D.C. Law 23-251. Prescription Drug Monitoring Program Query and Omnibus Health Amendments Act of 2020.

D.C. Law 23-251. Prescription Drug Monitoring Program Query and Omnibus Health Amendments Act of 2020.

AN ACT

To amend the Prescription Drug Monitoring Program Act of 2013 to require mandatory query of the prescription drug monitoring database by prescribers and dispensers prior to prescribing or dispensing an opioid or benzodiazepine for more than 7 consecutive days, and every 90 days thereafter while the course of treatment or therapy continues, or prior to dispensing another refill after 90 days, make specified exceptions to this requirement, and to impose penalties for failing to comply with this requirement; to amend the Health Care Privatization Amendment Act of 2001 to align the enrollment process and enrollment period for the DC HealthCare Alliance align with requirements for DC Medicaid; to amend the Department of Health Care Finance Establishment Act of 2007 to limit the initial use of the Medicaid Reserve to reforming the DC HealthCare Alliance application and recertification process, and make the funding in the Medicaid Reserve non-lapsing; to amend Title 47 of the District of Columbia Official Code to require that any reprogramming of funding from the Department of Health Care Finance or the Medicaid Reserve be actively approved by resolution in Fiscal Year 2021, and that all unspent local funds of the Department of Healthcare Finance in Fiscal Year 2021 be deposited into the Medicaid Reserve; and to amend the District of Columbia Health Occupations Revision Act of 1985 to make clarifying amendments to the standard of care for certified professional midwives.

BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may be cited as the "Prescription Drug Monitoring Program Query and Omnibus Health Amendments Act of 2020".

TITLE I. PRESCRIPTION DRUG MONITORING.

New § 48-853.03c

Sec. 101. The Prescription Drug Monitoring Program Act of 2013, effective February 22, 2014 (D.C. Law 20-66; D.C. Official Code § 48-853.01 et seq.), is amended by adding a new section 4c to read as follows:

"Sec. 4c. Database Query requirement for prescribers and dispensers.

"(a)(1) Except as provided in subsection (c) of this section, a prescriber who is licensed, registered, or otherwise permitted to prescribe a controlled substance or other covered substance in the course of his or her professional practice in the District of Columbia, or the prescriber's authorized delegee, shall query the District of Columbia prescription drug monitoring database before initiating a new course of treatment or therapy for a patient in the District of Columbia that includes prescribing an opioid or benzodiazepine for more than 7 consecutive days, and every 90 days thereafter while the course of treatment or therapy continues.

"(2) Nothing in this subsection shall prohibit a prescriber from making additional periodic queries of the prescription drug monitoring program database as may be required by routine prescribing practices.

"(b)(1) Except as provided in subsection (c) of this section, a dispenser who is licensed, registered, or otherwise permitted to dispense a controlled substance or other covered substance in the course of his or her professional practice in the District of Columbia, or the dispenser's authorized delegee, shall query the District of Columbia prescription drug monitoring database before dispensing an opioid or benzodiazepine for a course of treatment that is anticipated to last for more than 7 consecutive days, and before dispensing a refill for an opioid or benzodiazepine more than 90 days after the initial fill or previous refill date.

"(2) Nothing in this section shall prohibit a dispenser from making additional periodic queries of the prescription drug monitoring program database as may be required by routine prescribing practices.

"(c) A prescriber or dispenser shall not be required to meet the provisions of subsection (a) or (b) of this section if the:

"(1) Controlled substance or other covered substance is prescribed or otherwise provided to a patient currently receiving hospice or palliative care;

"(2) Controlled substance or other covered substance is prescribed or otherwise provided to a patient during an inpatient hospital admission or at discharge;

"(3) Controlled substance or other covered substance is prescribed or otherwise provided to a patient in a nursing home or residential care facility that uses a sole source pharmacy;

"(4) Prescription drug monitoring program database is not operational or available due to a temporary technological or electrical failure or natural disaster; or

"(5) Prescriber or dispenser is unable to access the prescription drug monitoring program database due to an emergency or a disaster and documents the circumstances in the patient's medical record.

"(d) Failure to comply with the provisions of this section shall constitute grounds for disciplinary action by the relevant health occupations board pursuant to section 514(c) of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1205.14(c)), and the imposition of civil fines pursuant to section 104 of the Department of Consumer and Regulatory Affairs Civil Infractions Act of 1985, effective October 5, 1985 (D.C. Law 6-42, D.C. Official Code § 2-1801.04).".

TITLE II. D.C. HEALTHCARE ALLIANCE REFORM.

Sec. 201. The Health Care Privatization Amendment Act of 2001, effective July 12, 2001 (D.C. Law 14-18; D.C. Official Code § 7-1401 et seq.) is amended as follows:

Repeal § 7-1408

(a) Section 7c (D.C. Official Code § 7-1408) is repealed.

(b) A new section 7e is added to read as follows:

New § 7-1410

"Sec. 7e. DC HealthCare Alliance application and recertification process.

"(a) The Mayor shall allow applicants and enrollees for the DC HealthCare Alliance program to complete initial application and recertification with the Department of Human Services:

"(1) In person;

"(2) Over the telephone; and

"(3) Through electronic means, including through a web-based portal.

"(b) Applicants for the DC HealthCare Alliance program shall not be required to:

"(1) Complete a face-to-face interview to establish eligibility for enrollment in the DC HealthCare Alliance program; or

"(2) Recertify their enrollment in person.

"(c) DC HealthCare Alliance program enrollees shall not be required to recertify more than once in a 12-month period.".

Sec. 202. The Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.01 et seq.), is amended as follows:

(a) Section 8b (D.C. Official Code § 7-771.07b) is amended as follows:

(1) Subsection (b) is amended as follows:

Amend § 7-771.07b

(A) Paragraph (1) is amended to read as follows:

"(1) To pay for the fiscal effect associated with section 7e; and".

Repeal § 7-771.07b

(B) Paragraph (2) is repealed.

Repeal § 7-771.07b

(C) Paragraph (3) is repealed.

(D) Paragraph (4) is amended as follows:

Amend § 7-771.07b

(i) Subparagraph (B) is amended as follows:

(I) Sub-subparagraph (ii) is amended by striking the word "and"

(II) Sub-subparagraph (iii) is amended by striking the phrase "tools;" and inserting the phrase "tools; and" in its place.

Repeal § 7-771.07b

(ii) Subparagraph (C) is repealed.

Amend § 7-771.07b

(2) Subsection (d) is amended to read as follows:

"(d)(1) There is established as a special fund the Medicaid Reserve Fund ("Fund").

"(2) The following monies shall be deposited into the Fund:

"(A) All unspent local fund monies remaining in the operating budget of the Medicaid Reserve at the end of Fiscal Year 2021; and

"(B) All unspent local fund monies remaining in the operating budget of the Department of Health Care Finance at the end of Fiscal Year 2021.

"(3) Money in the Fund shall be used for operating expenses permitted under this section.

"(4)(A) The money deposited into the Fund, but not expended in a fiscal year, shall not revert to the unassigned fund balance of the General Fund of the District of Columbia at the end of a fiscal year or at any other time.

"(B) Subject to authorization in an approved budget and financial plan, any funds appropriated in the Fund shall be continually available without regard to fiscal year limitation.".

New § 7-771.10a

(b) A new section 11a is added to read as follows:

"Sec. 11a. Unspent local funds.

"In Fiscal Year 2021, the Chief Financial Officer shall deposit all unspent local funds at the Department of Health Care Finance into the Medicaid Reserve Fund at the end of the fiscal year.".

Amend § 47-362

Sec. 203. Section 47-362 of the District of Columbia Official Code is amended by adding a new subsection (h) to read as follows:

"(h) Notwithstanding § 47-363, local funds appropriated for the Department of Health Care Finance and the Medicaid Reserve in Fiscal Year 2021 shall not be reprogrammed to other agencies unless the Council approves the reprogramming by resolution.".

TITLE III. Certified Professional Midwife Standard of Care Clarifications.

Sec. 301. The District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code§ 3-1201.01 et seq.), is amended as follows:

Amend § 3-1201.02

(a) Section 102(7A) (D.C. Official Code § 3-1201.02) is amended as follows:

(1) Strike the phrase "(7A)(A) "Practice of certified professional midwifery" and insert the phrase "(2D)(A) "Practice of Certified professional midwifery" in its place.

(2) Subparagraph (A) is amended as follows:

(A) Sub-subparagraph (v) is amended striking the phrase "plan of care" and inserting the phrase "plan of care that must be provided to a patient-client and included in the medical record" in its place.

(B) Sub-subparagraph (vi) is amended by striking the phrase "health care professionals;" and inserting the phrase "health care professionals in accordance with the national standard of care;" in its place.

(C) Sub-subparagraph (vii)(II) is amended by striking the phrase "out-of-hospital setting;" and inserting the phrase "out-of-hospital setting or inpatient setting;" in its place.

Amend § 3-1206.63

(b) Section 663(a)(2) (D.C. Official Code § 3-1206.63(a)(2)) is amended by striking the phrase "American College of Nurse Midwives." and inserting the phrase "American College of Nurse Midwives, but these practice guidelines shall not be interpreted to set, establish, define, enumerate, or otherwise lower the applicable standard of care for a certified professional midwife or certified nurse-midwife." in its place.

Amend § 7-743.09

Sec. 302. Section 4949(c)(2) of the Department of Health Functions Clarification Act of 2001, effective October 3, 2001 (D.C. Law 14-28; D.C. Official Code §7-743.09(c)(2)), is amended as follows:

(a) Subparagraph (A) is amended by striking the phrase "North American Registry of Midwives ("NARM");" and inserting the phrase "North American Registry of Midwives ("NARM"), but these practice guidelines shall not be interpreted to set, establish, define, enumerate, or otherwise lower the applicable standard of care for a certified professional midwife or certified nurse-midwife;" in its place.

(b) Subparagraph (I) is amended by striking the word "and".

(c) Subparagraph (J) is amended by striking the period and inserting the phrase "; and" in its place.

(d) A new subparagraph (K) is added to read as follows:

"(K) Not be interpreted to set, establish, define, enumerate, or otherwise lower the applicable standard of care for a licensed physician, licensed naturopathic physician, certified professional midwife, certified nurse-midwife, or licensed basic or advanced emergency medical technician.".

TITLE III. TITILE IV. APPLICABILITY; FISCAL IMPACT STATEMENT; EFFECTIVE DATE.

Sec. 401. Applicability.

(a) Sections 201 and 202(a)(1) of this act shall apply upon the date of inclusion of their fiscal effect in an approved budget and financial plan.

(b) The Chief Financial Officer shall certify the date of the inclusion of the fiscal effect in an approved budget and financial plan, and provide notice to the Budget Director of the Council of the certification.

(c)(1) The Budget Director shall cause the notice of the certification to be published in the District of Columbia Register.

(2) The date of publication of the notice of the certification shall not affect the applicability of this act.

Sec. 402. Fiscal impact statement.

The Council adopts the fiscal impact statement in the committee report as the fiscal impact statement required by section 4a of the General Legislative Procedures Act of 1975, approved October 16, 2006, (120 Stat. 2038; D.C. Official Code § 1-301.47(a)).

Sec. 403. Effective date.

This act shall take effect following approval by the Mayor (or in the event of veto by the mayor, action by the Council to override the veto), a 30-day period of Congressional review as provided in section 602(c)(1) of the District of Columbia Home Rule Act of 1973, as amended, approved December 24, 1973, (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of Columbia Register.