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News & Press: Advocacy & Legislative Updates

October Regulatory Update

Thursday, November 05, 2015  
Posted by: Sabrina Noah
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The October issue of the Louisiana Register contains several proposed rules which are of interest to our members.  As part of our continued efforts to keep you informed, we have developed the following summaries of the proposed administrative rules.  Please submit any comments or concerns about any of the proposed rules mentioned below to Wes Hataway, LSMS vice president, legal affairs and general counsel at wes@lsms.org prior to the dates designated below each rule discussion.

 

 

Final Rule

Department of Health and Hospitals / LSBME


The LSBME has enacted the final rule regarding telemedicine.  Again, the LSMS would like to thank all of the members who submitted comments and feedback during this process. Some important provisions of note included in the final version are:

  • Physicians utilizing telemedicine in Louisiana must maintain a Louisiana medical license as well as a physical practice location within the state; or holds a telemedicine permit and executes an affirmation, as describe in §408 of these rules, that he or she has an arrangement with one or more other physicians who maintain a physical practice location in this state to provide for referrals and follow-up care.
  • Allows for a physician to issue a prescription for a controlled substance via telemedicine as long as the physician has had at least one in-person visit with the patient at a physical location in this state within the past year, the prescription is for a legitimate medical purpose, and the prescription is in conformity with the same standard of care applicable to an in-person visit.
  • Telemedicine cannot be utilized for the treatment of obesity or non-cancer related chronic or intractable pain.  

 The final rule can be found here.


Department of Health and Hospitals / LSBME


The LSBME has enacted the final rule regarding “unprofessional conduct”.  PLEASE NOTE THE PUBLISHED RULE CONTAINS AN ERROR and the Louisiana Register published a correction on its website. 


The final rule inadvertently contains language regarding advertisement as a specialist.  The language was initially proposed in the original notice of intent but was later removed by a subsequent notice published by the Register.  It was noted that the decision to remove the language was due to feedback from stakeholders.  By accident, the language was again included in the final version.

The only area addressed by the final rule is defining the practice of physicians prescribing controlled substances to themselves or family members (except in emergencies) as “unprofessional conduct”.

 

The full text of the final rule can be found on here.

 

Notice of Intents


The October Register featured a number of proposed rules. 

 

Board of Dentistry

 

Seemingly following the lead of LSMS backed legislation regarding due process of for physicians (Act 441), the Board of Dentistry is also amending its rules concerning complaints and investigations of dentists.  Of particular interest, the Board is proposing additional language pertaining to “informal conferences”.   First, the proposal states “if a negotiated settlement occurs during the informal meeting and the licensee is offered a consent decree to settle the matter, prior to the licensee signing the consent decree, the board shall turn over whatever evidence in its possession at the time that it would intend to put into evidence at a formal hearing, if there were a formal hearing”.   Next, the proposal states the licensee has the option to make an electronic recording of the informal meeting.  If the licensee chooses this option, the board is allowed to make its own recording.  If the licensee does not choose this option, no recording is to be made.  Only electronic recordings are allowed.  Due to the informal nature of the meeting, a court reporter or transcriptionist is not allowed in the meeting”. 


During the development and discussion of the LSBME rules pertaining to physician investigations, the LSMS recommended the LSBME include a provision in its rules to allow for the electronic recording of the informal conference at the licensee’s request.  The recommendation was rejected. 


The LSMS will track the promulgation of the dentistry rule in order to possibly re-assert the inclusion of a similar provision for physicians. The full text of the proposed rule can be found here.


Board of Nursing


The Board of Nursing has introduced a rule which attempts “clarify” the exemption of CRNA’s from the requirement to have a collaborative practice agreement to provide anesthesia care and ancillary services to patients in a hospital or other licensed surgical facility.  The LSMS is concerned the proposed rule goes beyond “clarification” and potentially expands the scope of practice for CRNAs.  Specifically, the rule states “anesthesia care shall be within the scope of practice of CRNA’s as delineated by the American Association of Nurse Anesthetists…”  Further, the proposed rule states “ancillary services provided by CRNAs shall include services within the scope of practice of CRNAs as delineated by the American Association of Nurse Anesthetists…”  The LSMS is fears the proposed rule abdicates the authority to oversee, regulate and define the scope of practice for CRNAs from the Louisiana Legislature to a professional trade organization which is located outside of our state.  This move not only endangers patient safety but also sets bad precedent for circumventing the legislative process in determining scope of practice for other specialties.


A public hearing has not been scheduled but a request will be made.  Written comments are due to the Karen Lyon 17373 Perkins Rd., Baton Rouge, LA 70810 by COB on November 10, 2015.  Please submit any comments to this proposal to Wes Hataway (wes@lsms.org) by November 9, 2015.


The full text of the proposal can be found here.


Department of Health and Hospitals / Office of Behavioral Health


The proposed rule memorializes a simultaneously enacted Emergency Rule (see Emergency Rules Section) which (1) provides Medicaid coverage and reimbursement for licensed mental health professional services and mental health rehabilitative services to adult members enrolled in Bayou Health and terminates the behavioral health services rendered under 1915(i) state plan authority; (2) establishes the recipient qualifications criteria; and (3) revises the assessment and plan of care requirements. 


The full text of the proposed rules can be found here.


A public hearing will be held at DHH on November 25, 2015 at 9:30 am.  Please submit any comments to this proposal to Wes Hataway (wes@lsms.org) by November 18, 2015.


Office of Workers Compensation Administration


In keeping with its transition to ICD-10, the OWCA updated all existing ICD-9 references to ICD-10.  The full text of the proposed rule can be found here.


Emergency Rules


Department of Health and Hospitals / Office of Behavioral Health


The proposed emergency rule (1) provides Medicaid coverage and reimbursement for licensed mental health professional services and mental health rehabilitative services to adult members enrolled in Bayou Health and terminates the behavioral health services rendered under 1915(i) state plan authority; (2) establishes the recipient qualifications criteria; and (3) revises the assessment and plan of care requirements. 


It is noted that the emergency rule is needed in order to ensure continued access to these services.


The full text of the proposed emergency rule can be found here.


Department of Health and Hospitals


In 2014, the Louisiana legislature adopted Act 568 which directed DHH to implement a Recovery Audit Contractor (RAC) Program in order to comply with the Affordable Care Act.  Accordingly, the department promulgated an Emergency Rule in November, 2014, which adopted provisions to establish the RAC program in order to avoid federal sanctions. 


The proposed emergency rule is simply a continuation of that program with no substantive changes. 


The full text of the proposed emergency rule can be found here.


Department of Health and Hospitals/ Office for Citizens with Developmental Disabilities (OCDD)


The LSBME rendered an opinion which discontinued the use of “physician delegation forms” in intermediate care facilities and home and community-based settings for the developmental delayed.  As a result, unlicensed personnel were required to complete minimum training requirements in order to administer medications.  This resulted in a large influx of individuals seeking CMA training and certification as well as an additional administrative burden on providers to process the certifications. 


Accordingly, the OCDD now seeks to extend the certification period for certified medication attendants (CMA) to two years effective October 23, 2015.  The rule also allows CMAs who have not worked directly with medication administration for 12 months or more to be administered the statewide exam and competency evaluation rather than requiring that they repeat the training.  It is believed these measure will help reduce the expected administrative burden. 


The full text of the proposed emergency rule can be found here.

 

The full version of the October 2015 Register can be found here.  

 


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Louisiana State Medical Society

6767 Perkins Road, Suite 100
Baton Rouge, LA 70808

Ph: 800.375.9508 | 225.763.8500
Fax: 225.768.5601

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