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  • Summary date: Apr 4 2019 - View Summary

    Amends multiple statutes to advance non-opioid pain management as a first option suggested by providers where appropriate to manage acute or chronic pain and to allow patients to opt for alternatives to opioids.  Requires health insurance coverage of a variety of evidence-based non-opioid pain management therapies including for the State Health Plan for Teachers and State Employees.  

    Non-opioid directive for providers of pain management care. Amends GS 90-106 (prescriptions and labeling) as follows: expands subsection (a3) to apply to chronic as well as acute pain and directs practitioners to first provide referrals or prescriptions for non-opioid therapies and to use less addictive alternatives to targeted controlled substances when possible. Makes minor amendment to subsection (a4) by adding reference to subsection (a3). 

    Patient-initiated non-opioid directive for pain management care. Amends GS Chapter 90, Article 1B (Medical Malpractice Actions), by adding new GS 90-21.17A regarding voluntary non-opioid directives for patients. Provides definitions, directs the Department of Health and Human Services (DHHS) to develop an opt-out form for patients to choose non-opioid care, and allows patients or their duly authorized representatives to voluntarily choose non-opioid prescriptions by signing and dating an opt-out form in the presence of a medical provider.  Provides a procedure for medical providers to accept the opt-out and authorizes the medical provider to first assess a patient's history of alcohol or drug abuse to determine risk of medication misuse or abuse before acceptance.  Directs medical providers to honor the patient's wishes whenever possible unless and until the patient revokes the form in writing, which revocation must be kept in the patient's file.  Directs DHHS, in consultation with other named agencies, to adopt rules establishing procedures regarding personnel authorized to accept a patient opt-out form, recordation of the form in patient records, revocation, overriding the form, compliance with federal and state confidentiality laws, exemptions for opioids when medically necessary, and continuing education requirements of not less than four hours annually for providers regarding nonpharmacological alternatives to opioids.  Creates tailored immunities for: (1) pharmacists who unknowingly fill a prescription that contradicts a patient opt-out form, (2) health care providers who rely in good faith on the existence or absence of a patient opt-out form, and (3) patient representatives who act in good faith.  

    Directs DHHS, by October 1, 2019, and in consultation with the Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services; the North Carolina Medical Board; and the North Carolina Board of Pharmacy to develop and publish online a uniform opioid prescription and treatment opt-out form that complies with GS 90-21.17A, in a format that can be downloaded and copied.  This directive is effective upon becoming law.

    Insurance coverage for non-opioid pain management care. Amends GS Chapter 58, Article 51 (nature of insurance policies) to add new GS 58-51-56 mandating coverage for non-opioid pain management care in health benefit plans.  Provides a non-exclusive list of evidence-based opioid alternatives, including acupuncture, chiropractic care, massage therapy, and physical therapy.  Directs that this type of care be considered a rehabilitation and habilitation service under the Affordable Care Act, and that coverage is not to be subjected to annual or lifetime limits for the treatment of pain. 

    Amends GS 135-48.51 (state health plan coverage and operational mandates) by adding new subdivision (14) adding coverage for non-opioid pain management care pursuant to GS 58-51-56.

    Effective date of insurance provisions is October 1, 2019, and applies to health benefit plan contracts issued, renewed, or amended on or after that date.

    Effective date. Except as otherwise provided, effective January 1, 2020.