Pain Management of 1998
Rep. Gerald Law
MCL 333.16204c-d & 16228
Rep. Michael Griffin
Rep. Sharon Gire
Rep. Bev Hammerstrom
Rep. Kirk Profit
Effective Date: April 1, 1999
H.B. 4681 revises the Michigan advisory committee on pain and symptom management, consisting of physicians, a psychologist, a nurse, and a representative of the general public. The advisory committee will review guidelines on pain and symptom management issued by the Unites States department of health and human services. They will develop recommendations to the licensing and registration boards, the task force and the board of examiners of social workers on integrating pain and symptom management into the customary practice of health care professionals identifying the role and responsibilities of the various health care professionals in pain and symptom management.
H.B. 4682 provides more and better information to health care consumers regarding the medical treatment of intractable pain, health care coverage and benefits for the treatment of intractable pain, and the education of health professionals in pain and symptom management.
H.B. 4683 regulates the use of controlled substances in pain management.
H.B. 4684 regulates insurance coverage of substances used in pain management. It creates an incentive for insurance companies to include treatment for the intractable pain at facilities which offer comprehensive pain management programs. Benefits are not mandated.
H.B. 4685 regulates insurance coverage of pain management substances. A health maintenance organization must provide a written form to subscribers upon enrollment that describes the terms and conditions of the organization's contract. With an accurate description of the covered benefits, including prescription drug coverage, with specifications regarding requirements for the use of generic drugs.
H.B. 4686 requires health care corporations to provide a form describing the terms and conditions of the certificate. The information will include the current provider network in the certificate's service area, including names and locations of participating providers by specialty type of practice, a statement of limitations of accessibility and referrals to specialists and a disclosure of which providers will not accept new members.
Pain & Symptom Management
In his 1999 State of the State Address, Governor Engler announced that he would appoint a Michigan Commission on End of Life Care to provide a comprehensive report and recommendations on how to improve humane and dignified treatment at the end of life. The commission was appointed and it issued a report in August of 2001. The legislature developed a package based upon the recommendations developed by the End of Life Care Commission in accordance with the executive orders of June 11, 1999 and January 24, 2000. One of the major accomplishments of this package was to repeal the Official Prescription Program and replace it with a system that supports electronic monitoring to make it easier to prescribe palliative medications safely. This legislation also aims to change the perception of palliative care so that patients will receive adequate palliative care even if they are not near death. The 15-bill package introduced by a coalition of senators and representatives are as follows:
H.B. 5148 - P.A. 216 Driver licenses can have sticker or decal with emergency info; stickers may be paid for by any group. MCL 257.310
H.B. 5255 - P.A. 219 Hospitals notify patients, upon their request, that hospice care available in area. MCL 333.21534
H.B. 5258 - P.A. 239 Disclosure of pain management to certain patients; eliminate "terminal illness" in Dignified Death Act within Public Health Code. MCL 333.5652-5655
H.B. 5259 - P.A. 240 Amends Hospital Patients Rights Law by assuring patients in hospitals entitled to Pain & Symptom services and information about hospices in area. MCL 333.20201
H.B. 5260 - P.A. 231 Repeals Official Prescription Program(OPP); Replaces OPP with electronic system; OK to fax or email Rxs; patient info not accessible through Freedom of Information Act; Consumer Industry Services may study design of paper form that minimizes potential for forgery, report by October 2002. MCL 333.7333-7333a
H.B. 5261 - P.A. 232 Eliminates OPP fund and replaces with Pain Management Education and Controlled Substances Antidiversion Fund, and creates the Controlled Substances Electronic Monitoring Fund. MCL 333.16315
H.B. 5262 - P.A. 233 Allows e-fax transfer of Schedule II prescriptions; updates definitions in Rx section. MCL 333.7104,7107, 7109
H.B. 5263 - P.A. 234 Eliminates the phrase "intractable pain" in Public Health Code; updates Advisory Committee on Pain and Symptom Management. MCL 333.16204a
S.B. 660 - P.A. 241 Eliminates the phrase "intractable pain" and revises to "pain and symptom management" in the Public Health Code. MCL 333.16204b-d
S.B. 661 - P.A. 242 Eliminates the phrase "intractable pain" and revises to "pain and symptom management" in the Blue Cross Blue Shield statute. MCL 550.1402a
S.B. 662 - P.A. 235 Eliminates the phrase "intractable pain" and revises to "pain and symptom management" in the State Insurance Code. MCL 500.2212a
S.B. 781 - P.A. 237 Amends Dignified Death Act in the Public Health Code by eliminating language referring to a 6 month life expectancy; now uses phrase "advanced illness." MCL 333.5656-5660
S.B. 826 - P.A. 243 Requires nursing homes to notify patients and certain other persons of the availability or not of hospice in that facility, in services contract. MCL 333.21766
S.B. 827 - P.A. 236 Deletes references to the OPP and Rx form in the Public Health Code; Establishes electronic reporting system to replace the OPP. MCL 333.7401, 7403, 7407, 7521
S.B. 828 - P.A. 238 State ID cards may have a sticker or decal that designates the person has a do-not- resuscitate order, durable power of attorney for health care or designated patient advocate. MCL 28.292
These bills were signed on January 3, 2002 and became effective on January 8, 2002.
Governor Engler signed into law a bi-partisan, bi-cameral five bill package of initial pain management legislation on June 30, 1994. The laws were given immediate effect as Public Acts 232-236.
The first version of pain management bills were introduced by Sen. Fred Dillingham on December 18, 1993 as Senate Bills 960-964. A bi-partisan group of representatives introduced identical companion bills H.B. 5335-5339 in the House on February 15,1994. After being unanimously reported from the Senate Health Policy Committee, the full Senate unanimously passed the Senate package on March 1, 1994. The House Public Health Committee took up and unanimously reported a combination of the House and Senate bills, S.B. 961, 962, H.B. 5335, 5337, 5339. The House overwhelmingly approved the bills on June 8, 1994. The House and Senate gave final approval to the package on June14, 1994.
On December 9, 1997, after over a year of working on and redrafting a second version of pain management bills, H.B. 4681 - 4686, the House Health Policy Committee adopted a watered down version of the original RLM supported bills. As introduced, the bills would have provided greater access to and coverage of multi-disciplinary pain management for the chronically ill. Although the bills were extremely watered down, RLM did not oppose the committee's action in order to ensure that the bills would not be further delayed in committee. The bills were then quickly taken up for the consideration the following day, December 9, 1997, on the House floor. RLM prepared and supported substitute bills to restore the package to it's original strength. Within a matter of hours, a massive lobbying effort of insurance, business and labor interests converged on the House and succeeded in defeating the RLM supported substitute bills. The weak bills then passed the House by a unanimous 105 - 0 vote, leaving efforts to restore the bills to their original strength for the Senate.
In April of 1998, efforts by Senator Bill VanRegenmorter and Senator Mike Rogers, including drafting a revised set of bills, began to put the pain management legislation on the front burner again.
On September 29, 1998, Senator Dale Shugars, chair of the Senate Health Policy Committee, held a work group with Right to Life and the numerous special interests involved in the pain management bills to begin working on the bills.
A major confrontation on the Senate floor was avoided between the House originated package and a stronger set of bills Right to Life of Michigan was promoting after leaders in both chambers agreed to form a House/Senate task force on pain management in exchange for RLM not pressing for a vote on the RLM supported substitutes.
Due to mounting pressure to pass pain management legislation by the end of the year, the Senate Health Policy Committee sent the bills to the full Senate on 12/1/98, by a vote of 5-0. The Senate unanimously approved the six-bill package on 12/3/98. The House then concurred in the package on 12/8/98, sending the bills to the governor.
Overview of the Bills
The practical result of the S.B. 961, 962; and H.B. 5335, 5337 and 5339 will be to establish continuing education requirements in pain management in order for professionals to maintain their licenses. The bills also provide coordination of activities between professions regarding pain management and terminal care. They also amend insurance, HMO, and health codes to provide full disclosure to individuals about the nature and availability of hospice benefits covered by their insurance.
H.B. 4681 - 4686 attempt to ensure that patients are able to gain access to pain management specialists. The bills contain absolutely no mandated benefits. Instead, they create an incentive to encourage insurers to enhance and market their benefit package as meeting a high "state recommended standard" for pain management. Insurers will not be required to offer the benefit, but merely disclose within the policy whether it does or does not meet the standard. In choosing to meet the standard, insurers would not have to change the current benefit options for the first six months a patient experiences intractable pain. After six months, however, patients who continue to suffer from intractable pain would be given access to nationally accredited comprehensive multi-disciplinary programs, which specialize in treating patients in pain.
Pain management is a relatively new and rapidly growing specialty. It is anticipated that new medications will be released in the next 5-10 years which will be highly effective in the treatment of even the most painful conditions, such as neuropathic pain (pain due to partial nerve injury). Medications released in recent years have improved potency, efficacy, and specificity such that pain can be better controlled with longer lasting duration of effect and with fewer side effects.
Techniques such as spinal cord stimulation and infusion of intra spinal narcotics through internally implanted pumps have been developed within the last 10 years. These pumps allow pain to be well controlled while preserving the patient's mental alertness. Pain clinics staffed by well trained and professional people are now available in most major cities throughout the United States. There are pain clinics in most of Michigan's larger cities.