Opioid reimbursement under workers’ comp

What your physician needs to know about workers’ comp and opioid reimbursement rules in Michigan.

Michigan has seen a dramatic reduction (37%) in opioid prescriptions for patients on workers’ comp. This decrease has been attributed to new administrative rules that were adopted in 2014.

Reimbursement for opioids under workers’ comp are no longer authorized beyond 90 days unless detailed physician reporting requirements are met.

We are seeing more clients have trouble get their medications approved. Here are the items required when a doctor prescribes opioids.

What is required to be in the physician’s 90 day written report?

(a) A review and analysis of the relevant prior medical history, including any consultations that have been obtained, and a review of data received from an automated prescription drug monitoring program in the treating jurisdiction, such as the Michigan Automated Prescription System (MAPS), for identification of past history of narcotic use and any concurrent prescriptions.

(b) A summary of conservative care rendered to the worker that focused on increased function and return to work.

(c) A statement on why prior or alternative conservative measures were ineffective or contraindicated.

(d) A statement that the attending physician has considered the results obtained from appropriate industry accepted screening tools to detect factors that may significantly increase the risk of abuse or adverse outcomes including a history of alcohol or other substance abuse.

(e) A treatment plan which includes all of the following:

(i) Overall treatment goals and functional progress.

(ii) Periodic urine drug screens.

(iii) A conscientious effort to reduce pain through the use of non-opioid medications,
alternative non-pharmaceutical strategies, or both.

(iv) Consideration of weaning the injured worker from opioid use.

(f) An opioid treatment agreement that has been signed by the worker and the attending physician. This agreement shall be reviewed, updated, and renewed every 6 months. The opioid treatment agreement shall outline the risks and benefits of opioid use, the conditions under which opioids will be prescribed, and the responsibilities of the prescribing physician and the worker.

Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call (844) 201-9497 for a free consultation today.

Related information:

FAQ: Opioid Treatment Reimbursement Rules

Photo courtesy of Creative Commons, by .v1ctor Casale..

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