South Carolina Compliance Update

Transcription

1 South Carolina Compliance Update 2017 ACC Annual Meeting James Jamey Goldin and Robyn W. Madden November 7, 2017

2 Protecting the Public Increased focus to protect the public across the boards.

3 South Carolina Prescriptive Authority Crack Down Joint Revised Pain Management Guidelines SCRIPTS ProPublica Revised Injectable and Delegation Guidelines. If it s not documented, it did not happen.

4 SCRIPTS Verify each patient s information in the SCRIPTS system BEFORE writing a Schedule II prescription.

5 Registering for SCRIPTS Registration is free and may be accessed at Consider selecting a designee within the office to check the database. If a designee is selected, you must both register separately for the system.

6 SCRIPTS DOCUMENTATION Providers are expected to document in the patient s EHR that a search was conducted. If your designee runs the search, you must document the discussion and information provided. EHR automatic download access does not require additional documentation.

7 Information SCRIPTS Provides Prescription information for Schedule II, III, and IV drugs. Medication dispensed by all retail and outpatient hospital pharmacies. The practitioner who prescribed the medication, the duration and amount of controlled medication prescribed, the pharmacy that dispensed the prescription.

8 SCRIPTS Exclusions Methadone clinic or emergency room prescribing less than a 2 day supply, or Medication dispensed by a veterinarian.

9 Exceptions To SCRIPTS Review Prescriptions written for a patient in a skilled nursing facility, nursing home, community residential care facility, or assisted living facility and meds are stored, given and monitored by staff.

10 SCRIPTS EXCEPTIONS Hospice certified patients. A prescription written for no more than five days. Treatment of a patient with whom the practitioner has an established relationship for a chronic condition (review SCRIPTS every three months).

11 Other SCRIPTS Considerations If you can see it, so can everyone else. (consider SCRIPTS when prescribing any controlled medications) WHEN IN DOUBT, CHECK SCRIPTS.

12 The Pain Management Pendulum 2009: First pain management guidelines focus on patient reported pain 2014: Executive Order creates the Governor s Prescription Drug Abuse Prevention Council (PDAP)

13 The Pain Management Pendulum October 2014 Change to Prescriptive Authority and Schedule II Medication November 2014 Revised Pain Management Guidelines 2016 CDC Prescribing Guidelines

14 Opioid Epidemic On October 26, 2017 President Trump declared this country s opioid crisis a public health emergency. The South Carolina House of Representatives formed the Opioid Abuse Prevention Study Committee to craft legislation for 2018.

15 South Carolina s Opioid Problem Nearly five million opioid prescriptions were filled in South Carolina in According to the US Census Bureau, 4.961million people resided in South Carolina in United States Census Bureau; scdhec.gov

16 CDC Vital Signs, July 2017

17 The New Pain Management Guidelines The Powers Reconvene

18 SC Pain Management Guidelines Implemented by the South Carolina Board of Medical Examiners, Board of Pharmacy, Board of Dentistry, and Board of Nursing. Reiterate the importance of SCRIPTS Promote alternative therapies

19 Is Pain Medication Appropriate? Assess the patient and medical history History and characteristics of pain Contributing factors Is it acute or chronic pain Start with immediate use opioids. Use the lowest effective dose possible, for the shortest duration possible. Reassess with transferred patients.

20 Establish Treatment Goals Set goals for pain and function. Clarify expectations and consider when medication should be discontinued. Weigh, and periodically discuss, risks with the patient.

21 Counsel that Opioid Use May Not Be Necessary Alternative medications. Alternative therapies. Physical therapy Exercise Cognitive behavioral therapy

22 Set Treatment Expectations Evaluate the benefits and harms with patients within 1 to 4 weeks of starting opioid therapy. Plan for, and consider, tapering. Continually assess risk against benefits.

23 Assess Opioid Risk and Potential Harm Incorporate ways to minimize harm into the treatment plan. Consider, and plan for additional risks including age, other medical conditions, mental health conditions, substance use disorder.

24 Additional Considerations Discuss and offer Naloxone to patients with increased risk. Drug test patients. Avoid prescribing opioids and benzodiazepines concurrently.

25 How Do You Protect Yourself? Document Document Document Establish best practices

26 Best Practices Determine when to start, or continue, opioid medication for chronic pain. Carefully consider which medications to prescribe, the appropriate dose, the duration of the script, when to follow up with the patient and when to taper or discontinue meds.

27 Chronic Pain? Best Practices Nonpharmacoligic therapy and non-opioid pharmacologic therapy are preferred. Use of opioids should be combined with these therapies when appropriate.

28 Establish Treatment Goals Be realistic about pain and function. Decide when to reconsider. Continue only if there is clinically meaningful pain improvement and function outweighing risk to patient safety.

29 Talk Before You Prescribe Discuss all known risks and benefits and the licensee s responsibilities for pain management. Prescribe immediate release, not extended release, medication when initially prescribing.

30 Lowest dose Lowest duration Keep it Low Re-evaluate within 1 to 4 weeks of starting therapy for chronic pain or dose escalation.

31 Verify Review Patient History through SCRIPTS when starting,and periodically thereafter. Look for issues with dangerous drug interactions. Consider Naloxone.

32 Confirm Drug test patients when initially prescribing medication, and at least annually thereafter. Avoid prescribing opioids and benzodiazepines when possible.

33 Help Minimize Risk Physicians Consider Naloxone when appropriate. Explore treatment options for patients with opioid use disorder. Run yourself through SCRIPTS. Protect Prescription pad and EHR access when appropriate.

34 Offer Assistance Pharmacists Check each prescription. Talk with each patient. Verify information when appropriate. Report suspicious scripts or behavior. Dispense Naloxone when proper.

35 Defend your Practice The practitioner holds the decision concerning when and whether to prescribe controlled substances, specifically opioids. Thorough documentation and a complete medical record is your best defense.

36 Enhanced Regulation of Injectables Joint Advisory Opinion Actively licensed to practice. A documented provider patient relationship must be established prior to injection. Practitioners should adhere to FDA and manufacturer guidelines to ensure product safety.

37 Strict Scrutiny of Injectables Must be administered in an appropriate clinical setting governed by written policies and procedures. Cosmetic use is a delegable act, but the physician or dentist must be on-site and readily available for any problems that may occur.

38 SC Injectable Update Readily available means on site and available to help. Near proximity, and able to be contacted in person by phone or , does not apply.

39 South Carolina Board of Nursing Update The Interstate Commission of Nurse Licensure Compact Administrators will be effective January 19, 2018 Existing Multistate Licensees will likely be Grandfathered in.

40 Enhanced Interstate Compact Objectives Facilitate the states responsibility to protect the public s health and safety; Ensure and encourage the cooperation of party states in the areas of nurse licensure and regulation; Facilitate the exchange of information between party states in the areas of nurse regulation, investigation and adverse actions;

41 Enhanced Interstate Compact Objectives Promote compliance with the laws governing the practice of nursing in each jurisdiction; Invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party state licenses; and Decrease redundancies in the consideration and issuance of nurse licenses and to provide opportunities for interstate practice by nurses who meet uniform licensure requirements. Ncsbn.org

42 The Future of the Private Reprimand Private Reprimands associated with multistate licensure will no longer be available. Private Reprimands tied to single state licensure may continue in S.C. Code Ann (A)

43 EIC Proposed Licensure Requirements 1.Must meet the requirements of their state of residence; 2. Must have graduated from one of the following: a board-approved education program or an international education program that has been approved and verified by the pertinent agencies 3. Must pass a proficiency exam in English if English is not the applicant's first language or if the applicant's international program was not taught in English; 4. Must pass the NCLEX-RN or the NCLEX-PN or another predecessor exam;

44 EIC License Requirements 5. Currently hold, or be eligible for, an active license that is unencumbered by blemishes such as active disciplinary action in any state; 6. Have submitted to both federal and state criminal background checks that are fingerprint-based; 7. Be free of federal or state felony convictions; 8. Have no misdemeanor convictions that relate to nursing as determined on a case-by-case basis by the interstate commission;

45 EIC License Requirements 9. Does not currently participate in an alternative program; 10. Must self-disclose current participation in an alternative program; and 11. Must have a valid United States social security number.

46 Interim Monitoring

47 Real Estate Commission Increases Focus Real Estate Commission Fingerprint with Initial Application Criminal Background Check Every Third Renewal Failure to disclose a civil judgment brought on grounds of fraud, misrepresentation, or deceit will result in potential disciplinary action. Effective May 19, 2020

48 Contractor s Licensing Board Proposed Regulation Display of licensure required for HVAC All commercial vehicles In the office Invoice and proposal forms

49 Hot Topics (Legislatively) Energy Opioid Epidemic Municipal Business License

50 Election Year Variables Regulatory Framework Concerns Change in Political Climate- State and Federal

51 Energy What is the Baseload Review Act? Who do you buy your power from? What is the future of South Carolina s Generation Mix?

52 South Carolina s Baseload Review Act This bill was the result of the emissions limiting regulations that were coming down from the federal government in the 2000s It allows investor owned utilities to charge ratepayers for the costs of construction and capital as the project is being built

53 South Carolina s Baseload Review Act The traditional model of generation financing involved charging ratepayers after a plant came online The benefit of the Act was designed to be two-fold; you cannot get investor capital for such a project without the assurances contained in the Act, and it saves the ratepayers in interest payments

54 South Carolina s Baseload Review Act Had Westinghouse Completed the Units at VC Summer on time the Act would be heralded as a model for other states Significant changes, and a possible all-out repeal of the Act are on the table for 2018

55 Your Power Provider There will be legislation introduced to sell Santee Cooper (South Carolina Public Service Authority) which provides power to businesses and residences through either direct serve or wholesale supply to South Carolina s Electric Cooperatives

56 What Type of Power Solar Tax Credits Federal Policy Reversal on Carbon-Based Resources

57 Municipal License Fees on Businesses H is a bill that would revamp the Business License Fees imposed by Municipalities The Municipal Association and South Carolina Chamber of Commerce have worked diligently in an effort to compromise on legislation for 2018

58 Corporate Self-Evaluation Does your company have an in-house government and regulatory affairs director? Does your outside counsel have lawyers in the firm who practice in these areas?