Chapter 0101 - 532R - S Ver of SB1111

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 23-908, Arizona Revised Statutes, is amended to read:

START_STATUTE23-908. Injury reports by employer and physician; schedule of fees; violation; classification

A. Every employer that is affected by this chapter, and every physician who attends an injured employee of such that employer, shall file with the commission and the employer's insurance carrier from time to time a full and complete report of every known injury to the employee arising out of or in the course of employment and resulting in loss of life or injury. Such a The report shall be furnished to the commission and the insurance carrier at times and in the form and detail the commission prescribes, and the report shall make special answers to all questions required by the commission under its rules.

B. The commission shall fix a schedule of fees to be charged by physicians, physical therapists or occupational therapists attending injured employees and, subject to subsection C of this section, for prescription medicines required to treat an injured employee under this chapter. Notwithstanding subsection C of this section, the schedule of fees may include other reimbursement guidelines for medications dispensed in settings that are not accessible to the general public. The commission shall annually review the schedule of fees.

C. If a schedule of fees for prescription medicines adopted pursuant to subsection B of this section includes provisions regarding the use of generic equivalent drugs or interchangeable biological products, those provisions shall comply with section 32‑1963.01, subsections A, B and D through L. If the commission considers the adoption of fee schedule provisions that involve specific prices, values or reimbursements for prescription drugs, the commission shall base the adoption on studies or practices that are validated and accepted in the industry, including the applicability of formulas that use average wholesale price, plus a dispensing fee, and that have been made publicly available for at least one hundred eighty days before any hearing conducted by the commission.

D. Notwithstanding section 12‑2235, information obtained by any physician or surgeon examining or treating an injured person shall not be considered a privileged communication, if that information is requested by interested parties for a proper understanding of the case and a determination of the rights involved. Hospital records of an employee concerning an industrial claim shall not be considered privileged if requested by an interested party in order to determine the rights involved. Medical information from any source pertaining to conditions unrelated to the pending industrial claim shall remain privileged.

E. When an accident occurs to an employee, the employee shall forthwith report the accident and the injury resulting therefrom from the accident to the employer, and any physician employed by the injured employee shall forthwith report the accident and the injury resulting therefrom from the accident to the employer, the insurance carrier and the commission.

F. When If an accident occurs to an employee, the employer may designate in writing a physician chosen by the employer, who shall be permitted by the employee, or any person in charge of the employee, to make one examination of the injured employee in order to ascertain the character and extent of the injury occasioned by the accident. The physician so chosen shall forthwith report to the employer, the insurance carrier and the commission the character and extent of the injury as the physician ascertains. If the accident is not reported by the employee or the employee's physician forthwith, as required, or if the injured employee or those in charge of the employee refuse to permit the employer's physician to make the examination, and the injured employee is a party to the refusal, no compensation shall be paid for the injury claimed to have resulted from the accident. The commission may relieve the injured person or that person's dependents from the loss or forfeiture of compensation if it believes after investigation that the circumstances attending the failure on the part of the employee or physician to report the accident and injury are such as to have excused them.

G. Within ten days after receiving notice of an accident, the employer shall inform the insurance carrier and the commission on such the forms and in such the manner as may be prescribed by the commission.

H. Immediately on notice to the employer of an accident resulting in an injury to an employee, the employer shall provide the employee with the name and address of the employer's insurance carrier, the policy number and the expiration date.

I. Any person failing or refusing to comply with this section is guilty of a petty offense. END_STATUTE

Sec. 2. Section 23-1062.02, Arizona Revised Statutes, is amended to read:

START_STATUTE23-1062.02. Use of controlled substances; prescription of schedule II controlled substances; reports; treatment plans; monitoring program inquiries; preauthorizations; definitions

A. A physician who prescribes a schedule II controlled substance to an employee shall comply with title 32, chapter 32, article 4, including the provisions in that article relating to patients with traumatic injuries.

A. B. A physician shall include in the report required under commission rule the following information pertaining to the following:

1. The off‑label use of a narcotic, opium‑based controlled substance or schedule II controlled substance by a claimant.

2. The use of a narcotic or opium-based controlled substance or the prescription of a combination of narcotics or opium-based controlled substances at or exceeding a one hundred twenty milligram morphine equivalent dose per day.

3. The prescription of a long-acting or controlled release opioid for acute pain.

B. The information required pursuant to subsection A of this section shall include the use of a narcotic or opium-based controlled substance that is listed in schedule II or the prescription of any opioid medication:

1. Justification for the use of the controlled substance, and including documentation of the following:

(a) That a physical examination of the employee was conducted.

(b) That a substance use risk assessment of the employee was conducted.

2. A treatment plan that includes a description of describing the measures that the physician will implement to monitor and prevent the development of abuse, dependence, addiction or diversion by the employee. The physician shall include in the treatment plan all of the following:

(a) A medication agreement. , a plan for subsequent

(b) The frequency of face-to-face follow‑up visits and to reevaluate the employee's continued use of opioids.

(d) Documentation that the medication regime is providing relief that is demonstrated by clinically meaningful improvement in function.

(e) Criteria and procedures for tapering and discontinuing opioid prescription or administration as part of the treatment.

(f) Criteria and procedures for offering or referring the employee for treatment for dependence on or addiction to opioids.

C. If the drug test of the employee reveals inconsistent results, the physician within five business days shall provide a written report to the carrier, self‑insured employer or commission setting forth a treatment plan to address the inconsistent drug test results.

C. D. Within two business days of writing or dispensing an initial prescription order for at least a thirty‑day supply of an opioid medication for the employee, a physician shall submit an inquiry to the Arizona state board of pharmacy requesting the employee's prescription information that is compiled under the controlled substances prescription monitoring program prescribed in title 36, chapter 28. Before prescribing an opioid analgesic or benzodiazepine controlled substance that is listed in schedule II, III or IV for an employee and at least quarterly while that prescription remains a part of the treatment, the physician shall obtain a patient utilization report regarding the employee from the controlled substances prescription monitoring program's central database tracking system as required by section 36-2606. The physician shall report the results to the carrier, self‑insured employer or commission as soon as reasonably practicable but no not later than thirty days from after the date of the inquiry. Thereafter, the carrier, self‑insured employer or commission may request no not more than once every two months that the physician perform additional inquiries to obtain a patient utilization report regarding the employee from the Arizona state board of pharmacy controlled substances prescription monitoring program's central database tracking system.

D. E. If the result of an inquiry to patient utilization report from the Arizona state board of pharmacy controlled substances prescription monitoring program's central database tracking system reveals that the employee is receiving opioids from another undisclosed health care provider, the physician shall within five business days report the results to the carrier, self‑insured employer or commission.

E. F. If the physician does not comply with this section:

1. The carrier, self‑insured employer or commission is not responsible for payment for the physician's services until the physician complies with this section.

2. Except for a self-insured employer that provides medical care pursuant to section 23‑1070, an the employer, carrier or commission may request a change of physician after making a written request to the physician to comply with this section and the request identifies the area of noncompliance. If a change of physician is ordered and the order becomes final, the employee shall select a physician whose practice includes pain management and who agrees to comply with this section. If other medical providers are not available in the employee's area of residence, the employer, carrier or commission shall pay in advance for the employee's reasonable travel expenses, including the cost of transportation, food, lodging and loss of pay, if applicable.

F. G. If medically necessary, the carrier, self‑insured employer or commission shall provide drug rehabilitation and detoxification treatment for an employee who becomes dependent on or addicted to opioids that are prescribed for a work‑related injury. In the event of a medical conflict regarding the necessity for drug rehabilitation and detoxification, the carrier, self‑insured employer or commission shall continue to provide the opioids until a determination is made after a hearing by an administrative law judge.

G. H. If the employee resides out of state, the carrier, self‑insured employer or commission may is not be responsible for providing medications that are subject to this section if the out-of-state physician fails to comply with this section. If the other state has a controlled substances monitoring program, the physician shall submit an inquiry to the database as prescribed by subsection C D of this section.

H. This section does not apply to medications administered to the employee while the employee is receiving inpatient hospital treatment.

I. A carrier, a self‑insured employer or the commission may require physician compliance with this section notwithstanding the existence of a prior award addressing medical maintenance benefits for medications. A carrier or self‑insured employer is not liable for bad faith or unfair claims processing for any act taken in compliance of and consistent with this section or any act reasonably necessary to monitor or assess the appropriateness and effectiveness of an employee's opioid use.

J. For the purposes of this section:

1. "Clinically meaningful improvement in function" means any both of the following:

(a) A clinically documented improvement in range of motion.

(b) (a) An increase A significant improvement in the performance of activities of daily living or a reduction in work restrictions.

(b) A reduction in dependency on continued medical treatment.

2. "Inconsistent results" means:

(a) The employee's reported medications, including the parent drugs or metabolites, are not detected.

(b) Controlled substances are detected that are not reported by the employee.

3. "Off‑label use" means use of a prescription medication by a physician to treat a condition other than the use for which the drug was approved by the United States food and drug administration.

3. "Substance use risk assessment" means an evaluation of an employee's unique likelihood for addiction, misuse, diversion or another adverse consequence resulting from the employee being prescribed or receiving treatment with opioids.

4. "Traumatic injury" as used in title 32, chapter 32, article 4 means physical injury that creates a reasonable risk of death or that causes serious or permanent disfigurement, serious impairment of health or loss or protracted impairment of the function of any bodily organ or limb. END_STATUTE

Sec. 3. Industrial commission of Arizona; review of medication reimbursement guidelines; delayed repeal

A. On or before July 1, 2019, as part of the industrial commission of Arizona's annual review of the schedule of fees pursuant to section 23‑908, Arizona Revised Statutes, as amended by this act, the industrial commission of Arizona shall review information and data, consult with physician, employee and business and industry stakeholders and hold at least one public hearing in considering whether to adopt additional reimbursement guidelines for medications dispensed in settings that are not accessible to the general public.

B. This section is repealed from and after June 30, 2020.