4 Responses to the Opioid Crisis Impacting Hospice

Written By: John Loxterman | SVP, Chief Ethics and Compliance Officer

As the opioid crisis continues to devastate communities across America, state lawmakers are responding to media and public demands for action. States have enacted laws to prevent doctor and pharmacy shopping, limit the quantities of controlled substances prescribed, facilitate the destruction of unused drugs and increase the security of prescriptions via E-prescribing mandates.

While the efforts are focused on addressing the widespread issues regarding diversion, hospice providers have become vulnerable to significant challenges in providing quality care to the frail population they serve.

    1. Most states require providers to check their state’s prescription drug monitoring program (PDMP) before prescribing a controlled substance. State PDMPs are a vital tool for preventing diversion, as they provide a complete inventory of controlled substances dispensed to a patient. Recognizing the unique treatment patterns in hospice, most states exclude prescriptions for these patients from PDMP check requirements.
      Over the last year, however, California, Florida and Michigan have expanded PDMP mandates and have not exempted hospice.


    1. States are also taking measures in line with the CDC prescribing guidelines for opioids by limiting the number of days supplied for controlled substance prescriptions. California, Florida, Michigan and Nevada have all passed such measures. These new rules vary widely by state, including some limited exemptions for hospice and palliative care prescriptions. Prescribers should check with their state medical board for detailed information.


    1. To prevent diversion and assist hospice patients and their families, legislatures are enabling hospice providers to dispose of unused medications on behalf of their patients. Florida, Louisiana, Maryland, New Jersey, Ohio, Kentucky, South Carolina, Virginia, and Wisconsin currently authorize this practice, or will do so in the near future.


  1. Finally, states are continuing to promote security in the prescribing process by enacting electronic prescribing mandates. New York has required all prescriptions to be submitted electronically since March 2016. To increase security and prevent diversion, many states are moving to require electronic prescribing for controlled substances. Maine imposed such a mandate in 2017 and Connecticut followed suit in January 2018.

Several states have passed similar laws, but apparently recognizing the lag in adoption of electronic prescribing technology, have included compliance dates one to two years out: Arizona (January and July 2019), Iowa (January 2020), Oklahoma (January 2020), Tennessee (July 2020) and Virginia (July 2020).

This year saw legislative activity to address the opioid crisis in every state. As the epidemic shows no signs of lessening, we expect to be actively engaged in the discussions and stay abreast of these situations as they unfold during the balance of the year and into 2019.  With ongoing involvement and monitoring of the issues, Enclara endeavors to support the hospice community and alert our industry colleagues as new measures are enacted.

Enclara has many tools and processes in place to support your hospice’s compliance efforts. Contact us if you have questions or need assistance.

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