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LEGISLATURE OF NEBRASKA
ONE HUNDRED SIXTH LEGISLATURE
FIRST SESSION
LEGISLATIVE BILL 556
Approved by the Governor May 01, 2019
Introduced by Howard, 9; Lindstrom, 18; Briese, 41.
.
Read first time January 22, 2019
Committee:
1 A BILL FOR AN ACT relating to the prescription drugs;drug monitoring program;
2 to amend section 71-2454,
Reissue Revised Statutes of Nebraska, and sections 28-473, 28-474, and
38-101, Revised Statutes Cumulative Supplement, 2018; to transfer
provisions to the Uniform Credentialing Act; to change duties for
practitioners related to certain prescriptions; to exempt certain
prescriptions from requirements; to
3 change provisions relating to the
program purposes, reporting,
4 prescription drug monitoring program;information, disclosure, and user access as prescribed;
5 to provide duties; to define and redefine terms; to
eliminate obsolete provisions; to harmonize
6 provisions; to repeal the
original sectionssection; and to declare an
7 emergency.
8 Be it enacted by the people of the State of Nebraska,
Section 1. Section 38-101, Revised Statutes Cumulative Supplement, 2018,
is amended to read:
38-101 Sections 38-101 to 38-1,142 and sections 2 and 3 of this act and
the following practice acts shall be known and may be cited as the Uniform
Credentialing Act:
(1) The Advanced Practice Registered Nurse Practice Act;
(2) The Alcohol and Drug Counseling Practice Act;
(3) The Athletic Training Practice Act;
(4) The Audiology and Speech-Language Pathology Practice Act;
(5) The Certified Nurse Midwifery Practice Act;
(6) The Certified Registered Nurse Anesthetist Practice Act;
(7) The Chiropractic Practice Act;
(8) The Clinical Nurse Specialist Practice Act;
(9) The Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art
Practice Act;
(10) The Dentistry Practice Act;
(11) The Dialysis Patient Care Technician Registration Act;
(12) The Emergency Medical Services Practice Act;
(13) The Environmental Health Specialists Practice Act;
(14) The Funeral Directing and Embalming Practice Act;
(15) The Genetic Counseling Practice Act;
(16) The Hearing Instrument Specialists Practice Act;
(17) The Licensed Practical Nurse-Certified Practice Act until November 1,
2017;
(18) The Massage Therapy Practice Act;
(19) The Medical Nutrition Therapy Practice Act;
(20) The Medical Radiography Practice Act;
(21) The Medicine and Surgery Practice Act;
(22) The Mental Health Practice Act;
(23) The Nurse Practice Act;
(24) The Nurse Practitioner Practice Act;
(25) The Nursing Home Administrator Practice Act;
(26) The Occupational Therapy Practice Act;
(27) The Optometry Practice Act;
(28) The Perfusion Practice Act;
(29) The Pharmacy Practice Act;
(30) The Physical Therapy Practice Act;
(31) The Podiatry Practice Act;
(32) The Psychology Practice Act;
(33) The Respiratory Care Practice Act;
(34) The Surgical First Assistant Practice Act;
(35) The Veterinary Medicine and Surgery Practice Act; and
(36) The Water Well Standards and Contractors' Practice Act.
If there is any conflict between any provision of sections 38-101 to
38-1,142 and sections 2 and 3 of this act and any provision of a practice act,
the provision of the practice act shall prevail.
The Revisor of Statutes shall assign the Uniform Credentialing Act,
including the practice acts enumerated in subdivisions (1) through (35) of this
section, to articles within Chapter 38.
Sec. 2. Section 28-473, Revised Statutes Cumulative Supplement, 2018, is
amended to read:
28-473 (1) For purposes of this section, practitioner means a physician, a
physician assistant, a dentist, a pharmacist, a podiatrist, an optometrist, a
certified nurse midwife, a certified registered nurse anesthetist, and a nurse
practitioner.
(2) (1) When prescribing a controlled substance listed in Schedule II of
section 28-405 or any other opiate as defined in section 28-401 not listed in
Schedule II, prior to issuing the practitioner's initial prescription for a
course of treatment for acute or chronic pain and again prior to the
practitioner's third prescription for such course of treatment, a practitioner
involved in the course of treatment as the primary prescribing practitioner or
as a member of the patient's care team who is under the direct supervision or
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in consultation with the primary prescribing practitioner shall discuss with
the patient, or the patient's parent or guardian if the patient is younger than
eighteen years of age and is not emancipated, unless the discussion has already
occurred with another member of the patient's care team within the previous
sixty days:
(a) The risks of addiction and overdose associated with the controlled
substance or opiate being prescribed, including, but not limited to:
(i) Controlled substances and opiates are highly addictive even when taken
as prescribed;
(ii) There is a risk of developing a physical or psychological dependence
on the controlled substance or opiate; and
(iii) Taking more controlled substances or opiates than prescribed, or
mixing sedatives, benzodiazepines, or alcohol with controlled substances or
opiates, can result in fatal respiratory depression;
(b) The reasons why the prescription is necessary; and
(c) Alternative treatments that may be available.
(3) This section does not apply to a prescription for a hospice patient or
for a course of treatment for cancer or palliative care.
(4) (2) This section terminates on January 1, 2029.
Sec. 3. Section 28-474, Revised Statutes Cumulative Supplement, 2018, is
amended to read:
28-474 (1) For purposes of this section, practitioner means a physician, a
physician assistant, a dentist, a pharmacist, a podiatrist, an optometrist, a
certified nurse midwife, a certified registered nurse anesthetist, and a nurse
practitioner.
(2) (1) The Legislature finds that:
(a) In most cases, acute pain can be treated effectively with nonopiate or
nonpharmacological options;
(b) With a more severe or acute injury, short-term use of opiates may be
appropriate;
(c) Initial opiate prescriptions for children should not exceed seven days
for most situations, and two or three days of opiates will often be sufficient;
(d) If a patient needs medication beyond three days, the prescriber should
reevaluate the patient prior to issuing another prescription for opiates; and
(e) Physical dependence on opiates can occur within only a few weeks of
continuous use, so great caution needs to be exercised during this critical
recovery period.
(3) (2) A practitioner who is prescribing an opiate as defined in section
28-401 for a patient younger than eighteen years of age for outpatient use for
an acute condition shall not prescribe more than a seven-day supply except as
otherwise provided in subsection (4) (3) of this section and, if the
practitioner has not previously prescribed an opiate for such patient, shall
discuss with a parent or guardian of such patient, or with the patient if the
patient is an emancipated minor, the risks associated with use of opiates and
the reasons why the prescription is necessary.
(4) (3) If, in the professional medical judgment of the practitioner, more
than a seven-day supply of an opiate is required to treat such patient's
medical condition or is necessary for the treatment of pain associated with a
cancer diagnosis or for palliative care, the practitioner may issue a
prescription for the quantity needed to treat such patient's medical condition
or pain. The practitioner shall document the medical condition triggering the
prescription of more than a seven-day supply of an opiate in the patient's
medical record and shall indicate that a nonopiate alternative was not
appropriate to address the medical condition.
(5) (4) This section does not apply to controlled substances prescribed
pursuant to section 28-412.
(6) (5) This section terminates on January 1, 2029.
Sec. 4. Section 71-2454, Reissue Revised Statutes of Nebraska, is
2 amended
to read:
3 71-2454 (1) An entity described in section 71-2455 shall establish a
4 system of prescription drug monitoring for the purposes of (a) preventing
5 the
misuse of controlled substances that are prescribed, and (b) allowing
6 prescribers and dispensers to monitor the care and treatment of patients
7 for
whom such a prescription drug is prescribed to ensure that such
8 prescription
drugs are used for medically appropriate purposes, (c)
9 providing information to
improve the health and safety of patients, and
10 (d) ensuring and that the State
of Nebraska remains on the cutting edge
11 of medical information technology.
12 (2) Such system of prescription drug monitoring shall be implemented
13 as
follows: Except as provided in subsection (4) of this section,
14 beginning
January 1, 2017, all dispensed prescriptions of controlled
15 substances shall be
reported; and beginning January 1, 2018, all
16 prescription drug information
shall be reported to the prescription drug
17 monitoring system. The prescription
drug monitoring system shall include,
18 but not be limited to, provisions that:
19 (a) Prohibit any patient from opting out of the prescription drug
20 monitoring system;
21 (b) Require any prescription drug that is all prescriptions
22 dispensed in
this state or to an address in this state to be entered into
23 the system by the
dispenser or his or her designee daily after such
24 prescription drug is
dispensed, including prescription drugs those for
25 patients paying cash for such
prescription drug or otherwise not relying
26 on a third-party payor for payment
for the prescription drug;
27 (c) Allow all prescribers or dispensers of prescription drugs to
28 access
the system at no cost to such prescriber or dispenser;
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29 (d) Ensure that such system includes information relating to all
30 payors,
including, but not limited to, the medical assistance program
31 established
pursuant to the Medical Assistance Act; and
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1 (e) Make the prescription drug information available to the
2 statewide
health information exchange described in section 71-2455 for
3 access by its
participants if such access is in compliance with the
4 privacy and security
protections set forth in the provisions of the
5 federal Health Insurance
Portability and Accountability Act of 1996,
6 Public Law 104-191, and regulations
promulgated thereunder, except that
7 if a patient opts out of the statewide
health information exchange, the
8 prescription drug information regarding that
patient shall not be
9 accessible by the participants in the statewide health
information
10 exchange.
11 Dispensers may begin on February 25, 2016, to report dispensing of
12 prescriptions to the entity described in section 71-2455 which is
13 responsible
for establishing the system of prescription drug monitoring.
14 (3) Except as provided in subsection (4) of this section,
15 prescription
drug information that shall be submitted electronically to
16 the prescription
drug monitoring system shall be determined by the entity
17 described in section
71-2455 and shall include, but not be limited to:
18 (a) The patient's name, address, telephone number, if a telephone number
is available, gender, and date
19 of birth;
20 (b) A patient identifier such as a military identification number,
21 driver's license number, state identification card number, social
22 security number, or other valid
government-issued identification number,
23 insurance identification number,
pharmacy software-generated patient-
24 specific identifier, or other identifier
associated specifically with the
25 patient;
26 (c) (b) The name and address of the pharmacy dispensing the
27 prescription
drug;
28 (d) (c) The date the prescription is issued;
29 (e) (d) The date the prescription is filled;
30 (f) The number of refills authorized;
31 (g) (e) The prescription number name of the prescription drug;
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1 dispensed
;
2 (h) The or the National Drug Code number as published by the federal
3 Food
and Drug Administration of the prescription drug dispensed;
4 (i) (f) The strength of the prescription drug prescribed;
5 (j) (g) The quantity of the prescription drug prescribed and the
6 number of
days' supply; and
7 (k) The prescription directions, if available to be reported, in
8 accordance with the American Society for Automation in Pharmacy version
9 4.2A format;
10 (l) (h) The prescriber's name and National Provider Identifier
11 number or
Drug Enforcement Administration number when reporting a
12 controlled substance.
; and .
13 (m) Any other information as required by the Dispenser's
14 Implementation Guide for the prescription drug monitoring program
15 developed by the statewide health information exchange described in
16 section 71-2455 in collaboration with the department.
17 (4) Beginning July 1, 2018, a veterinarian licensed under the
18 Veterinary
Medicine and Surgery Practice Act shall be required to report
19 the dispensing of
a dispensed prescription drugs which are of controlled
20 substances listed on
Schedule II, Schedule III, Schedule IV, or Schedule
21 V IV pursuant to section
28-405. Each such veterinarian shall indicate
22 that the prescription is an
animal prescription and shall include the
23 following information in such report:
24 (a) The first and last name and address, including city, state, and
25 zip
code, of the individual to whom the prescription drug is dispensed in
26 accordance with a valid veterinarian-client-patient relationship;
27 (b) Reporting status;
28 (c) The first and last name of the prescribing veterinarian and his
29 or her
federal Drug Enforcement Administration number;
30 (d) The National Drug Code number as published by the federal Food and
Drug Administration name of the prescription drug dispensed and the
prescription
31 number;
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1 (e) The date the prescription is written and the date the
2 prescription is
filled;
3 (f) The number of refills authorized, if any; and
4 (g) The quantity of the prescription drug dispensed and the number
5 of
days' supply.
6 (5)(a) All prescription drug information submitted pursuant to this
7 section, all data contained in the prescription drug monitoring system,
8 and any
report obtained from data contained in the prescription drug
9 monitoring system
are confidential, are privileged, are not public
10 records, and may be withheld
pursuant to section 84-712.05 except for information released as provided in
subsection (9) of this section.
.
11 (b) No patient-identifying data as defined in section 81-664,
12 including
the data collected under subsection (3) of this section, shall
13 be disclosed,
made public, or released to any public or private person or
14 entity except to
the statewide health information exchange described in
15 section 71-2455 and its
participants, and to prescribers and dispensers
16 as provided in subsection (2)
of this section, or as provided in
17 subsection (7) of this section.
18 (c) All other data is for the confidential use of the department and the
statewide health information exchange described in section 71-2455 and its
participants. The department, or
19 the statewide health information exchange in
collaboration with the described in section 71-2455
20 and its participants. The department, or the statewide health information
21 exchange may release such information as Class I,
Class II, or Class IV
22 data in accordance with section 81-667 to the private or
public persons
23 or entities that the department determines may view such records
as
24 provided in sections 81-663 to 81-675. In addition, the department, or the
statewide health information exchange in collaboration with the department, may
release such information as provided in subsection (9) of this section.
(6) The
25 statewide health information exchange may release such information as
26 provided in subsection (9) of this section.
27 (6) The statewide health information exchange described in section
28 71-2455, in collaboration with the department, shall establish the
29 minimum
administrative, physical, and technical safeguards necessary to
30 protect the
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confidentiality, integrity, and availability of prescription
31 drug information.
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1 (7) If the entity receiving the prescription drug information has
2 privacy
protections at least as restrictive as those set forth in this
3 section and has
implemented and maintains the minimum safeguards required
4 by subsection (6) of
this section, the statewide health information
5 exchange described in section
71-2455, in collaboration with the
6 department, may release the prescription
drug information and any other
7 data collected pursuant to this section to:
8 (a) Other state prescription drug monitoring programs;
9 (b) State and regional health information exchanges;
10 (c) The medical director and pharmacy director of the Division of
11 Medicaid
and Long-Term Care of the department, or theirhis or her designees;
12 (d) The medical directors and pharmacy directors of medicaid-managed
13 care
entities, the state's medicaid drug utilization review board, and
14 any other
state-administered health insurance program or its designee if
15 any such
entities have a current data-sharing agreement with the
16 statewide health
information exchange described in section 71-2455, and
17 if such release is in
accordance with the privacy and security provisions
18 of the federal Health
Insurance Portability and Accountability Act of
19 1996, Public Law 104-191, and
all regulations promulgated thereunder;
20 (e) Organizations which facilitate the interoperability and mutual
21 exchange of information among state prescription drug monitoring programs
22 or
state or regional health information exchanges; or
23 (f) Electronic health record systems or pharmacy-dispensing software
24 systems for the purpose of integrating prescription drug information into
25 a
patient's medical record.
26 (8) The statewide health information exchange described in section
27 71-2455, in collaboration with the department, may release to patients
28 their
prescription drug information collected pursuant to this section.
29 Upon request
of the patient, such information may be released directly to
30 the patient or a
personal health record system designated by the patient
31 which has privacy
protections at least as restrictive as those set forth
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1 in this section and that
has implemented and maintains the minimum
2 safeguards required by subsection (6)
of this section.
(9) The department, or the statewide health information exchange described
in section 71-2455 in collaboration with the department, may release data
collected pursuant to this section for statistical, public research, public
policy, or educational purposes after removing information which identifies or
could reasonably be used to identify the patient, prescriber, dispenser, or
other person who is the subject of the information.
(10
3 (9) The statewide health information exchange described in section
4 71-2455 or the department may release data collected pursuant to this
5 section for statistical, public research, public policy, or educational
6 purposes after removing information which identifies or could reasonably
7 be used to identify the patient, prescriber, dispenser, or other person
8 who is the subject of the information.
9 (10) The statewide health information exchange described in section
10 71-2455 or the department may request and receive program information
11 from
other prescription drug monitoring programs for use in the
12 prescription drug
monitoring system in this state.
13 (11) The statewide health information exchange described in section
14 71-2455, in collaboration with the department, shall implement
15 technological
improvements to facilitate the secure collection of, and
16 access to,
prescription drug information in accordance with this section.
17 (12) (6) Before accessing the prescription drug monitoring system,
18 any
user shall undergo training on the purpose of the system, access to
19 and proper
usage of the system, and the law relating to the system,
20 including
confidentiality and security of the prescription drug
21 monitoring system. Such
training shall be administered by the statewide
22 health information exchange
described in section 71-2455 which shall have
23 access to the prescription drug
monitoring system for training and
24 administrative purposes. Users who have been
trained prior to May 10,
25 2017, or who are granted access by an entity receiving
prescription drug
26 information pursuant to subsection (7) of this section, are
deemed to be
27 in compliance with the training requirement of this subsection.
28 (13) (7) For purposes of this section:
29 (a) Deliver or delivery means to actually, constructively, or
30 attempt to
transfer a drug or device from one person to another, whether
31 or not for
consideration;
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1 (b) Department means the Department of Health and Human Services;
2 (c) (a) Designee means any licensed or registered health care
3 professional
credentialed under the Uniform Credentialing Act designated
4 by a prescriber or
dispenser to act as an agent of the prescriber or
5 dispenser for purposes of
submitting or accessing data in the
6 prescription drug monitoring system and who
is supervised by such
7 prescriber or dispenser;
8 (d) Prescription drug or drugs (b) Dispensed prescription means a
9 prescription drug or drugs dispensed by delivery delivered to the
10 ultimate user
or caregiver by or pursuant to the lawful order of a
11 prescriber but does not
include (i) the delivery of such prescription
12 drug for immediate use for
purposes of inpatient hospital care or
13 emergency department care, (ii) the
administration of a prescription drug
14 by an authorized person upon the lawful
order of a prescriber, (iii) a
15 wholesale distributor of a prescription drug
monitored by the
16 prescription drug monitoring system, or (iv) the dispensing to
a nonhuman
17 patient of a prescription drug which is not a controlled substance
listed
18 in Schedule II, Schedule III, Schedule IV, or Schedule V of section
19 28-405;
20 (e) (c) Dispenser means a person authorized in the jurisdiction in
21 which
he or she is practicing to deliver a prescription drug to the
22 ultimate user or
caregiver by or pursuant to the lawful order of a
23 prescriber;
24 (f) (d) Participant means an individual or entity that has entered
25 into a
participation agreement with the statewide health information
26 exchange
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described in section 71-2455 which requires the individual or
27 entity to comply
with the privacy and security protections set forth in
28 the provisions of the
federal Health Insurance Portability and
29 Accountability Act of 1996, Public Law
104-191, and regulations
30 promulgated thereunder; and
31 (g) (e) Prescriber means a health care professional authorized to
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1 prescribe in the profession which he or she practices.
2 Sec. 52. Original section 71-2454, Reissue Revised Statutes of
3 Nebraska,
and sections 28-473, 28-474, and 38-101, Revised Statutes Cumulative
Supplement, 2018, are is repealed.
4 Sec. 63. Since an emergency exists, this act takes effect when
5 passed and
approved according to law.
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