Commerce, Occupational and Professional Licensing

Rule R156-1

General Rule of the Division of Occupational and Professional Licensing

Notice of Proposed Rule

(Amendment)

DAR File No.: 33227
Filed: 12/01/2009 10:22:05 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this filing is to recodify the existing rule governing limited online prescribing as permitted under Subsection 58-1-501(4) from existing Rule R156-1 to the new Rule R156-1a. (DAR NOTE: The proposed new Rule R156-1a is under DAR No. 33228 in this issue, December 15, 2009, of the Bulletin.)

Summary of the rule or change:

In Subsection R156-1-102(3), the definition of "branching questionnaire" is deleted and the remaining subsections are renumbered. The definition will now appear in the new Rule R156-1a. Also throughout Section R156-1-102, the term "division" has been capitalized where appropriate. Section R156-601 which addresses online assessment, diagnosis, and prescribing protocols is deleted and will now appear in the new Rule R156-1a.

State statutory or constitutional authorization for this rule:

• Section 58-1-308
• Subsection 58-1-106(1)(a)
• Subsection 58-1-501(4)

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs of approximately $50 to print and distribute the rule once the proposed amendments are made effective. Any costs incurred will be absorbed in the Division's current budget. The Division is already regulating the practice of limited online prescribing so the costs of this recodification should not be significant to the state budget. The recodification of the rule simply better defines the method of regulation. Initial applications for limited online prescribing permits are estimated to be ten or fewer with a review process that should be better defined and easier as compared to the former negotiation process of the loosely defined consent agreements, thus resulting in some cost savings that cannot be quantified. Primary professional licenses will have to be reprinted and mailed at a nominal cost.

local governments:

The proposed amendments only apply to companies or practitioners applying for limited online prescribing permits. As a result, the proposed amendments do not apply to local governments.

small businesses:

The proposed amendments only apply to companies or practitioners applying for limited online prescribing permits. Such companies may or may not qualify as a small business. The impact on small businesses is impossible to quantify. The rule codifies existing practice in large part and therefore is not expected to be unduly burdensome and provides an enhanced business opportunity for limited online prescribing permit practitioners and their Internet facilitators and contractual pharmacies.

persons other than small businesses, businesses, or local governmental entities:

The rule codifies existing practice in large part and therefore the compliance costs are not expected to be unduly burdensome to limited online prescribing permit practitioners and their Internet facilitators and contractual pharmacies. This rule will likely result in a wider availability, as well as a cost savings to consumers who choose to use the services of a limited online prescribing permit practitioner.

Compliance costs for affected persons:

Any compliance costs for individuals is impossible to quantify. The rule codifies existing practice in large part and therefore the compliance costs are not expected to be unduly burdensome to limited online prescribing permit practitioners and their Internet facilitators and contractual pharmacies. This rule will likely result in a wider availability as well as a cost savings to consumers who choose to use the services of a limited online prescribing permit practitioner.

Comments by the department head on the fiscal impact the rule may have on businesses:

No fiscal impact to businesses is anticipated beyond those addressed in detail in the rule summary.

Francine A. Giani, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
160 E 300 S
SALT LAKE CITY, UT 84111-2316

Direct questions regarding this rule to:

• Mark Steinagel at the above address, by phone at 801-530-6292, by FAX at 801-530-6511, or by Internet E-mail at msteinagel@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/14/2010

Interested persons may attend a public hearing regarding this rule:

• 01/11/2010 09:00 AM, Heber Wells Bldg, 160 E 300 S, Conference Room 474 (fourth floor), Salt Lake City, UT

This rule may become effective on:

01/21/2010

Authorized by:

Mark Steinagel, Director

R156. Commerce, Occupational and Professional Licensing.

R156-1. General Rule of the Division of Occupational and Professional Licensing.

R156-1-102. Definitions.

In addition to the definitions in Title 58, as used in Title 58 or this rule:

(1) "Active and in good standing" means a licensure status which allows the licensee full privileges to engage in the practice of the occupation or profession subject to the scope of the licensee's license classification.

(2) "Aggravating circumstances" means any consideration or factors that may justify an increase in the severity of an action to be imposed upon an applicant or licensee. Aggravating circumstances include:

(a) prior record of disciplinary action, unlawful conduct, or unprofessional conduct;

(b) dishonest or selfish motive;

(c) pattern of misconduct;

(d) multiple offenses;

(e) obstruction of the disciplinary process by intentionally failing to comply with rules or orders of the Division;

(f) submission of false evidence, false statements or other deceptive practices during the disciplinary process including creating, destroying or altering records after an investigation has begun;

(g) refusal to acknowledge the wrongful nature of the misconduct involved, either to the client or to the Division;

(h) vulnerability of the victim;

(i) lack of good faith to make restitution or to rectify the consequences of the misconduct involved;

(j) illegal conduct, including the use of controlled substances; and

(k) intimidation or threats of withholding clients' records or other detrimental consequences if the client reports or testifies regarding the unprofessional or unlawful conduct.

(3) ["Branching questionnaire", as used in Section R156-1-601, means an adaptive, progressive inquiry used by a physician to determine a health history and assessment, and serves as the basis for a diagnosis.

(4)] "Cancel" or "cancellation" means nondisciplinary action by the [d]Division to rescind, repeal, annul, or void a license issued in error. Such action includes rescinding a license issued to an applicant whose payment of the required application fee is dishonored when presented for payment, or who has been issued a conditional license pending a criminal background check and the check cannot be completed due to the applicant's failure to resolve an outstanding warrant or to submit acceptable fingerprint cards.

([5]4) "Charges" means the acts or omissions alleged to constitute either unprofessional or unlawful conduct or both by a licensee, which serve as the basis to consider a licensee for inclusion in the diversion program authorized in Section 58-1-404.

([6]5) "Denial of licensure" means action by the [d]Division refusing to issue a license to an applicant for initial licensure, renewal of licensure, reinstatement of licensure or relicensure.

([7]6) "Disciplinary action" means adverse licensure action by the [d]Division under the authority of Subsections 58-1-401(2)(a) through (2)(b).

([8]7) "Diversion agreement" means a formal written agreement between a licensee, the [d]Division, and a diversion committee, outlining the terms and conditions with which a licensee must comply as a condition of entering in and remaining under the diversion program authorized in Section 58-1-404.

([9]8) "Diversion committees" mean diversion advisory committees authorized by Subsection 58-1-404(2)(a)(i) and created under Subsection R156-1-404a.

([10]9) "Duplicate license" means a license reissued to replace a license which has been lost, stolen, or mutilated.

([11]10) "Emergency review committees" mean emergency adjudicative proceedings review committees created by the [d]Division under the authority of Subsection 58-1-108(2).

([12]11) "Expire" or "expiration" means the automatic termination of a license which occurs:

(a) at the expiration date shown upon a license if the licensee fails to renew the license before the expiration date; or

(b) prior to the expiration date shown on the license:

(i) upon the death of a licensee who is a natural person;

(ii) upon the dissolution of a licensee who is a partnership, corporation, or other business entity; or

(iii) upon the issuance of a new license which supersedes an old license, including a license which:

(A) replaces a temporary license;

(B) replaces a student or other interim license which is limited to one or more renewals or other renewal limitation; or

(C) is issued to a licensee in an upgraded classification permitting the licensee to engage in a broader scope of practice in the licensed occupation or profession.

([13]12) "Inactive" or "inactivation" means action by the [d]Division to place a license on inactive status in accordance with Sections 58-1-305 and R156-1-305.

([14]13) "Investigative subpoena authority" means, except as otherwise specified in writing by the director, the [d]Division regulatory and compliance officer, or if the [d]Division regulatory and compliance officer is unable to so serve for any reason, a bureau manager designated by the regulatory and compliance officer, or if both the [d]Division regulatory and compliance officer and the designated bureau manager are unable to so serve for any reason, a department administrative law judge.

([15]14) "License" means a right or privilege to engage in the practice of a regulated occupation or profession as a licensee.

([16]15) "Limit" or "limitation" means nondisciplinary action placing either terms and conditions or restrictions or both upon a license:

(a) issued to an applicant for initial licensure, renewal or reinstatement of licensure, or relicensure; or

(b) issued to a licensee in place of the licensee's current license or disciplinary status.

([17]16) "Mitigating circumstances" means any consideration or factors that may justify a reduction in the severity of an action to be imposed upon an applicant or licensee.

(a) Mitigating circumstances include:

(i) absence of prior record of disciplinary action, unlawful conduct or unprofessional conduct;

(ii) absence of dishonest or selfish motive;

(iii) personal, mental or emotional problems provided such problems have not posed a risk to the health, safety or welfare of the public or clients served such as drug or alcohol abuse while engaged in work situations or similar situations where the licensee or applicant should know that they should refrain from engaging in activities that may pose such a risk;

(iv) timely and good faith effort to make restitution or rectify the consequences of the misconduct involved;

(v) full and free disclosure to the client or Division prior to the discovery of any misconduct;

(vi) inexperience in the practice of the occupation and profession provided such inexperience is not the result of failure to obtain appropriate education or consultation that the applicant or licensee should have known they should obtain prior to beginning work on a particular matter;

(vii) imposition of other penalties or sanctions; and

(viii) remorse.

(b) The following factors should not be considered as mitigating circumstances:

(i) forced or compelled restitution;

(ii) withdrawal of complaint by client or other affected persons;

(iii) resignation prior to disciplinary proceedings;

(iv) failure of injured client to complain; and

(v) complainant's recommendation as to sanction.

([18]17) "Nondisciplinary action" means adverse licensure action by the [d]Division under the authority of Subsections 58-1-401(1) or 58-1-401(2)(c) through (2)(d).

([19]18) "Peer committees" mean advisory peer committees to boards created by the legislature in Title 58 or by the [d]Division under the authority of Subsection 58-1-203(1)(f).

([20]19) "Private reprimand" means disciplinary action to formally reprove or censure a licensee for unprofessional or unlawful conduct, with the documentation of the action being classified as a private record.

([21]20) "Probation" means disciplinary action placing terms and conditions upon a license;

(a) issued to an applicant for initial licensure, renewal or reinstatement of licensure, or relicensure; or

(b) issued to a licensee in place of the licensee's current license or disciplinary status.

([22]21) "Public reprimand" means disciplinary action to formally reprove or censure a licensee for unprofessional or unlawful conduct, with the documentation of the action being classified as a public record.

([23]22) "Regulatory authority" as used in Subsection 58-1-501(2)(d) means any governmental entity who licenses, certifies, registers, or otherwise regulates persons subject to its jurisdiction, or who grants the right to practice before or otherwise do business with the governmental entity.

([24]23) "Reinstate" or "reinstatement" means to activate an expired license or to restore a license which is restricted, as defined in Subsection (26)(b), or is suspended, or placed on probation, to a lesser restrictive license or an active in good standing license.

([25]24) "Relicense" or "relicensure" means to license an applicant who has previously been revoked or has previously surrendered a license.

([26]25) "Remove or modify restrictions" means to remove or modify restrictions, as defined in Subsection (26)(a), placed on a license issued to an applicant for licensure.

([27]26) "Restrict" or "restriction" means disciplinary action qualifying or limiting the scope of a license:

(a) issued to an applicant for initial licensure, renewal or reinstatement of licensure, or relicensure in accordance with Section 58-1-304; or

(b) issued to a licensee in place of the licensee's current license or disciplinary status.

([28]27) "Revoke" or "revocation" means disciplinary action by the [d]Division extinguishing a license.

([29]28) "Suspend" or "suspension" means disciplinary action by the [d]Division removing the right to use a license for a period of time or indefinitely as indicated in the disciplinary order, with the possibility of subsequent reinstatement of the right to use the license.

([30]29) "Surrender" means voluntary action by a licensee giving back or returning to the [d]Division in accordance with Section 58-1-306, all rights and privileges associated with a license issued to the licensee.

([31]30) "Temporary license" or "temporary licensure" means a license issued by the [d]Division on a temporary basis to an applicant for initial licensure, renewal or reinstatement of licensure, or relicensure in accordance with Section 58-1-303.

([32]31) "Unprofessional conduct" as defined in Title 58 is further defined, in accordance with Subsection 58-1-203(1)(e), in Section R156-1-502.

([33]32) "Warning or final disposition letters which do not constitute disciplinary action" as used in Subsection 58-1-108(3) mean letters which do not contain findings of fact or conclusions of law and do not constitute a reprimand, but which may address any or all of the following:

(a) [d]Division concerns;

(b) allegations upon which those concerns are based;

(c) potential for administrative or judicial action; and

(d) disposition of [d]Division concerns.

 

[R156-1-601. Online Assessment, Diagnosis and Prescribing Protocols.

(1) In accordance with Subsection 58-1-501(4), a person licensed to prescribe under this title may prescribe legend drugs to a person located in this state following an online assessment and diagnosis in accordance with the following conditions:

(a) the prescribing practitioner is licensed in good standing in this state;

(b) an assessment and diagnosis is based upon a comprehensive health history and an assessment tool that requires the patient to provide answers to all the required questions and does not rely upon default answers, such as a branching questionnaire;

(c) only includes legend drugs and may not include controlled substances;

(d) the practice is authorized by this rule and a written agreement signed by the Division and the practitioner and approved by a panel comprised of three board members from the Physicians Licensing Board or the Osteopathic Physician and Surgeon's Licensing Board and three members from the Utah State Board of Pharmacy. The written agreement shall include:

(i) the specific name of the drug or drugs approved to be prescribed;

(ii) the policies and procedures that address patient confidentiality;

(iii) a method for electronic communication by the physician and patient;

(iv) a mechanism for the Division to be able to conduct audits of the website and records to ensure an assessment and diagnosis has been made prior to prescribing any medications; and

(v) a mechanism for the physician to have ready access to all patients' records.

 

] KEY: diversion programs, licensing, occupational licensing, supervision

Date of Enactment or Last Substantive Amendment: [August 10, 2009]2010

Notice of Continuation: March 1, 2007

Authorizing, and Implemented or Interpreted Law: 58-1-106(1)(a); 58-1-308; 58-1-501(4)