed under chapter 395 or for a resident in a facility 146 licensed under part II of chapter 400. 147 148 ================= T I T L E A M E N D M E N T ================ 149 And the title is amended as follows: 150 Delete line 15 151 and insert: 152 the review; amending s. 456.44, F.S.; revising the 153 application of provisions specifying requirements for 154 standards of practice for certain controlled substance 155 prescribing; providing an effective date.