Opioids is one of the hottest topics in the workers’ compensation arena. As a result of the epidemic across the country, the New York Workers’ Compensation Board has implemented new procedures to address opioids. You can locate our recent articles about opioid abuse, requesting a weaning program with the assistance of the Non-Acute Pain Medical Treatment Guidelines, and the recent Board Bulletin released by the Workers’ Compensation Board that reiterates a growing need to stop the proliferation of long-term opioid use. Continue reading Emergency Room Opioids?
Recognizing that opioid addiction is a major public health crisis, the New York Workers’ Compensation Board today announced a new hearing process to address opioid weaning issues. In 2014, the Board implemented the “Non-Acute Pain Medical Treatment Guidelines” (“MTG”) to address opioid usage in workers’ compensation claims.
As the “Non-Acute Pain Medical Treatment Guildeines” makes clear, long-term opioid use is only recommended in limited circumstances, and must involve constant clinical monitoring and re-evaluation. The guidelines also includes best practices for safely weaning injured workers from opioids and other narcotics.
Requesting a Hearing
Under the new process, the insurance carrier or self-insured employer can now request a hearing to address whether the claimant should be weaned from opioids. In order to request the hearing, the Board requires an IME report or Records Review, “which indicates weaning goals and recommended weaning program or resource” be submitted with the RFA-2.
Continue reading New York Workers’ Compensation Board Announces New Hearing Process for Opioid Weaning Issues
Timeline of the “Typical” case: Admitted Traumatic Accident with Lost Time.
- Initial investigation to confirm loss.
- If there is medical and lost time, begin benefits.
- File FROI-00 (Electronic Data Interchange, “EDI”).
- File update EDI documents as the case progresses.
The Board’s initiative to enforce EDI (“eClaims”).
Beginning in 2013, the Board has begun an increased tempo of “monitoring and compliance” initiatives intended to enforce the eClaims guidelines and generate more penalty income for the State. The Board has now established a “Compliance Unit” intended to do the following:
- monitor performance standards for timely submission of First Report of Injury,
- confirm timely first payment of indemnity benefits,
- check for timely submission of Subsequent Report of Injury showing first payment,
- monitor timely submission of Controversy; and
- track the Percentage of Claims Controverted (how many cases is the carrier denying?).
The New York Workers’ Compensation Board announced the creation of a Medical Portal to enable electronic submission of C-4AUTH, MG-1 and MG-2 authorization requests. The portal will provide users with real time status of requests and send a notification when a status changes. The Board claims that users will no longer need to know which form to complete when submitting a request and the portal’s user interface will ask the user questions, the answers will determine the correct path and type of treatment authorization request.
Use of the portal is not required
Health care providers may continue to submit requests using the paper forms, if they choose. It is anticipated, however, that electronic submission will make the approval process faster, reduce errors, improve data quality, and eliminate the need to submit paper authorization forms. Additionally, if a health care provider submits a treatment authorization request electronically, the payer will be required to respond to the request electronically. If the medical provider submits a paper form, the payer must respond in kind via paper submission.
Here is the post-webinar video from our most recent presentation, “Medical Treatment Guidelines?” from our New York webinar training series. The complete archive of prior presentations is here.
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Subject: New York, Workers’ Compensation Law, Medical Benefits, Nonacute Pain Management Guidelines
Date Presented: August 15, 2016
Presenter(s): Declan Gourley, Esq., Jeremy Janis, Esq., and Greg Lois, Esq.
Run time: 19:09
The use of opioids is widespread in the treatment of numerous injuries in New York. Although prescribed by a number of doctors, great care must be taken when opioids are found to no longer be necessary. Recently, Judges have ordered both the carrier and the claimant to submit drug weaning programs when an IME doctor finds that the use of opioid drugs is no longer necessary for the claimant’s continued treatment.
What is a Drug Weaning Program and Why is It Necessary?
In New York Workers Compensation claims the use of opioids by the claimant is subject to the 2014 Non-Acute Pain Medical Treatment Guidelines (“MTG”) recommendations in section F.2.b, Long Term
Use of Opioids: Transitioning/Managing Patients on Existing Opioid Therapy. The claimant’s physician must abide by the MTG recommendations to ensure that the management and treatment of a patient with non-acute pain is performed according to the principles for safe long-term opioid management and guidelines for optimizing opioid care pain (F.2.c [F.2.c.i-F.2.c.ii] and F.3 [F.3.a, F.3.b.i-iv, F.3.b.c.i-ii, F.3.d.i-iv, F.3.e.i-vi]).
Some of the MTG recommendations include: the need to routinely monitor the safety and effectiveness of treatment (improved function and pain control), an informed consent form (F.3.c), opioid understanding form (F.3.c.ii), appropriate monitoring and screening (random urine drug testing (F.3.d.i-iv), unannounced pill count(s), and evaluation and monitoring for adverse effects of and interactions with medications (F.3.b.i-ii and Table 3: Adverse Effects of Opioids). Continue reading Opioid Weaning Programs under the New York Non-Acute Pain Medical Treatment Guidelines