BILL REQ. #:  H-3593.1 

Read first time 01/18/12.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to suspending the pain management rules adopted pursuant to chapter 209, Laws of 2010; amending RCW 18.22.240, 18.32.785, 18.57.285, 18.57A.090, 18.71.450, 18.71A.100, and 18.79.400; and declaring an emergency.

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

Sec. 1   RCW 18.22.240 and 2010 c 209 s 1 are each amended 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.
     (5) The board shall suspend, and may not enforce, the rules adopted under subsection (2) of this section for a period of three years following the effective date of this section.

Sec. 2   RCW 18.32.785 and 2010 c 209 s 2 are each amended 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.
     (4) The commission shall suspend, and may not enforce, the rules adopted under this section for a period of three years following the effective date of this section.

Sec. 3   RCW 18.57.285 and 2010 c 209 s 3 are each amended 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.
     (5) The board shall suspend, and may not enforce, the rules adopted under subsection (2) of this section for a period of three years following the effective date of this section.

Sec. 4   RCW 18.57A.090 and 2010 c 209 s 4 are each amended 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.
     (5) The board shall suspend, and may not enforce, the rules adopted under subsection (2) of this section for a period of three years following the effective date of this section.

Sec. 5   RCW 18.71.450 and 2010 c 209 s 5 are each amended 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.
     (4) The commission shall suspend, and may not enforce, the rules adopted under subsection (2) of this section for a period of three years following the effective date of this section.

Sec. 6   RCW 18.71A.100 and 2010 c 209 s 6 are each amended 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.
     (4) The commission shall suspend, and may not enforce, the rules adopted under this section for a period of three years following the effective date of this section.

Sec. 7   RCW 18.79.400 and 2010 c 209 s 7 are each amended 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.
     (4) The commission shall suspend, and may not enforce, the rules adopted under this section for a period of three years following the effective date of this section.

NEW SECTION.  Sec. 8   This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately.