1.1.................... moves to amend H.F. No. 2527 as follows:
1.2Delete everything after the enacting clause and insert:
1.3 "Section 1. Minnesota Statutes 2012, section 152.126, as amended by Laws 2013,
1.4chapter 113, article 3, section 3, is amended to read:
1.5152.126 CONTROLLED SUBSTANCES PRESCRIPTION ELECTRONIC
1.6REPORTING SYSTEM PRESCRIPTION MONITORING PROGRAM.
1.7 Subdivision 1.
Definitions. (a) For purposes of this section, the terms defined in
1.8this subdivision have the meanings given.
1.9 (a) (b) "Board" means the Minnesota State Board of Pharmacy established under
1.10chapter 151.
1.11 (b) (c) "Controlled substances" means those substances listed in section
152.02,
1.12subdivisions 3 to
5 6, and those substances defined by the board pursuant to section
1.13152.02, subdivisions 7
, 8, and 12.
For the purposes of this section, controlled substances
1.14includes tramadol and butalbital.
1.15 (c) (d) "Dispense" or "dispensing" has the meaning given in section
151.01,
1.16subdivision 30
. Dispensing does not include the direct administering of a controlled
1.17substance to a patient by a licensed health care professional.
1.18 (d) (e) "Dispenser" means a person authorized by law to dispense a controlled
1.19substance, pursuant to a valid prescription. For the purposes of this section, a dispenser does
1.20not include a licensed hospital pharmacy that distributes controlled substances for inpatient
1.21hospital care or a veterinarian who is dispensing prescriptions under section
156.18.
1.22 (e) (f) "Prescriber" means a licensed health care professional who is authorized to
1.23prescribe a controlled substance under section
152.12, subdivision 1 or 2.
1.24 (f) (g) "Prescription" has the meaning given in section
151.01, subdivision 16.
1.25 Subd. 1a.
Treatment of intractable pain. This section is not intended to limit or
1.26interfere with the legitimate prescribing of controlled substances for pain. No prescriber
2.1shall be subject to disciplinary action by a health-related licensing board for prescribing a
2.2controlled substance according to the provisions of section
152.125.
2.3 Subd. 2.
Prescription electronic reporting system. (a) The board shall establish
2.4by January 1, 2010, an electronic system for reporting the information required under
2.5subdivision 4 for all controlled substances dispensed within the state.
2.6 (b) The board may contract with a vendor for the purpose of obtaining technical
2.7assistance in the design, implementation, operation, and maintenance of the electronic
2.8reporting system.
2.9 Subd. 3.
Prescription Electronic Reporting Monitoring Program Advisory
2.10Committee Task Force. (a) The board
shall convene shall appoint an advisory
committee.
2.11The committee must include task force consisting of at least one representative of:
2.12 (1) the Department of Health;
2.13 (2) the Department of Human Services;
2.14 (3) each health-related licensing board that licenses prescribers;
2.15 (4) a professional medical association, which may include an association of pain
2.16management and chemical dependency specialists;
2.17 (5) a professional pharmacy association;
2.18 (6) a professional nursing association;
2.19 (7) a professional dental association;
2.20 (8) a consumer privacy or security advocate; and
2.21 (9) a consumer or patient rights organization.
2.22 (b) The advisory
committee task force shall advise the board on the development and
2.23operation of the
electronic reporting system prescription monitoring program, including,
2.24but not limited to:
2.25 (1) technical standards for electronic prescription drug reporting;
2.26 (2) proper analysis and interpretation of prescription monitoring data; and
2.27 (3) an evaluation process for the program.
2.28(c) The task force is governed by section 15.059. Notwithstanding section 15.059,
2.29subdivision 5, the task force shall not expire.
2.30 Subd. 4.
Reporting requirements; notice. (a) Each dispenser must submit the
2.31following data to the board or its designated vendor
, subject to the notice required under
2.32paragraph (d):
2.33 (1) name of the prescriber;
2.34 (2) national provider identifier of the prescriber;
2.35 (3) name of the dispenser;
2.36 (4) national provider identifier of the dispenser;
3.1 (5) prescription number;
3.2 (6) name of the patient for whom the prescription was written;
3.3 (7) address of the patient for whom the prescription was written;
3.4 (8) date of birth of the patient for whom the prescription was written;
3.5 (9) date the prescription was written;
3.6 (10) date the prescription was filled;
3.7 (11) name and strength of the controlled substance;
3.8 (12) quantity of controlled substance prescribed;
3.9 (13) quantity of controlled substance dispensed; and
3.10 (14) number of days supply.
3.11 (b) The dispenser must submit the required information by a procedure and in a
3.12format established by the board. The board may allow dispensers to omit data listed in this
3.13subdivision or may require the submission of data not listed in this subdivision provided
3.14the omission or submission is necessary for the purpose of complying with the electronic
3.15reporting or data transmission standards of the American Society for Automation in
3.16Pharmacy, the National Council on Prescription Drug Programs, or other relevant national
3.17standard-setting body.
3.18 (c) A dispenser is not required to submit this data for those controlled substance
3.19prescriptions dispensed for:
3.20 (1) individuals residing in licensed skilled nursing or intermediate care facilities;
3.21 (2) individuals receiving assisted living services under chapter 144G or through a
3.22medical assistance home and community-based waiver;
3.23 (3) individuals receiving medication intravenously;
3.24 (4) individuals receiving hospice and other palliative or end-of-life care; and
3.25 (5) individuals receiving services from a home care provider regulated under chapter
3.26144A.
3.27 (1) individuals residing in a health care facility as defined in section 151.58,
3.28subdivision 2, paragraph (b), when a drug is distributed through the use of an automated
3.29drug distribution system according to section 151.58; and
3.30 (2) individuals receiving a drug sample that was packaged by a manufacturer and
3.31provided to the dispenser for dispensing as a professional sample pursuant to Code of
3.32Federal Regulations, title 21, section 203, subpart D.
3.33 (d) A dispenser must
not submit data under this subdivision unless provide to the
3.34patient for whom the prescription was written a conspicuous notice of the reporting
3.35requirements of this section
is given to the patient for whom the prescription was written
3.36 and notice that the information may be used for program administration purposes.
4.1 Subd. 5.
Use of data by board. (a) The board shall develop and maintain a database
4.2of the data reported under subdivision 4. The board shall maintain data that could identify
4.3an individual prescriber or dispenser in encrypted form.
Except as otherwise allowed
4.4under subdivision 6, the database may be used by permissible users identified under
4.5subdivision 6 for the identification of:
4.6 (1) individuals receiving prescriptions for controlled substances from prescribers
4.7who subsequently obtain controlled substances from dispensers in quantities or with a
4.8frequency inconsistent with generally recognized standards of use for those controlled
4.9substances, including standards accepted by national and international pain management
4.10associations; and
4.11 (2) individuals presenting forged or otherwise false or altered prescriptions for
4.12controlled substances to dispensers.
4.13 (b) No permissible user identified under subdivision 6 may access the database
4.14for the sole purpose of identifying prescribers of controlled substances for unusual or
4.15excessive prescribing patterns without a valid search warrant or court order.
4.16 (c) No personnel of a state or federal occupational licensing board or agency may
4.17access the database for the purpose of obtaining information to be used to initiate or
4.18substantiate a disciplinary action against a prescriber.
4.19 (d) Data reported under subdivision 4 shall be
retained by the board in the database
4.20for a 12-month period, and shall be removed from the database no later than 12 months
4.21from the last day of the month during which the data was received. made available to
4.22permissible users for a 12-month period beginning the day the data was received and
4.23ending 12 months from the last day of the month in which the data was received, except
4.24that permissible users defined in subdivision 6, paragraph (b), clauses (6) and (7), may
4.25use all data collected under this section for the purposes of administering, operating,
4.26and maintaining the prescription monitoring program and conducting trend analyses
4.27and other studies necessary to evaluate the effectiveness of the program. Data retained
4.28beyond 12 months must be de-identified.
4.29(e) The board shall not retain data reported under subdivision 4 for a period longer
4.30than five years from the date the data was received.
4.31 Subd. 6.
Access to reporting system data. (a) Except as indicated in this
4.32subdivision, the data submitted to the board under subdivision 4 is private data on
4.33individuals as defined in section
13.02, subdivision 12, and not subject to public disclosure.
4.34 (b) Except as specified in subdivision 5, the following persons shall be considered
4.35permissible users and may access the data submitted under subdivision 4 in the same or
5.1similar manner, and for the same or similar purposes, as those persons who are authorized
5.2to access similar private data on individuals under federal and state law:
5.3 (1) a prescriber or an agent or employee of the prescriber to whom the prescriber has
5.4delegated the task of accessing the data, to the extent the information relates specifically to
5.5a current patient, to whom the prescriber is
:
5.6 (i) prescribing or considering prescribing any controlled substance
;
5.7 (ii) providing emergency medical treatment for which access to the data may be
5.8necessary; or
5.9 (iii) providing other medical treatment for which access to the data may be necessary
5.10and the patient has consented to access to the submitted data, and with the provision that
5.11the prescriber remains responsible for the use or misuse of data accessed by a delegated
5.12agent or employee;
5.13 (2) a dispenser or an agent or employee of the dispenser to whom the dispenser has
5.14delegated the task of accessing the data, to the extent the information relates specifically
5.15to a current patient to whom that dispenser is dispensing or considering dispensing any
5.16controlled substance and with the provision that the dispenser remains responsible for the
5.17use or misuse of data accessed by a delegated agent or employee;
5.18 (3) an individual who is the recipient of a controlled substance prescription for
5.19which data was submitted under subdivision 4, or a guardian of the individual, parent or
5.20guardian of a minor, or health care agent of the individual acting under a health care
5.21directive under chapter 145C;
5.22 (4) personnel of the board specifically assigned to conduct a bona fide investigation
5.23of a specific licensee;
5.24 (5) personnel of the board engaged in the collection
, review, and analysis
5.25 of controlled substance prescription information as part of the assigned duties and
5.26responsibilities under this section;
5.27 (6) authorized personnel of a vendor under contract with the
board state of
5.28Minnesota who are engaged in the design, implementation, operation, and maintenance of
5.29the
electronic reporting system prescription monitoring program as part of the assigned
5.30duties and responsibilities of their employment, provided that access to data is limited to
5.31the minimum amount necessary to carry out such duties and responsibilities
, and subject
5.32to the requirement of de-identification and time limit on retention of data specified in
5.33subdivision 5, paragraphs (d) and (e);
5.34 (7) federal, state, and local law enforcement authorities acting pursuant to a valid
5.35search warrant;
6.1 (8) personnel of the
medical assistance program Minnesota health care programs
6.2assigned to use the data collected under this section to identify recipients whose usage of
6.3controlled substances may warrant restriction to a single primary care
physician provider,
6.4a single outpatient pharmacy,
or and a single hospital;
and
6.5(9) personnel of the Department of Human Services assigned to access the data
6.6pursuant to paragraph (h)
; and
6.7(10) personnel of the health professionals services program established under section
6.8214.31, to the extent that the information relates specifically to an individual who is
6.9currently enrolled in and being monitored by the program, and the individual consents to
6.10access to that information. The health professionals services program personnel shall not
6.11provide this data to a health-related licensing board or the Emergency Medical Services
6.12Regulatory Board, except as permitted under section 214.33, subdivision 3.
6.13 For purposes of clause
(3) (4), access by an individual includes persons in the
6.14definition of an individual under section
13.02.
6.15 (c)
Any A permissible user identified in paragraph (b),
who clauses (1), (2), (3), (6),
6.16(7), (9), and (11) may directly
accesses access the data electronically
,. If the data is directly
6.17accessed electronically, the permissible user shall implement and maintain a comprehensive
6.18information security program that contains administrative, technical, and physical
6.19safeguards that are appropriate to the user's size and complexity, and the sensitivity of the
6.20personal information obtained. The permissible user shall identify reasonably foreseeable
6.21internal and external risks to the security, confidentiality, and integrity of personal
6.22information that could result in the unauthorized disclosure, misuse, or other compromise
6.23of the information and assess the sufficiency of any safeguards in place to control the risks.
6.24 (d) The board shall not release data submitted under
this section subdivision 4 unless
6.25it is provided with evidence, satisfactory to the board, that the person requesting the
6.26information is entitled to receive the data.
6.27 (e) The board shall not release the name of a prescriber without the written consent
6.28of the prescriber or a valid search warrant or court order. The board shall provide a
6.29mechanism for a prescriber to submit to the board a signed consent authorizing the release
6.30of the prescriber's name when data containing the prescriber's name is requested.
6.31 (f) (e) The board shall maintain a log of all persons who access the data
for a period
6.32of at least three years and shall ensure that any permissible user complies with paragraph
6.33(c) prior to attaining direct access to the data.
6.34(g) (f) Section
13.05, subdivision 6, shall apply to any contract the board enters into
6.35pursuant to subdivision 2. A vendor shall not use data collected under this section for
6.36any purpose not specified in this section.
7.1(g) The board may participate in an interstate prescription monitoring program data
7.2exchange system provided that permissible users in other states have access to the data
7.3only as allowed under this section, and that section 13.05, subdivision 6, applies to any
7.4contract or memorandum of understanding that the board enters into under this paragraph.
7.5(h) With available appropriations, the commissioner of human services shall
7.6establish and implement a system through which the Department of Human Services shall
7.7routinely access the data for the purpose of determining whether any client enrolled in
7.8an opioid treatment program licensed according to chapter 245A has been prescribed or
7.9dispensed a controlled substance in addition to that administered or dispensed by the
7.10opioid treatment program. When the commissioner determines there have been multiple
7.11prescribers or multiple prescriptions of controlled substances, the commissioner shall:
7.12(1) inform the medical director of the opioid treatment program only that the
7.13commissioner determined the existence of multiple prescribers or multiple prescriptions of
7.14controlled substances; and
7.15(2) direct the medical director of the opioid treatment program to access the data
7.16directly, review the effect of the multiple prescribers or multiple prescriptions, and
7.17document the review.
7.18If determined necessary, the commissioner of human services shall seek a federal waiver
7.19of, or exception to, any applicable provision of Code of Federal Regulations, title 42, part
7.202.34
, item (c), prior to implementing this paragraph.
7.21(i) The board may provide de-identified data submitted under subdivision 4 for public
7.22research, policy, or education purposes, that does not involve information that is likely to
7.23reveal the identity of the patient, prescriber, or dispenser who is the subject of the data.
7.24 Subd. 7.
Disciplinary action. (a) A dispenser who knowingly fails to submit data to
7.25the board as required under this section is subject to disciplinary action by the appropriate
7.26health-related licensing board.
7.27 (b) A prescriber or dispenser authorized to access the data who knowingly discloses
7.28the data in violation of state or federal laws relating to the privacy of health care data
7.29shall be subject to disciplinary action by the appropriate health-related licensing board,
7.30and appropriate civil penalties.
7.31 Subd. 8. Evaluation and reporting. (a) The board shall evaluate the prescription
7.32electronic reporting system to determine if the system is negatively impacting appropriate
7.33prescribing practices of controlled substances. The board may contract with a vendor to
7.34design and conduct the evaluation.
7.35 (b) The board shall submit the evaluation of the system to the legislature by July
7.3615, 2011.
8.1 Subd. 9.
Immunity from liability; no requirement to obtain information. (a) A
8.2pharmacist, prescriber, or other dispenser making a report to the program in good faith
8.3under this section is immune from any civil, criminal, or administrative liability, which
8.4might otherwise be incurred or imposed as a result of the report, or on the basis that the
8.5pharmacist or prescriber did or did not seek or obtain or use information from the program.
8.6 (b) Nothing in this section shall require a pharmacist, prescriber, or other dispenser
8.7to obtain information about a patient from the program, and the pharmacist, prescriber,
8.8or other dispenser, if acting in good faith, is immune from any civil, criminal, or
8.9administrative liability that might otherwise be incurred or imposed for requesting,
8.10receiving, or using information from the program.
8.11 Subd. 10.
Funding. (a) The board may seek grants and private funds from nonprofit
8.12charitable foundations, the federal government, and other sources to fund the enhancement
8.13and ongoing operations of the prescription
electronic reporting system monitoring
8.14program established under this section. Any funds received shall be appropriated to the
8.15board for this purpose. The board may not expend funds to enhance the program in a way
8.16that conflicts with this section without seeking approval from the legislature.
8.17(b)
Notwithstanding any other section, the administrative services unit for the
8.18health-related licensing boards shall apportion between the Board of Medical Practice, the
8.19Board of Nursing, the Board of Dentistry, the Board of Podiatric Medicine, the Board of
8.20Optometry,
the Board of Veterinary Medicine, and the Board of Pharmacy an amount to
8.21be paid through fees by each respective board. The amount apportioned to each board
8.22shall equal each board's share of the annual appropriation to the Board of Pharmacy
8.23from the state government special revenue fund for operating the prescription
electronic
8.24reporting system monitoring program under this section. Each board's apportioned share
8.25shall be based on the number of prescribers or dispensers that each board identified in
8.26this paragraph licenses as a percentage of the total number of prescribers and dispensers
8.27licensed collectively by these boards. Each respective board may adjust the fees that the
8.28boards are required to collect to compensate for the amount apportioned to each board by
8.29the administrative services unit.
8.30 Sec. 2.
STUDY REQUIRED; PRESCRIPTION MONITORING PROGRAM
8.31DATABASE.
8.32The Board of Pharmacy, in collaboration with the Prescription Monitoring Program
8.33Advisory Task Force, shall report to the chairs and ranking minority members of the house
8.34and senate committees and divisions with jurisdiction over health and human services
8.35policy and finance, by December 15, 2014, with:
9.1(1) recommendations on whether or not to require the use of the prescription
9.2monitoring program database by prescribers when prescribing or considering prescribing,
9.3and pharmacists when dispensing or considering dispensing, a controlled substance as
9.4defined in Minnesota Statutes, section 152.126, subdivision 1, paragraph (b);
9.5(2) an analysis of the impact of the prescription monitoring program on rates of
9.6chemical abuse and prescription drug abuse; and
9.7(3) recommendations on approaches to encourage access to appropriate treatment
9.8for prescription drug abuse, through the prescription monitoring program."