Board of Nursing: News
- Joint Stakeholder Meeting - August 19, 2019
- Listen to PDMP Townhall
- New Legislation 2019
- Revised Opioid Guidelines Adopted
- Nursing Rules Chapter 1 & 20 Meeting Recordings Available
- Sunset Review Underway
- New Law Affects Colorado Prescribers, Limits Opioid Prescriptions
- Revised Opioid Guidelines
- Stakeholder Recordings: Chapter 2 Rules
- PDMP Delegate Training Video
- Changes to Disciplinary Procedures
- Mandatory Reporting Reminder
- Sunset Review Begins - Psychiatric Technician
- Important PDMP Updates
- New Articulated Plan Toolkit & Templates
- Free Access to PainNET System for Colorado Provider
The Colorado Podiatry Board, State Board of Optometry, State Board of Veterinary Medicine, Colorado Dental Board, Colorado Medical Board, and Board of Nursing will hold a Joint Stakeholder Meeting to receive input regarding the implementation of Colorado Senate Bill 19-228 (SB19-228), as it relates to a requirement that physicians, physician assistants, podiatrists, dentists, advanced practice nurses with prescriptive authority, optometrists, and veterinarians complete substance use disorder training in order to renew, reactivate, or reinstate a license.
- A copy of the SB19-228 and a list of questions that the Division requests specific feedback on, to help aid the Boards in adopting rules to implement this legislation is available for download.
- Monday, August 19, 2019, 12:30 p.m. (MDT)
Three Ways to Participate
- In Person: Civic Center Plaza, 1560 Broadway, Room 100C (1st Floor), Denver, CO 80202
- By Webinar: Register Here
- Submit Comments: Oral comments will be taken from participants who are present in-person or participating via webinar. If you cannot make the meeting in-person or wish to make written comments rather than speaking, you may email your written comments to: firstname.lastname@example.org on or before Friday, August 16, 2019.
Stakeholder input will be limited to discussions on the implementation of SB19-228. The Boards need your help to identify how these changes might affect consumer outcomes, positive or negative, and to assess “how” and “what” changes should be considered to implement the new legislation. Written and oral comments will be available for the Boards to consider prior to beginning the formal rulemaking process. If you have any questions or concerns about stakeholder input, please send them to email@example.com.
The Division of Professions and Occupations hosted two Telephone Townhalls on July 15, 2019, that addressed Colorado's requirements for prescribers related to the Prescription Drug Monitoring Program's registration and use. Licensees spanning the Medical, Podiatry, Dental, Optometry, Pharmacy, and Nursing Boards were in attendance.
Robert Valuck, Executive Director of the Colorado Consortium for Prescription Drug Abuse Prevention, was the featured speaker. Among the topics of discussion were the PDMP's structure and purpose; the selection of specialties; prescriber reports, and the use of delegated accounts to inform patient assessments.
Both Townhall recordings are available below for those licensees who were unable to participate in one or both of these sessions. A Q-and-A document also can be accessed that answers many frequently asked questions about the PDMP, its use, benefits, and contact information related to its operation.
On May 29, 2019, Governor Jared Polis signed HB19-1203 School Nurse Grant Program. The bill creates the School Nurse Grant Program in the Primary Care Office of the Colorado Department of Public Health and Environment (CDPHE) to award grants on a five-year cycle to local education providers (LEPs) to increase the number of school nurses. LEPs may use grant awards to hire school nurses; however, the grant may not supplant existing expenditures on school nurse positions or other student health care services
On May 29, 2019, Governor Jared Polis signed SB19-218 Sunset Medical Marijuana Program. This bill extends the Medical Marijuana Program in the Department of Public Health and Environment (CDPHE) until September 1, 2028, implements recommendations from the Department of Regulatory Agencies sunset review, and makes a number of other changes. Specifically, the bill clarifies that:
- Clarifies that if the patient is a minor, the physician must consult with the patient and the patient's parents and clarifies that a parent can serve as a primary caregiver for a child with a disabling medical condition.
- Specifies that doctor-patient consultations include explaining the possible risks and benefits of the use of medical marijuana
- Clarifies that caregivers for patients with debilitating medical conditions are extended the same confidentiality protections as caregivers for patients with disabling medical conditions.
- Clarifies that medical marijuana registry cards are subject to revocation if a patient is convicted of a drug crime.
- Specifies that only a physician can make a medical marijuana recommendation, except for recommendations for patients with disabling medical conditions, which may be made by a physician, dentist, or advanced practice practitioner with prescriptive authority who holds a license in good standing and who is acting within his or her scope of practice.
- Directs CDPHE to promulgate rules related to the length of time that a medical marijuana registry card is valid.
- Requires financial disclosures from members of the Retail Marijuana Public Health Advisory Committee and expands the expertise that must be represented on the committee.
- Allows CDPHE to inquire about collecting Colorado-specific data from the All-Payer Claims Database, hospital discharge data, and available peer-reviewed research studies.
On May 23, 2019, Governor Jared Polis signed SB19-228 Substance Use Disorders Prevention. The law went into effect immediately upon the Governor’s signature. The law requires the Colorado Medical Board, State Board of Nursing, Colorado Dental Board, State Board of Optometry, Colorado Podiatry Board, and the State Board of Veterinary Medicine to adopt rules on substance use disorder training for prescribers. The rules must require certain health care providers, as a condition of license renewal, reactivation or reinstatement on or after October 1, 2019, to complete up to four credit hours of training per licensing cycle related to:
- Best practices for opioid prescribing, according to the most recent version of the Division’s Guidelines for Prescribing and Dispensing Opioids;
- Recognition of substance use disorders;
- Referral of patients with substance use disorders for treatment; and,
- Use of the Electronic Prescription Drug Monitoring Program.
The new requirements apply to podiatrists, physicians, physician assistants, dentists, advanced practice nurses with prescriptive authority, optometrists, and veterinarians, except that each Board’s rules must exempt from the training requirements any health care provider who:
- Maintains a national board certification that requires equivalent substance use prevention training; or
- Attests to the appropriate board that the health care provider does not prescribe opioids.
In addition to the substance abuse prevention training requirements, the new law includes the following provisions:
- Restricts a physician, physician assistant, or advanced practice nurse from accepting any direct or indirect benefits for prescribing a specific medication,
- Allows pharmacies to charge enhanced dispensing fees if they provide counseling concerning the risks of opioids to patients who have not previously received opioid prescriptions,
- Allows medical examiners and coroners to access the Prescription Drug Monitoring Program (PDMP) under specified circumstances,
- Requires opioid prescriptions for outpatient use to bear a warning label, and,
- Provides funding for the implementation of several programs for the prevention of opioid and other substance use disorders in the Department of Human Services (DHS), the Department of Public Health and Environment (CDPHE) and local public health agencies (LPHAs), and the University of Colorado.
On May 23, 2019, Governor Jared Polis signed SB19-227 Harm Reduction Substance Use Disorders. The new law creates and expands certain substance use disorder treatment programs. Among other provisions, the new law:
- creates an opiate antagonist bulk purchase program;
- expands the list of individuals and organizations to whom a physician and advanced practice nurse may prescribe or dispense an opiate antagonist;
- requires opioid antagonists to be made available alongside publicly funded defibrillators;
- allows opiate antagonists to be administered by school staff; and,
- expands the medication take-back program to include syringes.
On May 16, 2019, Governor Jared Polis signed SB19-052 Emergency Medical Service Provider Scope of Practice. The new law is effective August 2, 2019, and expands an emergency medical service (EMS) provider’s scope of practice to practice in a clinical setting under the medical supervision of a physician, physician assistant, advanced practice nurse, or registered nurse. The State Board of Health in the Department of Public Health and Environment must promulgate conforming rules. Each clinical setting at which an EMS provider practices must establish operating policies and procedures to ensure that EMS providers perform tasks and procedures within their scope of practice.
On May 13, 2019, Governor Jared Polis signed SB19-154 Sunset Regulation of Psychiatric Technicians. The new law goes into effect on July 1, 2019, and continues the regulation of psychiatric technicians by the State Board of Nursing (Board) in the Department of Regulatory Agencies to September 1, 2034. The new law also:
- Changes references from "accredited" psychiatric technician education programs to "approved" programs.
- Removes a requirement that applicants submit a statement of whether he or she has been convicted of a felony or misdemeanor involving moral turpitude.
- Modifies the grounds for discipline for alcohol or substance abuse and remove the terms "willfully" and "negligently" as conditions for various grounds for discipline.
- Allows the board to enter into a confidential agreement with a psychiatric technician to limit their scope of practice if the psychiatric technician suffers from a physical or mental illness and subjects a psychiatric technician to discipline if he or she does not limit their practice as agreed to in the confidential agreement.
- Eliminates a requirement that the Board send letters of admonition by certified mail.
On May 6, 2019, Governor Jared Polis signed SB 19-201 Open Discussions About Adverse Health Care Incidents. This new law creates the "Colorado Candor Act” and establishes a process for the communication between a patient and a healthcare provider or health facility after an adverse health care incident. Under the new law, if an adverse health care incident occurs, a health care provider involved with the incident, either individually or jointly with the facility involved, may request that the patient enter into an open discussion concerning the incident. The request must include certain components listed in the law.
If an offer of compensation is made, the new law requires certain processes for payment and financial resolution to be followed. If a health care provider or health facility determines that no offer of compensation is warranted, the health care provider or health facility shall orally communicate that decision with the patient.
A health care provider or facility may provide de-identified information about an adverse health care incident to any patient safety centered nonprofit organization.
On March 14, 2019, the revised Guidelines for Prescribing and Dispensing Opioids were adopted by all six of Colorado’s prescribing and dispensing Boards: the Colorado Dental Board, the Colorado Medical Board, the State Board of Nursing, the State Board of Optometry, the Colorado Podiatry Board, and the State Board of Pharmacy, and endorsed by the State Board of Veterinary Medicine.
The State Board of Nursing hosted the following Rulemaking Hearing in Denver on proposed changes made necessary by Senate Bill 18-027 Enhanced Nurse Licensure Compact to Chapter 1 and 20 of the Board's Rules.
- Listen to the recording of the January 23, 2019 Rulemaking Hearing
- Listen to the recording of the January 15, 2019, Stakeholder Meeting
- Listen to the recording of the December 11, 2018, Stakeholder Meeting
The Colorado Office of Policy, Research and Regulatory Reform is conducting a sunset review of the Board of Nursing. An analysis in a sunset review is performed to determine whether the regulatory program is necessary and should be continued, modified or eliminated. This review will produce a report with recommendations to the Colorado General Assembly and result in subsequent legislation based on the recommendations in the report. Your input is an important component of a successful sunset review. If you would like to submit comments online, please visit COPRRR's website.
Note: The prescribing and dispensing Boards are reviewing Senate Bill 18-22 Clinical Practice for Opioid Prescribing, and considering its impact, if any, on the Guidelines for Prescribing and Dispensing Opioids. Please check back for updates.
On Monday, May 21, 2018, Governor John Hickenlooper signed Senate Bill 18-22 Clinical Practice for Opioid Prescribing. The bill went into effect immediately upon the Governor’s signature. This new state law limits the number of opioid pills a healthcare provider can prescribe and affects physicians, physician assistants, advanced practice registered nurses with prescriptive authority, dentists, optometrists, podiatrists, and veterinarians.
Under the new law, a prescriber must limit a patient’s initial prescription of an opioid to a seven-day supply, if the prescriber has not written an opioid prescription for the patient in the last 12 months. The prescriber may exercise discretion in including a second fill for a seven-day supply. These limits do not apply, if, in the judgment of the prescriber, the patient:
- Has chronic pain that typically lasts longer than 90 days or past the time of normal healing, as determined by the prescriber, or following transfer of care from another prescriber who prescribed an opioid to the patient;
- Has been diagnosed with cancer and is experiencing cancer-related pain; or
- Is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days.
- Is undergoing palliative care or hospice care focused on providing the patient with relief from symptoms, pain, and stress resulting from a serious illness in order to improve the quality of life. (This exemption is allowed for physicians, physician assistants and advanced practice registered nurses only.)
After the first prescription, the prescriber is required to check the Prescription Drug Monitoring Program (PDMP) database before prescribing any additional opioids for the same patient. Failure to check the PDMP constitutes unprofessional conduct if the prescriber repeatedly fails to comply with this new requirement. The second fill requirement to check the PDMP does not apply when a patient:
- Is receiving the opioid in a hospital, skilled nursing facility, residential facility, or correctional facility;
- Has been diagnosed with cancer and is experiencing cancer-related pain; or
- Is undergoing palliative care or hospice care;
- Is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days;
- Is receiving treatment during a natural disaster or during an incident where mass casualties have taken place; or has received only a single dose to relieve pain for a single test or procedure.
After the second opioid prescription, the law has no further restrictions on the healthcare provider’s prescribing practices. The new law does require a healthcare provider, or the provider’s designee, to specify the provider’s specialty upon the initial query of the PDMP. It also states a violation of the new requirements does not constitute negligence or contributory negligence per se and does not create a private right of action or serve as the basis of a cause of action.
On March 16, 2018, the revised Guidelines for Prescribing and Dispensing Opioids were adopted by all six of Colorado’s prescribing and dispensing Boards: the Colorado Dental Board, the Colorado Medical Board, the State Board of Nursing, the State Board of Optometry, the Colorado Podiatry Board, and the State Board of Pharmacy, and endorsed by the State Board of Veterinary Medicine.
This revised Policy is a product of the collaboration between the seven Boards and a robust stakeholder engagement process. Stakeholder views, opinions, and comments were essential in the revision of the 2014 Policy for Prescribing and Dispensing Opioids.
The State Board of Nursing hosted the following stakeholder meetings in Denver to collect input on proposed changes to Chapter 2 of the Board’s Rules regarding the process and requirements for approval of nursing education programs.
- Listen to the recording of the October 19, 2017 stakeholder meeting.
- Listen to the recording of the January 31, 2018 stakeholder meeting.
- Listen to the recording of the March 29, 2018 stakeholder meeting.
A training video is available to show prescribers and pharmacists how to set up delegate accounts for the PDMP. Any prescriber or pharmacist can create up to three delegate accounts for trained individuals who can check the PDMP on the prescriber or pharmacist's behalf. You can utilize the PDMP more frequently to get the most complete medical history possible.
On June 6, 2017, Governor John Hickenlooper signed House Bill 17-1165 (HB17-1165) Department of Regulatory Agencies Boards Disciplinary Action Resolution Process. The new law became effective upon the Governor’s signature on June 6, 2017, and modifies the disciplinary procedures for six healthcare boards (prescriber boards) within the Division of Professions and Occupations in the Department of Regulatory Agencies (DORA). The prescriber boards affected include:
- Colorado Dental Board;
- Colorado Medical Board;
- State Board of Nursing;
- State Board of Optometry;
- Colorado Podiatry Board; and
- State Board of Veterinary Medicine.
As part of the bill’s implementation, we want to make sure you are aware of certain deadlines that affect the prescriber boards’ complaint processes and how you may need to respond to a board request. The following deadlines now apply unless a prescriber board has more protective provisions in current state law:
- Within 15 days of receipt of a complaint, the boards must provide the complainant with a written notice that includes contact information for the board, a summary of the complaint process and the complainant's rights, including a patient's right to receive a copy of his or her patient records.
- If relevant to a complaint, licensees must provide the board with patient records within 30 days of a board request for the records in the form of the response to a 30-day letter.
- If an investigation was initiated as a result of a complaint, and the board took public, formal action, the board must provide the complainant with written notice of the action within 30 days of the action.
- If a complaint is still pending after six months, the board must notify the complainant that the complaint is still pending, subject to applicable restrictions in state law.
- Each prescriber board is required to update its website within 30 days after suspending or revoking a license, listing each licensee subject to the suspension or revocation separately.
Finally, insurance carriers must now update their participating provider lists every 30 days to remove providers whose licenses have been suspended or revoked.
These deadlines are now in effect as required by state law. If you have questions about the new requirement or any other aspect of House Bill 17-1165, please contact Jo Donlin at firstname.lastname@example.org or 303-894-7434.
Did you know you are a mandatory reporter? Under Colorado law, more than 40 professions are required to report suspected child abuse and elder abuse. These professions include many regulated through the Division of Professions and Occupations (DPO) at DORA, such as:
- Physicians (including physician assistants and physicians in training);
- Dentists and dental hygienists;
- Nurses (including registered nurses, licensed practical nurses, and nurse practitioners);
- Nursing home administrators;
- Occupational therapists;
- Physical therapists;
- Mental health professionals (including psychologists, social workers, professional counselors, marriage and family therapists, registered psychotherapists and all candidates for licensure);
Online trainings help mandatory reporters recognize and report abuse, neglect, and exploitation. Licensees of the regulatory boards at DPO may accrue credit towards continuing education and continuing competency requirements for completing the trainings (should they exist for their profession).
Section 19-3-304, C.R.S. outlines the persons required by law to report child abuse and/or neglect. To assist mandatory reporters, training is available on the Colorado Department of Human Services website at http://coloradocwts.com/mandated-reporter-training.
Section 18-6.5-108, C.R.S outlines the persons required by law to report abuse and exploitation of at-risk elders and at-risk adults with intellectual and developmental disabilities. Further information and online training can be found on the Colorado Department of Human Services website at http://www.coloradoaps.com/about-mandatory-reporting-update.html.
If you have further questions regarding these requirements, please contact the Colorado Department of Human Services.
For questions regarding mandatory reporting of at-risk elders and at-risk adults with intellectual and developmental disabilities, please contact the Office of Community Access and Independence’s Division of Aging and Adult Services at email@example.com.
As we work together to tackle prescription drug misuse, abuse and diversion, we see PDMP utilization rates continue to increase as the database continues to serve as an important tool for meeting the standard of care for safe prescribing.
We are pleased to announce a new and improved PDMP website: colorado.gov/dora-pdmp. We listened to your challenges and ideas and hope you’ll find the new website easier to navigate and more relevant to your needs. You will be able to link to your PDMP account and access other information directly from the homepage. We also selected a new vendor, APPRISS, and will be utilizing the PMP AWARxE system. The database interface will look different and make PDMP queries easier and quicker. We encourage your continued feedback for ongoing improvement efforts.
New State Law Improves Access to PDMP
To make the PDMP more accessible and easier for health professionals to incorporate into daily use, the Colorado General Assembly passed legislation in 2017. On April 6, 2017, Governor John Hickenlooper signed Senate Bill 17-146 Access To Prescription Drug Monitoring Program, which clarifies health professionals' access to the PDMP database by:
- Allowing a health care provider with prescribing authority to query the PDMP about a current patient, including checking on drug interactions and side effects, thus making the PDMP an even more useful tool for health professionals in their clinical decision-making for patients;
- Allowing a veterinarian with prescribing authority to query the PDMP about a current client if the veterinarian has a reasonable basis to suspect the client has committed drug abuse or has mistreated an animal; and
- Allowing a pharmacist to query the PDMP about a current patient for whom the pharmacist is dispensing any prescription drug, rather than only patients receiving controlled substances.
The law became effective immediately, and the Division is working with the appropriate Boards to implement the new law including rulemaking, outreach and education. If you have questions about the Colorado PDMP, please contact Division staff at 303-894-5957 or firstname.lastname@example.org. If you need technical assistance with the PMP AWARxE system, please contact the vendor help desk at 1-855-263-6403.
The Colorado Department of Health Care Policy and Financing (HCPF) has worked with the vendor of its Project ECHO Pain Management Program, Community Health Center, to expand access to the program website known as PainNET.
The PainNET website is an online learning community that aims to improve pain care expertise among primary care providers. The website is also now available to other Health First Colorado (Colorado’s Medicaid Program) primary care medical providers (PCMPs) for free.
The PainNET learning community enables PCMPs to develop the expertise to treat patients with complex chronic pain through a combination of archived Project ECHO Pain case presentations, resource libraries, community forums, and expert consultations. Providers and specialists are able to communicate through discussion boards, chat rooms and direct messaging.
This is a great resource for Colorado providers to access resources that can increase their knowledge on how to manage chronic pain more effectively.
Learn More About PainNET
- Download the PainNET Access flyer.
- Watch the Introduction to PainNET video.
- Sign up for access by contacting Agi Erickson at email@example.com.
- Contact JD Belshe, Consultant/Policy & Program Analyst for HCPF, at firstname.lastname@example.org for any other questions about the PainNET program.