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A00608 Summary:

SPONSORRosenthal L
COSPNSRJaffee, Steck, Ortiz, Weprin, Lupardo
Add Art 28-F 2899-k, amd 2807-s, Pub Health L; amd 6507, Ed L
Establishes standards to advance the management and treatment of chronic pain; incorporates continuing education programs for health care professionals who treat patients that have chronic pain.
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A00608 Actions:

01/09/2019referred to higher education
01/08/2020referred to higher education
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A00608 Text:

                STATE OF NEW YORK
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                     January 9, 2019
        Introduced  by  M.  of  A.  L. ROSENTHAL,  JAFFEE, STECK, ORTIZ, WEPRIN,
          LUPARDO -- read once and referred to the Committee on Higher Education
        AN ACT to amend the public health law and the education law, in relation
          to chronic pain management

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section  1.  Legislative  intent:  The  legislature  hereby finds that
     2  medical treatment of chronic pain in this state needs to  be  reexamined
     3  to  enhance  the  ability  to  assess such condition, increase access to
     4  appropriate care to treat and mitigate chronic  pain,  and  improve  the
     5  quality  of  life  for  those  afflicted  with this condition. Currently
     6  chronic pain is most often treated by primary  care  providers  who  may
     7  have  little  training in the assessment and proper treatment of complex
     8  chronic pain conditions. This, in turn,  has  led,  in  certain  circum-
     9  stances,  to  patients seeing multiple health care providers and experi-
    10  encing multiple and repeated diagnostic tests, that lead  to  inadequate
    11  or  unproven  surgeries, prescription of unneeded or strong pain medica-
    12  tions, with its consequential heightened possibility to lead to the long
    13  term addiction to such strong pain medications, and the  performance  of
    14  procedures or treatment regimens that are not able to successfully treat
    15  or mitigate such chronic pain.
    16    Further, the current practice of the repeated utilization of different
    17  health  practitioners, tests and unnecessary medical procedures to treat
    18  such chronic pain is resulting in  higher  health  care  costs.    These
    19  increased  costs come from unnecessary visits to health care practition-
    20  ers, more and longer hospital stays, performing unnecessary surgeries or
    21  other medical procedures, and unnecessary  prescription  of  costly  and
    22  dangerous  drugs. This inefficient use of valuable health care resources
    23  is contributing to the rapidly increasing cost of providing health care.
    24  With the continuing aging of New York's general population,  this  trend
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 608                              2
     1  may  only  continue  to  grow.  Further,  the  consequences  to patients
     2  afflicted with chronic pain will continue  to  undermine  the  physical,
     3  social,  economic  and  psychological well being of such patients, their
     4  families and loved ones.
     5    The  current  health  care delivery system both over treats and under-
     6  treats those afflicted with chronic pain. Ideally, all patients  subject
     7  to  chronic  pain  should be able to obtain an appropriate assessment of
     8  the underlying conditions that cause such pain, followed by an appropri-
     9  ate plan of care that reflects the best practices currently available to
    10  prevent the adverse effects of pain. Such care should be provided  in  a
    11  coordinated  manner  that minimizes such chronic pain and is cost effec-
    12  tive for the patient, health care delivery system, and for employers  of
    13  such  persons.  In sum, the provision of chronic pain treatments needs a
    14  major reassessment to enhance assessment capabilities,  increase  access
    15  to  appropriate care, improve the quality of care, and do so in a manner
    16  that minimizes the cost of providing such care.
    17    § 2. The public health law is amended by adding a new article 28-F  to
    18  read as follows:
    19                                ARTICLE 28-F
    20                           CHRONIC PAIN MANAGEMENT
    21  Section 2899-k. Chronic pain management.
    22    § 2899-k. Chronic pain management. 1. Definitions. The following words
    23  or phrases as used in this article shall have the following meanings:
    24    (a) "chronic pain" shall mean consistent and significant physical pain
    25  or  discomfort that lasts for an extended period of time beyond an acute
    26  physical injury or painful stimulus, and persists unabated for a  period
    27  of  time  greater  than  six  months. Further such condition impedes the
    28  ability of such person from conducting many normal life  activities,  or
    29  impedes  or  leads to the loss of employment, or curtails the ability to
    30  perform a number of previously executed physical employment tasks.  Such
    31  chronic  pain  may  be associated with cancer pain, pain from chronic or
    32  degenerative diseases or conditions, or from an unidentified cause.
    33    (b) "chronic pain care certified medical school" shall mean a  medical
    34  school  in  the  state  which is an institution which grants a degree of
    35  doctor of medicine or doctor of osteopathic medicine in accordance  with
    36  regulations  promulgated  by  the  commissioner of education pursuant to
    37  subdivision two of section sixty-five hundred twenty-four of the  educa-
    38  tion  law,  and  which meets the standards established pursuant to regu-
    39  lations promulgated by the commissioner,  after  consultation  with  the
    40  council, that are used to determine whether a medical school is eligible
    41  for funding pursuant to this section.
    42    (c) "chronic pain care certified residency program" shall mean a grad-
    43  uate  medical education program in the state which has received accredi-
    44  tation from a nationally recognized accreditation body  for  medical  or
    45  osteopathic  residency  programs,  and  which meets the standards estab-
    46  lished pursuant to regulations promulgated by  the  commissioner,  after
    47  consultation  with  the  council,  that  are used to determine whether a
    48  residency training program is eligible  for  funding  pursuant  to  this
    49  section.
    50    (d)  "council"  shall mean the state chronic pain management education
    51  and training council established by subdivision two of this section.
    52    (e) "health care professionals" shall mean and  include  those  health
    53  care  professionals who regularly treat patients that have chronic pain,
    54  and includes, but is  not  limited  to,  acupuncturists,  chiropractors,
    55  dentists,  nurse  practitioners,  registered professional nurses, podia-

        A. 608                              3
     1  trists, pharmacists, physicians, physical therapists, physician  assist-
     2  ants, psychiatrists and occupational therapists.
     3    (f)  "professional  continuing  education"  or  "continuing education"
     4  shall mean  all  professional  continuing  education  programs  required
     5  either  by  state  law or by professional associations authorized by the
     6  education department to monitor the requirements of  licensure,  and  to
     7  conduct and approve professional continuing education requirements for a
     8  health  care  profession.    Such  professions shall include, but not be
     9  limited to, acupuncture,  chiropractic,  dentistry,  nursing,  podiatry,
    10  pharmacy,  medicine,  physical therapy, physician assistance, psychology
    11  and occupational therapy.
    12    2. State chronic pain management education and training council.   (a)
    13  The  state  chronic  pain  management  education and training council is
    14  hereby established in the department to be an expert panel to advise the
    15  commissioner and commissioner of education on: (i) advances in the opti-
    16  mum treatment, management and best practices related  to  mitigating  or
    17  alleviating  chronic  pain, (ii) to promote better interdisciplinary and
    18  coordinated provision of care related to chronic pain management,  (iii)
    19  to develop new public policies related to advancing the teaching of such
    20  new  treatments,  management regimens, or best practices on chronic pain
    21  management and care in chronic pain care certified medical  schools  and
    22  chronic  pain care certified residency programs, and (iv) develop guide-
    23  lines to assist the education department in establishing  materials  and
    24  curricula  to  be  used  in  providing professional continuing education
    25  programs for those health care professionals regulated by  such  depart-
    26  ment.
    27    (b)  The council shall be composed of twenty-five members appointed by
    28  the  commissioner.  The  commissioner  shall  seek  recommendations  for
    29  appointments  to  such  council from health care professional, consumer,
    30  medical institutional, medical educational  leaders  and  other  profes-
    31  sional  educational leaders from this state. The membership of the coun-
    32  cil shall include: nine representatives of medical schools and  hospital
    33  organizations;  two representatives of medical academies; one acupunctu-
    34  rist licensed pursuant to section eighty-two  hundred  fourteen  of  the
    35  education  law;  individual  representatives  of  organizations  broadly
    36  representative of physicians, family  physicians,  primary  care  physi-
    37  cians,  internal  medicine, rheumatology, nursing, gerontology, hospice,
    38  neurology, psychiatry, pediatrics,  surgery,  acupuncture,  chiropractic
    39  care,  podiatric care, pharmacists or those professionals related to the
    40  prescription or manufacture of pain medications, emergency  room  health
    41  care professionals, massage therapists, occupational and physical thera-
    42  py,  patient  advocates and the hospital philanthropic community; health
    43  care plan payors or insurers; the executive director or a member of  the
    44  New  York  state  council on graduate medical education; and a member of
    45  the New York state palliative care education and training council.
    46    (c) The members of the council shall have expertise in  the  treatment
    47  and  management  of  chronic  pain  and  the  care  of patients that are
    48  afflicted with chronic pain conditions. The term of such  members  shall
    49  be  four  years  and such terms may be renewed. Members shall receive no
    50  compensation for their services, but shall be allowed actual and  neces-
    51  sary expenses in the performance of their duties.
    52    (d) A chair and vice-chair of the council shall be elected annually by
    53  the council. The council shall meet upon the call of the commissioner or
    54  the  chair.  The  council  may  adopt  regulations  consistent with this
    55  section.

        A. 608                              4
     1    (e) The commissioner shall designate such employees  and  provide  for
     2  other  resources  from  the department as may be reasonably necessary to
     3  provide support and services for the work of the  council.  The  council
     4  may  employ additional staff and consultants and incur other expenses to
     5  carry  out  its  duties,  to  be paid for from amounts which may be made
     6  available to the council for that purpose.
     7    (f) The council may provide  technical  information  and  guidance  to
     8  health  care  professionals  on  the  latest best practices, strategies,
     9  therapies and medications to treat or manage chronic pain.  Further,  to
    10  provide  technical information and guidance to health care professionals
    11  to encourage better coordinated care  to  treat  or  mitigate  the  pain
    12  suffered by chronic pain patients.
    13    3.    Policies to be considered, examined and possibly advanced by the
    14  council. The council shall consider and examine the  following  policies
    15  and guidelines in the adoption of any rules and regulations:
    16    (a)  The  treatment  and care provided to patients that suffer chronic
    17  pain should be centered in the primary care environment and foster coor-
    18  dinated care between the various health care professional disciplines.
    19    (b) Chronic pain management and care should  be  coordinated  to  help
    20  minimize  the  dispensing  of  prescription drugs, avoid duplicative and
    21  costly evaluations and diagnostic  tests,  and  treatments  to  minimize
    22  chronic pain.
    23    (c)  Development  of  chronic pain management and care techniques that
    24  address discrepancies that may occur in the treatment of patients  based
    25  on race, ethnicity, gender, income level or age.
    26    (d)  Develop  and  promote  the  use of best practices to mitigate the
    27  suffering of chronic pain in patients.  The  utilization  of  such  best
    28  practices can be promoted by: (i) the provision of professional continu-
    29  ing  education  programs to all health care professionals on advances in
    30  best practices in chronic pain management and care, and (ii) the  devel-
    31  opment  of  advances  in  best practices based on new research, clinical
    32  experience, and the promotion of inter-disciplinary dialog  and  cooper-
    33  ation between the various health care professionals.
    34    (e) Encourage the wider use of coordinated health information technol-
    35  ogy systems to track pain disorders, treatments, and outcomes as a mech-
    36  anism  to  improve chronic pain care and to better integrate coordinated
    37  care among the various treating health care professionals.
    38    (f) Consider alterations in Medicaid and private  payor  reimbursement
    39  rates  and  practices  to  encourage  more  optimum provision of quality
    40  chronic pain management and care by all health care professionals.
    41    (g) Encourage a balanced approach to regulate the  distribution,  use,
    42  and  prescription  of  medications  that  are used to treat chronic pain
    43  conditions. Such balanced approach needs to  ensure  that  patients  can
    44  obtain  the medications that they need, but are not over prescribed such
    45  medications, which can lead to patient abuse  or  long  term  addiction.
    46  Further,  the  need  to  monitor  multiple daily medication prescription
    47  regimens, coupled with  psychological,  behavioral,  and  social  inter-
    48  vention  activities  of  such patients. Further, to reduce the threat of
    49  drug abuse, addiction or diversion  of  such  medications  to  uses  not
    50  related to proper treatment of chronic pain conditions.
    51    4.  Grants  for undergraduate medical education in chronic pain treat-
    52  ment and management. (a) The commissioner is authorized, within  amounts
    53  from  any source appropriated or otherwise provided for such purpose, to
    54  make grants to chronic pain care certified medical schools  and  schools
    55  of health care professionals to enhance the study and research of chron-
    56  ic  pain treatment and management, increase the opportunities for under-

        A. 608                              5
     1  graduate medical education in chronic pain care  treatment  and  manage-
     2  ment,  and  encourage  the  education of physicians in chronic pain care
     3  management and treatment.
     4    (b)  Grant  proceeds  under  this  subdivision may be used for faculty
     5  development in chronic pain care treatment and  management;  recruitment
     6  of  faculty with an expertise in the management and treatment of chronic
     7  pain; costs incurred teaching medical students at hospital-based  sites,
     8  non-hospital based ambulatory care settings, certified home health agen-
     9  cies,  licensed  long term home health care programs, private and public
    10  health care clinics, and in private physician practices  including,  but
    11  not  limited  to personnel, administration and student-related expenses;
    12  expansion or development of programs that train physicians in the treat-
    13  ment and management of  chronic  pain;  and  other  innovative  programs
    14  designed  to  increase  the  competency  of  medical students to provide
    15  chronic pain care to patients.
    16    (c) Grants under this subdivision shall be awarded by the commissioner
    17  through a competitive application process to the  council.  The  council
    18  shall make recommendations for funding to the commissioner.
    19    5.  Grants  for graduate health care professional education in chronic
    20  pain treatment and management. (a) The commissioner is authorized, with-
    21  in amounts from any source appropriated or otherwise provided  for  such
    22  purpose,  to  make  grants  to  chronic  pain  care  certified residency
    23  programs to establish or expand education in chronic pain treatment  and
    24  management  for graduate medical education, and to increase the opportu-
    25  nities for trainee education in the treatment and management of  chronic
    26  pain in the hospital-based and non-hospital-based settings.
    27    (b)  Grants  under  this  subdivision for graduate health care profes-
    28  sional education and education in chronic pain treatment and  management
    29  may  be  used  for  administration, faculty recruitment and development;
    30  start-up costs and costs incurred teaching the most advanced strategies,
    31  therapies, medications or best practices with  regard  to  the  care  of
    32  patients  with  chronic  pain  in  either hospital-based or non-hospital
    33  based settings including, but not limited to  personnel,  administration
    34  and  trainee  related expenses; and other expenses deemed reasonable and
    35  necessary by the commissioner.
    36    (c) Grants under this subdivision shall be awarded by the commissioner
    37  through a competitive application process to the  council.  The  council
    38  shall make recommendations for funding to the commissioner.
    39    6.   Chronic  pain  health  care  professional  practitioner  resource
    40  centers.  The commissioner, in consultation with the council, may desig-
    41  nate a chronic  pain  treatment  and  management  practitioner  resource
    42  center  or  centers.  Such resource center may be statewide or regional,
    43  and shall act as a source of technical support, information and guidance
    44  for practitioners on the latest strategies,  therapies,  medications  or
    45  best  practices  with  regard to the optimum treatment and management of
    46  chronic pain. The department, in  consultation  with  the  council,  may
    47  contract  with not-for-profit organizations or associations to establish
    48  and manage such resource centers. Such resource centers may charge a fee
    49  to help offset the cost of providing such services.
    50    7. Continuing education requirements for  health  care  professionals.
    51  The  council, in consultation with the department, the education depart-
    52  ment and health care professional organizations, shall develop,  compile
    53  and  publish  information and course materials on the advanced treatment
    54  and mitigation of chronic pain suffered by patients. In addition  within
    55  two  years of the effective date of this article, the council shall make
    56  recommendations to the education department for the course work,  train-

        A. 608                              6
     1  ing  and  curriculum  to  be included in the continuing education on the
     2  best practices, strategies, therapies and approaches for the  mitigation
     3  and  treatment  of  chronic pain required to be completed by the various
     4  health  care professions pursuant to paragraph d of subdivision three of
     5  section sixty-five hundred seven of the education law. Such  recommenda-
     6  tions  shall  include components which address the increasing and neces-
     7  sary interdisciplinary cooperation between health care professionals for
     8  the coordinated reduction of chronic pain in patients and the  reduction
     9  of health care costs.
    10    8.  Report.    On or before March first of each odd numbered year, the
    11  council shall submit to the governor, the commissioner, the commissioner
    12  of education, the temporary president of the senate, the speaker of  the
    13  assembly, and the chairs of the senate and assembly committees on health
    14  a report on its activities and accomplishments relating to the treatment
    15  and mitigation of chronic pain. Such report may also include such legis-
    16  lative proposals as it deems necessary to more effectively implement the
    17  provisions of this article.
    18    § 3. Paragraphs b and c of subdivision 3 of section 6507 of the educa-
    19  tion law, as added by chapter 987 of the laws of 1971, are amended and a
    20  new paragraph d is added to read as follows:
    21    b.  Review  qualifications  in connection with licensing requirements;
    22  [and]
    23    c. Provide for licensing examinations and reexaminations[.]; and
    24    d. (i) Establish standards for preprofessional and professional educa-
    25  tion for health care professionals,  as  defined  in  paragraph  (e)  of
    26  subdivision  one  of  section  twenty-eight hundred ninety-nine-k of the
    27  public health law, relating to the mitigation and treatment  of  chronic
    28  pain.  In  the  promulgation  of  such standards, the department and the
    29  appropriate board of each such profession shall  consider  and,  to  the
    30  extent  practicable,  implement the recommendations of the state chronic
    31  pain management education and training council. Furthermore, such stand-
    32  ards shall provide for such training  and  coursework  on  the  advanced
    33  treatment and mitigation of chronic pain as shall be appropriate for the
    34  health  care  profession, and shall address the increasing and necessary
    35  interdisciplinary cooperation between health care professionals for  the
    36  coordinated  reduction  of chronic pain in patients and the reduction of
    37  health care costs.
    38    (ii) The commissioner shall establish  standards  requiring  that  all
    39  health care professionals applying, on or after January first, two thou-
    40  sand  twenty-two,  initially or for a renewal of a license, registration
    41  or certificate pursuant to this title, shall, in addition to  all  other
    42  licensure,  registration  or  certification requirements, have completed
    43  such coursework and training in the treatment and mitigation of  chronic
    44  pain  as  shall  be  required pursuant to subparagraph (i) of this para-
    45  graph. The coursework and training shall be obtained from an institution
    46  or provider that has been approved by the  department  to  provide  such
    47  coursework  and  training.  Each  applicant shall provide the department
    48  with documentation showing he or she has completed the  required  train-
    49  ing.
    50    (iii)  The department shall provide an exemption from the requirements
    51  of subparagraphs (i) and (ii) of  this  paragraph  to  any  health  care
    52  professional  who requests such an exemption and who demonstrates to the
    53  department's satisfaction that:
    54    (A) there would be no need for him or her to complete such  coursework
    55  and training because of the nature of his or her practice; or

        A. 608                              7
     1    (B)  he  or  she  has  completed coursework and training deemed by the
     2  department to be equivalent to the standards for coursework and training
     3  approved by the department under this paragraph.
     4    §  4.  Subdivision  7  of  section  2807-s of the public health law is
     5  amended by adding a new paragraph (d) to read as follows:
     6    (d) notwithstanding any inconsistent provision of this section,  prior
     7  to  the  allocation of funds for distribution in accordance with section
     8  twenty-eight hundred seven-j of this article pursuant to paragraphs  (b)
     9  and  (c) of this subdivision, the commissioner on an annualized basis up
    10  to two million five hundred thousand dollars for grants for  undergradu-
    11  ate  health  care  professional  education in chronic pain treatment and
    12  management pursuant to subdivision four of section twenty-eight  hundred
    13  ninety-nine-k  of this chapter; and up to two million five hundred thou-
    14  sand dollars for grants for graduate health care professional  education
    15  in chronic pain treatment and management pursuant to subdivision five of
    16  section twenty-eight hundred ninety-nine-k of this chapter.
    17    §  5.  This act shall take effect immediately provided that the amend-
    18  ments to subdivision 7 of section 2807-s of the public health  law  made
    19  by  section  four  of  this  act shall not affect the expiration of such
    20  section and shall expire therewith.
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