DEPARTMENT OF HEALTH
(Dental Quality Assurance Commission)
[Filed October 21, 2019, 11:23 a.m.]
Preproposal statement of inquiry was filed as WSR 19-15-095.
Title of Rule and Other Identifying Information: WAC 246-817-907 Patient notification, secure storage, and disposal, the dental quality assurance commission (commission) is proposing amending WAC 246-817-907 to establish patient notification, documentation, counseling requirements, and the right to refuse an opioid prescription for those prescribing opioids, as directed by section 4, codified as RCW 18.32.810
, and section 17, codified as RCW 69.50.317
, of SSB 5380 (chapter 314, Laws of 2019) for licensed dentists. The commission is also proposing exemptions to clarify when patient notification, documentation, and counseling requirements for opioid prescribing is needed.
Hearing Location(s): On December 6, 2019, at 9:35 a.m., at the Department of Health, Town Center 2, 111 Israel Road S.E., Tumwater, WA 98501.
Date of Intended Adoption: December 6, 2019.
Submit Written Comments to: Jennifer Santiago, P.O. Box 47852, Olympia, WA 98504, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2901, by November 27, 2019.
Assistance for Persons with Disabilities: Contact Jennifer Santiago, phone 360-236-4893, fax 360-236-2901, TTY 360-833-6388 or 711, email firstname.lastname@example.org, by November 27, 2019.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: SSB 5380 requires the commission, along with the Washington medical commission, podiatric medical board, board of osteopathic medicine and surgery, and nursing care quality assurance commission to adopt or amend rules establishing additional patient notification and right to refuse requirements.
Section 4 of SSB 5380, codified as RCW 18.32.810
directs the commission to adopt or amend the opioid prescribing rules by January 1, 2020, to establish the requirement for licensed dentists to notify patients of their right to refuse an opioid prescription or order and to document any refusal.
Section 17 of SSB 5380, codified as RCW 69.50.317
requires the prescribing practitioner, prior to the first opioid prescription, to discuss with the patient risks of opioids, pain management alternatives to opioids, and provide the patient a written copy of the warning language. The proposed rule includes alternatives in the patient notification.
In addition, the proposed rule clarifies situations where the notification requirements would not apply. Specifically, notification requirements that would not apply to emergent care, situations where pain represents a significant health risk, procedures involving administration of medications, when a patient is unable to grant or revoke consent, or for medication assisted treatment for substance use disorders. The exemptions are included because SSB 5380 only applies to prescriptions and these exemptions clarify settings in which direct administration is occurring.
The intent of SSB 5380 is to reduce the number of people who inadvertently become addicted to opioids and, consequently, reduce the burden on opioid treatment programs.
Reasons Supporting Proposal: The proposed rule is necessary to restate patient notification and patient right to refuse related to opioid prescribing requirements for dentists, and to clarify situations when notification is not required. The proposed rules provide a necessary framework and structure for safe, consistent opioid prescribing practice consistent with the directives of SSB 5380. The goal of this legislation is to further reduce the number of people who inadvertently become addicted to opioids and, consequently, reduce the burden on opioid treatment programs.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Dental quality assurance commission, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Jennifer Santiago, 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4893.
A school district fiscal impact statement is not required under RCW 28A.305.135
A cost-benefit analysis is required under RCW 34.05.328
. A preliminary cost-benefit analysis may be obtained by contacting Jennifer Santiago, P.O. Box 47852, Olympia, WA 98504, phone 360-236-4893, fax 360-236-2901, TTY 360-833-6388 or 711, email email@example.com [firstname.lastname@example.org]
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Is exempt under RCW 19.85.025
(3) as the rules only correct typographical errors, make address or name changes, or clarify language of a rule without changing its effect; and rule content is explicitly and specifically dictated by statute.
October 20, 2019
Julia Richman, DDS, Chairperson
Dental Quality Assurance Commission
AMENDATORY SECTION(Amending WSR 19-02-043, filed 12/26/18, effective 1/26/19)
WAC 246-817-907Patient notification, secure storage, and disposal.
(1) The dentist shall ((provide information to))discuss with the patient educating them of risks associated with the use of opioids, including the risk of dependence and overdose. The dentist shall document such notification in the patient record.
(2) Patient notification must occur, at a minimum, at the following points of treatment:
(a) The first issuance of a prescription for an opioid; and
(b) The transition between phase of treatment, as follows:
(i) Acute nonoperative pain or acute perioperative pain to subacute pain; and
(ii) Subacute pain to chronic pain.
(3) Patient written notification must include information regarding:
(a) Pain management alternative to opioid medications;
(b) The safe and secure storage of opioid prescriptions; ((and
(b)))(c) The proper disposal of unused opioid medication including, but not limited to, the availability of recognized drug take-back programs((.
(4) This)); and
(d) The patient's right to refuse an opioid prescription or order for any reason. If the patient indicates a desire to not receive an opioid, the dentist shall document the patient's request and avoid prescribing or ordering opioids, unless the request is revoked by the patient.
(4) The requirements in this section do not apply to the administration of an opioid including, but not limited to, the following situations:
(a) Emergent care;
(b) Where patient pain represents a significant health risk;
(c) Procedures involving the administration of anesthesia;
(d) When the patient is unable to grant or revoke consent; or
(e) MAT for substance use disorders.
(5) If the patient is under eighteen years old or is not competent, the discussion required by subsection (1) of this section must include the patient's parent, guardian, or other person identified in RCW 7.70.065, unless otherwise provided by law.
(6) The requirements of this section may be satisfied with a document provided by the department of health.
(7) The requirements of this section may be satisfied by a dentist designating any individual who holds a credential issued by a disciplining authority under RCW 18.130.040 to provide the information.