Florida Senate - 2019                                    SB 1360
       By Senator Gruters
       23-01253A-19                                          20191360__
    1                        A bill to be entitled                      
    2         An act relating to alternative treatments to
    3         controlled substances; amending s. 456.44, F.S.;
    4         requiring a practitioner who prescribes controlled
    5         substances to recommend specified alternative
    6         treatments for chronic nonmalignant pain before
    7         prescribing a controlled substance to a patient;
    8         requiring a licensed massage therapist to maintain
    9         certain treatment records and submit them to the
   10         referring practitioner; clarifying that a practitioner
   11         who prescribes controlled substances may
   12         simultaneously prescribe a controlled substance and
   13         refer a patient to alternative treatment for chronic
   14         nonmalignant pain; directing applicable boards to
   15         adopt rules establishing guidelines for alternative
   16         treatments for acute pain; amending s. 627.413, F.S.;
   17         requiring certain insurance policies to provide
   18         coverage for a minimum number of visits to alternative
   19         treatment providers for the treatment of chronic
   20         nonmalignant pain under certain conditions; providing
   21         an exception; providing restrictions on deductibles,
   22         coinsurances, and co-pays required for alternative
   23         treatment; providing an effective date.
   25  Be It Enacted by the Legislature of the State of Florida:
   27         Section 1. Present paragraphs (a) through (g) of subsection
   28  (3) of section 456.44, Florida Statutes, are redesignated as
   29  paragraphs (b) through (h), respectively, a new paragraph (a) is
   30  added to that subsection, and subsection (4) of that section is
   31  amended, to read:
   32         456.44 Controlled substance prescribing.—
   34  NONMALIGNANT PAIN.—The standards of practice in this section do
   35  not supersede the level of care, skill, and treatment recognized
   36  in general law related to health care licensure.
   37         (a)1. Before a registrant prescribes a controlled substance
   38  to a patient, the registrant must refer to the patient one or
   39  more of the following alternative treatments based on the
   40  registrant’s clinical judgment and the availability of the
   41  treatment:
   42         a. Acupuncture by an acupuncturist licensed under chapter
   43  457.
   44         b. Osteopathic manipulation by an osteopathic physician
   45  licensed under chapter 459.
   46         c. Chiropractic services by a chiropractor licensed under
   47  chapter 460.
   48         d. Occupational therapy by an occupational therapist
   49  licensed under part III of chapter 468.
   50         e. Massage therapy by a massage therapist licensed under
   51  chapter 480.
   52         f. Physical therapy by a physical therapist licensed under
   53  chapter 486.
   54         2. A licensed massage therapist treating a patient for
   55  chronic nonmalignant pain pursuant to a registrant’s referral
   56  shall maintain treatment records that document each treatment’s
   57  effect on the patient and shall submit such records to the
   58  referring registrant.
   59         3. This paragraph does not prohibit a registrant from
   60  simultaneously prescribing a controlled substance and referring
   61  a patient to an alternative treatment for chronic nonmalignant
   62  pain.
   64  This subsection does not apply to a board-eligible or board
   65  certified anesthesiologist, physiatrist, rheumatologist, or
   66  neurologist, or to a board-certified physician who has surgical
   67  privileges at a hospital or ambulatory surgery center and
   68  primarily provides surgical services. This subsection does not
   69  apply to a board-eligible or board-certified medical specialist
   70  who has also completed a fellowship in pain medicine approved by
   71  the Accreditation Council for Graduate Medical Education or the
   72  American Osteopathic Association, or who is board eligible or
   73  board certified in pain medicine by the American Board of Pain
   74  Medicine, the American Board of Interventional Pain Physicians,
   75  the American Association of Physician Specialists, or a board
   76  approved by the American Board of Medical Specialties or the
   77  American Osteopathic Association and performs interventional
   78  pain procedures of the type routinely billed using surgical
   79  codes. This subsection does not apply to a registrant who
   80  prescribes medically necessary controlled substances for a
   81  patient during an inpatient stay in a hospital licensed under
   82  chapter 395.
   84  applicable boards shall adopt rules establishing guidelines for
   85  the use of evidence-based, nonpharmaceutical alternative
   86  treatments including chiropractic, osteopathic manipulation,
   87  acupuncture, physical therapy, massage therapy, and occupational
   88  therapy, and for prescribing controlled substances, for acute
   89  pain, including evaluation of the patient, creation and
   90  maintenance of a treatment plan, obtaining informed consent and
   91  agreement for treatment, periodic review of the treatment plan,
   92  consultation, medical record review, and compliance with
   93  controlled substance laws and regulations. Failure of a
   94  prescriber to follow such guidelines constitutes grounds for
   95  disciplinary action pursuant to s. 456.072(1)(gg), punishable as
   96  provided in s. 456.072(2).
   97         Section 2. Subsection (7) is added to section 627.413,
   98  Florida Statutes, to read:
   99         627.413 Contents of policies, in general; identification.—
  100         (7) Every policy must provide coverage for at least five
  101  visits in total to alternative treatment providers for the
  102  treatment of chronic nonmalignant pain when recommended by a
  103  registrant as described in s. 456.44(3)(a). If an insured’s pain
  104  was treated by an alternative treatment provider listed in s.
  105  456.44(3)(a)1. before he or she sought treatment for the chronic
  106  nonmalignant pain from a registrant as defined in s. 456.44(1),
  107  the registrant’s referral is not required as a condition of
  108  coverage by an insurance provider that offers an insurance
  109  product in this state. Any deductible, coinsurance, or co-pay
  110  required for alternative treatment when recommended by a
  111  registrant may not be greater than the deductible, coinsurance,
  112  or co-pay required for a primary care visit.
  113         Section 3. This act shall take effect July 1, 2019.