Chapter 52, Acts of 2016

AN ACT RELATIVE TO SUBSTANCE USE TREATMENT, EDUCATION AND PREVENTION

Implications for Emergency Departments and Emergency Physician

1. 7-day limit on opioid prescriptions.  Effective immediately
   1. Please note that while the bill carries a 7 day limit on opioid prescriptions, MACEP as part of the MHA guidelines had previously supported a 5 day limit on opioids from the ED.  MACEP continues to support this guideline and encourages each ED to educate their providers with respect to this distinction.
   2. The 7 day limit applies to the first time a provider gives a patient an opioid prescription (18 and over) and all opioid prescriptions for minors.  Also must review with parent/guardian the inherent risks of an opioid and why it is necessary.
   3. There is an exception for an “acute medical condition,” “chronic pain management,” palliative care, and pain associated with cancer diagnoses.
   4. For all opioid prescriptions, before prescribing, providers need to notify patients of the option for a partial fill, and need to discuss the risks associated with the opioid.  May need some sort of informational pamphlet. 
2. Partial fill: prescriptions must include a notation allowing for a partial fill.
3.  Use of the PMP (effective October 15, 2016)
   1. Please note that the PMP is being totally revamped with an expected rollout of summer 2016 for the new system
   2. The law requires DPH to issue regulations by the October date to regulate all prescribers’ use of the PMP.  Emergency Medicine previously had a carve-out for this in regulations and we will continue to advocate for this again.  Also, resident physicians are currently allowed into the PMP and we are allowed to have unlimited delegates log-in.  We are also working to make sure the PMP data can be pushed to the new hospital information exchange (PreManage) set to roll out across MA this year.
   3. PMP will be used to evaluate benchmarking prescribing patterns by individual physician, to be shared annually beginning March 1, 2017.
4. Substance abuse evaluation (effective July 1, 2016)
   1. Applies to any patient who arrives in an ED experiencing an opioid overdose or who was administered naloxone before arrival.
   2. Individuals must undergo a substance abuse evaluation by an ESP or licensed mental health professional (i.e. not emergency physician) within 24 hours.  Patients may refuse this service and if they leave physicians are not held liable for any civil suit.  The provider would need to document in the chart that the patient left prior to the evaluation being completed.  For minors it would require providers to notify their parents. 
   3. Upon discharge patient must receive information on local and statewide treatment programs, the overdose must be recorded in the EMR, and the facility must notify the PCP if known.
   4. Insurers are required to pay for the evaluations without pre-authorization.
5. Requires the Massachusetts behavioral health access (MABHA) website to post contact information for all insurance payers, including a phone number which is accessible 24 hours per day. Effective Immediately.

The new system should be in place by October 15, 2016 when the new law goes into effect.

In terms of the SUDE (which goes into effect July 1, 2016), MHA & MACEP have created a workgroup which is in the process of developing questions for DPH to clarify the “who, what, and how” of the SUDE requirement.  We hope to have an “Interpretive Guidelines” document as well as a “SUDE Template” that hospitals/EDs can use to help meet the requirement.  

A few other useful links related to the Opioid law (Chapter 52) can be found at: http://www.massmed.org/opioidbill2016/#.V0XRyZErKM8