Bill Text: VA HB1185 | 2025 | Regular Session | Engrossed
Bill Title: Prescription Monitoring Program; overdose information.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed) 2024-03-04 - Continued to 2025 in Finance and Appropriations (12-Y 3-N) [HB1185 Detail]
Download: Virginia-2025-HB1185-Engrossed.html
Be it enacted by the General Assembly of Virginia:
1. That §§32.1-276.6 and 54.1-2522.1, as it is currently effective and as it shall become effective, of the Code of Virginia are amended and reenacted as follows:
§32.1-276.6. Patient level data system continued; reporting requirements.
A. The Virginia Patient Level Data System is hereby continued, hereinafter referred to as the "System." Its purpose shall be to establish and administer an integrated system for collection and analysis of data which shall be used by consumers, employers, providers, and purchasers of health care and by state government to continuously assess and improve the quality, appropriateness, and accessibility of health care in the Commonwealth and to enhance their ability to make effective health care decisions.
B. Every inpatient hospital shall submit to the Board patient level data as set forth in this subsection. Every general hospital, ordinary hospital, outpatient surgical hospital or other facility licensed or certified pursuant to Article 1 (§32.1-123 et seq.) of Chapter 5 of this title and every physician and every oral and maxillofacial surgeon certified to perform certain procedures pursuant to §54.1-2709.1 performing surgical procedures in his office shall also submit to the board outpatient surgical data as set forth in this subsection. Every oral and maxillofacial surgeon certified to perform certain procedures pursuant to §54.1-2709 shall submit to the Board outpatient surgical data as set forth in this subsection for only those procedures for which certification is required pursuant to §54.1-2709.1.
Any such hospital, facility, physician or oral and maxillofacial surgeon, as defined in §32.1-276.3, may report the required data directly to the nonprofit organization cited in §32.1-276.4. Unless otherwise noted, patient level data elements for hospital inpatients and patients having outpatient surgery shall include, where applicable and included on standard claim forms:
1. Hospital identifier;
2. Attending physician identifier (inpatient only);
3. Operating physician or oral and maxillofacial surgeon identifier;
4. Payor identifier;
5. Employer identifier as required on standard claims forms;
6. Patient identifier (all submissions);
7. Patient sex, race (inpatient only), date of birth (including century indicator), street address, city or county, zip code, employment status code, status at discharge, and birth weight for infants (inpatient only);
8. Admission type, source (inpatient only), date and hour, and diagnosis;
9. Discharge date (inpatient only) and status;
10. Principal and secondary diagnoses;
11. External cause of injury;
12. Co-morbid conditions existing but not treated;
13. Procedures and procedure dates;
14. Revenue center codes, units, and charges as required on standard claims forms; and
15. Total charges.
C. State agencies providing coverage for outpatient services shall submit to the Board patient level data regarding paid outpatient claims. Information to be submitted shall be extracted from standard claims forms and, where available, shall include:
1. Provider identifier;
2. Patient identifier;
3. Physician or oral and maxillofacial surgeon identifier;
4. Dates of service and diagnostic, procedural, demographic, pharmaceutical, and financial information; and
5. Other related information.
D. When a patient has experienced a nonfatal opioid
overdose, the Board shall report [ all patient level Admit,
Transfer, and Discharge ] data elements submitted for such patient
pursuant to [ subsection B or C §32.1-372 ] to the
Department of Health Professions for use in the Prescription Monitoring Program
established in §54.1-2520. The [ Director of the ]
Department of Health Professions shall [ establish, maintain, and
administer the system through which the Board submits such data consult
with the Department of Health as appropriate to ensure the successful transfer
of Admit, Transfer, and Discharge data elements for use in the Prescription
Monitoring Program ] . The Department of Health Professions shall only
provide such data to practitioners as provided in §54.1-2522.1 and in
accordance with the confidentiality requirements of this chapter and §
54.1-2523.
The Board shall promulgate regulations specifying the format for submission of such outpatient data. State agencies may submit this data directly to the nonprofit organization cited in §32.1-276.4.
§54.1-2522.1. (Effective until July 1, 2027) Requirements of practitioners.
A. Any prescriber who is licensed in the Commonwealth to treat human patients and is authorized pursuant to §§54.1-3303 and 54.1-3408 to issue a prescription for a covered substance shall be registered with the Prescription Monitoring Program by the Department of Health Professions.
B. A prescriber registered with the Prescription Monitoring Program or a person to whom he has delegated authority to access information in the possession of the Prescription Monitoring Program pursuant to §54.1-2523.2 shall, at the time of initiating a new course of treatment to a human patient that includes the prescribing of opioids anticipated at the onset of treatment to last more than seven consecutive days, request information from the Director for the purpose of determining (i) what, if any, other covered substances are currently prescribed to the patient and (ii) whether and under what circumstances the patient has experienced an opioid overdose. In addition, any prescriber who holds a special identification number from the Drug Enforcement Administration authorizing the prescribing of controlled substances approved for use in opioid addiction therapy shall, prior to or as a part of execution of a treatment agreement with the patient, request information from the Director for the purpose of determining (i) what, if any, other covered substances the patient is currently being prescribed and (ii) whether and under what circumstances the patient has experienced an opioid overdose. Nothing in this section shall prohibit prescribers from making additional periodic requests for information from the Director as may be required by routine prescribing practices.
C. A prescriber shall not be required to meet the provisions of subsection B if:
1. The opioid is prescribed to a patient currently receiving hospice or palliative care;
2. The opioid is prescribed to a patient during an inpatient hospital admission or at discharge;
3. The opioid is prescribed to a patient in a nursing home or a patient in an assisted living facility that uses a sole source pharmacy;
4. The Prescription Monitoring Program is not operational or available due to temporary technological or electrical failure or natural disaster; or
5. The prescriber is unable to access the Prescription Monitoring Program due to emergency or disaster and documents such circumstances in the patient's medical record.
D. Prior to issuing a written certification for the use of cannabis oil in accordance with §4.1-1601, a practitioner shall request information from the Director for the purpose of determining what, if any, other covered substances have been dispensed to the patient.
§54.1-2522.1. (Effective July 1, 2027) Requirements of practitioners.
A. Any prescriber who is licensed in the Commonwealth to treat human patients and is authorized pursuant to §§54.1-3303 and 54.1-3408 to issue a prescription for a covered substance shall be registered with the Prescription Monitoring Program by the Department of Health Professions.
B. Prescribers registered with the Prescription Monitoring Program shall, at the time of initiating a new course of treatment to a human patient that includes the prescribing of benzodiazepine or an opiate anticipated at the onset of treatment to last more than 90 consecutive days, request information from the Director for the purpose of determining (i) what, if any, other covered substances are currently prescribed to the patient and (ii) whether and under what circumstances the patient has experienced an opioid overdose. In addition, any prescriber who holds a special identification number from the Drug Enforcement Administration authorizing the prescribing of controlled substances approved for use in opioid addiction therapy shall, prior to or as a part of execution of a treatment agreement with the patient, request information from the Director for the purpose of determining (i) what, if any, other covered substances the patient is currently being prescribed and (ii) whether and under what circumstances the patient has experienced an opioid overdose. Nothing in this section shall prohibit prescribers from making additional periodic requests for information from the Director as may be required by routine prescribing practices.
C. The Secretary of Health and Human Resources may identify and publish a list of benzodiazepines or opiates that have a low potential for abuse by human patients. Prescribers who prescribe such identified benzodiazepines or opiates shall not be required to meet the provisions of subsection B. In addition, a prescriber shall not be required to meet the provisions of subsection B if the course of treatment arises from pain management relating to dialysis or cancer treatments.
D. Prior to issuing a written certification for the use of cannabis oil in accordance with §4.1-1601, a practitioner shall request information from the Director for the purpose of determining what, if any, other covered substances have been dispensed to the patient.
