The regular session of the 2018 Colorado General Assembly adjourned May 9 and CMS is celebrating the bills that died as much as those that passed into law. We expended considerable resources advocating for health care issues that improve patient care, promote physician professional satisfaction and create healthier communities in Colorado.
This is a preliminary report on some of the highlights of our major priorities.
The liability climate: Colorado's relatively stable liability and professional review climate was maintained, though both will be under assault in 2019 (stay tuned).
Reversing the opioid crisis: Colorado, like virtually every state in the country, is struggling with ways to mitigate the medical and economic consequences of an opioid-addicted patient cohort of overwhelming magnitude. Five of six bills resulting from a 2017 interim legislative opioid abuse study passed into law. They include measures that increase funding for access to treatment, enhance misuse prevention, require health plans to cover certain FDA-approved drugs for medication-assisted opioid dependence treatment without prior authorization, and measures for safer opioid prescribing.
The latter, SB18-022, Clinical Measures for Safer Opioid Prescribing, will, for acute pain circumstances, limit initial prescriptions to 7-days for patients that have not had an opioid prescription in 12-months by that physician, with the discretion to include a second fill for a 7-day supply. The limits on initial prescribing do not apply, if, in the judgement of the physician the patient:
- Has chronic pain that typically lasts longer than 90 days or past the time of normal healing as determined by the physician, or following transfer of care from another physician who prescribed an opioid to the patient;
- Has been diagnosed with cancer and is experiencing cancer-related pain;
- Is experiencing post-surgical pain that, because of the nature of the procedure, is expected to last longer than 14 days;
- Is undergoing palliative care or hospice care focused on providing the patient with relief from symptoms, pain, and stress resulting from a serious illness in order to improve quality of life.
The bill also requires prescribers to check the PDMP (Prescription Drug Monitoring Program) prior to prescribing the first refill with certain exemptions.
While these provisions will repeal in three years, legal protections for PDMP-generated report cards were included over the initial objections of Colorado Trial Lawyers Association and will remain in effect. Additionally, failure to check the PDMP before prescribing a second fill only constitutes unprofessional conduct when done repeatedly.
We urge all physicians to be on the watch for more detailed information on SB 22 in the near future. CMS will be providing a full explanation of the new law, the obligation of physicians and additional resources.
HB18-1279 Electronic Prescribing Controlled Substances
CMS strongly and successfully opposed this bill, which sought to mandate electronic prescribing for all schedule II, III and IV controlled substances. Supported by retail pharmacies on the basis that counterfeit and fraudulent prescriptions will be reduced, the bill will undoubtedly emerge in some form in 2019. CMS was not convinced that mandatory e-prescribing would meaningfully assist in reversing the opioid crisis nor could CMS agree to the violation provision of the bill making failure to e-prescribe grounds for unprofessional conduct under Colorado Medical Board jurisdiction.
SB18-115 Apply Stark Laws to Medical Referrals Outside Medicaid:
While well intentioned, the proponent's argument that applying federal laws and regulations known as the "Stark law" to the Colorado commercial health insurance market would reduce the overall cost of medical care did not carry the day. CMS countered that federal Stark was created in the volume-based world of fee-for-service and was meant to prevent overutilization, and inappropriate self-referral. In addition, CMS argued that the health care system as a whole is now transitioning to value-based reimbursement, which has different incentives than fee-for-service.
For a more in-depth look at the CMS' work during this legislative session, read coverage from Colorado Medicine.