Florida Senate - 2019 SB 1360 By Senator Gruters 23-01253A-19 20191360__ 1 A bill to be entitled 2 An act relating to alternative treatments to 3 controlled substances; amending s. 456.44, F.S.; 4 requiring a practitioner who prescribes controlled 5 substances to recommend specified alternative 6 treatments for chronic nonmalignant pain before 7 prescribing a controlled substance to a patient; 8 requiring a licensed massage therapist to maintain 9 certain treatment records and submit them to the 10 referring practitioner; clarifying that a practitioner 11 who prescribes controlled substances may 12 simultaneously prescribe a controlled substance and 13 refer a patient to alternative treatment for chronic 14 nonmalignant pain; directing applicable boards to 15 adopt rules establishing guidelines for alternative 16 treatments for acute pain; amending s. 627.413, F.S.; 17 requiring certain insurance policies to provide 18 coverage for a minimum number of visits to alternative 19 treatment providers for the treatment of chronic 20 nonmalignant pain under certain conditions; providing 21 an exception; providing restrictions on deductibles, 22 coinsurances, and co-pays required for alternative 23 treatment; providing an effective date. 24 25 Be It Enacted by the Legislature of the State of Florida: 26 27 Section 1. Present paragraphs (a) through (g) of subsection 28 (3) of section 456.44, Florida Statutes, are redesignated as 29 paragraphs (b) through (h), respectively, a new paragraph (a) is 30 added to that subsection, and subsection (4) of that section is 31 amended, to read: 32 456.44 Controlled substance prescribing.— 33 (3) STANDARDS OF PRACTICE FOR TREATMENT OF CHRONIC 34 NONMALIGNANT PAIN.—The standards of practice in this section do 35 not supersede the level of care, skill, and treatment recognized 36 in general law related to health care licensure. 37 (a)1. Before a registrant prescribes a controlled substance 38 to a patient, the registrant must refer to the patient one or 39 more of the following alternative treatments based on the 40 registrant’s clinical judgment and the availability of the 41 treatment: 42 a. Acupuncture by an acupuncturist licensed under chapter 43 457. 44 b. Osteopathic manipulation by an osteopathic physician 45 licensed under chapter 459. 46 c. Chiropractic services by a chiropractor licensed under 47 chapter 460. 48 d. Occupational therapy by an occupational therapist 49 licensed under part III of chapter 468. 50 e. Massage therapy by a massage therapist licensed under 51 chapter 480. 52 f. Physical therapy by a physical therapist licensed under 53 chapter 486. 54 2. A licensed massage therapist treating a patient for 55 chronic nonmalignant pain pursuant to a registrant’s referral 56 shall maintain treatment records that document each treatment’s 57 effect on the patient and shall submit such records to the 58 referring registrant. 59 3. This paragraph does not prohibit a registrant from 60 simultaneously prescribing a controlled substance and referring 61 a patient to an alternative treatment for chronic nonmalignant 62 pain. 63 64 This subsection does not apply to a board-eligible or board 65 certified anesthesiologist, physiatrist, rheumatologist, or 66 neurologist, or to a board-certified physician who has surgical 67 privileges at a hospital or ambulatory surgery center and 68 primarily provides surgical services. This subsection does not 69 apply to a board-eligible or board-certified medical specialist 70 who has also completed a fellowship in pain medicine approved by 71 the Accreditation Council for Graduate Medical Education or the 72 American Osteopathic Association, or who is board eligible or 73 board certified in pain medicine by the American Board of Pain 74 Medicine, the American Board of Interventional Pain Physicians, 75 the American Association of Physician Specialists, or a board 76 approved by the American Board of Medical Specialties or the 77 American Osteopathic Association and performs interventional 78 pain procedures of the type routinely billed using surgical 79 codes. This subsection does not apply to a registrant who 80 prescribes medically necessary controlled substances for a 81 patient during an inpatient stay in a hospital licensed under 82 chapter 395. 83 (4) STANDARDS OF PRACTICE FOR TREATMENT OF ACUTE PAIN.—The 84 applicable boards shall adopt rules establishing guidelines for 85 the use of evidence-based, nonpharmaceutical alternative 86 treatments including chiropractic, osteopathic manipulation, 87 acupuncture, physical therapy, massage therapy, and occupational 88 therapy, and for prescribing controlled substances, for acute 89 pain, including evaluation of the patient, creation and 90 maintenance of a treatment plan, obtaining informed consent and 91 agreement for treatment, periodic review of the treatment plan, 92 consultation, medical record review, and compliance with 93 controlled substance laws and regulations. Failure of a 94 prescriber to follow such guidelines constitutes grounds for 95 disciplinary action pursuant to s. 456.072(1)(gg), punishable as 96 provided in s. 456.072(2). 97 Section 2. Subsection (7) is added to section 627.413, 98 Florida Statutes, to read: 99 627.413 Contents of policies, in general; identification.— 100 (7) Every policy must provide coverage for at least five 101 visits in total to alternative treatment providers for the 102 treatment of chronic nonmalignant pain when recommended by a 103 registrant as described in s. 456.44(3)(a). If an insured’s pain 104 was treated by an alternative treatment provider listed in s. 105 456.44(3)(a)1. before he or she sought treatment for the chronic 106 nonmalignant pain from a registrant as defined in s. 456.44(1), 107 the registrant’s referral is not required as a condition of 108 coverage by an insurance provider that offers an insurance 109 product in this state. Any deductible, coinsurance, or co-pay 110 required for alternative treatment when recommended by a 111 registrant may not be greater than the deductible, coinsurance, 112 or co-pay required for a primary care visit. 113 Section 3. This act shall take effect July 1, 2019.