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Regulatory Corner Comments

Director of Physician Services: Regulatory Corner Comments

CA: The CA DWC is moving forward with updating the chronic pain section of the MTUS as well as adding a new chapter for opioid treatment guidelines. According to an executive summary published by the DWC, the proposed opioid guidelines contain a number of key recommendations, including:

  • Opioids are not the first line of treatment for pain and generally should not be used for “mild injuries.” Providers should try appropriate physical activity, or alternative modalities, such as yoga and acupuncture, first.
  • Opioids should be used only for acute pain when nonopioids and other therapies fail. Opioids for acute pain should be tapered to zero within two weeks whenever possible.
  • Providers should be increasingly vigilant for opioid dosages exceeding a daily morphine equivalent dose of 80 mg. Patients who have not previously been treated with opioids should not receive dosages exceeding that threshold.

The California Division of Workers’ Compensation will hold a public hearing on the proposed revisions to the chronic pain section of the MTUS and the new opioid section Sept. 1 from 10 a.m. to 1 p.m. at the Elihu Harris state office building, 1515 Clay St. in Oakland. Written comments will be accepted until 5 p.m. on Sept. 1. Comments can be sent by fax to 510-286-0687, or by e-mail to dwcrules@dir.ca.gov. (The proposed rules, proposed guidelines and initial statement of reasons are here.)

CA: The CA DWC is not waiting on the outcome of AB1124 before proceeding with the development of a formulary. Debate as to whether the DWC can implement rules without legislative mandate remains a topic of debate; though they remain confident in their ability to proceed. The formulary is going to focus primarily on identifying drugs that are clinically appropriate to be approved for injured workers. A secondary focus will be to control the costs of those drugs. The DWC will start soliciting public comments from system users early this fall. Claims Eval will keep you posted when this occurs.

CT: Effective 10/1/15, Medical providers in Connecticut will be required to check the state’s prescription drug monitoring program database before prescribing greater than a 72hour supply of any controlled substances. Practitioners will also have to review the patient’s record at least every 90 days if prescribing for prolonged treatment. Starting in July 2016, pharmacies will be required to immediately report to the PDMP when filling controlled substances.

NM: A New Mexico Court of Appeals in May 2014 ruled that employers are required to pay for medical marijuana when recommended by an injured worker’s treating physician. The state Supreme Court declined to review the case, and the appellate court has since issued two more decisions holding employers liable for medical marijuana in 1/15 &6/15. As a result, the New Mexico Workers’ Compensation Administration has proposed rules which would allow injured workers to be reimbursed for the cost of purchasing medical marijuana. The maximum reimbursement for marijuana will be set forth in the Health Care Provider Fee Schedule. As a result of this change (and BTW similar changes are expected in many states’ rules), changes in utilization rules as well as compensability of injuries will likely ensue.