DAR File No. 40864

Commerce, Occupational and Professional Licensing

Rule R156-67

Utah Medical Practice Act Rule

Notice of Proposed Rule

(Amendment)

DAR File No.: 40864
Filed: 10/11/2016 10:14:52 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

H.B. 240, passed by the legislature during the 2016 General Session, made changes to the newly defined Opiate Overdose Response Act, Title 26, Chapter 55, and to the Utah Medical Practice Act, Title 58, Chapter 67. These changes permit physicians to issue a standing order for the dispensing of an opiate antagonist by pharmacists and require the Division to promulgate rules to address the standing order and the requirements for dispensing. The Division is filing this rule to accomplish that mandate.

Summary of the rule or change:

Subsection R156-67-502(16) is added to establish that failing to submit an annual report as required in Section R156-67-604 is unprofessional conduct. New Section R156-67-604 is enacted because newly enacted Subsection 26-55-105(2)(c) requires physicians to review at least annually the dispensing practices of those the physician has authorized to dispense an opiate antagonist pursuant to a standing order. This new section requires the physician to submit an annual written report to the Division to indicate that the physician has done so.

Statutory or constitutional authorization for this rule:

• Section 58-67-101
• Subsection 58-1-106(1)
• Subsection 58-1-202(1)

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs of approximately $75 to print and distribute the rule once the proposed amendments are made effective.

local governments:

The proposed amendments only apply to licensed physicians and surgeons who choose to issue a standing order for dispensing an opiate antagonist. If a local government employs a physician or surgeon who issues a standing order for dispensing an opiate antagonist, then these reporting requirements may translate into a loss of employee services and loss of income relative to the time required for the physician or surgeon to review and report the required information. However, whether or not a physician or surgeon is employed by a local government, a standing order may result in saving the life of one or more residents within the local government's jurisdiction, which may translate into cost savings and enhanced health services to the community impacted by the opioid overdose crisis. The Division is not able to determine any exact amount of costs or savings due to varying circumstances.

small businesses:

Physicians and surgeons who own or operate a small business, and who choose to issue a standing order for dispensing an opiate antagonist, will be impacted by using some of their time to comply with these reporting requirements. This may translate into a loss of income relative to the time required for reviewing and reporting. The Division is not able to determine any exact amount of costs due to varying circumstances.

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

Physicians and surgeons who issue standing orders for dispensing opiate antagonists will be impacted by using some of their time to comply with these review and reporting requirements. This may translate into a loss of income relative to the time required for reviewing and reporting. One or more persons may have their lives saved due to the overdose-reversing effects of prescriptions issued pursuant to these standing orders. This may translate into a cost savings for those persons as well as for their friends and family. The Division is not able to determine any exact amount of costs or savings due to varying circumstances.

Compliance costs for affected persons:

Physicians or surgeons who choose to issue a standing order for dispensing an opiate antagonist will be impacted by using some of their time to comply with these review and reporting requirements. This may translate into a loss of income relative to the time required for reviewing and reporting. The Division is not able to determine any exact amount of costs or savings due to varying circumstances.

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

Physicians who own or operate a small business and who choose to issue a standing order for dispensing an opiate antagonist will be impacted by using some of their time to comply with these report requirements. This may translate into a loss of income relative to the time required for reviewing and reporting. These costs may vary depending on the number of persons the physician has authorized to dispense the opiate antagonist. Because the report is only made annually, the anticipated cost is negligible.

Francine A. Giani, Executive Director

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

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

Direct questions regarding this rule to:

• Larry Marx at the above address, by phone at 801-530-6254, by FAX at 801-530-6511, or by Internet E-mail at lmarx@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:

12/01/2016

Interested persons may attend a public hearing regarding this rule:

• 11/17/2016 11:00 AM, Heber Wells Bldg, 160 E 300 S, Hearing Room 403 (fourth floor), Salt Lake City, UT

This rule may become effective on:

12/08/2016

Authorized by:

Mark Steinagel, Director

R156. Commerce, Occupational and Professional Licensing.

R156-67. Utah Medical Practice Act Rule.

R156-67-502. Unprofessional Conduct.

"Unprofessional conduct" includes:

(1) prescribing for oneself any Schedule II or III controlled substance; however, nothing in this rule shall be interpreted by the division or the board to prevent a licensee from using, possessing or administering to himself a Schedule II or III controlled substance which was legally prescribed for him by a licensed practitioner acting within his scope of licensure when it is used in accordance with the prescription order and for the use for which it was intended;

(2) knowingly prescribing, selling, giving away or administering, directly or indirectly, or offering to prescribe, sell, furnish, give away or administer any scheduled controlled substance as defined in Title 58, Chapter 37 to a drug dependent person, as defined in Subsection 58-37-2(s) unless permitted by law and when it is prescribed, dispensed or administered according to a proper medical diagnosis and for a condition indicating the use of that controlled substance is appropriate;

(3) knowingly engaging in billing practices which are abusive and represent charges which are grossly excessive for services rendered;

(4) directly or indirectly giving or receiving any fee, commission, rebate or other compensation for professional services not actually and personally rendered or supervised; however, nothing in this section shall preclude the legal relationships within lawful professional partnerships, corporations or associations or the relationship between an approved supervising physician and physician assistants or advanced practice nurses supervised by them;

(5) knowingly failing to transfer a copy of pertinent and necessary medical records or a summary thereof to another physician when requested to do so by the subject patient or by his legally designated representative;

(6) failing to furnish to the board information requested by the board which is known by a licensee with respect to the quality and adequacy of medical care rendered to patients by physicians licensed under the Medical Practice Act;

(7) failing as an operating surgeon to perform adequate pre-operative and primary post-operative care of the surgical condition for a patient in accordance with the standards and ethics of the profession or to arrange for competent primary post-operative care of the surgical condition by a licensed physician and surgeon who is equally qualified to provide that care;

(8) billing a global fee for a procedure without providing the requisite care;

(9) supervising the providing of breast screening by diagnostic mammography services or interpreting the results of breast screening by diagnostic mammography to or for the benefit of any patient without having current certification or current eligibility for certification by the American Board of Radiology. However, nothing in this subsection shall be interpreted to prevent a licensed physician and surgeon from reviewing the results of any breast screening by diagnostic mammography procedure upon a patient for the purpose of considering those results in determining appropriate care and treatment of that patient if the results are interpreted by a physician and surgeon qualified under this subsection and a timely written report is prepared by the interpreting physician and surgeon in accordance with the standards and ethics of the profession;

(10) failing of a licensee under Title 58, Chapter 67, without just cause to repay as agreed any loan or other repayment obligation legally incurred by the licensee to fund the licensee's education or training as a medical doctor;

(11) failing of a licensee under Title 58, Chapter 67, without just cause to comply with the terms of any written agreement in which the licensee's education or training as a medical doctor is funded in consideration for the licensee's agreement to practice in a certain locality or type of locality or to comply with other conditions of practice following licensure;

(12) a physician providing services to a department of health by participating in a system under which the physician provides the department with completed and signed prescriptions without the name and address of the patient, or date the prescription is provided to the patient when the prescription form is to be completed by authorized registered nurses employed by the department of health which services are not in accordance with the provisions of Section 58-17a-620;

(13) failing to keep the division informed of a current address and telephone number;

(14) engaging in alternate medical practice except as provided in Section R156-67-603;[ and]

(15) violation of any provision of the American Medical Association (AMA) "Code of Medical Ethics", 2012-2013 edition, which is hereby incorporated by reference; and

(16) failing to timely submit an annual written report to the division indicating that the physician has reviewed at least annually the dispensing practices of those authorized by the physician to dispense an opiate antagonist pursuant to Section R156-67-604.

 

R156-67-604. Required Reporting of Annual Review of Physician of Dispensing Practices of Those Authorized to Dispense an Opiate Antagonist.

(1) In accordance with Subsection 26-55-105(2)(c), a physician who issues a standing prescription drug order authorizing the dispensing of an opiate antagonist shall annually submit a written report to the division indicating that he has reviewed at least annually the dispensing practices of those authorized by the physician to dispense the opiate antagonist.

(2) The report described above shall be submitted no later than January 31 of each calendar year and shall continue as long as the standing order remains in effect. Null reporting is not required.

(3) A physician shall be considered to have satisfactorily reviewed the dispensing practices of those authorized by the physician to dispense the opiate antagonist by reviewing the report of the licensee dispensing the opiate antagonist specified in Subsection R156-17b-625(1).

 

KEY: physicians, licensing

Date of Enactment or Last Substantive Amendment: [August 21, 2014]2016

Notice of Continuation: February 8, 2016

Authorizing, and Implemented or Interpreted Law: 58-67-101; 58-1-106(1)[(a)]; 58-1-202(1)[(a)]