21 Jun Notes from the Legislature
This legislative session was unusually busy for the TOS. The TOS spent considerable time opposing several bills early in the session ranging from balance billing issues to a bill that would have allowed physician assistants to earn a new degree and title.
Several bills were introduced that would have prohibited balance billing altogether or prohibited the collection of balance bills. Those bills (SB2350, SB2348, and SB2717) were taken off notice during the session. The TMA balance billing legislation (SB2640) was also taken off notice and did not advance. The remaining bill (SB1869) was amended to require that facilities that are out of network or are using out of network providers provide a notice to the patient advising them of the possibility of out of network charges and giving an estimate of such charges.
The physical therapists briefly pursued a bill that would have given them direct patient access with no physician oversight. We asked that they wait and engage us over the summer to discuss whether there are situations in which direct access makes sense. They will be in contact with us to talk further about this issue. No bill was drafted or put on a committee calendar this session.
Opioid Abuse Plan
The Governor’s announcement of an opioid abuse plan caught everyone by surprise early in the session. The TOS opposed the governor’s initial proposal to sharply limit opioid prescriptions to opioid naïve patients. This proposal evolved into SB2257. As passed the bill makes many changes to the way in which physicians prescribe opioids. The legislation places limits and requirements on the number of opioids prescribed and dispensed. It allows up to a 3-day opioid script at a total of 180 MME (morphine milligram equivalents) with no requirements. It allows a 10-day (500 MME total) or a 20-day (850 MME total for a procedure that is more than minimally invasive) prescription if the prescriber: checks the CSMD (controlled substance monitoring database), evaluates the patient, obtains informed consent (including counseling about NAS (neonatal abstinence syndrome) and contraception, if the patient is a woman of childbearing age), and includes the ICD-10 code on the prescription. A 30-day script (1200 MME total) is only allowed if the prescriber meets the above requirements and documents trial and failure of
non-opioid treatments or documents why the risk of adverse effects from pain exceeds the risk of developing a SUD (substance use disorder). These prescriptions shall include a “medical necessity” statement to be entered into the CSMD. No prescription for a 10, 20, or 30-day opioid shall be filled for more than half of the rescription. These limits and requirements apply to all opioids except prescriptions written to treat chronic pain management, palliative/hospice care, sickle cell, substance use disorder, severe burns or major trauma.
Requirements for Schedule II Controlled for Providers to File Prescriptions
The general assembly also passed a requirement that providers file prescriptions for Schedule II controlled substances electronic means only by July 1, 2020. The bill contains various exceptions for providers where the
prescription is: (1) Issued by veterinarians; (2) Issued in circumstances where electronic prescribing is not available due to technological or electrical failure, as set forth in rule; (3) Issued by a healthcare prescriber to be dispensed by a pharmacy located outside the state, as set forth in rule; (4) Issued when the healthcare
prescriber and dispenser are the same entity; (5) Issued while including elements that are not supported by the most recently implemented version of the National Council for Prescription Drug Programs Prescriber/Pharmacist Interface SCRIPT Standard; (6) Issued by a healthcare prescriber for a drug that the federal food and drug administration (FDA) requires the prescription to contain certain elements that are not able to be accomplished with electronic prescribing; (7) Issued by a healthcare prescriber allowing for the dispensing of a non-patient-specific prescription pursuant to a standing order, approved protocol for drug therapy, collaborative pharmacy practice agreement in response to a public health emergency, or in other circumstances where the healthcare prescriber may issue a non-patient-specific prescription; (8) Issued by a healthcare prescriber prescribing a drug under a research protocol; (9) Issued by a healthcare prescriber who has received a waiver or a renewed waiver for a specified period determined by the commissioner of health, not to exceed one year without renewal by the commissioner, from the requirement to use electronic prescribing, pursuant to a process established in rule by the
commissioner, due to economic hardship, technological limitations that are not reasonably within the control of the healthcare prescriber, or other exceptional circumstance demonstrated by the healthcare prescriber; or (10) Issued by a healthcare prescriber under circumstances where, notwithstanding the healthcare prescriber’s present ability to make an electronic prescription, the healthcare prescriber reasonably determines that it would be impractical for the patient to obtain substances prescribed by electronic prescription in a timely manner, and such delay would adversely impact the patient’s medical condition.
The Medical Cannabis Act
The Medical Cannabis Act (SB1710) was heavily debated this session. Ultimately the legislation was taken off notice in the House and Senate Committees. Some version of this legislation will appear again in next year’s legislative session.
In other news, this was my last session serving as the lobbyist for the Tennessee Orthopaedic Society. I have accepted a position as Senior Director of Government and Community Affairs at Vanderbilt University Medical Center. It has been an honor to serve as your representative and I look forward to seeing you all at events in the medical community. I wish you all the best of luck in the future.