We are seeing a wide range of new state laws that impact the prescribing of opioids to hospice patients. Several bills are before the New York State Assembly that, if passed, could affect how prescriptions are written to hospice patients. Because of the nation’s opioid crisis, laws in this area are highly fluid and providers should monitor state laws for changes that might impact their provision of care. Below are answers to some questions frequently asked by hospice providers about current and proposed New York law.
1. Are New York hospices required to e-prescribe opioids to hospice patients?
Yes. All prescriptions for controlled and non-controlled substances must be issued electronically.
2. Are hospice providers required to view a hospice patient’s record in the state prescription monitoring program (“PMP”) registry before writing or renewing an opioid prescription?
No. State law generally requires that most providers consult the PMP registry prior to writing a prescription for schedule II, III, or IV controlled substances. However, a provider who prescribes a controlled substance to a patient under the care of a hospice is not required to consult the registry prior to writing the prescription.
3. Does New York law limit opioid prescriptions written to hospice patients?
No. While state law limits the supply of a schedule II, III, or IV opioid that a provider may prescribe upon an initial consultation or treatment for acute pain to seven days , this limitation does not apply to such prescriptions written to address a patient’s chronic pain, pain being treated as part of cancer care, hospice or other end-of-life care, or pain being treated as part of palliative care practices.
4. Does New York law require a provider who prescribes opioids to meet special continuing education requirements?
Yes. Providers with a DEA registration number to prescribe controlled substances must complete three hours of course work or training in pain management, palliative care, and addiction approved by the New York State Department of Health every three years. New DEA registrants must complete this training within one year of registering and then again every three years.
5. Does New York law require that providers of in-home hospice care dispose of a deceased or discharged patient’s opioid medications?
No. There is no New York law requiring a hospice provider to dispose of a patient’s opioid medications. However, under federal law, certain employees of qualified hospice programs are permitted to handle any controlled substance that was lawfully dispensed to a hospice patient for the purpose of disposal. Such disposal by the hospice is allowed after the hospice patient’s death, once the controlled substance has expired, or, if the hospice employee is a physician who is registered under the Controlled Substances Act, once the hospice patient no longer needs the medication due to a change in the plan of care. If the hospice program elects to dispose of the patient’s controlled substances, the disposal must (i) be performed by an employee who is acting within the scope of his or her employment, (ii) occur at the site of care, and (iii) be performed in compliance with all relevant laws.
6. Are hospice providers required to prescribe an opioid antagonist to hospice patients who are prescribed opioids?
No. Currently, there is no New York law requiring a hospice provider to prescribe or offer a prescription of an opioid antagonist such as naloxone to a hospice patient when prescribing an opioid. However, two bills before the New York State Assembly (S04095 and A05603), if passed in their current versions, would require all providers to co-prescribe an opioid antagonist with each initial opioid prescription per year, which is greater than or equal to 50 morphine milligram equivalents.
Current as of April 19, 2019