Federal Legislation
FEDERAL OPIOID LEGISLATION:
Opioids
- The Opioid Prescription Verification Act of 2019 (H.R. 4810) was introduced by Rep. Rodney Davis (R-IL) and would require the Secretary of Health and Human Services (HHS), within one year of bill enactment, to create materials for training pharmacists on circumstances under which they may decline to fill a prescription. The bill would also allow the CDC to use a set of preferences in awarding grants, including the use of PDMPs by physicians and pharmacists.
- The Ensuring Compliance Against Drug Diversion Act of 2019 (H.R. 4812), introduced by Rep. Morgan Griffith (R- VA), would provide for the modification, transfer, and termination of a registration to manufacture, distribute, or dispense controlled substances under the Controlled Substances Act under certain circumstances, including when a registrant: dies, ceases legal existence, discontinues business or professional practice or surrenders such registration.
- The RESTORE Act of 2019 (H.R. 4563), introduced by Rep. Brian Fitzpatrick (R-PA), would repeal the provisions of the Ensuring Patient Access and Efficient Drug Enforcement Act of 2016.
- The DEBAR Act of 2019 (H.R. 4806), introduced by Rep. Bob Latta (R-OH), would allow the Attorney General to prohibit any person from being registered to manufacture, distribute, or dispense a controlled substance or a list I chemical under certain circumstances.
H.R. 2569: Comprehensive Addiction Resources Emergency Act of 2019
Sponsor: Rep. Elijah Cummings [D-MD7]
Introduced
May 8, 2019 Cosponsors
115 (115D)
H.R. 4111: Combating Meth and Cocaine Act
Sponsor: Rep. Bob Gibbs [R-OH7]
Introduced
Jul 30, 2019 Cosponsors
1 (1D)
H.R. 2922: Respond NOW Act
Sponsor: Rep. Ann Kuster [D-NH2]
Introduced
May 22, 2019 Cosponsors
36 (34D,2R)
S. 1925: Combating Meth and Cocaine Act
Sponsor: Sen. Robert “Rob” Portman [R-OH]
Introduced
Jun 20, 2019 Cosponsors
H.R. 3974: Prescription Drug Monitoring Act of 2019
Sponsor: Rep. Tim Ryan [D-OH13]
Introduced
Jul 25, 2019
Opioids & Addiction Treatment
Protecting Jessica Grubb's Legacy Act (S. 1012) - Senator Manchin (D-WV) introduced a bill to amend the Public Health Service Act to protect the confidentiality of substance use disorder patient records.
Mainstreaming Addiction Treatment Act of 2019 (H.R. 2482) - Rep. Tonko (D-NY) introduced a bill which would eliminate the separate registration requirement for dispensing narcotic drugs in schedule III, IV, or V (such as buprenorphine) for maintenance or detoxification treatment. The bill also provides for a national education campaign to encourage practitioners to integrate substance use treatment into their practices and include education on publicly available educational resources and training modules that can assist practitioners in treating patients with a substance use disorder.
Comprehensive Addiction Resources Emergency Act of 2019 (S. 1365/H.R. 2569) - Sen. Warren (D-MA) in the Senate and Rep. Cummings (D-NY) in the House introduced a bill that would provide emergency and financial assistance to areas impacted by the opioid crisis and provide for the development, organization, coordination, and operation of more effective and cost efficient systems for the delivery of essential services to individuals with substance use disorder and their families.
Opioid Workforce Act of 2019 (H.R. 2439) - Rep. Schneider (D-IL), along with seven cosponsors, introduced a bill to provide for the distribution of 1,000 additional residency positions to help combat the opioid crisis.
View CQ StateTrack reports on recent legal developments concerning opioids:
(Large files; might take several minutes to load)
Opioid Legislation by State
State Legislation
The Latest Legislative Tracking on Pain Management
Source: FSMB
Find & Track Proposed Opioid Legislation in Your State:
STATE LEGISLATURE - CLICK HERE
Legislation of Interest
Thousands of bills focusing on issues relating to state medical boards and the practice of medicine have been introduced during the 2019 legislative session. Below are some of the bills that have been enacted into law this year.
- North Carolina HB 228- Enacted August 1, mandates that every licensee has a duty to report in writing to the Board within 30 days any incidents that the licensee reasonably believes to have occurred involving sexual misconduct, fraudulent prescribing, drug diversion, or theft of controlled substances. Failure to report shall constitute unprofessional conduct. The newly enacted law also decreases the amount of graduate medical education required for international medical school graduates from three years to two years, or proof of certification by an approved specialty board.
- California AB 241 - Enacted October 2, requires that by January 1, 2022 all continuing education courses for physicians, nurses, and physician assistants to contain curriculum that includes specified instruction in the understanding of implicit bias in treatment.
- California AB 528 - Enacted October 9, requires dispensing pharmacies, clinics, or other dispensers to report specified information to the state's PDMP no more than one workday after a controlled substance is released to a patient. It also requires that the dispensing of a Schedule V controlled substance to be reported to the PDMP. Authorized health care practitioners are also required to consult the PDMP to review a patient's history at least once every six months after the first time, instead of the current requirement of every four months.
- Alaska SB 44 - Enacted October 23, permits physician assistants to diagnose, provide treatment, and prescribe, dispense, or administer a non-controlled substance prescription drug to a person without conducting a physical examination. A physician or physician assistant may not prescribe or dispense in response to an internet questionnaire or email without a prior patient-physician relationship.
As a handful of state legislatures are still in the 2019 legislative session, other state legislatures have begun pre-filing for the 2020 legislative session. Among the states where pre-filed legislation has been submitted, the following bills may be of interest to state medical boards:
- Florida HB 309/SB 500 - Authorizes the Department of Health to impose penalties upon individuals who knowingly and falsely use the name or title "physician," "surgeon," "medical doctor," "osteopath," among other titles, or any other words, letters, abbreviations or insignia indicating or implying they are authorized to practice as such.
- Florida HB 331/SB 120 - Permits a public school to buy a supply of naloxone from a wholesale distributor or manufacturer to use in the event of a student having an opioid overdose. The school district must adopt a protocol developed by a licensed physician.
- Florida HB 409 - Adds an exemption for licensure requirements for the treatment of veterans if a physician has an unencumbered license to practice in another state or territory and if they are currently employed by the Department of Veterans Affairs. The physician would only be able to provide medical services to veterans, pursuant to their employment with the VA, and in designated hospitals.
- Kentucky BR 8- Requires a practitioner to offer a prescription for naloxone when prescribing an opioid, as well as provide education on overdose prevention and on opioid depression reversal drugs.
The FSMB's state legislative staff will continue to track and monitor legislation and regulations of interest to state medical boards. If there is specific legislation you would like us to assist with, please contact John Bremer, Director of State Legislation and Policy, at jbremer@fsmb.org, or by phone at (202) 463-4021.
IN S 162
2019
Chronic Pain Management
Status: Enacted - Act No. 149-2019
Date of Last Action:* 05/01/2019 - Enacted
Author: Messmer (R)
Topics: Prescription Drug Abuse, Other
Summary: Relates to chronic pain management. Requires a practitioner to prescribe alternative treatments for certain chronic pain prior to prescribing an opioid.
History: Click for History
LA H 284
2019
Drugs and Prescription
Status: Enacted - Act No. 426
Date of Last Action:* 06/20/2019 - Enacted
Author: Abraham (R)
Topics: Prescription Drug Abuse, Prescribing Guidelines/Limits
Summary: Provides relative to prescribing and dispensing of opioid drugs, provides that the medical practitioner shall indicate on the prescription that more than a seven-day supply of the opioid is medically necessary.
History: Click for History
Continuing Medical Education
- Oklahoma SB 848 - Requires osteopathic physicians with DEA registration to complete not less than one hour of continuing medical education in pain management or one hour of continuing medical education in opioid use or addiction each year preceding renewal.
Prescription Drug Monitoring Programs
- Arkansas HB 1627- Permits the Department of Health to exchange - provide, request, and receive - prescription monitoring information with federal prescription drug monitoring programs.
- Arkansas HB 1317- Authorizes the Office of Medicaid Inspector General to access PDMP data for review and investigation of fraud, waste, and abuse within the Arkansas Medicaid prescription drug assistance program, so long as access is limited to beneficiaries of the program.
- Georgia SB 121- Increases the length of time prescription data is retained in the PDMP from two years to five years. Also authorizes the Attorney General's Medicaid Fraud Control Unit to access the PDMP for enforcement purposes.
- Maryland HB 466- Repeals the requirement that the Board of Physicians must have a quorum of a disciplinary panel to issue an administrative subpoena in order to receive PDMP data. Also authorizes the Attorney General to access PDMP data after a subpoena is issued for the purposes of furthering a bona fide existing investigation. The FSMB submitted a letter of support on this legislation.
- South Carolina HB 3728 - Requires hospital emergency departments and first responders to report when an individual has been administered an opioid antidote for an overdose so that it can be included in the PDMP.
Board Structure & Function
- Idaho HB 244 - Creates an advisory naturopathic medical board under the purview of the Board of Medicine.
- North Dakota SB 2059- Creates a licensure exemption for physicians in good standing who are providing services with a traveling sports team or who have been invited to provide services at an event or competition sanctioned by a national sport governing body.
- Oklahoma HB 2571- Permits the Oklahoma State Medical Board of Licensure and Supervision to conduct state and national criminal history checks, provided that reports are not shared with other states.
- Washington SB 5846- Establishes the international medical graduate (IMG) work group to study barriers to practice and make recommendations on how the state can implement an IMG assistance program to assist IMGs in integrating into the Washington health care delivery system.
- Washington SB 5764 - Changes the name of the Washington Medical Quality Assurance to the Washington Medical Commission.
Prescribing Laws & Regulations by State
STATE OPIOID LAWS & REGULATIONS:
The 3 Branches of the U.S. Government
How Does Our Government Work?
How the U.S. Government Is Organized
The Constitution of the United States divides the federal government into three branches to make sure no individual or group will have too much power:
- Legislative—Makes laws (Congress—House of Representatives and Senate)
- Executive—Carries out laws (president, vice president, Cabinet, most federal agencies)
- Judicial—Evaluates laws (Supreme Court and other courts)
Each branch of government can change acts of the other branches:
- The president can veto legislation created by Congress and nominates heads of federal agencies.
- Congress confirms or rejects the president's nominees and can remove the president from office in exceptional circumstances.
- The Justices of the Supreme Court, who can overturn unconstitutional laws, are nominated by the president and confirmed by the Senate.
This ability of each branch to respond to the actions of the other branches is called the system of checks and balances.
Legislative Branch
The legislative branch drafts proposed laws, confirms or rejects presidential nominations for heads of federal agencies, federal judges, and the Supreme Court, and has the authority to declare war. This branch includes Congress (the Senate and House of Representatives) and special agencies and offices that provide support services to Congress. American citizens have the right to vote for Senators and Representatives through free, confidential ballots.
- Senate—There are two elected Senators per state, totaling 100 Senators. A Senate term is six years and there is no limit to the number of terms an individual can serve.
- House of Representatives—There are 435 elected Representatives, which are divided among the 50 states in proportion to their total population. There are additional non-voting delegates who represent the District of Columbia and the territories. A Representative serves a two-year term, and there is no limit to the number of terms an individual can serve.
Executive Branch
The executive branch carries out and enforces laws. It includes the president, vice president, the Cabinet, executive departments, independent agencies, and other boards, commissions, and committees.
American citizens have the right to vote for the president and vice president through free, confidential ballots.
Key roles of the executive branch include:
- President—The president leads the country. He or she is the head of state, leader of the federal government, and Commander in Chief of the United States Armed Forces. The president serves a four-year term and can be elected no more than two times.
- Vice president—The vice president supports the president. If the president is unable to serve, the vice president becomes president. The vice president can be elected and serve an unlimited number of four-year terms as vice president, even under a different president.
- The Cabinet—Cabinet members serve as advisors to the president. They include the vice president, heads of executive departments, and other high-ranking government officials. Cabinet members are nominated by the president and must be approved by a simple majority of the Senate—51 votes if all 100 Senators vote.
Executive Branch Agencies, Commissions, and Committees
Much of the work in the executive branch is done by federal agencies, departments, committees, and other groups.
- Executive Office of the President – The Executive Office of the president communicates the president's message and deals with the federal budget, security, and other high priorities.
- Executive Departments – These are the main agencies of the federal government. The heads of these 15 agencies are also members of the president's cabinet.
- Executive Department Sub-Agencies – Smaller sub-agencies support specialized work within their parent executive department agencies.
- Independent Agencies – These agencies are not represented in the cabinet and are not part of the Executive Office of the president. They deal with government operations, the economy, and regulatory oversight.
- Boards, Commissions, and Committees – Congress or the president establish these smaller organizations to manage specific tasks and areas that don't fall under parent agencies.
- Quasi-Official Agencies – Although they're not officially part of the executive branch, these agencies are required by federal statute to release certain information about their programs and activities in the Federal Register, the daily journal of government activities.
Judicial Branch
The judicial branch interprets the meaning of laws, applies laws to individual cases, and decides if laws violate the Constitution. It's comprised of the Supreme Court and other federal courts.
- Supreme Court—The Supreme Court is the highest court in the United States. The Justices of the Supreme Court are nominated by the president and must be approved by the Senate.
- Nine members make up the Supreme Court— a Chief Justice and eight Associate Justices. There must be a minimum or quorum of six Justices to decide a case.
- If there is an even number of Justices and a case results in a tie, the lower court's decision stands.
- There is no fixed term for Justices. They serve until their death, retirement, or removal in exceptional circumstances.
- Federal Courts and Judicial Agencies – The Constitution gives Congress the authority to establish other federal courts to handle cases that involve federal laws including tax and bankruptcy, lawsuits involving U.S. and state governments or the Constitution, and more. Other federal judicial agencies and programs support the courts and research judicial policy.
Confirmation Process for Judges and Justices
Appointments for Supreme Court Justices and other federal judgeships follow the same basic process:
- The president nominates a person to fill a vacant judgeship.
- The Senate Judiciary Committee holds a hearing on the nominee and votes on whether to forward the nomination to the full Senate.
- If the nomination moves forward, the Senate can debate the nomination. Debate must end before the Senate can vote on whether to confirm the nominee. A Senator will request unanimous consent to end the debate, but any Senator can refuse.
- Without unanimous consent, the Senate must pass a cloture motion to end the debate. It takes a simple majority of votes—51 if all 100 Senators vote—to pass cloture and end debate about a federal judicial nominee.
- Once the debate ends, the Senate votes on confirmation. The nominee for Supreme Court or any other federal judgeship needs a simple majority of votes—51 if all 100 Senators vote—to be confirmed.