Final Pain Management Clinic Licensure Rules Clarified – Licensure Application Deadline is June 20

Here are the key points to HB 93 that will affect physicians in Ohio:

• Requires the State Board of Pharmacy (the Pharmacy Board) to license pain management clinics.
• Provides for pain management clinics to be licensed as terminal distributors of dangerous drugs with a pain management clinic classification.
• Delays, until 30 days after the bill's effective date, the prohibition on operating a pain management clinic without holding a terminal distributor of dangerous drugs with a pain management clinic classification.
• Requires the State Medical Board (the Medical Board) to adopt rules establishing standards for physician operation of pain management clinics and standards to be followed by physicians who provide care at pain management clinics.
• Authorizes the Pharmacy Board to impose a fine of up to $5,000, and the Medical Board to impose a fine of up to $20,000, for failure to follow the rules of operation or standards for pain management clinics.

In the rush to make the bill effective immediately, some confusion and many questions arose in the physician community. In amending the proposed emergency rule, the Medical Board considered comments received from individuals and organizations concerning the requirements for ownership of a pain management clinic, requirements for practicing at a pain management clinic, and other provisions of the rule. AMCNO has been active in the rule review process and in touch the Ohio State Medical Board and the Kasich administration.

The State Medical Board of Ohio [Medical Board] has amended the language of proposed emergency Rule 4731-29-01, Standards and Procedures for the Operation of a Pain Management Clinic. The emergency rule will be effective on June 20, 2011. In summary, the changes include the following:

1. Adds definitions for “chronic pain” and “pain.”
2. Deletes the definition of “local hospital” and the requirement that a physician owning or practicing at a pain management clinic must have staff privileges at a local hospital.
3. Establishes the general requirement for physician ownership of a pain management clinic as current subspecialty certification in pain management or hospice and palliative medicine or current board certification by the American Board of Pain Medicine or the American Board of Interventional Pain Physicians.
4. Provides a limited grandfather provision for physicians who wish to own a pain management clinic but who do not meet the general requirements for subspecialty certification or current board certification.
5. The physician must have filed an application for a license as a category III terminal distributor of dangerous drugs with a pain management clinic classification with the State Board of Pharmacy by June 20.
6. The physician must meet of one of several educational and practice options. One option is that the physician has provided at least three years of full-time clinical services in pain medicine, pain management, hospice and palliative medicine, addiction psychiatry, physical medicine and rehabilitation, occupational medicine, or rheumatology.
7. The Medical Board must determine, following an investigation that the physician’s practice appears to comply with the minimal standards of care.
8. Allows any physician to provide care at a pain management clinic under the direction, supervision, and control of the owner.
9. Requires all physicians who own and/or provide care at a pain management clinic to complete at least 20 hours of category I continuing medical education in pain medicine every two years.
10. Clarifies record keeping requirements and other provisions of the proposed rule.

Information on rules proposed to implement H.B. 93 and other topics related to safe prescribing may be found at the Center for Safe Prescribing: http://med.ohio.gov/Center_for_Safe_Prescribing.html.