- Physician Assistant Collaborative Agreements Explained
- FAQ: SB19-079: Electronic Prescribing of Controlled Substances
- Inappropriate Use of Antipsychotic Medications and Erroneous Diagnosis of Schizophrenia in
- Important Information on ESA recommendation
- PDMP Update and Training Webinar
- Recommending Medical Marijuana
- Medical Board Advisory
- Expectations Under Adopted Policy 10-28
Physician Assistant Collaborative Agreements Explained
SB19-079: Electronic Prescribing of Controlled Substances
Inappropriate Use of Antipsychotic Medications and Erroneous Diagnosis of Schizophrenia in Nursing Homes
The Centers for Medicare and Medicaid Services (CMS) are responsible for the oversight and health and safety of nursing home residents. Over the past decade, through the work of the National Partnership to Improve Dementia Care, CMS has been monitoring antipsychotic medication use in nursing homes. Though steps have been taken to reduce the use of these drugs, there continue to be concerns that
nursing home residents may be inappropriately prescribed antipsychotic medications due to being erroneously diagnosed and coded as having schizophrenia; see the Office of Inspector General report for more information. Antipsychotic medications are dangerous among the vulnerable nursing home population because of their potential side effects, including death.
If you have any questions regarding this issue, below is a list of contacts to refer your inquiry to:
Graham, Dara (CMS/CCSQ) - Dara.Graham@cms.hhs.gov
Shulman, Evan (CMS/CCSQ) - Evan.Shulman@cms.hhs.gov
Casal, Eimee (CMS/CCSQ) - Eimee.Casal@cms.hhs.gov
Laughman, Michele (CMS/CCSQ) - Michele.Laughman@cms.hhs.gov
Emotional Support Animal Recommendations Require Bonafide Provider-Patient Relationship
A bona fide provider-patient relationship should exist between a licensed healthcare professional and an individual seeking an emotional support animal (ESA) for therapeutic benefit prior to the issuance of a recommendation letter in Colorado. This bonafide provider-patient relationship is defined in the mental health, medical and nursing practice acts.
Healthcare professionals must first establish whether a disability exists and if found, determine whether there is sufficient information for a recommendation for an ESA to provide a therapeutic benefit for that disability. In order to make such determinations, licensees must be both sufficiently familiar with the patient and the patient’s disability; and legally and professionally qualified to make this determination.
Nursing and mental health law (Section 12-255-133(3)(a) and 12-245-229(3)(a) Colorado Revised Statutes) further clarifies that “a licensee shall not make a determination … unless the licensee has met with the patient in person.” Registered nurses are permitted to issue ESA recommendations but must be under the direct supervision of a licensed physician.
Physicians shouldn’t make a determination unless having “met with the person or by telemedicine,” according to 12-240-144(3)(a), C.R.S.
Healthcare practitioners under the purview of Division of Professions and Occupations must follow all applicable laws for those seeking an assistance animal.
An ESA is an animal that provides a therapeutic benefit, such as emotional support, comfort, or companionship, to a person with a mental health or psychiatric disability. An ESA is not considered a Service Animal and ESA users don’t receive the same accommodations as service dog users.
ESAs don’t perform specific tasks related to the person’s disability, instead, it is the presence of the animal that relieves the symptoms associated with the serious mental health condition. This condition is documented by a properly formatted prescription letter.
Colorado Prescription Drug Monitoring Program Legislative Update and Training Webinar Recording and Summary/FAQ Document Now Available
In August and September 2022, the Colorado Prescription Drug Monitoring Program (PDMP) hosted three webinars concerning several statutory updates to the Colorado PDMP as well as training and resources regarding registration and use of the Colorado PDMP. A recording of the August 23rd webinar, copy of the presentation slides, and a Summary and Frequently Asked Questions (FAQ) document are now available at dpo.colorado.gov/PDMP/Training.
Medical Board Issues COVID-19 Advisory
Colorado Medical Board Advisory Statement
The Colorado Medical Board believes misinformation and disinformation related to COVID-19, vaccinations, mask and social distancing guidelines, and appropriate treatments pose a significant health risk to the public and has a negative impact on the health of Coloradans. General treatment and guidance from practitioners should align with evidence-based studies and treatments, as well as Executive Orders, Policies, and Statutes in the State of Colorado.
The Federation State Medical Boards (FSMB) has issued the following statement: “Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license. Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not. They also have an ethical and professional responsibility to practice medicine in the best interests of their patients and must share information that is factual, scientifically grounded, and consensus-driven for the betterment of public health. Spreading inaccurate COVID-19 vaccine information contradicts that responsibility, threatens to further erode public trust in the medical profession and puts all patients at risk.”
Spreading misinformation provides false or out-of-context information that is presented as fact, regardless of the intent. The spreading of inaccurate medical information concerning COVID-19 that a licensee should reasonably know to be false poses a significant health risk to the public. The Colorado Medical Board endorses concern regarding misinformation and disinformation around COVID-19 and will investigate and act to impose sanctions, as deemed appropriate, on a case-by-case basis.
As the pandemic has progressed, clear clinical evidence is now available supporting the benefits of social distancing, masks, vaccinations, and treatment protocols that have clear benefits in minimizing the severity of illness and decreasing hospitalizations. It is the expectation of the Medical Board that licensees will incorporate evidence-based recommendations and treatment int their clinical practices. Prescribing medications or other treatment protocols that have not shown to have any clinical benefit in approved clinical trials risks toxicity and adverse side effects and can delay initiation of approved interventions. The Board will review such detrimental practices and may, on a case-by-case basis, take disciplinary actions as deemed appropriate.
Expectations Under Recently Adopted Policy 10-28
The Colorado Medical Board (Board) recently adopted Policy 10-28, Confidential Assessment and Monitoring of Voluntary Treatment through the Designated Peer Health Provider to clarify expectations and obligations of the administration of the medical peer health assistance program, enacted by Section 12-240-131, Colorado Revised Statutes.
Since its inception, the Board’s designated peer health provider has been required to honor its commitment to early intervention for health conditions. The Board and the Division of Professions and Occupations (DPO), which oversees the Board, has been committed to clarifying expectations and has issued Policy 10-28 to provide public clarity as the program continues to operate in accordance with the law and ensure that those who wish to seek participation in the program understand the parameters pertaining to confidentiality. In short, the terms and limitations of the confidentiality agreement of all participants in the peer assistance program, both voluntary and for those with an active case, remain consistent and have not changed.
This document describes the Colorado Medical Board’s Confidential Assessment and Monitoring of Voluntary Treatment Through the Designated Peer Health Provider policy and the stakeholder engagement process leading to its formal adoption.
Stakeholder Engagement Process
Beginning February 2021, public input was solicited as the Board’s Policy Subcommittee considered formalizing, through written policy, the parameters for confidential assessment and monitoring of voluntary treatment for Colorado Medical Board applicants and licensees seeking treatment through the designated peer health provider. A survey was distributed to stakeholders and two stakeholder meetings were held prior to drafting the policy, seeking input regarding the Board’s longstanding guidelines for confidential treatment and what, if any, changes stakeholders would like to see. The overarching sentiment of the community was for the Board to maintain the “status quo” for confidential treatment and formalize those guidelines in written policy.
Throughout the drafting process, stakeholders were engaged through five additional stakeholder meetings and requests for written feedback concerning each revised version of the proposed draft policy. The Board’s Policy Subcommittee thoughtfully considered all stakeholder feedback, and revised the draft policy as necessary to ensure a comprehensive policy that is reflective of stakeholder input. That policy was presented to the Board for its consideration on May 20.
Medical Peer Assistance Participation FY18. Licensees: 32,000, PAP Participants: 750, Board Ordered: 150, Utilization Rate: 2%.
Overview of the Policy
The Colorado Medical Board adopted its policy on May 20, 2021 concerning Confidential Assessment and Monitoring of the Voluntary Treatment through a Board Designated Peer Health Provider. The policy clarified eligibility and reporting requirements for Board applicants and licensees who voluntarily sought confidential assessment and monitoring of treatment through the Board’s designated peer health provider.
Confidential Assessment and Monitoring of Voluntary Treatment is a significant benefit to Colorado Medical Board applicants and licensees as well as the people of Colorado.
This program encourages applicants and licensees to voluntarily seek and receive necessary medical and mental health care, confidentially, when appropriate. The Board recognizes its licensees are a valuable resource to the health and well-being of Coloradans and the goal of the Board is to rehabilitate licensees struggling with health concerns back to the safe practice of medicine.
The Board has long regarded confidential assessment and monitoring of voluntary treatment as a means to promote the health and well-being of its licensees, while ensuring patient safety. The Board has a responsibility to uphold the Medical Practice Act, particularly as it relates to a licensee’s duty to self-report violations of the Act. In those cases in which there is a legitimate, objective concern that a licensee’s condition has compromised their patients’ safety, the licensee has a duty to self-report that condition to the Board. The Board remains committed to restoring that licensee to a state of health and wellness and returning that licensee to safe practice when appropriate and in a manner that ensures patient safety.
The role and responsibility of the Board’s designated Peer Health Provider is critical to making sure that the physician receives the necessary help they need while ensuring patient safety. This includes ensuring applicant or licensee eligibility for confidential assessment and monitoring of voluntary treatment and the obligation to timely communicate participant noncompliance to the Board.
In general, acts of noncompliance by a licensee that require reporting to the Board include the following:
- Participating in Confidential Assessment and Monitoring where illness or condition directly results in patient harm or compromises patient safety as determined by the Board designated peer health provider;
- An illness or condition which has resulted in conduct that violates state or federal law, including the Medical Practice Act, during the individual's participation in Confidential Assessment and Monitoring;
- Instances of non-compliance as determined by the Liaison Committee.
Upon report by the Board-designated peer health provider of non-compliance by a Board licensee/applicant with Confidential Assessment and Monitoring requirements, the Board must issue an Order requiring the individual to undergo evaluation by the Board-designated peer health provider.
The Board’s designated peer health provider must comply with the aforementioned policy. If you have any questions, please contact Paula.Martinez@state.co.us. Thank you.