ESHB 2876 -
By Senators Keiser, Pflug
ADOPTED 03/04/2010
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1 A new section is added to chapter 18.22 RCW
to read as follows:
(1) By June 30, 2011, the board shall repeal its rules on pain
management, WAC 246-922-510 through 246-922-540.
(2) By June 30, 2011, the board shall adopt new rules on chronic,
noncancer pain management that contain the following elements:
(a) Dosing criteria, including:
(i) A dosage amount that must not be exceeded unless a podiatric
physician and surgeon first consults with a practitioner specializing
in pain management, at no additional cost to the patient; and
(ii) Exigent or special circumstances under which the dosage amount
may be exceeded without consultation with a practitioner specializing
in pain management, including the specific circumstance of a patient
requiring a stable and ongoing course of treatment for pain management
in which an initial consultation shall suffice for that complete course
of treatment.
(b) Guidance on when to seek specialty consultation and ways in
which electronic specialty consultations may be sought;
(c) Guidance on tracking clinical progress by using assessment
tools focusing on pain interference, physical function, and overall
risk for poor outcome; and
(d) Guidance on tracking the use of opioids.
(3) The board shall consult with the agency medical directors'
group, the department of health, the University of Washington, and the
largest professional association of podiatric physicians and surgeons
in the state.
(4) The rules adopted under this section do not apply:
(a) To the provision of palliative, hospice, or other end-of-life
care; or
(b) To the management of acute pain caused by an injury or a
surgical procedure.
NEW SECTION. Sec. 2 A new section is added to chapter 18.32 RCW
to read as follows:
(1) By June 30, 2011, the commission shall adopt new rules on
chronic, noncancer pain management that contain the following elements:
(a) Dosing criteria, including:
(i) A dosage amount that must not be exceeded unless a dentist
first consults with a practitioner specializing in pain management, at
no additional cost to the patient; and
(ii) Exigent or special circumstances under which the dosage amount
may be exceeded without consultation with a practitioner specializing
in pain management, including the specific circumstance of a patient
requiring a stable and ongoing course of treatment for pain management
in which an initial consultation shall suffice for that complete course
of treatment.
(b) Guidance on when to seek specialty consultation and ways in
which electronic specialty consultations may be sought;
(c) Guidance on tracking clinical progress by using assessment
tools focusing on pain interference, physical function, and overall
risk for poor outcome; and
(d) Guidance on tracking the use of opioids.
(2) The commission shall consult with the agency medical directors'
group, the department of health, the University of Washington, and the
largest professional association of dentists in the state.
(3) The rules adopted under this section do not apply:
(a) To the provision of palliative, hospice, or other end-of-life
care; or
(b) To the management of acute pain caused by an injury or a
surgical procedure.
NEW SECTION. Sec. 3 A new section is added to chapter 18.57 RCW
to read as follows:
(1) By June 30, 2011, the board shall repeal its rules on pain
management, WAC 246-853-510 through 246-853-540.
(2) By June 30, 2011, the board shall adopt new rules on chronic,
noncancer pain management that contain the following elements:
(a) Dosing criteria, including:
(i) A dosage amount that must not be exceeded unless an osteopathic
physician and surgeon first consults with a practitioner specializing
in pain management, at no additional cost to the patient; and
(ii) Exigent or special circumstances under which the dosage amount
may be exceeded without consultation with a practitioner specializing
in pain management, including the specific circumstance of a patient
requiring a stable and ongoing course of treatment for pain management
in which an initial consultation shall suffice for that complete course
of treatment.
(b) Guidance on when to seek specialty consultation, including
information on sufficient training and experience to exempt an
osteopathic physician and surgeon from the specialty consultation
requirement, and ways in which electronic specialty consultations may
be sought;
(c) Guidance on tracking clinical progress by using assessment
tools focusing on pain interference, physical function, and overall
risk for poor outcome; and
(d) Guidance on tracking the use of opioids, particularly in the
emergency department.
(3) The board shall consult with the agency medical directors'
group, the department of health, the University of Washington, and the
largest association of osteopathic physicians and surgeons in the
state.
(4) The rules adopted under this section do not apply:
(a) To the provision of palliative, hospice, or other end-of-life
care; or
(b) To the management of acute pain caused by an injury or a
surgical procedure.
NEW SECTION. Sec. 4 A new section is added to chapter 18.57A RCW
to read as follows:
(1) By June 30, 2011, the board shall repeal its rules on pain
management, WAC 246-854-120 through 246-854-150.
(2) By June 30, 2011, the board shall adopt new rules on chronic,
noncancer pain management that contain the following elements:
(a) Dosing criteria, including:
(i) A dosage amount that must not be exceeded unless an osteopathic
physician's assistant first consults with a practitioner specializing
in pain management, at no additional cost to the patient; and
(ii) Exigent or special circumstances under which the dosage amount
may be exceeded without consultation with a practitioner specializing
in pain management, including the specific circumstance of a patient
requiring a stable and ongoing course of treatment for pain management
in which an initial consultation shall suffice for that complete course
of treatment.
(b) Guidance on when to seek specialty consultation, including
information on sufficient training and experience to exempt an
osteopathic physician's assistant from the specialty consultation
requirement, and ways in which electronic specialty consultations may
be sought;
(c) Guidance on tracking clinical progress by using assessment
tools focusing on pain interference, physical function, and overall
risk for poor outcome; and
(d) Guidance on tracking the use of opioids, particularly in the
emergency department.
(3) The board shall consult with the agency medical directors'
group, the department of health, the University of Washington, and the
largest association of osteopathic physician's assistants in the state.
(4) The rules adopted under this section do not apply:
(a) To the provision of palliative, hospice, or other end-of-life
care; or
(b) To the management of acute pain caused by an injury or a
surgical procedure.
NEW SECTION. Sec. 5 A new section is added to chapter 18.71 RCW
to read as follows:
(1) By June 30, 2011, the commission shall repeal its rules on pain
management, WAC 246-919-800 through 246-919-830.
(2) By June 30, 2011, the commission shall adopt new rules on
chronic, noncancer pain management that contain the following elements:
(a) Dosing criteria, including:
(i) A dosage amount that must not be exceeded unless a physician
first consults with a practitioner specializing in pain management, at
no additional cost to the patient; and
(ii) Exigent or special circumstances under which the dosage amount
may be exceeded without consultation with a practitioner specializing
in pain management, including the specific circumstance of a patient
requiring a stable and ongoing course of treatment for pain management
in which an initial consultation shall suffice for that complete course
of treatment.
(b) Guidance on when to seek specialty consultation, including
information on sufficient training and experience to exempt a physician
from the specialty consultation requirement, and ways in which
electronic specialty consultations may be sought;
(c) Guidance on tracking clinical progress by using assessment
tools focusing on pain interference, physical function, and overall
risk for poor outcome; and
(d) Guidance on tracking the use of opioids, particularly in the
emergency department.
(3) The commission shall consult with the agency medical directors'
group, the department of health, the University of Washington, and the
largest professional association of physicians in the state.
(4) The rules adopted under this section do not apply:
(a) To the provision of palliative, hospice, or other end-of-life
care; or
(b) To the management of acute pain caused by an injury or a
surgical procedure.
NEW SECTION. Sec. 6 A new section is added to chapter 18.71A RCW
to read as follows:
(1) By June 30, 2011, the commission shall adopt new rules on
chronic, noncancer pain management that contain the following elements:
(a) Dosing criteria, including:
(i) A dosage amount that must not be exceeded unless a physician
assistant first consults with a practitioner specializing in pain
management, at no additional cost to the patient; and
(ii) Exigent or special circumstances under which the dosage amount
may be exceeded without consultation with a practitioner specializing
in pain management, including the specific circumstance of a patient
requiring a stable and ongoing course of treatment for pain management
in which an initial consultation shall suffice for that complete course
of treatment.
(b) Guidance on when to seek specialty consultation, including
information on sufficient training and experience to exempt a physician
assistant from the specialty consultation requirement, and ways in
which electronic specialty consultations may be sought;
(c) Guidance on tracking clinical progress by using assessment
tools focusing on pain interference, physical function, and overall
risk for poor outcome; and
(d) Guidance on tracking the use of opioids, particularly in the
emergency department.
(2) The commission shall consult with the agency medical directors'
group, the department of health, the University of Washington, and the
largest professional association of physician assistants in the state.
(3) The rules adopted under this section do not apply:
(a) To the provision of palliative, hospice, or other end-of-life
care; or
(b) To the management of acute pain caused by an injury or a
surgical procedure.
NEW SECTION. Sec. 7 A new section is added to chapter 18.79 RCW
to read as follows:
(1) By June 30, 2011, the commission shall adopt new rules on
chronic, noncancer pain management that contain the following elements:
(a) Dosing criteria, including:
(i) A dosage amount that must not be exceeded unless an advanced
registered nurse practitioner or certified registered nurse anesthetist
first consults with a practitioner specializing in pain management, at
no additional cost to the patient; and
(ii) Exigent or special circumstances under which the dosage amount
may be exceeded without consultation with a practitioner specializing
in pain management, including the specific circumstance of a patient
requiring a stable and ongoing course of treatment for pain management
in which an initial consultation shall suffice for that complete course
of treatment.
(b) Guidance on when to seek specialty consultation, including
information on sufficient training and experience to exempt an advanced
registered nurse practitioner or certified registered nurse anesthetist
from the specialty consultation requirement, and ways in which
electronic specialty consultations may be sought;
(c) Guidance on tracking clinical progress by using assessment
tools focusing on pain interference, physical function, and overall
risk for poor outcome; and
(d) Guidance on tracking the use of opioids, particularly in the
emergency department.
(2) The commission shall consult with the agency medical directors'
group, the department of health, the University of Washington, and the
largest professional associations for advanced registered nurse
practitioners and certified registered nurse anesthetists in the state.
(3) The rules adopted under this section do not apply:
(a) To the provision of palliative, hospice, or other end-of-life
care; or
(b) To the management of acute pain caused by an injury or a
surgical procedure.
NEW SECTION. Sec. 8 (1) The boards and commissions required to
adopt rules on pain management under sections 1 through 7 of this act
shall work collaboratively to ensure that the rules are as uniform as
practicable.
(2) On January 11, 2011, each of the boards and commissions
required to adopt rules on pain management under sections 1 through 7
of this act shall submit the proposed rules required by this act to the
appropriate committees of the legislature."
ESHB 2876 -
By Senators Keiser, Pflug
ADOPTED 03/04/2010
On page 1, line 1 of the title, after "management;" strike the remainder of the title and insert "adding a new section to chapter 18.22 RCW; adding a new section to chapter 18.32 RCW; adding a new section to chapter 18.57 RCW; adding a new section to chapter 18.57A RCW; adding a new section to chapter 18.71 RCW; adding a new section to chapter 18.71A RCW; adding a new section to chapter 18.79 RCW; and creating a new section."
EFFECT: The dates for repealing current board rules for pain
management and adopting new ones are aligned to both be June 30, 2011.
Rules must consider special circumstances when dosage amounts may
be exceeded without consultation from a pain specialist.
A single consultation with a pain specialist shall suffice for a
patient on a stable, ongoing course of pain management treatment.
When a health care provider seeks a pain specialist consultation,
the patient cannot be charged.
Rules adopted by each practitioner board or commission must include
information on sufficient training and experience to exempt a
practitioner from the specialty consultation requirement.
In January 2011, each of the boards and commissions must report the
proposed rules to the legislature.