ARIZONA HOUSE OF REPRESENTATIVES

SB 1111: workers' compensation; opioids; dispensed medications

PRIME SPONSOR: Senator Fann, LD 1

BILL STATUS: Banking & Insurance

Abstract

Relating to workers' compensation.

Provisions

1. Requires a physician who prescribes a schedule II controlled substance to an employee to comply with statutory requirements relating to controlled substances.

a. Laws 2018, First Special Session Chapter 1, provides for the requirements relating to controlled substances and becomes effective April 26, 2018.  (Sec. 2)

2. Modifies the information a physician must include in an ICA report as follows:

a. Requires the report to contain information regarding the use of a schedule II narcotic or opium-based controlled substance and prescription of any opioid medication.

b. The report must further include the following:

i. Documentation regarding a physical examination, substance use risk assessment, and informed consent from the employee for opioid treatment.

ii. The frequency of face-to-face follow up visits to reevaluate an employee's continued use of opioids, guidelines for tapering and discontinuing the opioid, and the offering of treatment for opioid dependency or addiction associated with a treatment plan. (Sec. 2)

3. Removes the provision regarding writing or dispensing an initial prescription order. (Sec. 2)

4. Requires a physician to obtain an employee's CSPMP utilization report prior to prescribing the employee an opioid analgesic or benzodiazepine controlled substance that is listed as schedule II, III, or IV.

a. A physician must obtain a report at least quarterly while that prescription remains part of the treatment. (Sec. 2)

5. Allows the insurance carrier, self-insured employer or ICA to request, not more than once every two months, that a physician obtain a CSPMP utilization report regarding an employee. (Sec. 2)

6. Clarifies the CSPMP utilization report, rather than the results of an inquiry to the Arizona State Board of Pharmacy is used to determine if the employee is receiving opioids from another provider. (Sec. 2)

7. Asserts that the insurance carrier or self-insured employer is not liable for any action reasonably necessary to monitor or assess the appropriateness and effectiveness of the employee's opioid use. (Sec. 2)

8. Allows the ICA to adopt fee reimbursement guidelines for medications dispensed in settings not accessible to the public. (Sec. 1,)

9. Requires the ICA to review the fee reimbursement guidelines with stakeholders and hold a public hearing by July 1, 2019.

a. Repeals this requirement on July 1, 2020. (Sec. 3)

10. Removes the qualification that a physician practice pain management in a change of physician ordered by the ICA. (Sec. 2)

11. Removes the reporting exemption for medications administered to the employee while receiving inpatient hospital treatment. (Sec. 2)

12. Modifies the definition of clinically meaningful improvement in function as:

a. A significant improvement in the performance of daily activities or reduction in work restrictions; and

b. A reduction in dependency on continued medical treatment. (Sec. 2)

13. Eliminates the definition of off-label use. (Sec. 2)

14. Defines substance use risk assessment as an evaluation of an employee's likelihood for opioid addiction, misuse, diversion or another adverse consequence. (Sec. 2)

15. Defines a traumatic injury as a physical injury that creates a reasonable risk of death or that causes serious or permanent impairment. (Sec. 2)

16. Makes technical and conforming changes. (Sec. 1-3)

Current Law

A.R.S. Title 23, Chapter 6 outlines the scope, administration and process of compensation for workers’ compensation insurance. The ICA regulates the worker's compensation system to ensure that any claim is processed in accordance with statues and rules. The ICA produces a schedule of fees to be charged by a physician treating an injured employee. A physician must report to the ICA documentation pertaining to the off-label use, use of and prescription of a narcotic or opium-based controlled substance.

Laws 2018, First Special Session, Chapter 1 limits all initial prescriptions for opioids to a 5-day supply and prescriptions for opioids following surgical procedures to a 14-day supply, with certain exceptions. The legislation also provides dosage limits for opioids, with exception.

A.R.S. § 36-2606 provides that each medical practitioner and pharmacist must have a current CSPMP registration and be granted access to the program’s central database tracking system.

A.R.S § 36-2513 defines schedule II controlled substance as any material, compound, mixture or preparation containing any quantity of the substances outlined in statute.

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Fifty-third Legislature                  SB 1111

Second Regular Session                               Version 1: Banking & Insurance

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