- Important Information on ESA recommendation
- PDMP Update and Training Webinar
- Recommending Medical Marijuana
- Medical Board Advisory
- Expectations Under Recently Adopted Policy 10-28
- New Rules Effective February 14, 2021
- Advisory Committee Members Wanted
- Medical Marijuana Guidance
- New Disclosure Required
- Listen to PDMP Townhalls
- Revised Opioid Guidelines Adopted
Emotional Support Animal Recommendations Require Bonafide Provider-Patient Relationship
A bonafide 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 recommednation 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.
Recommending Medical Marijuana
Marijuana remains a Schedule I controlled substance under the Federal Controlled Substances Act, and recommendations for medical marijuana are not prescriptions.
Article XVIII, Section 14 of the Colorado Constitution, and Section 25-1.5-106 of the Colorado Revised Statutes authorize qualified physicians and advanced practice practitioners with prescriptive authority to recommend medical marijuana if they determine that the patient suffers from a debilitating or disabling medical condition and might benefit from such use. The recommendation is submitted to the Medical Marijuana Registry with the rest of the patient's application. If all other application information is complete and correct, the patient will be issued a registry identification card. The prescriber's recommendation for medical marijuana cannot be "filled" as a prescription at a pharmacy.
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.
New Rules Effective February 14, 2021
New rules for the Colorado Medical Board went into effect on February 14, 2021. These rules were adopted to implement:
Colorado Senate Bill 19-079, concerning the requirement that certain practitioners prescribe controlled substances electronically; and
Colorado Senate Bill 20-102, concerning required disclosures to patients regarding formal actions based on sexual misconduct.
To view the details of this rulemaking project and track all rule changes, follow Tracking Numbers 2020-00822 and 2020-00823. The Board encourages all licensees and stakeholders to read the published new rules 160 and 170. Please direct any questions to firstname.lastname@example.org.
Advisory Committee Members Wanted
The Division of Professions and Occupations is seeking qualified candidates to serve on the Naturopathic Medical Advisory Committee ("Committee") The Committee is appointed by the Director of Professions and Occupations, under the Department of Regulatory Agencies (DORA) umbrella. The Committee consists of nine members, including three naturopathic doctors, three doctors of medicine or osteopathy, one pharmacist and two public members.
Recent legislative changes require that of the doctors of medicine or osteopathy who serve on the Committee, one must be a pediatrician and one must be a member of a statewide multi-specialty medical society.
The Committee will meet at least annually and will advise the Director regarding administration and enforcement of laws and rules governing naturopathic doctor practice, discuss issues of importance to naturopathic doctors and their patients, and make recommendations for additions to the naturopathic formulary.
Members are appointed to serve four year terms and may be appointed to serve a second term. Members are not compensated but are reimbursed for expenses incurred in performing their duties.
If you would like to be considered for this opportunity, please submit an application to: email@example.com
Guidance to Physicians/Dentists/Advance Practice Nurses who make medical marijuana recommendations, in light of Executive Action taken pursuant to COVID-19:
On March 20, 2020, Governor Polis issued Executive Order D 2020 011. Directive II.B temporarily suspends C.R.S. § 25-1.5-106(2)(a.5)(I), which requires an appropriate personal physical examination for the issuance of medical marijuana cards, through April 18, 2020.
As a result of, and during the effective dates of, Executive Order D 2020 011, telehealth technologies are not prohibited for use to establish a bona-fide physician-patient relationship, to prevent exposure of COVID-19 among medical professionals and medical marijuana patients.
New Disclosure Required
On May 14, 2019, Governor Jared Polis signed House Bill 19-1174 Out of Network Healthcare Services. The bill includes provisions for how health insurance carriers will reimburse providers (doctors, hospitals and other health care providers) for out-of-network emergency and non-emergency care. The new law went into effect on January 1, 2020, and also requires healthcare providers to develop and provide consumer disclosures about the potential effects of receiving emergency or non-emergency services from an out-of-network provider, and the possibility of “surprise billing.” As part of the implementation of House Bill 19-1174 Out-of-network Surprise Billing, the Division of Professions and Occupations is providing a sample disclosure form. Please feel free to use your own form if you prefer.
Listen to PDMP Townhalls & Get New FAQs Document
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.
Revised Opioid Guidelines Adopted
On March 14, 2019, the revised Guidelines for Prescribing and Dispensing Opioidswere adopted by all six of Colorado's prescribing and dispensing Boards: the Colorado Dental Board, the Colorado Medical Board, theState 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.