NY State Senate Bill 2017-S4296

Senate Bill S4296

2017-2018 Legislative Session

Includes nurse practitioners as a provider of services for purposes of collaborative drug therapy management and makes the authorization for pharmacists to perform such management permanent

download bill text pdf

Archive: Last Bill Status - In Senate Committee Higher Education Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2018	referred to higher education
Jun 21, 2017	recommitted to rules
Jun 15, 2017	ordered to third reading cal.1787 committee discharged and committed to rules
Feb 08, 2017	referred to higher education

Votes

- Jun 15, 2017 - Rules Committee Vote
  S4296
  
  24
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Rules Committee Vote: Jun 15, 2017
      
      aye (24)
      
      Bonacic
      
      Breslin
      
      Carlucci
      
      DeFrancisco
      
      Dilan
      
      Flanagan
      
      Gianaris
      
      Griffo
      
      Hannon
      
      Kennedy
      
      Krueger
      
      LaValle
      
      Lanza
      
      Larkin
      
      Little
      
      Montgomery
      
      Parker
      
      Robach
      
      Savino
      
      Seward
      
      Squadron
      
      Stewart-Cousins
      
      Valesky
      
      Young
      
      aye wr (1)
      
      Ranzenhofer

2017-S4296 (ACTIVE) - Details

See Assembly Version of this Bill:: A10196
Current Committee:: Senate Higher Education
Law Section:: Education Law
Laws Affected:: Amd §6801-a, Ed L; amd §5, Chap 21 of 2011
Versions Introduced in Other Legislative Sessions:: 2013-2014: S5400
2015-2016: S280
2019-2020: A3048
2021-2022: S4689, A1036
2023-2024: S4043, A9702

2017-S4296 (ACTIVE) - Summary

Includes nurse practioners as a provider of services for purposes of collaborative drug therapy management and makes the authorization for pharmacists to perform such management permanent.

2017-S4296 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S4296

 TITLE OF BILL :  An act to amend the education law, in relation to
including nurse practitioners as a provider of services for purposes
of collaborative drug therapy management; and to amend chapter 21 of
the laws of 2011 amending the education law relating to authorizing
pharmacists to perform collaborative drug therapy management with
physicians in certain settings, in relation to making the
authorization for pharmacists to perform collaborative drug therapy
management permanent

 PURPOSE :

To extend and expand provisions enacted in 2011 that permit
pharmacists to collaborate with physicians in the provision of
collaborative drug therapy.

 SUMMARY OF PROVISIONS :

The bill would extend and make permanent the Collaborative Drug
Therapy Demonstration Project and expand the scope of the
authorization for collaborative drug therapy management (CDTM) as
follows:

Section one of the bill would amend section 6801-a of the Education
Law as follows:

*Deletes reference to a "demonstration program" in the title of the
section;
*Adds nurse practitioners (NPs) to the legislation to allow NPs to
enter into collaborative agreements with pharmacists by which drug
therapies would be reviewed, evaluated and managed;
*Authorizes CDTM to occur in all hospitals and other Article 28
facilities, such as nursing homes and clinics; and
*Permits the State Education Department in consultation with the
Department of Health, to include up to fifteen community practice
sites as authorized locations for the provision of CDTM.

Section two of the bill would repeal the expiration date of the prior
statute and make the provisions permanent.

 EXISTING LAW :

Section 6801-a established the CDTM Demonstration Program and
authorized physicians and pharmacists in teaching hospitals (including
clinics associated with them) to engage in collaborative drug therapy
management. The existing law authorizes pharmacists and physicians,
pursuant to protocols entered into between them, to adjust and manage
a drug regimen of a patient, including adjusting drug strength,
frequency of administration and route of administration. If authorized
by the protocol, the substitution of a different drug may also be
permitted. In addition, requirements relating to follow up with the
patient's treating physicians, the qualifications of the pharmacists
and various other requirements and limitations exist in the current
law.

 JUSTIFICATION :

Legislation was enacted in 2011 to establish the Collaborative Drug
Therapy Management Demonstration Program, by which pharmacists,
working in collaborative agreements with physicians, could adjust,
manage, evaluate and implement drug therapies for patients in certain
settings. The current law only applies to teaching hospitals and their
affiliated outpatient and freestanding clinics. A report on the
results of the current statute will be issued in late 2013 or early
2014 but all preliminary reports have indicated that the legislation
has been successfully implemented by eligible facilities and the
collaboration between pharmacists and physicians has been very much in
the interest of promoting the best interests of their patients.  This
bill would extend the current program to all Article 28 licensed
health care facilities (hospitals, clinics and residential health care
facilities) as well as permit the practice on a more limited basis in
certain community based settings. The bill would also permit nurse
practitioners to engage in the collaborative agreements with
pharmacists.

Adverse drug reactions or adverse drug events (ADRs or ADEs) are
reported to be among the leading causes of death in the United States,
behind only heart disease, cancer and stroke. The most updated
information on ADRs suggests that these earlier estimates may actually
understate the problem. A recent comprehensive study of medication
errors, estimated that as many as 2.7 million medication errors occur
each year in hospitals in the United States, adversely affecting
130,000 patients. Studies have shown that at least 28% of these errors
were preventable. Nearly half of the errors made were the result of
errors in the prescribing process. These errors are not only
potentially dangerous to patients, they are extremely costly to the
health care system, resulting in additional and unnecessary
expenditures of as much as $177 billion per year. Of this amount,
seventy percent was attributed to unnecessary hospital admissions or
prolonged hospital stays due to medication errors.

Virtually every other state permits CDTM, most of which authorize the
practice in many more settings than permitted under the current New
York State law and the results have been uniformly positive: CDTM
along with pharmacist provided drug information services, adverse drug
reaction monitoring, drug protocol management and medial rounds
participation by pharmacists have all shown to make a statistically
significant contribution to the reduction of medication errors. The
expansion of the statute to additional settings and the authorizing of
Nurse Practitioners as collaborating practitioners is warranted not
only by the success of the New York State initiative, but based on the
records of other states.

 LEGISLATIVE HISTORY :

2015-16 S.280; Chapter 21 of the Laws of 2011.

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
This act shall take effect on the one hundred twentieth day after it
shall have become a law; provided that, effective immediately, the
addition, amendment and/or repeal of any rule or regulation necessary
for the implementation of this act on its effective date are
authorized and directed to be made and completed on or before such
effective date.

2017-S4296 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4296
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                             February 8, 2017
                                ___________
 
 Introduced  by  Sen. LAVALLE -- read twice and ordered printed, and when
   printed to be committed to the Committee on Higher Education
 
 AN ACT to amend the education law, in relation to including nurse  prac-
   titioners as a provider of services for purposes of collaborative drug
   therapy management; and to amend chapter 21 of the laws of 2011 amend-
   ing  the  education law relating to authorizing pharmacists to perform
   collaborative drug  therapy  management  with  physicians  in  certain
   settings,  in  relation to making the authorization for pharmacists to
   perform collaborative drug therapy management permanent
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. Section 6801-a of the education law, as amended by chapter
 238 of the laws of 2015, is amended to read as follows:
   §  6801-a.  Collaborative  drug  therapy   management   [demonstration
 program].    1.  As used in this section, the following terms shall have
 the following meanings:
   a. "Board" shall mean the state board of pharmacy  as  established  by
 section sixty-eight hundred four of this article.
   b. "Clinical services" shall mean the collection and interpretation of
 patient  data  for  the  purpose of initiating, modifying and monitoring
 drug therapy  with  associated  accountability  and  responsibility  for
 outcomes in a direct patient care setting.
   c.  "Collaborative drug therapy management" shall mean the performance
 of clinical services by a pharmacist relating to the review,  evaluation
 and  management  of drug therapy to a patient, who is being treated by a
 physician OR NURSE PRACTITIONER for a  specific  disease  or  associated
 disease  states, in accordance with a written agreement or protocol with
 a voluntarily participating  physician  OR  NURSE  PRACTITIONER  and  in
 accordance with the policies, procedures, and protocols of the facility.
 Such  agreement  or  protocol  as entered into by the physician OR NURSE
 PRACTITIONER and a pharmacist, may include, and shall be limited to:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD09687-01-7

 S. 4296                             2
 
   (i) adjusting or managing a drug regimen of a patient, pursuant  to  a
 patient  specific  order  or protocol made by the patient's physician OR
 NURSE PRACTITIONER, which may include adjusting drug strength, frequency
 of administration or route of administration. Adjusting the drug regimen
 shall  not  include  substituting  or  selecting  a different drug which
 differs from that initially prescribed by  the  patient's  physician  OR
 NURSE  PRACTITIONER  unless such substitution is expressly authorized in
 the written order or protocol. The pharmacist shall be required to imme-
 diately document in the patient record changes  made  to  the  patient's
 drug therapy and shall use any reasonable means or method established by
 the  facility to notify the patient's other treating physicians OR NURSE
 PRACTITIONERS with whom he or she does not have a written  agreement  or
 protocol  regarding such changes. The patient's physician OR NURSE PRAC-
 TITIONER may prohibit, by written instruction, any adjustment or  change
 in the patient's drug regimen by the pharmacist;
   (ii)  evaluating  and, only if specifically authorized by the protocol
 and only to the extent necessary to discharge the  responsibilities  set
 forth  in  this section, ordering disease state laboratory tests related
 to the drug therapy management for the specific disease or disease state
 specified within the written agreement or protocol; and
   (iii) only if specifically authorized  by  the  written  agreement  or
 protocol  and only to the extent necessary to discharge the responsibil-
 ities set forth in this section, ordering or performing routine  patient
 monitoring functions as may be necessary in the drug therapy management,
 including  the collecting and reviewing of patient histories, and order-
 ing or checking patient vital signs, including pulse, temperature, blood
 pressure and respiration.
   d. "Facility" shall mean: (i) a [teaching hospital or general]  hospi-
 tal,  [including  any  diagnostic center, treatment center, or hospital-
 based outpatient department] as defined in SUBDIVISION  ONE  OF  section
 twenty-eight  hundred  one  of  the public health law; or (ii) a nursing
 home  with  an  on-site  pharmacy  staffed  by  a  licensed  pharmacist;
 provided,  however, for the purposes of this section the term "facility"
 shall not  include  dental  clinics,  dental  dispensaries,  residential
 health care facilities and rehabilitation centers.
   [For  the purposes of this section, a "teaching hospital" shall mean a
 hospital licensed pursuant to article twenty-eight of the public  health
 law  that  is  eligible  to  receive direct or indirect graduate medical
 education payments pursuant to article twenty-eight of the public health
 law.] IN ADDITION, A FACILITY MAY ALSO INCLUDE UP TO FIFTEEN  COMMUNITY-
 PRACTICE  SITES,  SELECTED  BY  THE  DEPARTMENT IN CONSULTATION WITH THE
 DEPARTMENT OF HEALTH, WHERE PHARMACISTS AND PHYSICIANS OR NURSE  PRACTI-
 TIONERS  MAY  PROPOSE TO ENTER INTO COLLABORATIVE ARRANGEMENTS, PURSUANT
 TO THE PROVISIONS OF THIS SECTION. SUCH SITES SHALL  BE  SELECTED  BASED
 UPON  A REVIEW OF APPLICATIONS SUBMITTED TO THE DEPARTMENT BY SUCH PHAR-
 MACISTS AND PHYSICIANS OR NURSE PRACTITIONERS,  WHICH  DEMONSTRATE  THAT
 THE APPLICANTS CAN SATISFY THE REQUIREMENTS OF THIS SECTION.
   e.  "Physician"  OR  "NURSE  PRACTITIONER" shall mean the physician OR
 NURSE PRACTITIONER selected by or assigned to a patient, who has primary
 responsibility for the treatment and care of the patient for the disease
 and associated disease states that are the subject of the  collaborative
 drug therapy management.
   f.  "Written  agreement  or  protocol"  shall mean a written document,
 pursuant to and consistent with any applicable state or federal require-
 ments, that addresses a specific disease or  associated  disease  states
 and  that  describes  the nature and scope of collaborative drug therapy

 S. 4296                             3
 
 management to be undertaken by the pharmacists,  in  collaboration  with
 the participating physician OR NURSE PRACTITIONER in accordance with the
 provisions of this section.
   2.  a. A pharmacist who meets the experience requirements of paragraph
 b of this subdivision and who is EITHER employed by or otherwise  affil-
 iated with a facility OR IS PARTICIPATING WITH A COMMUNITY-PRACTICE SITE
 SELECTED  PURSUANT  TO  PARAGRAPH  D  OF SUBDIVISION ONE OF THIS SECTION
 shall be permitted to enter into a written agreement or protocol with  a
 physician  OR  NURSE PRACTITIONER authorizing collaborative drug therapy
 management, subject to the limitations set forth in this section, within
 the scope of such employment [or], affiliation OR PARTICIPATION.
   b. A participating pharmacist must:
   (i)(A) have been awarded either a master of science in clinical  phar-
 macy or a doctor of pharmacy degree;
   (B) maintain a current unrestricted license; and
   (C) have a minimum of two years experience, of which at least one year
 of such experience shall include clinical experience in a health facili-
 ty,  which  involves consultation with physicians OR NURSE PRACTITIONERS
 with respect to drug therapy and may include a residency at  a  facility
 involving such consultation; or
   (ii)(A) have been awarded a bachelor of science in pharmacy;
   (B) maintain a current unrestricted license; and
   (C) within the last seven years, have a minimum of three years experi-
 ence,  of which at least one year of such experience shall include clin-
 ical experience in a health facility, which involves  consultation  with
 physicians with respect to drug therapy and may include a residency at a
 facility involving such consultation; and
   (iii) meet any additional education, experience, or other requirements
 set forth by the department in consultation with the board.
   c. Notwithstanding any provision of law, nothing in this section shall
 prohibit  a licensed pharmacist from engaging in clinical services asso-
 ciated with collaborative drug therapy  management,  in  order  to  gain
 experience  necessary to qualify under clause (C) of subparagraph (i) or
 (ii) of paragraph b of this subdivision, provided that such practice  is
 under  the  supervision  of a pharmacist that currently meets the refer-
 enced requirement, and that such practice is authorized under the  writ-
 ten agreement or protocol with the physician OR NURSE PRACTITIONER.
   d. Notwithstanding any provision of this section, nothing herein shall
 authorize the pharmacist to diagnose disease. In the event that a treat-
 ing  physician  OR  NURSE PRACTITIONER may disagree with the exercise of
 professional judgment by a pharmacist,  the  judgment  of  the  treating
 physician OR NURSE PRACTITIONER shall prevail.
   3.  The  physician  OR  NURSE PRACTITIONER who is a party to a written
 agreement or protocol authorizing collaborative drug therapy  management
 shall be employed by or otherwise affiliated with the same facility with
 which the pharmacist is also employed or affiliated.
   4.  The  existence of a written agreement or protocol on collaborative
 drug therapy management and the patient's right to choose to not partic-
 ipate in collaborative drug therapy management shall be disclosed to any
 patient who is eligible to receive collaborative  drug  therapy  manage-
 ment. Collaborative drug therapy management shall not be utilized unless
 the  patient  or  the  patient's  authorized representative consents, in
 writing, to such management. If the patient or the patient's  authorized
 representative  consents,  it  shall  be  noted on the patient's medical
 record. If the patient or the patient's  authorized  representative  who
 consented  to collaborative drug therapy management chooses to no longer

 S. 4296                             4
 
 participate in such management, at any time, it shall be  noted  on  the
 patient's  medical  record.  In  addition,  the existence of the written
 agreement or protocol and the patient's consent to such management shall
 be  disclosed  to  the patient's primary physician OR NURSE PRACTITIONER
 and any other treating physician OR  NURSE  PRACTITIONER  or  healthcare
 provider.
   5. Participation in a written agreement or protocol authorizing colla-
 borative  drug  therapy  management  shall be voluntary, and no patient,
 physician OR  NURSE  PRACTITIONER,  pharmacist,  or  facility  shall  be
 required to participate.
   6. Nothing in this section shall be deemed to limit the scope of prac-
 tice of pharmacy nor be deemed to limit the authority of pharmacists and
 physicians  OR  NURSE  PRACTITIONERS  to engage in medication management
 prior to the effective date of this section and to the extent authorized
 by law.
   § 2. Section 5 of chapter 21 of the laws of 2011 amending  the  educa-
 tion  law  relating  to authorizing pharmacists to perform collaborative
 drug therapy management with physicians in certain settings, as  amended
 by chapter 238 of the laws of 2015, is amended to read as follows:
   § 5. This act shall take effect on the one hundred twentieth day after
 it  shall  have become a law [and shall expire 7 years after such effec-
 tive date when upon such date the provisions of this act shall be deemed
 repealed]; provided, however, that the amendments to  subdivision  1  of
 section  6801 of the education law made by section one of this act shall
 be subject to the expiration and reversion of such subdivision  pursuant
 to section 8 of chapter 563 of the laws of 2008, when upon such date the
 provisions  of  section  one-a  of this act shall take effect; provided,
 further, that effective  immediately,  the  addition,  amendment  and/or
 repeal  of  any  rule  or regulation necessary for the implementation of
 this act on its effective date is authorized and directed to be made and
 completed on or before such effective date.
   § 3. This act shall take effect on the one hundred twentieth day after
 it shall have become a law; provided that,  effective  immediately,  the
 addition,  amendment  and/or  repeal of any rule or regulation necessary
 for the implementation of this act on its effective date are  authorized
 and directed to be made and completed on or before such effective date.

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