SB 440 - AS AMENDED BY THE SENATE
02/08/2024 0397s
2024 SESSION
24-3025
09/08
SENATE BILL 440
AN ACT relative to the board of optometry and the regulation of optometry.
SPONSORS: Sen. Ward, Dist 8; Sen. Lang, Dist 2; Sen. Innis, Dist 7; Sen. Gendreau, Dist 1; Sen. Soucy, Dist 18; Sen. Pearl, Dist 17; Sen. Carson, Dist 14; Sen. Birdsell, Dist 19; Sen. Altschiller, Dist 24
COMMITTEE: Executive Departments and Administration
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ANALYSIS
This bill makes various amendments to the regulation of optometry, including changing the board's name to the board of optometry, definitional changes to include what constitutes the "practice of optometry", repealing the joint credentialing committee, modifying the rulemaking authority of the board, and modifying the prescribing authority of optometrists.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
02/08/2024 0397s 24-3025
09/08
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Four
AN ACT relative to the board of optometry and the regulation of optometry.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Providing Controlled Drug Prescription Health and Safety Information. Amend RSA 126-A:93, I(b)(2) to read as follows:
(2) The board of dentistry, the board of medicine, the board of nursing, the board of [registration in] optometry, the board of podiatry, the board of veterinary medicine, and the pharmacy board; provided, however, that the request is pursuant to the boards' official duties and responsibilities and the disclosures to each board relate only to its licensees and only with respect to those licensees whose prescribing or dispensing activities indicate possible fraudulent conduct.
2 Office of Professional Licensure and Certification; Definitions; Establishment. Amend RSA 310:2, II(ii) to read as follows:
(ii) Board of [registration in] optometry under RSA 327.
3 Administration of the Office of Professional Licensure and Certification; Funding. Amend RSA 310:5, III to read as follows:
III. There is hereby established a dedicated, nonlapsing fund to be known as the New Hampshire health professionals' program administration fund for the administration of the professionals' health program, including the professionals' health program in RSA 329:13-b, the alternative recovery monitoring program in RSA 326-B:36-a, and the impaired pharmacist program set forth in RSA 318:29-a, with a fee charged to licensees at the time of initial licensure, renewal licensure, or reinstatement of licensure, for the board of medicine, board of dental examiners, pharmacy board, board of nursing, board of veterinary medicine, board of psychologists, board of chiropractic examiners, board of mental health practice, midwifery council, board of [registration in] optometry, board of podiatry, board of licensed dietitians, and board of licensing for alcohol and other drug use professionals, not to exceed 125 percent of the actual cost of providing the services. Other health and technical professions boards may be added to the program at the same annual fee per licensee. The moneys in this fund shall be continually appropriated to the office.
4 Pharmacy Board; Inspectional Services. Amend RSA 318:9-a to read as follows:
318:9-a Inspectional Services. The office of professional licensure and certification shall provide inspectional services under this chapter and RSA 318-B:25 to the board of medicine, the board of veterinary medicine, the board of podiatry, the board of [registration in] optometry, the board of dental examiners, the board of nursing, and the naturopathic board of examiners. Pharmacy board inspections shall be provided by pharmacists or pharmacy technicians licensed by the New Hampshire board of pharmacy who have training and experience regarding pharmacy statutes and rules.
5 Controlled Drug Prescription Health and Safety Program; Rulemaking for Prescribing Controlled Drugs. Amend RSA 318-B:41, I(a)(4) to read as follows:
(4) The board of [registration in] optometry, concerning optometrists.
6 Optometry; Definitions. Amend RSA 327:1 to read as follows:
327:1 Definitions. In this chapter:
I. "Board" means the board of [registration in] optometry.
II. "Dispensing pharmaceutical agents" means that a licensed optometrist authorized to use pharmaceutical agents may dispense a pharmaceutical agent to a patient if no charge is imposed for the pharmaceutical agent and the amount dispensed does not exceed a 24-hour supply, except that if the minimum available quantity for dispensing is greater than a 24-hour supply, the optometrist may dispense the minimum available quantity. Nothing in this paragraph shall prohibit a licensed optometrist authorized to use pharmaceutical agents pursuant to RSA 327:6-a from dispensing therapeutic contact lenses for a fee.
III. "Pharmaceutical agent" means the following pharmaceutical products:
(a) Non-legend, over the counter, agents.
(b) Mydriatic and cycloplegic agents [which are topically applied].
(c) Miotic agents approved pursuant to RSA 327:6-a, VI.
(d) Antibiotics, [sulfonomides] sulfonamides, and combinations thereof[, which are topically applied or orally administered] to treat or alleviate the effects of disease or abnormal conditions of the human eye, adnexa, and eyelids, [or] excluding structures posterior to the iris, approved pursuant to RSA 327:6-a, VI.
(e) Anti-allergy medications, including but not limited to antihistamines, decongestants, and mast-cell stabilizers [which are topically applied].
(f) Anesthetics and dyes [which are topically applied].
(g) Ocular lubricants and ocular hypertonic agents [which are topically applied].
(h) Orally administered analgesic agents used for the purpose of alleviating pain caused by a disease or abnormal condition of the human eye or eyelid, [or] excluding structures posterior to the iris. This may include class III and IV controlled substances approved pursuant to RSA 327:6-a, VI, or hydrocodone in combination with analgesics when limited to 72 hours with no refills and included in the formulary.
(i) Other pharmaceutical agents, any solely diagnostic agents, and diagnostic agents combined with pharmaceutical agents as defined in this paragraph and as approved pursuant to RSA 327:6-a, VI.
(j) Non-steroidal anti-inflammatory agents approved pursuant to RSA 327:6-a, VI.
(k) Anti-glaucoma agents provided that an optometrist may dispense or prescribe such agents if the optometrist has met the requirements of RSA 327:6-c.
(l) Corticosteroids [which are topically applied,] as approved by the board.
(m) Antivirals which are approved pursuant to RSA 327:6-a, VI.
[(n) Corticosteroids or antivirals, provided that optometrists with patients on corticosteroids or antivirals who demonstrate no improvement in 10 days shall be referred to an ophthalmologist.]
[(o)] (n) Influenza, COVID-19, and shingles vaccines which have been approved by the Food and Drug Administration to adults.
IV. "Practice of optometry":
(a) Means the employment of any methods or means[, other than surgery,] for the:
[(a)] (1) Diagnosis and treatment of any optical defect, deficiency, deformity, or disease of the human eye, adnexa and eyelids.
[(b)] (2) Diagnosis and treatment of any visual or muscular anomaly of the visual system.
[(c)] (3) Adaptation or prescribing of spectacle lenses, contact lenses, prisms or ocular exercises for the correction, relief or aid of the visual functions.
[(d)] (4) Prescribing, administering or dispensing of pharmaceutical agents.
[(e)] (5) Application, prescribing, or removal of Food and Drug Administration approved medical devices, as approved by the board and consistent with the practice of optometry as set forth in this chapter, including, but not limited to, contact lenses, plano lenses, and punctal plugs. The term "plano lenses" means contact lenses with no refractive power.
[(f) Diagnosis of acute angle closure glaucoma. Upon such diagnosis, an optometrist may administer emergency care and shall immediately refer the patient to an ophthalmologist. Oral pharmaceutical agents may be used for the emergency treatment of acute angle closure glaucoma.]
(b) Shall not mean the following ophthalmic surgery procedures, except for the preoperative and postoperative care, of:
(1) The following procedures:
(A) Retina laser procedures.
(B) Penetrating keratoplasty or corneal transplant.
(C) The administration of general anesthesia.
(D) Surgery done with general anesthesia.
(E) Laser or non-laser procedures into the vitreous chamber of the eye to treat any retinal or macular disease.
(F) Laser-assisted in situ keratomileus, photorefractive keratectomy, laser epithelial keratomileusis, or any forms of refractive surgery.
(2) The following non-laser surgical procedures:
(A) Surgery related to removal of the eye from a living human being.
(B) Surgery requiring full thickness incision or excision of the cornea or sclera other than paracentesis in an emergency situation requiring immediate reduction of the pressure inside the eye.
(C) Surgery requiring incision of the iris and ciliary body, including diathermy or cryotherapy.
(D) Surgery requiring incision of the vitreous.
(E) Surgery requiring incision of the retina.
(F) Surgical extraction of the crystalline lens.
(G) Surgical intraocular implants.
(H) Incisional or excisional surgery of the extraocular muscles.
(I) Surgery of the eyelid for suspect malignancies or for incisional cosmetic or mechanical repair of blepharochalasis, ptosis, and tarsorrhaphy.
(J) Surgery of the bony orbit, including orbital implants.
(K) Incisional or excisional surgery of the lacrimal system other than probing or related procedures.
(L) Surgery requiring full thickness conjunctivoplasty with graft or flap.
(M) Pterygium surgery.
V. "Prescription of pharmaceutical agents" means a written or oral direction to dispense a pharmaceutical agent, including inscription, subscription, transcription, and renewal.
[VI. "Surgery" means any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical means. Surgical procedures shall include the use of lasers for therapeutic and photorefractive purposes, ionizing radiation, therapeutic ultrasound, or medication administered by injection, provided that the removal of superficial foreign bodies from the eye, adnexa or eyelid shall not be considered a surgical procedure prohibited by this chapter. With respect to a foreign body, any part of which is situated within 3 millimeters of the visual axis, "superficial foreign body" means that which has not penetrated deeper than the corneal epithelium.]
[VI-a.] VI. "Telemedicine" means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment.
VII. "Therapeutic contact lenses" means contact lenses which contain one or more medications and which deliver such medication to the eye.
7 Optometry; Examining Board; Board. Amend RSA 327:2, I to read as follows:
I. There shall be a board of [registration in] optometry consisting of 5 members; including 4 optometrists and one public member, each to be appointed by the governor, with the approval of the council, to a term of 5 years. No member shall be appointed to more than 2 consecutive terms.
8 Optometry; Examinations and Licenses; Authorization for Pharmaceutical Agents. Amend RSA 327:6-a, II to read as follows:
II. An optometrist licensed to practice optometry prior to January 1, 1993, shall complete a post-graduate course of study approved by the board covering the subjects of ocular pharmacology and the treatment and management of eye diseases and shall pass an examination administered by the National Board of Examiners in Optometry or its successor and approved by the board. Every optometrist licensed to practice optometry after January 1, 1993, shall pass an examination administered by the National Board of Examiners in Optometry or its successor and approved by the board. To meet the requirements of this section, an approved course shall be given by an accredited school or college of optometry in the United States and shall consist of a minimum of 105 hours, of which a minimum of 25 hours shall be in direct clinical training. The board shall adopt rules, under RSA 541-A, to carry out the provisions of this section and to [insure] ensure the safety of the public.
9 Optometry; Examinations and Licenses; Authorization for Pharmaceutical Agents. Amend RSA 327:6-a, IV to read as follows:
IV. Nothing in this section shall be construed to permit an optometrist to [administer any pharmaceutical product by injection; or to] administer, prescribe or dispense any pharmaceutical product designated as a schedule I or schedule II controlled substance under RSA 318-B:1-a, except hydrocodone in combination with analgesics when limited to 72 hours with no refills; or to administer, prescribe or dispense any pharmaceutical product except for the diagnosis or treatment of disease or conditions of the human eye, adnexa or eyelids.
10 Optometry; Examinations and Licenses; Treatment of Glaucoma. Amend RSA 327:6-c to read as follows:
327:6-c Treatment of Glaucoma.
I.(a) Optometrists seeking authorization to treat glaucoma shall complete at least 40 hours of classroom education, approved by the board, incorporating: epidemiology of the glaucomas; genetics of the glaucomas; anatomy, physiology, and mechanics of aqueous inflow and aqueous outflow; optic nerve anatomy and pathophysiology; neurotoxicity and neuroprotectants; receptor biology; pharmacology, clinical use and toxic effects of alpha and beta adrenergic agents, carbonic anhydrase inhibitors, and cholinergic agents.
(b) Optometrists shall pass an examination approved by the board that covers the educational components listed in subparagraph (a). Upon passage of such exam, an optometrist shall have prescriptive authority during the clinical management period pursuant to RSA 327:6-a.
(c) The board shall waive the requirements of this paragraph and of paragraph II for optometrists who have either graduated after 2002 or who have proof of 12 months of credentialed privileges to treat glaucoma by the United States Department of Defense or Department of Veteran Affairs or the national Indian Health Service, or who are certified by the American Board of Optometry, verified by the board.
II.(a) To be authorized to initiate treatment of glaucoma for patients 18 years of age or older, a therapeutic pharmaceutical agent certified optometrist shall complete the educational requirements in paragraph I and provide evidence of written referrals and consultations with an ophthalmologist. For purposes of this section, "ophthalmologist"; means a physician licensed under RSA 329 with a specialty in ophthalmology. The [joint credentialing committee] board shall review evidence of glaucoma co-management submitted pursuant to subparagraph (b).
(b) Except as provided in subparagraph I(c) or paragraph III, therapeutic pharmaceutical agent certified optometrists are required to provide evidence of successful collaborative treatment and co-management of 25 glaucoma patients, up to 5 of which may be established patients, during a period of not less than 18 months for each patient, to ophthalmologists according to the following criteria:
(1) A new or existing glaucoma patient is examined and diagnosed by the optometrist;
(2) The optometrist develops a proposed treatment plan and forwards the plan with examination documentation to an ophthalmologist for consultation;
(3) The ophthalmologist reviews the optometrist's examination documentation and proposed treatment plan;
(4) The ophthalmologist, optometrist, and patient mutually agree to and document a treatment plan;
(5) The optometrist shall consult with the co-managing ophthalmologist when any of the following occurs: the patient's target pressure is not reached within 90 days; the patient is experiencing documented progression of optic nerve damage; the patient develops documented and repeated progression of visual field loss; or the patient develops angle-closure; and
(6) For each successfully co-managed glaucoma patient the optometrist and co-managing ophthalmologist shall complete a glaucoma credentialing reporting form and submit the form to the [joint credentialing committee] board upon completion of the 18 months of treatment.
III. The [joint credentialing committee] board may waive or reduce the requirements of RSA 327:6-c, I and II for the following categories of optometrists:
(a) Optometrists with a license and proof of practice for 12 months treating glaucoma patients in another state that currently authorizes the treatment of glaucoma by optometrists; or
(b) Optometrists who have proof of successful completion of a 12-month accredited optometric residency program or its equivalent.
IV. [Upon certification] An optometrist certified to treat glaucoma but not having certification to perform ophthalmic procedures for the treatment of glaucoma shall refer the patient to the appropriate certified eye care provider [patients an optometrist shall consult with an ophthalmologist] within 30 days when any of the following occurs:
(a) The patient is experiencing documented progression of optic nerve damage or the patient develops documented and repeated progression of visual field loss on maximum tolerated topical medical therapy; or
(b) The patient develops angle-closure.
11 New Section; Optometry; Examinations and Licenses; Authorization to Perform Ophthalmic Procedures. Amend RSA 327 by inserting after section 6-c the following new section:
327:6-d Authorization to Perform Ophthalmic Procedures.
Unless otherwise specified in this chapter, the board shall have the authority to determine what constitutes the practice of optometry by persons licensed under this chapter and shall establish the credentialing requirements which shall be fulfilled before a person may be certified to perform ophthalmic procedures for the practice of optometry.
12 Optometry; License Renewal; Disciplinary Action. Amend RSA 327:20, II(i) to read as follows:
(i) The use of any pharmaceutical agent by an optometrist not authorized under RSA 327:6-a or the use of any pharmaceutical agent other than those agents described in RSA 327:1 or those previously approved by the [joint credentialing committee] board.
13 Optometry; Regulations and Penalties; Contact Lens Prescriptions to be Provided to Patient. Amend RSA 327:25-a, IV to read as follows:
IV.(a) No person shall conduct or operate a business outside of the state for the sale at retail of contact lenses to individuals within the state unless such business is registered with a permit issued by the board of pharmacy if the out-of-state business is a pharmacy, or by the board of [registration in] optometry if the out-of-state business is not a pharmacy.
(b) The board of pharmacy or the board of [registration in] optometry shall issue a permit to such out-of-state business if the business discloses and provides proof:
(1) That the business is in compliance with all applicable laws and rules in the state in which the business is located;
(2) Of the operating locations and the names and titles of all principal corporate officers;
(3) That the business complies with all lawful directions and requests for information from the board of pharmacy and the board of [registration in] optometry of all states in which it conducts business;
(4) That the business agrees in writing to comply with all New Hampshire laws and rules relating to the sale or dispensing of contact lenses; and
(5) That the business has paid the established fee.
14 Optometry; Regulation and Penalties; Rulemaking Authority. Amend RSA 327:31, I to read as follows:
I. The qualifications of applicants in addition to those requirements set by RSA 327:6, [and] RSA 327:6-a, RSA 327:6-c, and RSA 327:6-d;
15 Optometry; Regulations and Penalties; Continuing Education Courses Required for Pharmaceutical and Glaucoma Certification. Amend RSA 327:33-a to read as follows:
327:33-a Continuing Education Courses Required for Pharmaceutical and Glaucoma Certification.
I. An optometrist certified to use pharmaceutical agents in the practice of optometry shall complete a minimum of [50 hours of continuing education every year in order to maintain pharmaceutical certification. A minimum of] 20 hours of continuing education every year [shall be] by participation in formal synchronous courses [and the remainder by independent study]. Each optometrist shall report continuing education hours to the board in accordance with rules adopted by the board for the implementation of this section. Such continuing education courses and activities shall satisfy the requirements of RSA 327:33.
II. An optometrist certified to treat glaucoma shall complete a minimum of 10 of the required hours in ocular pathology or pharmacology [glaucoma] specific education. [A minimum of 7 hours shall be by participation in formal courses and 3 hours may be by independent study.]
16 Repeal. RSA 327:6-b, relative to the optometry joint credentialing committee, is repealed.
17 Effective Date. This act shall take effect 60 days after its passage.
| Date | Amendment |
|---|---|
| Feb. 1, 2024 | 2024-0397s |
| May 13, 2024 | 2024-1815h |
| May 17, 2024 | 2024-2030h |
| May 20, 2024 | 2024-2066h |
| May 21, 2024 | 2024-2094h |
| Date | Body | Type |
|---|---|---|
| Jan. 17, 2024 | Senate | Hearing |
| Feb. 8, 2024 | Senate | Floor Vote |
| April 24, 2024 | House | Hearing |
| May 8, 2024 | House | Exec Session |
| May 8, 2024 | House | Floor Vote |
Oct. 10, 2024: Died on Table, Session ended 10/10/2024 HJ 17
May 23, 2024: Lay SB440 on Table (Rep. Nagel): MA DV 224-137 05/23/2024 HJ 14 P. 55
May 13, 2024: Minority Committee Report: Refer for Interim Study
May 13, 2024: Majority Committee Report: Ought to Pass with Amendment # 2024-1815h 05/08/2024 (Vote 14-6; RC) HC 20 P. 16
April 26, 2024: Executive Session: 05/08/2024 11:00 am LOB 306-308
April 25, 2024: Subcommittee Work Session: 05/01/2024 10:00 am LOB 306-308
April 15, 2024: Public Hearing: 04/24/2024 01:15 pm LOB 306-308
April 12, 2024: Introduced 04/12/2024 and referred to Executive Departments and Administration HJ 11 P. 103
Feb. 8, 2024: Ought to Pass with Amendment 2024-0397s, MA, VV; OT3rdg; 02/08/2024; SJ 3
Feb. 8, 2024: Committee Amendment # 2024-0397s, AA, VV; 02/08/2024; SJ 3
Feb. 1, 2024: Committee Report: Ought to Pass with Amendment # 2024-0397s, 02/08/2024; Vote 5-0; CC; SC 6
Jan. 5, 2024: Hearing: 01/17/2024, Room 103, SH, 09:00 am; SC 3
Dec. 12, 2023: To Be Introduced 01/03/2024 and Referred to Executive Departments and Administration; SJ 1