Rule 4123-6-21.8 | Reimbursement for Services to Assist in the Discontinuation of Medications.
This rule governs the bureau's reimbursement for services to aid injured workers in discontinuing medications which may be necessary and appropriate in the treatment of work related injuries, but which may increase the risk of dependency, misuse, and substance use disorder in some injured workers if continued. Medically necessary and appropriate services to aid injured workers in discontinuing these medications may include services which provide functional restoration and pharmacologic and non-pharmacologic treatment alternatives.
(A) Assessment services will be reimbursed when the medical documentation reflects:
(1) The injured worker is currently receiving a medication prescribed for and reimbursed in the injured workers claim;
(2) The injured worker has expressed a desire to discontinue the medication(s) and is willing to participate in a treatment program; and
(3) The physician of record determines, based on clinical observation and other factors, that a dependency assessment may be appropriate.
(B) Ongoing services, subject to paragraph (C) of this rule, will be reimbursed when the results of the dependency assessment indicate treatment is medically necessary and appropriate to aid in the discontinuation of the medication and a treatment plan and monthly documentation of the injured worker's participation and progress in the treatment plan are submitted.
(C) The bureau will reimburse outpatient, inpatient, or any combination of inpatient and outpatient treatment for the purpose of discontinuing medication for:
(1) Up to a total of forty-two days of inpatient care during the life of the claim; and
(2) Up to a total of eighteen months of outpatient care during the life of the claim.
(D) The bureau will reimburse medically necessary and appropriate medications prescribed for assisting the injured workers discontinuance of the targeted medication.
Last updated May 31, 2023 at 9:59 AM
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