Nevada 2019 Regular Session Status: Enacted

AB 239 — Revises provisions relating to controlled substances. (BDR 54-703)

Last action — Chapter 346.

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Assembly
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced March 05, 2019. Enacted.

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    Current position in the legislative process.

  • 1 sponsor

    1 primary, 0 co-sponsors signed on.

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Summary

AN ACT relating to controlled substances; revising requirements concerning the review and investigation of a complaint concerning certain violations relating to controlled substances; requiring certain professional licensing boards that regulate prescriptions for controlled substances or practitioners who issue such prescriptions to develop and disseminate an explanation or technical advisory bulletin concerning certain requirements relating to such prescriptions; clarifying the independent authority of the State Board of Pharmacy to take disciplinary action; revising provisions concerning prescribing controlled substances for the treatment of pain; requiring a system for the maintenance of electronic health records to have certain capabilities; and providing other matters properly relating thereto.

Bill Text

What changed in the latest version

870 added · 932 removed

870 line(s) added, 932 removed.

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(Reprinted with amendments adopted on May 14, 2019) SECOND REPRINT A.B.
Assembly Bill No.
239 ASSEMBLY BILL N O.
239–Committee on Health and Human Services CHAPTER..........
239–COMMITTEE ON H EALTH AND HUMAN SERVICES M ARCH 5, 2019 ____________ Referred to Committee on Commerce and Labor SUMMARY—Revises provisions relating to controlled substances.
(BDR 54-703) FISCAL NOTE:
Effect on Local Government:
No.
Effect on the State:
Yes.
~ EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
LegiExisting law requires the Executive Director of a professional licensing board that licenses practitioners who are authorized to prescribe controlled substances to conduct a review and evaluation of any complaint or information indicating that a practitioner has engaged in certain inappropriate activity with regard to a controlled substance listed in schedule II, III or IV.
Legislative Counsel’s Digest:
(NRS 630.323, 631.364, 632.352, such a review and an investigation include requiring the practitioner to attest that he or she has complied with certain requirements concerning the prescription of such controlled substances.
Existing law requires the Executive Director of a professional licensing board conduct a review and evaluation of any complaint or information indicating that a to practitioner has engaged in certain inappropriate activity with regard to a controlled substance listed in schedule II, III or IV.
Existing law requires a practitioner, other than a veterinarian, to obtain a patient utilization report from the computerized prescription monitoring program before - *AB239_R2* – 2 – issuing an initial prescription for a controlled substance listed in schedule II, III or IV or an opioid that is a controlled substance listed in schedule V and at least once every 90 days thereafter for the duration of the course of treatment using the controlled substance.
(NRS 630.323, 631.364, 632.352, 633.574, 635.152, 636.338) Sections 1-6 of this bill remove the requirement that such a review and an investigation include requiring the practitioner to attest that he or she has complied with certain requirements concerning the prescription of such controlled substances.
(NRS 639.23507) Existing law additionally requires a practitioner, other than a veterinarian, to meet certain requirements, including performing an evaluation and risk assessment and obtaining informed written consent, before issuing an initial prescription for a controlled substance listed in Existing law defines the term “initial prescription” to mean a prescription) originated for a new patient of a practitioner, other than a veterinarian, or a new prescription to begin a new course of treatment for an existing patient of a practitioner, other than a veterinarian.
utilization report from the computerized prescription monitoring program beforea patient issuing an initial prescription for a controlled substance listed in schedule II, III or IV or an opioid that is a controlled substance listed in schedule V and at least once every 90 days thereafter for the duration of the course of treatment using the controlled substance.
(NRS 639.0082) Existing regulations of the State Board of Pharmacy define the term “course of treatment” to mean all treatment of a patient for a particular disease or symptom of a disease.
(NRS 639.23507) Existing law additionally requires a practitioner, other than a veterinarian, to meet certain requirements, including consent, before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of pain.
(NRS 639.23911, 639.23914) Existing law defines the term “initial prescription” to mean a prescription originated for a new patient of a practitioner, other than a veterinarian, or a new prescription to begin a new course of treatment for an existing patient of a practitioner, other than a veterinarian.
(NRS 639.0082) Existing regulations of the treatment of a patient for a particular disease or symptom of a disease.
prescriptions of a controlled substance listed in schedule II, III or IV for the treatment of pain do not apply to prescriptions for the treatment of the pain of a patient with whom the prescribing practitioner has a bona fide relationship and who:
- 80th Session (2019) – 2 – Section 7.6 of this bill provides that certain requirements concerning prescriptions of a controlled substance listed in schedule II, III or IV for the treatment of pain do not apply to prescriptions for the treatment of the pain of a patient with whom the prescribing practitioner has a bona fide relationship and or (2) is receiving hospice or palliative care.
(1) has been diagnosed with cancer or sickle cell disease or any of its variants;
Section 7.6 also authorizes avariants;
or (2) is receiving hospice or palliative care.
practitioner to obtain informed consent that meets certain guidelines in lieu of obtaining informed consent that meets the statutory requirements for informed consent before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of the pain of such a patient.
Section 7.6 also authorizes a practitioner to obtain informed consent that meets certain guidelines in lieu of obtaining informed consent that meets the statutory requirements for informed consent before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of the pain of such a patient.
Existing law imposes certain limitations on an initial prescription of a controlled substance listed in schedule II, III or IV for the treatment of acute pain.
controlled substance listed in schedule II, III or IV for the treatment of acute pain.
Existing law requires an evaluation and risk assessment to be performed before IV for the treatment of pain to include:
Existing law requires an evaluation and risk assessment to be performed before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of pain to include:
(1) a review of the medical history of theII or patient;
(1) a review of the medical history of the use of the controlled substance;
(2) a physical examination;
(3) obtaining informed written consent to the use of the controlled substance;
disseminate to each professional licensing board that licenses a practitioner who is authorized to prescribe controlled substances or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those professional licensing boards of requirements concerning prescriptions for controlled substances listed in schedule II, III or IV and to update those - *AB239_R2* – 3 – explanations or bulletins as necessary.
Section 11.5 of this bill requires the State Board of Pharmacy to develop and disseminate to each professional licensing board that licenses a practitioner who is authorized to prescribe controlled substances or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those professional licensing boards of requirements concerning prescriptions for controlled substances listed in schedule II, III or IV and to update those explanations or bulletins as necessary.
registration to dispense a controlled substance under certain circumstances.
Existing law authorizes the State Board of Pharmacy to suspend or revoke a registration to dispense a controlled substance under certain circumstances.
Existing law requires the State Board of Pharmacy and the Investigation Division of the Department of Public Safety to cooperatively develop a computerized program to track prescriptions for controlled substances listed in that program to include the ability to integrate the records of patients in therequires database of the program with the electronic health records of practitioners.
- 80th Session (2019) – 3 – Existing law requires the State Board of Pharmacy and the Investigation Division of the Department of Public Safety to cooperatively develop a computerized program to track prescriptions for controlled substances listed in schedule II, III, IV or V.
(NRS 453.162) If the program includes that ability, section 12.5 of this bill requires any person or entity that provides a system for the maintenance of electronic health records to a practitioner to ensure that the system includes the ability to integrate the records of patients in the database into the practitioner’s electronic health records.
To the extent that money is available, existing law requires that program to include the ability to integrate the records of patients in the 453.162) If the program includes that ability, section 12.5 of this bill requires any person or entity that provides a system for the maintenance of electronic health records to a practitioner to ensure that the system includes the ability to integrate the records of patients in the database into the practitioner’s electronic health records.
EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
or - *AB239_R2* – 4 – (c) A patient of a licensee has acquired, used or possessed a controlled substance listed in schedule II, III or IV in a fraudulent, illegal, unauthorized or otherwise inappropriate manner.
or (c) A patient of a licensee has acquired, used or possessed a controlled substance listed in schedule II, III or IV in a fraudulent, illegal, unauthorized or otherwise inappropriate manner.
and (b) [A requirement that the licensee who is the subject of the review and evaluation attest that he or she has complied with the requirements of NRS 639.23507, 639.2391, 639.23911 and 639.23915, as applicable;
and - 80th Session (2019) – 4 – (b) [A requirement that the licensee who is the subject of the review and evaluation attest that he or she has complied with the requirements of NRS 639.23507, 639.2391, 639.23911 and 639.23915, as applicable;
If, after a review and evaluation conducted pursuant to subsection 1, the Executive Director or his or her designee determines that a licensee may have issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription for a controlled substance listed in schedule II, III or IV, the Board must proceed as if a written complaint had been filed against the licensee.
If, after a review and evaluation conducted pursuant to subsection 1, the Executive Director or his or her designee determines that a licensee may have issued a fraudulent, illegal, substance listed in schedule II, III or IV, the Board must proceed as if a written complaint had been filed against the licensee.
If, after provisions of this chapter, the Board determines that the licensee issued a fraudulent, illegal, unauthorized or otherwise inappropriate pre5.ripWhen deemed appropriate, the Executive Director of thection.
If, after conducting an investigation and a hearing in accordance with the provisions of this chapter, the Board determines that the licensee issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription, the Board must impose appropriate disciplinary action.
Board may:
5.
When deemed appropriate, the Executive Director of the Board may:
(a) Adopt regulations providing for disciplinary action against a licensee for inappropriately prescribing a controlled substance listed in schedule II, III or IV or violating the provisions of NRS 639.2391 to 639.23916, inclusive, and any regulations adopted by the State Board of Pharmacy pursuant thereto.
licensee for inappropriately prescribing a controlled substance listed in schedule II, III or IV or violating the provisions of NRS 639.2391 to 639.23916, inclusive, and any regulations adopted by the State Board of Pharmacy pursuant thereto.
Such disciplinary action must - *AB239_R2* – 5 – include, without limitation, requiring the licensee to complete additional continuing education concerning prescribing controlled substances listed in schedules II, III and IV.
Such disciplinary action must include, without limitation, requiring the licensee to complete additional continuing education concerning prescribing controlled substances listed in schedules II, III and IV.
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(b) Develop and disseminate to each physician and physician assistant licensed pursuant to this chapter or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those physicians and physician assistants of the requirements of this section and NRS 630.324, 639.23507 and 639.2391 to 639.23916, inclusive, and any regulations adopted pursuant thereto.
(b) Develop and disseminate to each physician and physician assistant licensed pursuant to this chapter or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those physicians and physician assistants of the requirements of this section and NRS 630.324, 639.23507 and 639.2391 to 639.23916, inclusive, and any - 80th Session (2019) – 5 – regulations adopted pursuant thereto.
The Executive Director of the Board or his or her designee shall review and evaluate any complaint or information received from the Investigation Division of the Department of Public Safety or the State Board of Pharmacy, including, without limitation, information provided pursuant to NRS 453.164, or from a law enforcement agency, professional licensing board or any other source indicating that:
The Executive Director of the Board or his or her designee shall review and evaluate any complaint or information Public Safety or the State Board of Pharmacy, including, without limitation, information provided pursuant to NRS 453.164, or from a law enforcement agency, professional licensing board or any other source indicating that:
otherwise inappropriate prescription for a controlled substance listed in schedule II, III or IV;
(a) A licensee has issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription for a controlled substance listed in schedule II, III or IV;
the licensee has issued prescriptions in the manner described in that paragraph (a);
(b) A pattern of prescriptions issued by a licensee indicates that the licensee has issued prescriptions in the manner described in paragraph (a);
(a) A review of relevant information contained in the database of the program established pursuant to NRS 453.162;
of the program established pursuant to NRS 453.162;
and (b) [A requirement that the licensee who is the subject of the review and evaluation attest that he or she has complied with the requirements of NRS 639.23507, 639.2391, 639.23911and 639.23915, as applicable;
ande database (b) [A requirement that the licensee who is the subject of the review and evaluation attest that he or she has complied with the requirements of NRS 639.23507, 639.2391, 639.23911 and 639.23915, as applicable;
and - *AB239_R2* – 6 – (c)] A request for additional relevant information from the licensee who is the subject of the review and evaluation.
and (c)] A request for additional relevant information from the licensee who is the subject of the review and evaluation.
If, after conducting an investigation and a hearing in accordance with the provisions of this chapter, the Board determines that the licensee issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription, the Board must impose appropriate disciplinary action.
If, after - 80th Session (2019) – 6 – conducting an investigation and a hearing in accordance with the provisions of this chapter, the Board determines that the licensee issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription, the Board must impose appropriate disciplinary action.
(a) Refer information acquired during a review and evaluation conducted pursuant to subsection 1 to another professional licensing board, law enforcement agency or other appropriate governmental entity for investigation and criminal or administrative proceedings.
(a) Refer information acquired during a review and evaluation conducted pursuant to subsection 1 to another professional licensing board, law enforcement agency or other appropriate governmental ent(b) Postpone any notification, review or part of such a reviewgs.
(b) Postpone any notification, review or part of such a review required by this section if he or she determines that it is necessary to avoid interfering with any pending administrative or criminal investigation into the suspected fraudulent, illegal, unauthorized or otherwise inappropriate prescribing, dispensing or use of a con6.
required by this section if he or she determines that it is necessary to avoid interfering with any pending administrative or criminal investigation into the suspected fraudulent, illegal, unauthorized or otherwise inappropriate prescribing, dispensing or use of a controlled substance.
6.
(a) Adopt regulations providing for disciplinary action against a in schedule II, III or IV or violating the provisions of NRS 639.2391d to 639.23916, inclusive, and any regulations adopted by the State Board of Pharmacy pursuant thereto.
(a) Adopt regulations providing for disciplinary action against a licensee for inappropriately prescribing a controlled substance listed in schedule II, III or IV or violating the provisions of NRS 639.2391 to 639.23916, inclusive, and any regulations adopted by the State Board of Pharmacy pursuant thereto.
(b) Develop and disseminate to each dentist licensed pursuant to this chapter or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those dentists of the requirements of this section and NRS 631.365, 639.23507 and 639.2391 to 639.23916, inclusive, and any regulations adopted pursuant thereto.
(b) Develop and disseminate to each dentist licensed pursuant to this chapter or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those dentists of the requirements of this section and NRS regulations adopted pursuant thereto.
- *AB239_R2* – 7 – Sec.
Sec.
The Executive Director of the Board or his or her designee shall review and evaluate any complaint or information received from the Investigation Division of the Department of Public Safety or the State Board of Pharmacy, including, without limitation, information provided pursuant to NRS 453.164, or from a law enforcement agency, professional licensing board or any other source indicating that:
The Executive Director of the Board or his or her designee shall review and evaluate any complaint or information received from the Investigation Division of the Department of Public Safety or the State Board of Pharmacy, including, without limitation, information provided pursuant to NRS 453.164, or from - 80th Session (2019) – 7 – a law enforcement agency, professional licensing board or any other source indicating that:
or (c) A patient of a licensee has acquired, used or possessed a controlled substance listed in schedule II, III or IV in a fraudulent, illegal, unauthorized or otherwise inappropriate manner.
or (c) A patient of a licensee has acquired, used or possessed a illegal, unauthorized or otherwise inappropriate manner.
2.
a fraudulent, 2.
of the program established pursuant to NRS 453.162;
(a) A review of relevant information contained in the database of the program established pursuant to NRS 453.162;
ande database (b) [A requirement that the licensee who is the subject of the requirements of NRS 639.23507, 639.2391, 639.23911 anded with the 639.23915, as applicable;
and (b) [A requirement that the licensee who is the subject of the review and evaluation attest that he or she has complied with the requirements of NRS 639.23507, 639.2391, 639.23911 and 639.23915, as applicable;
If, after a review and evaluation conducted pursuant to subsection 1, the Executive Director or his or her designee determines that a licensee may have issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription for a controlled substance listed in schedule II, III or IV, the Board must proceed as if a written complaint had been filed against the licensee.
If, after a review and evaluation conducted pursuant to subsection 1, the Executive Director or his or her designee determines that a licensee may have issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription for a controlled if a written complaint had been filed against the licensee.
(a) Refer information acquired during a review and evaluation conducted pursuant to subsection 1 to another professional licensing - *AB239_R2* – 8 – board, law enforcement agency or other appropriate governmental entity for investigation and criminal or administrative proceedings.
(a) Refer information acquired during a review and evaluation conducted pursuant to subsection 1 to another professional licensing board, law enforcement agency or other appropriate governmental entity for investigation and criminal or administrative proceedings.
(b) Postpone any notification, review or part of such a review required by this section if he or she determines that it is necessary to avoid interfering with any pending administrative or criminal investigation into the suspected fraudulent, illegal, unauthorized or otherwise inappropriate prescribing, dispensing or use of a controlled substance.
(b) Postpone any notification, review or part of such a review required by this section if he or she determines that it is necessary to - 80th Session (2019) – 8 – avoid interfering with any pending administrative or criminal investigation into the suspected fraudulent, illegal, unauthorized or otherwise inappropriate prescribing, dispensing or use of a controlled substance.
(a) Adopt regulations providing for disciplinary action against a licensee for inappropriately prescribing a controlled substance listed in schedule II, III or IV or violating the provisions of NRS 639.2391 to 639.23916, inclusive, and any regulations adopted by the State Board of Pharmacy pursuant thereto.
(a) Adopt regulations providing for disciplinary action against a licensee for inappropriately prescribing a controlled substance listed in schedule II, III or IV or violating the provisions of NRS 639.2391 to 639.23916, inclusive, and any regulations adopted by the State include, without limitation, requiring the licensee to completest additional continuing education concerning prescribing controlled substances listed in schedules II, III and IV.
Such disciplinary action must include, without limitation, requiring the licensee to complete additional continuing education concerning prescribing controlled substances listed in schedules II, III and IV.
(b) Develop and disseminate to each advanced practice registered nurse licensed pursuant to NRS 632.237 or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those advanced practice registered nurses of the requirements of this section and NRS 632.353, 639.23507 and 639.2391 to 639.23916, inclusive, and any regulations adopted pursuant thereto.
(b) Develop and disseminate to each advanced practice registered nurse licensed pursuant to NRS 632.237 or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those advanced practice registered nurses of the requirements of this section and NRS 632.353, 639.23507 and 639.2391 to 639.23916, inclusive, and any explanation or bulletin as necessary to include any revisions to those provisions of law or regulations.
The Board shall update the explanation or bulletin as necessary to include any revisions to those provisions of law or regulations.
The explanation or bulletin requirements that apply to specific controlled substances or categories of controlled substances.
The explanation or bulletin must include, without limitation, an explanation of the requirements that apply to specific controlled substances or categories of controlled substances.
The Executive Director of the Board or his or her designee shall review and evaluate any complaint or information received from the Investigation Division of the Department of Public Safety or the State Board of Pharmacy, including, without limitation, information provided pursuant to NRS 453.164, or from a law enforcement agency, professional licensing board or any other source indicating that:
The Executive Director of the Board or his or her designee shall review and evaluate any complaint or information received from the Investigation Division of the Department of limitation, information provided pursuant to NRS 453.164, or from a law enforcement agency, professional licensing board or any other source indicating that:
or - *AB239_R2* – 9 – (c) A patient of a licensee has acquired, used or possessed a controlled substance listed in schedule II, III or IV in a fraudulent, illegal, unauthorized or otherwise inappropriate manner.
or (c) A patient of a licensee has acquired, used or possessed a controlled substance listed in schedule II, III or IV in a fraudulent, illegal, unauthorized or otherwise inappropriate manner.
2.
- 80th Session (2019) – 9 – 2.
and (b) [A requirement that the licensee who is the subject of the review and evaluation attest that he or she has complied with the requirements of NRS 639.23507, 639.2391, 639.23911 and 639.23915, as applicable;
and (b) [A requirement that the licensee who is the subject of the requirements of NRS 639.23507, 639.2391, 639.23911 anded with the 639.23915, as applicable;
If, after provisions of this chapter, the Board determines that the licensee issued a fraudulent, illegal, unauthorized or otherwise inappropriate pre5.ripWhen deemed appropriate, the Executive Director of thection.
If, after conducting an investigation and a hearing in accordance with the provisions of this chapter, the Board determines that the licensee issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription, the Board must impose appropriate disciplinary action.
Board may:
5.
(a) Refer information acquired during a review and evaluation conducted pursuant to subsection 1 to another professional licensing board, law enforcement agency or other appropriate governmental entity for investigation and criminal or administrative proceedings.
When deemed appropriate, the Executive Director of the Board may:
(b) Postpone any notification, review or part of such a review required by this section if he or she determines that it is necessary to avoid interfering with any pending administrative or criminal investigation into the suspected fraudulent, illegal, unauthorized or otherwise inappropriate prescribing, dispensing or use of a controlled substance.
(a) Refer information acquired during a review and evaluation conducted pursuant to subsection 1 to another professional licensing board, law enforcement agency or other appropriate governmental ent(b) Postpone any notification, review or part of such a reviewgs.
required by this section if he or she determines that it is necessary to avoid interfering with any pending administrative or criminal investigation into the suspected fraudulent, illegal, unauthorized or otherwise inappropriate prescribing, dispensing or use of a controlled substance.
Such disciplinary action must - *AB239_R2* – 10 – include, without limitation, requiring the licensee to complete additional continuing education concerning prescribing controlled substances listed in schedules II, III and IV.
Such disciplinary action must include, without limitation, requiring the licensee to complete - 80th Session (2019) – 10 – additional continuing education concerning prescribing controlled substances listed in schedules II, III and IV.
The Board shall update the explanation or bulletin as necessary to include any revisions to those provisions of law or regulations.
The Board shall revisions to those provisions of law or regulations.
The explanation or bulletin must include, without limitation, an explanation of the requirements that apply to specific controlled substances or categories of controlled substances.
Thede any explanation or bulletin must include, without limitation, an explanation of the requirements that apply to specific controlled substances or categories of controlled substances.
otherwise inappropriate prescription for a controlled substance listed in schedule II, III or IV;
(a) A licensee has issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription for a controlled substance listed in schedule II, III or IV;
the licensee has issued prescriptions in the manner described in that paragraph (a);
(b) A pattern of prescriptions issued by a licensee indicates that the licensee has issued prescriptions in the manner described in paragraph (a);
or (c) A patient of a licensee has acquired, used or possessed a controlled substance listed in schedule II, III or IV in a fraudulent, illegal, unauthorized or otherwise inappropriate manner.
or (c) A patient of a licensee has acquired, used or possessed a illegal, unauthorized or otherwise inappropriate manner.
2.
a fraudulent, 2.
and - *AB239_R2* – 11 – (c)] A request for additional relevant information from the licensee who is the subject of the review and evaluation.
and - 80th Session (2019) – 11 – (c)] A request for additional relevant information from the licensee who is the subject of the review and evaluation.
If, after conducting an investigation and a hearing in accordance with the provisions of this chapter, the Board determines that the licensee issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription, the Board must impose appropriate disciplinary action.
If, after conducting an investigation and a hearing in accordance with the provisions of this illegal, unauthorized or otherwise inappropriate prescription, thet, Board must impose appropriate disciplinary action.
(a) Adopt regulations providing for disciplinary action against a licensee for inappropriately prescribing a controlled substance listed to 639.23916, inclusive, and any regulations adopted by the State2391 Board of Pharmacy pursuant thereto.
6.
Such disciplinary action must include, without limitation, requiring the licensee to complete additional continuing education concerning prescribing controlled substances listed in schedules II, III and IV.
The Board shall [adopt] :
(a) Adopt regulations providing for disciplinary action against a licensee for inappropriately prescribing a controlled substance listed in schedule II, III or IV or violating the provisions of NRS 639.2391 to 639.23916, inclusive, and any regulations adopted by the State Board of Pharmacy pursuant thereto.
Such disciplinary action must additional continuing education concerning prescribing controlled substances listed in schedules II, III and IV.
The explanation or bulletin must include, without limitation, an explanation of the requirements that apply to specific controlled substances or categories of controlled substances.
The explanation or bulletin must include, without limitation, an explanation of the requirements that apply to - 80th Session (2019) – 12 – specific controlled substances or categories of controlled substances.
- *AB239_R2* – 12 – Sec.
Sec.
The Executive Director of the Board or his or her designee shall review and evaluate any complaint or information received from the Investigation Division of the Department of Public Safety or the State Board of Pharmacy, including, without limitation, information provided pursuant to NRS 453.164, or from a law enforcement agency, professional licensing board or any other source indicating that:
The Executive Director of the Board or his or her designee shall review and evaluate any complaint or information received from the Investigation Division of the Department of Public Safety or the State Board of Pharmacy, including, without limitation, information provided pursuant to NRS 453.164, or from a law enforcement agency, professional licensing board or any other sou(a) A licensee has issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription for a controlled substance listed in schedule II, III or IV;
(a) A licensee has issued a fraudulent, illegal, unauthorized or otherwise inappropriate prescription for a controlled substance listed in schedule II, III or IV;
of the program established pursuant to NRS 453.162;
(a) A review of relevant information contained in the database of the program established pursuant to NRS 453.162;
ande database (b) [A requirement that the licensee who is the subject of the requirements of NRS 639.23507, 639.2391, 639.23911 anded with the 639.23915, as applicable;
and (b) [A requirement that the licensee who is the subject of the review and evaluation attest that he or she has complied with the 639.23915, as applicable;
and (c)] A request for additional relevant information from the licensee who is the subject of the review and evaluation.
and, 639.2391, 639.23911 and (c)] A request for additional relevant information from the licensee who is the subject of the review and evaluation.
5.
- 80th Session (2019) – 13 – 5.
(a) Refer information acquired during a review and evaluation conducted pursuant to subsection 1 to another professional licensing - *AB239_R2* – 13 – board, law enforcement agency or other appropriate governmental entity for investigation and criminal or administrative proceedings.
(a) Refer information acquired during a review and evaluation conducted pursuant to subsection 1 to another professional licensing board, law enforcement agency or other appropriate governmental entity for investigation and criminal or administrative proceedings.
(b) Postpone any notification, review or part of such a review required by this section if he or she determines that it is necessary to avoid interfering with any pending administrative or criminal investigation into the suspected fraudulent, illegal, unauthorized or otherwise inappropriate prescribing, dispensing or use of a controlled substance.
(b) Postpone any notification, review or part of such a review required by this section if he or she determines that it is necessary to avoid interfering with any pending administrative or criminal otherwise inappropriate prescribing, dispensing or use of ahorized or controlled substance.
(b) Develop and disseminate to each optometrist who is certified to prescribe and administer therapeutic pharmaceutical agents pursuant to NRS 636.288 or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those optometrists of the requirements of this section and NRS 636.339, 639.23507 and 639.2391 to 639.23916, Board shall update the explanation or bulletin as necessary to include any revisions to those provisions of law or regulations.
(b) Develop and disseminate to each optometrist who is certified to prescribe and administer therapeutic pharmaceutical agents pursuant to NRS 636.288 or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those optometrists of the requirements of this section and NRS 636.339, 639.23507 and 639.2391 to 639.23916, inclusive, and any regulations adopted pursuant thereto.
explanation of the requirements that apply to specific controlled substances or categories of controlled substances.
The Board shall update the explanation or bulletin as necessary to The explanation or bulletin must include, without limitation, an explanation of the requirements that apply to specific controlled substances or categories of controlled substances.
Except as otherwise provided in this section, the provisions of NRS 639.2391 to 639.23914, inclusive, do not apply to any prescription for a controlled substance listed in schedule II, III or IV for the treatment of the pain of a patient who:
Except as otherwise provided in this section, the provisions of NRS 639.2391 to 639.23914, inclusive, do not apply - 80th Session (2019) – 14 – to any prescription for a controlled substance listed in schedule II, III or IV for the treatment of the pain of a patient who:
- *AB239_R2* – 14 – 2.
2.
(a) Have established a bona fide relationship, as described in subsection 4 of NRS 639.235, with the patient;
(a) Have established a bona fide relationship, as described in sub(b) Obtain informed consent to the use of the controlled substance that meets the requirements of subsection 2 of NRS 639.23912 or any applicable guidelines or standards for informed consent prescribed by:
and (b) Obtain informed consent to the use of the controlled substance that meets the requirements of subsection 2 of NRS 639.23912 or any applicable guidelines or standards for informed consent prescribed by:
639.001 As used in this chapter, unless the context otherwise inclusive, and section 7.3 of this act have the meanings ascribed to them in those sections.
639.001 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 639.0015 to 639.016, them in those sections.7.3 of this act have the meanings ascribed to Sec.
9.
NRS 639.23507 is hereby amended to read as follows:
[A]9.23507Exceptrebasameotherwiseeaprovidedlowin subsection 2, a practitioner, other than a veterinarian, shall, before issuing an initial prescription for a controlled substance listed in schedule II, III or IV or an opioid that is a controlled substance listed in schedule V and at least once every 90 days thereafter for the duration of the course of treatment using the controlled substance, obtain a patient utilization report regarding the patient from the computerized program established by the Board and the Investigation Division of the Department of Public Safety pursuant to NRS 453.162.
[A] Except as otherwise provided in subsection 2, a practitioner, other than a veterinarian, shall, before issuing an initial prescription for a controlled substance listed in schedule II, III or IV or an opioid that is a controlled substance listed in schedule V and at least once every 90 days thereafter for the duration of the course of treatment using the controlled substance, obtain a patient utilization report regarding the patient from the computerized program established by the Board and the Investigation Division of the Department of Public Safety pursuant to NRS 453.162.
(a) Review the patient utilization report ;
- 80th Session (2019) – 15 – (a) Review the patient utilization report ;
If the practitioner determines from the patient utilization report or from any other source that the patient has been issued such a prescription, the - *AB239_R2* – 15 – practitioner shall not prescribe the controlled substance [.] unless the practitioner determines that issuing the prescription is medically necessary.
If the practitioner determines from the patient utilization report or from any other source that the patient has been issued such a prescription, the practitioner shall not prescribe the controlled substance [.] unless medically necessary.ermines that issuing the prescription is 2.
2.
(b) Is not liable for the failure.
The Board shall adopt regulations to provide alternative she is providing service in a hospital emergency department.
The Board shall adopt regulations to provide alternative methods of compliance with subsection 1 for a physician while he or she is providing service in a hospital emergency department.
The or regulations must include, without limitation, provisions that allow a for the purposes of accessing the database of the computerizedgates program and obtaining patient utilization reports from the computerized program on behalf of such a physician.
The regulations must include, without limitation, provisions that allow a hospital to designate members of hospital staff to act as delegates for the purposes of accessing the database of the computerized program and obtaining patient utilization reports from the computerized program on behalf of such a physician.
If a practitioner, other than a veterinarian, prescribes or dispenses to a patient for the treatment of pain a quantity of controlled substance that exceeds the amount prescribed by this subsection, the practitioner must document in the medical record of the patient the reasons for prescribing that quantity.
If a practitioner, other than a veterinarian, prescribes or dispenses to a patient for the treatment of pain a quantity of controlled substance that exceeds the amount prescribed by this subsection, the practitioner must document in the medical - 80th Session (2019) – 16 – record of the patient the reasons for prescribing that quantity.
or (b) At any one time, a larger quantity of a controlled substance listed in schedule II, III or IV than will be used in 90 days if the patient adheres to the dose prescribed.
or (b) At any one time, a larger quantity of a controlled substance listed in schedule II, III or IV than will be used in 90 days if the pat2.nt [A] Unless the practitioner determines that the prescription is medically necessary, a practitioner, other than a veterinarian, shall not issue an initial prescription of a controlled substance listed in schedule II, III or IV for the treatment of acute pain that prescribes:
- *AB239_R2* – 16 – 2.
[A] Unless the practitioner determines that the prescription is medically necessary, a practitioner, other than a veterinarian, shall not issue an initial prescription of a controlled substance listed in schedule II, III or IV for the treatment of acute pain that prescribes:
and (b) If the controlled substance is an opioid and a prescription for an opioid has never been issued to the patient or the most recent prescription issued to the patient for an opioid was issued more than 19 days before the date of the initial prescription for the treatment of acute pain, a dose of the controlled substance that exceeds 90 morphine milligram equivalents per day.
and (b) If the controlled substance is an opioid and a prescription for an opioid has never been issued to the patient or the most recent prescription issued to the patient for an opioid was issued more than days before the date of the initial prescription for the treatment of acute pain, a dose of the controlled substance that exceeds 90 morphine milligram equivalents per day.
As used in this section, “acute pain” means pain that has an abrupt onset and is caused by injury or another cause that is not ongoing.
As used in this section, “acute pain” means pain that has an abrupt onset and is caused by injury or another cause that is is being treated as part of care for cancer, palliative care, hospice care or other end-of-life care.
The term does not include chronic pain or pain that is being treated as part of care for cancer, palliative care, hospice care or other end-of-life care.
NRS 639.23911 is hereby amended to read as fol639.23911 1.
NRS 639.23911 is hereby amended to read as follows:
Before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of (a) Have established a bona fide relationship, as described in subsection 4 of NRS 639.235, with the patient;
639.23911 1.
Before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of pain, a practitioner, other than a veterinarian, must:
(a) Have established a bona fide relationship, as described in subsection 4 of NRS 639.235, with the patient;
(c) Establish a preliminary diagnosis of the patient and a treatment plan tailored toward treating the pain of the patient and the cause of that pain;
- 80th Session (2019) – 17 – (c) Establish a preliminary diagnosis of the patient and a treatment plan tailored toward treating the pain of the patient and the cause of that pain;
(1) The patient, if the patient is 18 years of age or older or legally emancipated and has the capacity to give such consent;
legally emancipated and has the capacity to give such consent;lder or (2) The parent or guardian of a patient who is less than 18 years of age and not legally emancipated;
(2) The parent or guardian of a patient who is less than 18 years of age and not legally emancipated;
or (3) The legal guardian of a patient of any age who has been adjudicated mentally incapacitated.
or - *AB239_R2* – 17 – (3) The legal guardian of a patient of any age who has been adjudicated mentally incapacitated.
(b) Conducting a physical examination of the patient [.] directed to the source of the patient’s pain and within the scope of practice of the practitioner.
to the source of the patient’s pain and within the scope of practice of the practitioner.
(1) Making a good faith effort to obtain and review [the] any who has provided care to the patient [.
(1) Making a good faith effort to obtain and review [the] any medical records of the patient from any other provider of health care who has provided care to the patient [.
The practitioner shallth care document] that are relevant to the prescription;
The practitioner shall document] that are relevant to the prescription;
and the conclusions from reviewing any such medical records in thend medical record of the patient.
and (2) Documenting efforts to obtain such medical records and the conclusions from reviewing any such medical records in the medical record of the patient.
(d) Assessing the mental health and risk of abuse, dependency and addiction of the patient using methods supported by peer- reviewed scientific research and validated by a nationally recognized organization.
- 80th Session (2019) – 18 – (d) Assessing the mental health and risk of abuse, dependency and addiction of the patient using methods supported by peer- reviewed scientific research and validated by a nationally recognized organization.
(a) The potential risks and benefits of treatment using the controlled substance, including if a form of the controlled substance that is designed to deter abuse is available, the risks and benefits of using that form;
(a) The potential risks and benefits of treatment using the controlled substance, including if a form of the controlled substance using that form;
(b) Proper use of the controlled substance;
to deter abuse is available, the risks and benefits of (b) Proper use of the controlled substance;
- *AB239_R2* – 18 – (d) The important provisions of the treatment plan established for the patient pursuant to paragraph (c) of subsection 1 of NRS 639.23911 in a clear and simple manner;
(d) The important provisions of the treatment plan established for the patient pursuant to paragraph (c) of subsection 1 of NRS 639.23911 in a clear and simple manner;
(i) If the controlled substance is an opioid, the availability of an opioid antagonist, as defined in NRS 453C.040, without a prescription;
opioid antagonist, as defined in NRS 453C.040, without ailability of an prescription;
A practitioner shall document a conversation in which a subsection 2 in the medical record of the patient.
A practitioner shall document a conversation in which a patient provided informed consent that meets the requirements of subsection 2 in the medical record of the patient.
If a patientf provides informed written consent, the practitioner must include medical record of the patient.rmed consent is recorded in the Sec.
If a patient provides informed written consent, the practitioner must include the document on which the informed consent is recorded in the medical record of the patient.
- 80th Session (2019) – 19 – Sec.
The Board shall develop and disseminate to each professional licensing board that licenses a practitioner, other than a veterinarian, or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those professional licensing boards of the requirements of NRS 639.23507 and 639.2391 to 639.23916, inclusive, and any regulations adopted pursuant thereto.
The Board shall develop and disseminate to each than a veterinarian, or make available on the Internet website of the Board an explanation or a technical advisory bulletin to inform those professional licensing boards of the requirements of NRS 639.23507 and 639.2391 to 639.23916, inclusive, and any regulations adopted pursuant thereto.
The explanation or bulletin - *AB239_R2* – 19 – must include, without limitation, an explanation of the requirements that apply to specific controlled substances or categories of controlled substances.
The explanation or bulletin must include, without limitation, an explanation of the requirements that apply to specific controlled substances or categories of controlled substances.
The authority of the Board to take disciplinary action to enforce the provisions of this chapter is not limited by the authority of any other regulatory body that may be authorized or required to take disciplinary action for the same conduct with respect to any license, registration, certificate or other professional designation issued and regulated by that regulatory body.
The authority of the Board to take disciplinary action to enforce the provisions of this chapter is not limited by the required to take disciplinary action for the same conduct withor respect to any license, registration, certificate or other professional designation issued and regulated by that regulatory body.
(a)(1) The inappropriate use by a patient of controlled substances listed in schedules II, III, IV or V to pharmacies, including, without limitation, law enforcement agencies andagencies, occupational licensing boards, to prevent the improper or illegal use of those controlled substances;
(a) Be designed to provide information regarding:
(1) The inappropriate use by a patient of controlled substances listed in schedules II, III, IV or V to pharmacies, - 80th Session (2019) – 20 – practitioners and appropriate state and local governmental agencies, including, without limitation, law enforcement agencies and occupational licensing boards, to prevent the improper or illegal use of those controlled substances;
(b) Be administered by the Board, the Investigation Division, the Division of Public and Behavioral Health of the Department and various practitioners, representatives of professional associations for practitioners, representatives of occupational licensing boards and prosecuting attorneys selected by the Board and the Investigation Division.
(b) Be administered by the Board, the Investigation Division, the Division of Public and Behavioral Health of the Department and various practitioners, representatives of professional associations for prosecuting attorneys selected by the Board and the Investigationnd Division.
- *AB239_R2* – 20 – (3) The telephone number of the person;
(3) The telephone number of the person;
(2) Each state in which the patient to whom the controlled substance was prescribed has previously resided or filled a prescription for a controlled substance listed in schedule II, III, IV or V;
(2) Each state in which the patient to whom the controlled prescription for a controlled substance listed in schedule II, III, IV or V;
(1) A means by which a practitioner may designate in the seeking a prescription for a controlled substance for an improper or illegal purpose.
(1) A means by which a practitioner may designate in the database of the program that he or she suspects that a patient is - 80th Session (2019) – 21 – seeking a prescription for a controlled substance for an improper or illegal purpose.
If the Board reviews the designation and determines pharmacies, practitioners and appropriate state agencies that the patient is seeking a prescription for a controlled substance for an improper or illegal purpose as described in subparagraph (1) of paragraph (a).
If the Board reviews the designation and determines that such a designation is warranted, the Board shall inform pharmacies, practitioners and appropriate state agencies that the patient is seeking a prescription for a controlled substance for an improper or illegal purpose as described in subparagraph (1) of paragraph (a).
and (b) Any person or entity that provides a system for the maintenance of electronic health records to a practitioner must ensure that the system includes, as a function of the system, the ability to integrate the records of patients in the database of the program into the electronic health records of the practitioner.
and (b) Any person or entity that provides a system for the maintenance of electronic health records to a practitioner must ensure that the system includes, as a function of the system, the ability to integrate the records of patients in the database of the pro3.
- *AB239_R2* – 21 – 3.
The Board, the Division and each employee thereof arener.
The Board, the Division and each employee thereof are immune from civil and criminal liability for any action relating to the collection, maintenance and transmission of information pursuant to this section and NRS 453.163 to 453.1645, inclusive, if a good faith effort is made to comply with applicable laws and regulations.
immune from civil and criminal liability for any action relating to the collection, maintenance and transmission of information pursuant to this section and NRS 453.163 to 453.1645, inclusive, if a good faith effort is made to comply with applicable laws and regulations.
TEXT OF REPEALED SECTION 639.23915 Practitioner to consider certain factors before prescribing certain controlled substances.
~~~~~ 19 - 80th Session (2019)
Before prescribing a controlled substance listed in schedule II, III or IV, a practitioner, other than a veterinarian, must consider the following factors, when applicable:
1.
Whether there is reason to believe that the patient is not using the controlled substance as prescribed or is diverting the controlled substance for use by another person.
2.
Whether the controlled substance has had the expected effect on 3.e Whether there is reason to believe that the patient is using other drugs, including, without limitation, alcohol, controlled substances listed in schedule I or prescription drugs, that:
(a) May interact negatively with the controlled substance prescribed by the practitioner;
or (b) Have not been prescribed by a practitioner who is treating the patient.
4.
The number of attempts by the patient to obtain an early refill of the prescription.
- *AB239_R2* – 22 – 5.
The number of times the patient has claimed that the con6.olInformation from the database of the program established pursuant to NRS 453.162 that is irregular or inconsistent or indicates that the patient is inappropriately using a controlled substance.
7.
Whether previous blood or urine tests have indicated inappropriate use of controlled substances by the patient.
8.
The necessity of verifying that controlled substances, other than those authorized under the treatment plan established pursuant to paragraph (c) of subsection 1 of NRS 639.23911, are not present in the body of the patient.
9.
Whether the patient has demonstrated aberrant behavior or int10.
Whether the patient has increased his or her dose of the controlled substance without authorization from the practitioner.
11.
Whether the patient has been reluctant to stop using the controlled substance or has requested or demanded a controlled substance that is likely to be abused or cause dependency or addiction.
12.
Whether the patient has been reluctant to cooperate with any examination, analysis or test recommended by the practitioner.
13.
Whether the patient has a history of substance abuse.
14.
Any major change in the health of the patient, including, without limitation, pregnancy, or any diagnosis concerning the appropriateness of prescribing the controlled substance for the patient.
15.
Any other evidence that the patient is chronically using opioids, misusing, abusing, illegally using or addicted to any drug or failing to comply with the instructions of the practitioner concerning the use of the controlled substance.
16.
Any other factor that the practitioner determines is necessary to make an informed professional judgment concerning the medical appropriateness of the prescription.
H - *AB239_R2*
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Amendments

2 amendments

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Action History

  1. Chapter 346.

  2. Approved by the Governor.

  3. Enrolled and delivered to Governor.

  4. Senate Amendment No. 685 concurred in. To enrollment.

  5. In Assembly.

  6. Read third time. Passed, as amended. Title approved. (Yeas: 20, Nays: None, Excused: 1.) To Assembly.

  7. Taken from General File. Placed on General File for next legislative day.

  8. Taken from General File. Placed on General File for next legislative day.

  9. From printer. To re-engrossment. Re-engrossed. Second reprint. Taken from General File. Placed on General File for next legislative day.

  10. Read second time. Amended. (Amend. No. 685.) To printer.

  11. From committee: Amend, and do pass as amended.

  12. In Senate. Read first time. Referred to Committee on Commerce and Labor. To committee.

  13. From printer. To engrossment. Engrossed. First reprint. Read third time. Passed, as amended. Title approved, as amended. (Yeas: 41, Nays: None, Excused: 1.) To Senate.

  14. From committee: Amend, and do pass as amended. Placed on Second Reading File. Read second time. Amended. (Amend. No. 509.) To printer.

  15. From printer. To committee.

  16. Read first time. Referred to Committee on Commerce and Labor. To printer.

Sponsors

  • Assembly Committee on Health and Human Services · Primary

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 66 not signed on

Sponsors (1)

  • Assembly Committee on Health and Human Services

Co-sponsors (0)

None.

Not signed on (66)

66 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

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Subjects

healthcare health-insurance
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Frequently asked questions

What does AB 239 do?
AN ACT relating to controlled substances; revising requirements concerning the review and investigation of a complaint concerning certain violations relating to controlled substances; requiring certain professional licensing boards that regulate prescriptions for controlled substances or practitioners who issue such prescriptions to develop and disseminate an explanation or technical advisory bulletin concerning certain requirements relating to such prescriptions; clarifying the independent authority of the State Board of Pharmacy to take disciplinary action; revising provisions concerning prescribing controlled substances for the treatment of pain; requiring a system for the maintenance of electronic health records to have certain capabilities; and providing other matters properly relating thereto.
Who sponsors AB 239?
AB 239 is sponsored by Assembly Committee on Health and Human Services.
What is the current status of AB 239?
This bill has been enacted into law. Introduced March 05, 2019. Enacted.
Where can I track AB 239?
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