READ FIRST TIME 01/26/10.   

     AN ACT Relating to pain management; 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.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

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)(i) Dosing criteria, including:
     (A) A dosage amount that must not be exceeded unless a podiatric physician and surgeon first consults with a practitioner specializing in pain management; and
     (B) Exigent or special circumstances under which the dosage amount may be exceeded without consultation with a practitioner specializing in pain management.
     (ii) The rules regarding consultation with a practitioner specializing in pain management must, to the extent practicable, take into account:
     (A) Circumstances under which repeated consultations would not be necessary or appropriate for a patient undergoing a stable, ongoing course of treatment for pain management;
     (B) Minimum training and experience that is sufficient to exempt a podiatric physician and surgeon from the specialty consultation requirement;
     (C) Methods for enhancing the availability of consultations;
     (D) Allowing the efficient use of resources; and
     (E) Minimizing the burden on practitioners and patients.
     (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)(i) Dosing criteria, including:
     (A) A dosage amount that must not be exceeded unless a dentist first consults with a practitioner specializing in pain management; and
     (B) Exigent or special circumstances under which the dosage amount may be exceeded without consultation with a practitioner specializing in pain management.
     (ii) The rules regarding consultation with a practitioner specializing in pain management must, to the extent practicable, take into account:
     (A) Circumstances under which repeated consultations would not be necessary or appropriate for a patient undergoing a stable, ongoing course of treatment for pain management;
     (B) Minimum training and experience that is sufficient to exempt a dentist from the specialty consultation requirement;
     (C) Methods for enhancing the availability of consultations;
     (D) Allowing the efficient use of resources; and
     (E) Minimizing the burden on practitioners and patients.
     (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)(i) Dosing criteria, including:
     (A) A dosage amount that must not be exceeded unless an osteopathic physician and surgeon first consults with a practitioner specializing in pain management; and
     (B) Exigent or special circumstances under which the dosage amount may be exceeded without consultation with a practitioner specializing in pain management.
     (ii) The rules regarding consultation with a practitioner specializing in pain management must, to the extent practicable, take into account:
     (A) Circumstances under which repeated consultations would not be necessary or appropriate for a patient undergoing a stable, ongoing course of treatment for pain management;
     (B) Minimum training and experience that is sufficient to exempt an osteopathic physician and surgeon from the specialty consultation requirement;
     (C) Methods for enhancing the availability of consultations;
     (D) Allowing the efficient use of resources; and
     (E) Minimizing the burden on practitioners and patients.
     (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, 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)(i) Dosing criteria, including:
     (A) A dosage amount that must not be exceeded unless an osteopathic physician's assistant first consults with a practitioner specializing in pain management; and
     (B) Exigent or special circumstances under which the dosage amount may be exceeded without consultation with a practitioner specializing in pain management.
     (ii) The rules regarding consultation with a practitioner specializing in pain management must, to the extent practicable, take into account:
     (A) Circumstances under which repeated consultations would not be necessary or appropriate for a patient undergoing a stable, ongoing course of treatment for pain management;
     (B) Minimum training and experience that is sufficient to exempt an osteopathic physician's assistant from the specialty consultation requirement;
     (C) Methods for enhancing the availability of consultations;
     (D) Allowing the efficient use of resources; and
     (E) Minimizing the burden on practitioners and patients.
     (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, 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)(i) Dosing criteria, including:
     (A) A dosage amount that must not be exceeded unless a physician first consults with a practitioner specializing in pain management; and
     (B) Exigent or special circumstances under which the dosage amount may be exceeded without consultation with a practitioner specializing in pain management.
     (ii) The rules regarding consultation with a practitioner specializing in pain management must, to the extent practicable, take into account:
     (A) Circumstances under which repeated consultations would not be necessary or appropriate for a patient undergoing a stable, ongoing course of treatment for pain management;
     (B) Minimum training and experience that is sufficient to exempt a physician from the specialty consultation requirement;
     (C) Methods for enhancing the availability of consultations;
     (D) Allowing the efficient use of resources; and
     (E) Minimizing the burden on practitioners and patients.
     (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, 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)(i) Dosing criteria, including:
     (A) A dosage amount that must not be exceeded unless a physician assistant first consults with a practitioner specializing in pain management; and
     (B) Exigent or special circumstances under which the dosage amount may be exceeded without consultation with a practitioner specializing in pain management.
     (ii) The rules regarding consultation with a practitioner specializing in pain management must, to the extent practicable, take into account:
     (A) Circumstances under which repeated consultations would not be necessary or appropriate for a patient undergoing a stable, ongoing course of treatment for pain management;
     (B) Minimum training and experience that is sufficient to exempt a physician assistant from the specialty consultation requirement;
     (C) Methods for enhancing the availability of consultations;
     (D) Allowing the efficient use of resources; and
     (E) Minimizing the burden on practitioners and patients.
     (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, 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)(i) Dosing criteria, including:
     (A) 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; and
     (B) Exigent or special circumstances under which the dosage amount may be exceeded without consultation with a practitioner specializing in pain management.
     (ii) The rules regarding consultation with a practitioner specializing in pain management must, to the extent practicable, take into account:
     (A) Circumstances under which repeated consultations would not be necessary or appropriate for a patient undergoing a stable, ongoing course of treatment for pain management;
     (B) Minimum training and experience that is sufficient to exempt an advanced registered nurse practitioner or certified registered nurse anesthetist from the specialty consultation requirement;
     (C) Methods for enhancing the availability of consultations;
     (D) Allowing the efficient use of resources; and
     (E) Minimizing the burden on practitioners and patients.
     (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, 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.
     *Sec. 8 was vetoed. See message at end of chapter.