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New York Non-Acute Pain Medical Treatment Guidelines

UPDATE

Effective Monday, December 15, 2014, urine drug testing (UDT) will become a mandatory component of New York’s chronic opioid management guidelines for the purposes of establishing a baseline and a process for ongoing assessment of injured workers’ adherence to prescribed opioid treatment.

SUMMARY

Section F.3.d.i of the New York Non-Acute Pain Medical Treatment Guidelines is entitled “Monitoring Opioid Therapy”.  Summarized below are the key highlights specific to drug testing and the areas we believe may impact payers and physicians operating in New York.

  1. Urine Drug Testing is a mandatory component of chronic opioid management – baseline and ongoing assessment
  2. The claimant has the right to refuse the drug test but will receive no prescriptions for opiate medications as a consequence
  3. UDT results are not to be released to the carrier, employer or Board.  However, the treating physician must certify the claimant’s adherence to or non-compliance by completing the Patient Understanding for Opioid Treatment Form – – and attach it to the claimant’s medical record.
  4. Employers cannot use test results to fire or discipline the employee in a discriminatory manner
  5. Guidelines do not apply to acute care situations
  6. Guidelines outline specific criteria to be used for determining risk levels for urine drug testing.

WHAT THIS MEANS FOR PAYERS

The criteria and drug testing frequency utilized in Cordant’s program aligns closely with the New York State guidelines as well as the recommended frequency for testing.  Cordant does not perceive any conflict with the guidelines for identification of risk levels or testing frequency.

There are, however, a few items for payers to keep in mind.

  1. An injured worker may refuse a drug test.  However, as a consequence of the injured worker’s refusal to drug test, opiate medications should not be prescribed nor approved.Cordant will promptly alert the claim adjuster if the doctor or injured worker has refused to comply with testing. Non-compliance with testing would allow for adjuster denial for any further requested opioid fills.If testing has already been performed by the physician or another laboratory, you will need to discuss the results with the provider.  The provider must certify the claimant’s adherence or non-compliance with their opioid treatment.   You may also advise the provider that Cordant will provide further drug testing services on your behalf.However, if there is no evidence of prior drug testing and the claimant is being prescribed opioids, the guidelines do indicate that the claimant should have a baseline test and then ongoing testing dependent upon the claimant’s risk level.  Cordant will follow the appropriate schedule for testing based on injured worker’s risk level. Anyone may contact Cordant Health Solutions by phone at (855) 895-8099 to initiate testing requests or by fax at (844) 543-5900.
  2. UDT results are not to be released to the carrier, employer, or Board.  Pursuant to the newly released guidelines, Cordant will no longer be able to provide the laboratory testing results. Cordant will continue to partner with your organization to continue to provide information on care coordination services, case management services and utilization reviews.

BACKGROUND

The New York Workers’ Compensation Board proposed amendments to 12 NYCRR Part 324.2. The amended regulations referenced by New York Non-Acute Pain Medical Treatment Guidelines updates the March 1, 2013 Medical Treatment Guidelines. The Chair adopted the rule on November 7, 2014. The Notice of Adoption was published in the November 26, 2014, edition of the State Register. The rule is effective December 15, 2014

References for Additional Review:
https://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/Non-AcutePainMTG2014.pdf

 

 

Disclaimer:  Cordant is providing this information to you for reference and education purposes only.  This information is in no way intended to provide legal counsel or interpretation of legislative, regulatory or market changes.  The information contained within this notice is Cordant Health Solutions’s own interpretation of the information reviewed and should not be considered an endorsement either implicit or explicitly implied.  This information does not and should not replace any guidelines or clinical judgment used in the course of claim, medical adjudication or management.

Cordant Health Solutions’s programs provide healthcare solutions that promote positive claim outcomes.  Cordant Health Solutions’s clinical expertise, technical capabilities and innovative programs helps clients’ contain drug testing utilization and costs. Contact Cordant Health Solutions’s today to learn more about our solutions and how we can design a program to meet your specific needs.