Legislation that Passed
SB 62 - Health Care Providers, Facilities; Right to Refuse to Make Referrals
SB 62 adds to current law that no person shall be required to make a referral for medical procedures or the prescription or administration of any device or drug that results in the termination of a pregnancy or an effect of which the person reasonably believes may result in the termination of a pregnancy. Additionally, no person would be required to perform or participate in the prescription or administration of any device or drug that results in the termination of a pregnancy or an effect of which the person reasonably believes may result in the termination of a pregnancy.
Current law already states no person shall be required to perform or participate in medical procedures that result in the termination of a pregnancy. Further, the refusal to do so would not be the basis for civil liability to any person, and no medical care facility, medical care facility administrator, or governing body of a medical care facility would be able to terminate the person's employment, prevent or impair the person's practice or occupation, or impose any other sanction on the person because of the person's exercise of these rights.
Similarly, the bill adds language stating no medical care facility, medical care facility administrator, or governing board of any medical care facility would be required to permit the performance, referral for, or participation in medical procedures, or in the prescription or administration of any device or drug that would result in the termination of a pregnancy or an effect of which the person reasonably believes may result in the termination of a pregnancy. The refusal to do so would not constitute grounds for civil liability to any person.
The bill also provides no person would be required to make referrals for medical procedures that result in sterilization and no medical care facility, medical care facility administrator, or governing board of any medical care facility would be required to permit the performance or referral for or participation in medical procedures that result in sterilization. Refusal to do so would not be a basis for civil liability to any person.
SB 134 – Electronic Prescriptions; Prescription Monitoring Program
SB 134 amends the Pharmacy Act and the Uniform Controlled Substances Act regarding electronic prescriptions and amends the Prescription Monitoring Program (PMP) Act to: authorize the Board of Pharmacy (Board) to pursue and accept grant funding and accept donations, gifts, or bequests; add two entities authorized to obtain information from the PMP; create a penalty for obtaining or attempting to obtain PMP information without authority; and authorize the PMP Advisory Committee to identify and review concerns involving controlled substances and drugs of concern, through the use of volunteer peer review committees, and to notify the appropriate entities. The bill would add one new substance each to Schedules IV and V of the Uniform Controlled Substances Act, and allow for the distribution of free samples of Schedule V nonnarcotic depressants by manufacturers or distributors.
Definitions, Electronic Prescriptions (Sections 1 and 7)
The bill adds the following key definitions, generally found in federal regulations related to electronic orders of controlled substances and electronic prescriptions for controlled substances to the Pharmacy Act and the Uniform Controlled Substances Act:
● An "electronic prescription" would be electronically prepared and authorized and transmitted from the prescriber to the pharmacy using electronic transmission;
● A "pharmacist intern" would include a pharmacy student, a pharmacy resident, or a foreign pharmacist graduate;
● A "prescriber" would include a practitioner or a mid- level practitioner; and
● A "valid prescription order" would require the prescription to be issued for a legitimate medical purpose by an individual licensed prescriber acting within such prescriber's scope of practice. Prescriptions issued without an appropriate prescriber-patient relationship, but instead issued only on an internet-based questionnaire or consultation, would not be valid.
Other definitions which also would be added and are based on federal regulations related to electronic orders and electronic prescriptions of controlled substances include: "application service provider," "Drug Enforcement Agency (DEA)," "electronic prescription application," "electronic signature," "electronically prepared prescription," "facsimile transmission," "intermediary," "pharmacy prescription application," and "readily retrievable."
The following definitions would be expanded by the bill:
● "Electronic transmission" is defined and distinguished from a facsimile transmission;
● The definition of "pharmacist" would be expanded in the Uniform Controlled Substances Act to mirror the definition in the Pharmacy Act; and
2 - 134
● "Prescription" or "prescription order" would be combined as one definition to clarify no distinction is made with regard to the manner in which the prescription is communicated.
Some definitions that appear to have been added are in current law, but would be moved to re-alphabetize the definitions within the Acts.
Writing, Filling, Refilling and Recording of Prescriptions Under the Pharmacy Act
The bill also moves most of the language found in KSA 2011 Supp. 65-1637 (Section 2) related to the writing, filling, refilling, and recording of prescriptions to New Section 3, thereby placing all language referring to such current practices together. New language has been added to New Section 3 to incorporate requirements pertaining to electronic prescribing of controlled substances found in federal law as follows.
Validity of Prescriptions
A valid prescription will need to meet the following requirements:
● Pharmacists must exercise professional judgment regarding the accuracy, validity, and authenticity of any prescription order consistent with federal and state laws and rules and regulations;
● A pharmacist will be prohibited from dispensing a prescription drug, if a pharmacist exercising professional judgment determines a prescription is not a valid prescription order;
● The prescriber may authorize an agent to transmit to the pharmacy a prescription order orally, by fax, or by electronic transmission with the first and last name of the transmitting agent included;
● A new written or electronic prescription must be signed manually or electronically by the prescriber and include the first and last name of the transmitting agent;
● A prescription for a controlled substance which is written or printed from an electronic prescription application must be signed by the prescriber manually prior to the delivery of the prescription to the patient or prior to the facsimile transmission to the pharmacy; and
● An electronically prepared prescription cannot be electronically transmitted if it has been printed prior to transmission and, if the prescription is printed after electronic transmission, it must be clearly labeled as a copy and is not valid for dispensing.
Electronic Transmission Study
The State Board of Pharmacy, in consultation with industry, will be required to conduct a study on electronic transmission of prior authorization and step therapy protocols. The study report must be completed and submitted to the Legislature by January 15, 2013. The Board also will be authorized to conduct pilot projects related to any new technology implementation when necessary and practicable, but no state moneys could be expended for this purpose.
Filling or Refilling of Prescription Orders
A refill is defined by the bill as one or more dispensings of a prescription drug or device resulting in the patient's receipt of a single fill as per the prescription and as authorized by the prescriber. In order to fill or refill a prescription, the following conditions need to be met:
● When refilling a prescription or renewing or continuing a drug therapy, an authorization may be transmitted orally, in writing, by fax, or by electronic means initiated by or directed by the prescriber;
● The prescriber's signature is not required on a fax or alternate electronic transmission when the first and last name of the prescriber's agent making the transmission is provided;
● Any refill order or renewal order which differs from an original order must be signed by the prescriber, unless transmitted by fax or electronically by the prescriber's agent and the first and last name of such agent is provided;
● Only pharmacists or pharmacy interns are authorized to receive a new order;
● A pharmacist, pharmacist intern, or a registered pharmacy technician (if authorized to do so by the supervising pharmacist) is permitted to receive a refill or renewal order;
● No more than 12 refills within 18 months of the issuance of the prescription may be authorized for a prescription drug or device which is not a controlled substance; and
● Prescriptions for Schedule III, IV, or V controlled substances will be limited to five refills within six months of the issuance of the prescription.
Prescription Monitoring Program (PMP) Act
The Board will be authorized, for the purpose of furthering the PMP Act, to apply for and accept grants and to accept any donation, gift or bequest. All moneys received by the Board would be submitted for deposit in the State Treasury to the credit of the Non-federal Gifts and Grants Fund of the Board.
The bill replaces the Kansas Health Policy Authority (KHPA) with the Kansas Department of Health and Environment (KDHE) as the entity authorized to obtain PMP information regarding authorized Medicaid program recipients, as necessitated by the passage of Executive Reorganization Order No. 38 in 2011 that reorganized KHPA into the Division of Health Care Finance within KDHE.
The bill also allows access to PMP data for two new categories of persons. Prescribers and dispensers will be allowed access to the data when an individual appears to be obtaining prescriptions for the misuse, abuse or diversion of scheduled substances or drugs of concern. The Board also will be able to provide information to medical examiners, coroners, or other persons authorized by law to investigate or determine causes of death.
PMP Monitoring Program Advisory Committee Review
The PMP Monitoring Program Advisory Committee is to review and analyze PMP data to identify patterns and activity of concern. When individuals are suspected of obtaining prescriptions indicating misuse or abuse of controlled substances, the Advisory Committee could contact the prescribers and dispensers. If the individuals are suspected of criminal activity, the Advisory Committee could notify the appropriate law enforcement agency.
If the PMP information appears to indicate the occurrence of a violation on the part of a prescriber or dispenser in prescribing controlled substances or drugs of concern inconsistent with recognized standards of care for the profession, the Advisory Committee will determine if a report to the appropriate professional licensing, certification, or regulatory agencies or law enforcement agency is warranted.
The Advisory Committee will consult with appropriate regulatory agencies and professional organizations to establish criteria for standards and will utilize volunteer peer review committees to create such standards and to review individual prescriber or dispenser cases. The volunteer peer review committees have the authority to request and receive information in the PMP database from the PMP Director. If referral to a regulatory or law enforcement agency is not warranted, the Advisory Committee could refer prescribers or dispensers to educational or professional advising, as appropriate.
Penalty for Unauthorized Access to PMP Information
An unauthorized person who knowingly obtains or attempts to obtain prescription monitoring information will be guilty of a severity level 10, nonperson felony.
Controlled Substance Additions and Distribution of Free Samples under the Uniform Controlled
The bill amends the Uniform Controlled Substances Act to add Carisoprodol to the Schedule IV controlled substances list and Ezogabine N-[2-amino-4(4- fluorobenzylamino)-phenyl]-carbamic acid ethyl ester to Schedule V list. The bill also allows for the distribution of free samples of Schedule V nonnarcotic depressants by manufacturers or distributors to practitioners, mid-level practitioners, pharmacists, or other persons.
Dispensing Under the Uniform Controlled Substances Act
Controlled substances will be dispensed with the following changes:
● Except when dispensed by a practitioner, other than a pharmacy, to the ultimate user, Schedule II controlled substances will not be allowed to be dispensed unless a practitioner or mid-level practitioner provides a written or electronic prescription. In emergency situations, Schedule II substances could be dispensed upon an oral order if reduced promptly to writing or transmitted electronically and filled by the pharmacy; and
● Except when dispensed by a practitioner, other than a pharmacy, to the ultimate user, Schedule V drugs, which also are prescription drugs, would be added to Schedule III and IV drugs which could only be dispensed when a paper prescription is manually signed by the prescriber, a facsimile of a manually signed paper prescription is transmitted by the prescriber or the agent, an electronic prescription is digitally signed by a prescriber with a digital certificate, or an oral prescription is made by an individual prescriber and promptly reduced to writing.
A controlled substance could not be distributed or dispensed except by a valid prescription order as defined in this act.
Retention of Prescription Record under the Uniform Controlled Substances Act
The bill provides for electronic prescriptions to be retained electronically for five years and requires the record to be readily retrievable into a format a person could read. Paper, oral, and fax prescriptions must be maintained as a hard copy for five years at the registered location.
The bill goes into effect upon publication in the Kansas Register.
HB 2249 – HIPAA; Provider-Patient Privilege Exception
HB 2249 amends one of the provisions of the Kansas Health Information Technology and Exchange Act. Under the current law, the Act would supersede any state law that is contrary to or inconsistent with or more restrictive than the provisions of the Health Insurance Portability and Accountability Act (HIPAA). Two of the existing exceptions to this provision are peer reviews and risk management statutes. The bill deletes the third exception: any statutory health care provider-patient privilege. The bill also includes a provision stating this act would not limit or restrict the state agency's authority to require the disclosure of health information pursuant to law.
HB 2428 – Peer Review; KUMC
HB 2428 adds the University of Kansas Medical Center to the list of Health Care Provider Groups as defined by KSA 2011 Supp. 65-4915. In 1998, when the KU Hospital was separated from the University of Kansas Medical Center, the bill that separated those two entities did not include language to allow the Medical Center to maintain its status as a health care provider group under the Kansas Statutes. As such, the Medical Center lost its protection under the quality assurance/peer review section of the law.
HB 2562 – Emergency Care at Accident Scene
HB 2562 provides that any person who is not a health care provider and in good faith, without compensation, renders emergency care or assistance to a person, including a minor without first obtaining the consent of the parent or guardian of such minor, at the scene of an emergency or accident will not be held liable for any civil damages for acts or omissions other than damages occasioned by gross negligence or by willful or wanton acts or omissions by the person in rendering such emergency care.
Additionally, the bill exempts the Kansas Board of Healing Arts from competitive bidding when contracting with persons licensed to practice the healing arts, who are not members of the Board to provide advice and assistance to the Board. The bill is effective upon publication in the Kansas Register.
Legislation that Did Not Pass
HB 2094 – Vaccination Exemption for Conscience or Personal Belief
HB 2094 would have amended K.S.A. 72-5209 and K.S.A. 2010 Supp. 65-508 concerning public health, relating to exemptions from the administration of vaccinations. The bill would have provided an additional exemption to childhood immunizations, for reasons of conscience or personal beliefs. The law already allows for an exemption based on religious beliefs.
HB 2159 – Physical Therapists Evaluation and Treatment of Patients
HB 2159 would have allowed physical therapists to initiate treatment without referral from a licensed healthcare practitioner. In doing so, the bill would:
● Require a physical therapist, when treating a patient without a referral, to refer the patient to a licensed healthcare practitioner after ten visits, or a period of 15 business days from the initial treatment visit following the initial evaluation visit, if the patient is not progressing toward documented treatment goals as demonstrated by objective, measurable, or functional improvement, or any combination thereof;
● Require the physical therapist to transmit a copy of the initial evaluation to the licensed practitioner identified by the patient no later than five business days after the evaluation is performed;
● Delete existing language that restricts a physical therapist from initiating treatment only after the approval of a licensed physician, podiatrist, physician assistant, or advanced registered nurse practitioner working under the direction of a licensed physician, chiropractor, dentist, or optometrist in appropriately related cases;
● Delete existing language that allows physical therapists to initiate treatment under the approval of a practitioner of the healing arts licensed by another state, based upon an order by that practitioner in any setting in which physical therapists would be authorized to provide the treatment by a Kansas licensee;
● Delete existing language allowing physical therapists to provide services which do not constitute treatment for a specific condition, disease, or injury without a referral;
● State the section is not to be construed to prevent a hospital or ambulatory surgical center from requiring a physician's order or referral for physical therapy services for a patient currently being treated in such a facility;
● Require the physical therapist, prior to commencing treatment, to provide written notice to the patient that a physical therapy diagnosis is not a medical diagnosis;
● Require the physical therapist to perform wound debridement services only after approval by a person licensed to practice medicine and surgery or other licensed healthcare practitioner in appropriately related cases; and
● Define "licensed healthcare practitioner" to mean a person licensed to practice medicine and surgery, or a licensed podiatrist, physician assistant, or advanced practice registered nurse working under specified direction.
HB 2340 – Smoking Regulations; Deleting Casino Exemption
HB 2340 would have amended the Kansas Indoor Clean Air Act, which bans smoking in enclosed areas or public places while providing specific exemptions where smoking is allowed. The bill would delete the current law's smoking ban exemption for the gaming floor of a lottery gaming facility or racetrack gaming facility. The bill would add a smoking ban exemption for any annual benefit cigar dinner or other annual smoking event conducted for charitable purposes by certain not-for-profit organizations. These organizations must have held charitable events during the previous three years.
HB 2353 – Personal & Family Protection Act; State-Local Buildings
HB 2353 would have revised the Personal and Family Protection Act regarding concealed carry of handguns in state or municipal buildings. The term "municipality" does not include school districts in this Act.
Individuals who are licensed to carry concealed handguns would be allowed to carry concealed while in a state or municipal building, unless the building has adequate security measures, as defined in the bill, and is properly posted to prevent weapons in such buildings. The same would apply to state and municipal employees and their work places in such buildings that have adequate security measures at public entrances and that are properly posted.
It would not be a crime for a person to carry a concealed handgun into such buildings if the person is licensed and has the authority to enter through a restricted access entrance in such buildings with adequate security measures at pubic access entrances that are properly posted.
Any state or municipal building that contains both public and restricted access entrances would be required to provide adequate security measures at public entrances.
The bill would not prohibit a state agency or municipality from having employee policies restricting concealed carry in such buildings where adequate security measures are used and signs are properly posted.
The bill would not limit a correctional facility, jail, or law enforcement agency from prohibiting the carrying of a concealed weapon by any person on such premises, as long as adequate security at the public access entrances is provided to prohibit the carrying of concealed handguns into public places.
A postsecondary educational institution, defined as any public university, municipal university, community college, technical college and vocational education school, and any entity resulting from the consolidation or affiliation of any two or more such postsecondary educational institutions, may exempt itself from the provisions of this act for four years by stating its reason and filing notice with the Attorney General.
A state- or municipal-owned medical care facility may exempt itself from the provisions of this act for four years by stating its reason and filing notice with the Attorney General.
A state- or municipal-owned adult care home may exempt itself from the provisions of this act for four years by stating its reason and filing notice with the Attorney General.
Numerous provisions were added to the bill stating that state agencies, municipalities and private entities shall not be liable for any wrongful act or omission relating to actions of persons licensed to carry a concealed handgun. The no liability provisions would apply to all entities prohibiting concealed carry in buildings, whether providing adequate security under requirements of the bill or not providing adequate security under requirement of the bill. In addition, the same no liability provisions would apply to all entities that permit concealed carry in buildings.
HB 2690 – Kansas Clean Air Act; Exemptions
HB 2690 would have amended the Kansas Indoor Clean Air Act as related to certain premises. The bill would add a definition of "private business" to mean any business where one or more persons are employed or engaged in the purchase, sale, provision or manufacturing of commodities, products or services, whether for-profit or not-for-profit, and which is not owned or controlled by any state or local governmental entity.
An exception to the Kansas Indoor Clean Air Act would be included in the bill to permit smoking in any private business if the proprietor or person in charge of the private business:
● Employs and serves only persons 21 years of age or older;
● Posts signs in a conspicuous place at each entrance that state no person under the age of 21 will be admitted;
● Posts signs in a conspicuous place at each entrance that state that the private business permits smoking on the premises only for persons 21 years of age or older;
● Posts in a conspicuous place at each exit the phone number the Kansas quit line signs (hotline to smoking cessation assistance); and
● Posts all required signs at eye level and no smaller than 12 inches by 12 inches in size.
HR 6026 – Tobacco Harm Reduction Study
HR 6026 would have urged the Kansas Department of Health and Environment to conduct a study of tobacco harm reduction. The resolution was drafted and forwarded by the RJ Reynolds tobacco company. The essence of the Resolution would be to advance the idea that switching from smoking to smokeless tobacco products, also sold and distributed by tobacco companies, will significantly reduce the risk of disease and premature death caused by smoking.
Credit: The Source of most bill information contained in this document is the Kansas Legislative Research Department.