In May, Governor Kasich signed into law Substitute House Bill 93. This legislation was intended to address concerns over the sale, distribution and use of narcotics for chronic pain.
In order to try and better control the distribution and utilization of narcotics, the Ohio legislature decided to tighten the regulations for pain management clinics. Sub. H.B. 93 requires that all pain management clinics be licensed as “terminal distributors” of dangerous drugs. The legislation also requires the State Medical Board to adopt rules establishing special standards for physicians who operate pain management clinics. The legislation provides steep fines for those who violate the licensing and regulatory requirements.
The bill also sets up a special reporting system that would allow for the review and retention of information concerning the distribution and utilization of certain controlled narcotics. Through the use of this reporting system, doctors and pain management clinics could quickly identify whether a patient had been previously prescribed a narcotic by another physician or clinic. The information could also be used by the State to monitor clinics and their distribution patterns. The legislation provides for stiff penalties for both doctors and clinics including suspension and loss of medical licenses.
The immediate impact of the legislation on healthcare providers that treat workers’ compensation claimants for long term or chronic pain will be significant. The limitations on the amount of medications to be prescribed are very specific. For instance, the bill establishes limits on the amount of controlled substances that may be personally furnished by a physician on a monthly and 72 hour basis. In any 30 day period, a physician cannot prescribe to a patient an amount that exceeds a total of 2500 dosage units. In any 72 hour period, the physician cannot prescribe an amount of a controlled substance that exceeds the amount necessary for the patient’s use in that 72 hour period. Therefore, physicians now treating injured workers and providing narcotics over a long period of time will have to comply with these limitations. Gone are the days when a doctor would provide patients with a surplus of medication for treatment.
More importantly, the legislation requires a certain amount of coordination from the Bureau of Workers’ Compensation with the state medical and pharmacy boards. The Bureau is now required to establish a “coordinated service program” to track prescription medications prescribed to injured workers under Ohio’s Workers’ Compensation Program. The Bureau’s system is supposed to be similar or identical to the system established for Medicaid by the state.
The legislation requires that, no later than July 1, 2012, the administrator shall adopt rules in accordance with Chapter 119 of the Ohio Revised Code to implement its coordinated service program. The program will identify claimants who were found to have obtained prescription drugs that were reimbursed pursuant to an order of the administrator, or the Industrial Commission, or by a self-insured employer but were obtained in a frequency or in an amount that is not medically necessary. This reporting requirement does not involve a review of the use of the drug as a form of treatment but, instead, focuses on the amount of the drugs provided to the injured worker. Therefore, even though the Industrial Commission may find that the use of particular medication is reasonable, the amount prescribed and the frequency of the prescriptions could still be questioned under this program.
The State Medical Board and the State Board of Pharmacy have yet to complete their final regulations for the implementation of House Bill 93, but in the meantime, physicians are supposed to be operating under the general guidelines set forth in the legislation. For this reason, you may see many physicians who will be reluctant or cautious to prescribe any narcotics to their workers’ compensation patients for pain. The legislation could prove to be a very effective tool in preventing the abuse and over use of narcotics for injured workers and could have a positive impact on the workers’ compensation system. Of course, we will have to wait to see the final regulations to truly understand the full impact of the legislation in the workers’ compensation area.