State Seal2 copy Bill Number: S.B. 1001

Yarbrough Floor Amendment #1

Reference to: printed bill

Amendment drafted by: Steve Yarbrough

 

 

FLOOR AMENDMENT EXPLANATION

 

 

The Yarbrough Floor amendment to SB 1001 does the following:

 

1.    Prohibits specified health professionals and physicians from dispensing schedule II controlled substances that are opioids, and provides exemptions for opioids that are dispensed for medically-assisted treatment for substance abuse disorders.

 

2.    Directs the Board of Nursing to adopt rules that prohibit nurse practitioners and certified nurse midwives from dispensing schedule II controlled substances except for medication assisted treatment (MAT) for substance abuse disorders.

 

3.    Exempts hospitals and medically-assisted treatment by a health care provider from a health care institution, private office, or clinic from the definition of "pain management clinic".

 

4.    Specifies that initial prescription supply limitations do not apply to a patient that is an infant being weaned off opioids at the time of hospital discharge.

 

5.    Specifies that the 90 morphine milligram equivalent (MME) limitation does not apply to a continuation of a prior prescription order that is from the same health professional and issued within the previous 60 days.

 

6.    Requires a health professional that believes a patient requires a prescription in excess of the 90 MME limitation to first consult with a licensed physician who is board-certified in pain, and specifies that the consultation may be completed by telephone or through telemedicine.

 

7.    Provides that if a consulting physician is unavailable for a consultation within 48 hours after a request, that the requesting health professional may prescribe in excess of the 90 MME limitation.

 

8.    Exempts a physician who is board-certified in pain from consultation requirements for prescribing in excess of the 90 MME limitation.

 

9.    Requires the Board of Pharmacy to establish a process to grant waivers for compliance with electronic prescribing requirements for practitioners who lack adequate access to broadband or face other hardships that prevent compliance with electronic prescribing requirements.

 

10. Requires a dispenser to obtain a patient's 12 month utilization report from the Controlled Substances Prescription Monitoring Program (CSPMP) at the beginning of each new course of treatment.

 

11. Directs the Board of Pharmacy to establish a process to provide a waiver, for up to one year, due to technological limitations or other exceptional circumstances that prevent compliance and are demonstrated by the dispenser.

 

12. Beginning September 1, 2018, requires each hospital and healthcare facility that provides substance abuse treatment to submit a quarterly report to DHS that includes information regarding the number of days in the quarter that the hospital or facility was at capacity and unable to accept referrals for substance abuse treatment.

13. Directs DHS to request outpatient abuse treatment providers to report on the provider's outpatient treatment capacity on a quarterly basis.

 

14. Requires that the quarterly report submitted by the Director of DHS to the Governor and the presiding officer in each legislative chamber additionally include information regarding the state's outpatient treatment capacity.

 

15. Clarifies that AHCCCS is required to distribute Naloxone kits as necessary.

 

16. Directs DHS to engage with local education agencies in the development of abuse prevention campaigns.

 

17. Appropriates $400,600 from the Consumer Remediation Subaccount of the Consumer Restitution and Remediation Revolving Fund in fiscal year 2017-2018 to DHS for the opioid abuse prevention campaign.

 

18. Appropriates $400,600 from the Consumer Remediation Subaccount of the Consumer Restitution and Remediation Revolving Fund in fiscal year 2017-2018 to the Attorney General for the purpose of awarding grants for community opioid education and prevention efforts.

 

19. Exempts a health care services plan from providing a receipt acknowledging a prior authorization request was received if the provider did not include the necessary return contact information.

 

20. Appropriates $10,00,000 from the General Fund in fiscal year 2017-2018 to the Substance Use Disorder Services Fund.

 

21. Defines "medication-assisted treatment" and "prescription order".

 

22. Makes technical and conforming changes.


 

Fifty-third Legislature Yarbrough

First Special Session S.B. 1001

 

YARBROUGH FLOOR AMENDMENT #1

SENATE AMENDMENTS TO S.B. 1001

(Reference to printed bill)

 

 


Page 1, line 5, strike "definition" insert "definitions"

Line 33, strike the comma insert ":

1.  "Medication‑assisted treatment" has the same meaning prescribed in section 32‑3201.01.

2."

Line 35, strike "1." insert "(a)"

Line 42, strike "2." insert "(b)"

Page 2, line 12, strike "definition" insert "definitions"

Line 40, strike the comma insert ":

1.  "Medication‑assisted treatment" has the same meaning prescribed in section 32‑3201.01.

2."

Line 42, strike "1." insert "(a)"

Page 3, line 4, strike "2." insert "(b)"

Page 4, line 10, strike "and" insert a comma

Line 11, after "assistance" insert "and for whom medical assistance is sought pursuant to subsection A of this section"

Line 27, after "offense" strike remainder of line insert "other than the possession or use of a controlled substance or drug paraphernalia or a preparatory offense."

Line 41, after "Medical" insert "programs;"

Line 43, strike "medical"

Page 4, line 44, strike "school" insert "program"; after "state" insert "and whose intended degree may make the student eligible for a United States drug enforcement administration registration"

Page 6, between lines 9 and 10, insert:

"9.  "Medication‑assisted treatment" has the same meaning prescribed in section 32‑3201.01."

Renumber to conform

Line 43, strike "medically assisted" insert "medication‑assisted"

Page 8, line 7, after "received" insert ", unless the necessary return contact information is not provided"

Page 10, lines 18 and 19, strike "for pain management" insert "that is an opioid"

Page 11, line 12, strike "for pain management" insert "that are opioids"

Page 14, lines 34 and 35, strike "for pain management" insert "that is an opioid"

Line 41, strike "for pain management" insert "that are opioids"

Page 19, lines 32 and 33, strike "for pain management" insert "that is an opioid"

Page 25, line 3, after "dispense" insert "a"

Strike line 4

Line 5, strike "substances" insert "substance that is an opioid, except for an opioid that is"

Page 27, line 23, after "practitioners" insert "or certified nurse midwives"

Line 24, after "substance" strike remainder of line

Strike line 25

Line 26, strike the first "substance" insert "that is an opioid, except for an opioid that is"

Page 30, lines 27 and 28, strike "for pain management" insert "that is an opioid"

Page 33, lines 33 and 34, strike "for pain management" insert "that is an opioid"

Page 36, line 8, after "dispense" insert "a"

Strike line 9

Line 10, strike "substances" insert "substance that is an opioid, except for an opioid that is"

Page 41, lines 12 and 13, strike "for pain management" insert "that is an opioid"

Page 44, line 21, after "dispense" insert "a"

Page 44, line 22, after "controlled" strike remainder of line

Line 23, strike "controlled substances" insert "substance that is an opioid, except for an opioid that is"

Lines 41 and 42, strike "for pain management" insert "that are opioids, except for opioids that are for medication‑assisted treatment for substance use disorders"

Page 47, lines 10 and 11, strike "for pain management" insert "that is an opioid"

Page 49, line 43, after "dispense" insert "a"; strike "substances for pain management"

Line 44, strike "but may dispense schedule II controlled substances" insert "substance that is an opioid, except for an opioid that is"

Page 50, line 34, strike "for pain management" insert "that are opioids"

Page 51, between lines 25 and 26, insert:

"Sec. 28.  Title 32, chapter 32, article 1, Arizona Revised Statutes, is amended by adding section 32-3201.01, to read:

START_STATUTE32-3201.01.  Definition of medication-assisted treatment

In this title, unless the context otherwise requires, "medication‑assisted treatment" means the use of pharmacological medications that are approved by the United States food and drug administration, in combination with counseling and behavioral therapies, to provide a whole patient approach to the treatment of substance use disorders."END_STATUTE

Renumber to conform

Lines 33 and 35, strike "for pain management" insert "that is an opioid"

Page 52, between lines 2 and 3, insert:

"9.  Is an infant who is being weaned off opioids at the time of hospital discharge."

Line 9, strike "for pain management" insert "that is an opioid"

Line 15, after "antagonist" insert "; definition"

Line 18, strike "for pain management" insert "that is an opioid"

Page 52, strike lines 22 and 23, insert:

"1.  A continuation of a prior prescription order that is from the same health professional and that was issued within the previous sixty days."

Renumber to conform

Line 40, strike "specialist" insert "physician who is licensed pursuant to chapter 13 or 17 of this title and"

Line 41, after the period insert "The consultation may be done by telephone or through telemedicine. If the consulting physician is not available to consult within forty‑eight hours after the request, the health professional may prescribe the amount that the health professional believes the patient requires and subsequently have the consultation. If the health professional is a physician who is licensed pursuant to chapter 13 or 17 of this title and is board‑certified in pain, the health professional may issue a prescription order for more than ninety morphine milligram equivalents per day without a consultation under this subsection."

Page 53, between lines 2 and 3, insert:

"E.  For the purposes of this section, "prescription order" has the same meaning prescribed in section 32‑1901."

Between lines 25 and 26, insert:

"4.  The number of days in the quarter that the hospital or health care facility was at capacity and not able to accept referrals for substance abuse treatment."

Between lines 32 and 33, insert:

"D.  The department shall request outpatient substance abuse treatment providers to report to the department on a quarterly basis regarding the provider's outpatient treatment capacity."

Reletter to conform

Line 36, after "capacity" insert ", including outpatient treatment capacity,"

Page 54, line 3, after "the" insert "local"; strike "system" insert "agency"

Line 8, strike "In addition to the naloXone kits that are distributed by"

Line 9, strike the comma insert "shall continue to distribute naloXone kits as necessary. In addition,"

Page 55, line 11, strike "Definition of pain management clinic" insert "Definitions"

Line 12, strike the second comma insert ":

1.  "Medication‑assisted treatment" has the same meaning prescribed in section 32‑3201.01.

2."

Line 14, strike "1." insert "(a)"

Line 17, strike "suboxone" insert "for medication‑assisted treatment"; strike "for pain management" insert "by a health care provider from the health care institution or private office or clinic"

Line 19, strike "2." insert "(b)"; strike "an" insert "a hospital,"

Lines 41 and 42, strike "in this state" insert "pursuant to title 32, chapter 13 or 17 and who is"

Page 57, line 24, after "packaging" insert "; definition"

Page 58, line 27, strike "for pain management" insert "that is an opioid"

Lines 30 and 31, strike "for pain management" insert "that is an opioid"

Page 61, lines 9 and 10, strike "for pain management" insert "that is an opioid"

Lines 25 and 30, strike "for pain management" insert "that is an opioid"

Line 34, after "substance" insert "that is an opioid"

Line 36, strike ": , " insert a comma

Line 37, strike "1."

Line 39, strike "2." insert "Q.  The board"

Line 41, after "practitioner" strike remainder of line

Line 42, strike "less than one hundred fifty thousand persons and"

After line 44, insert:

"R.  For the purposes of this section, "medication‑assisted treatment" has the same meaning prescribed in section 32‑3201.01."

Page 64, line 38, strike "and a dispenser"; strike "or dispensing"

Page 64, line 45, strike "and the Arizona state board of"

Page 65, line 1, strike "pharmacy"; strike "and dispensers"

Lines 2, 5 and 6, strike "or dispenser"

Between lines 7 and 8, insert:

"G.  A dispenser, before dispensing a schedule II controlled substance, shall obtain a patient utilization report regarding the patient for the preceding twelve months from the controlled substances prescription monitoring program's central database tracking system at the beginning of each new course of treatment. The Arizona state board of pharmacy shall establish a process to provide to a dispenser a waiver for up to one year after the effective date of this amendment to this section from the requirement in this subsection due to technological limitations that are not reasonably within the control of the dispenser or other exceptional circumstances as demonstrated by the dispenser."

Reletter to conform

Line 35, after "practitioner" insert "or dispenser"

Page 67, line 40, after "providers" strike remainder of line

Line 41, strike "than one hundred fifty thousand persons"

Page 68, line 8, strike "2018‑2019" insert "2017‑2018"

Between lines 10 and 11, insert:

"Sec. 44.  Appropriations; department of health services; attorney general; opioid abuse prevention; opioid education; exemption

A.  Notwithstanding the requirements of section 44‑1531.02, Arizona Revised Statutes, the following sums are appropriated to the following entities from the consumer remediation subaccount of the consumer restitution and remediation revolving fund established by section 44‑1531.02, Arizona Revised Statutes, in fiscal year 2017‑2018 for the following purposes:

1.  $400,600 to the department of health services for the opioid abuse prevention campaign established pursuant to section 36‑123, Arizona Revised Statutes, as added by this act.

2.  $400,600 to the attorney general department of law for the purpose of awarding community grants for opioid education and prevention efforts.

B.  Monies appropriated pursuant to subsection A of this section are exempt from section 35‑190, Arizona Revised Statutes, relating to lapsing of appropriations."

Renumber to conform

Amend title to conform


 

 

STEVE YARBROUGH

 

1001FloorYARBROUGH

01/25/2018

03:33 PM

C: MH