844 IAC 2.2-3-3 - Triggers for imposition of requirements; exemptions
Authority: IC 25-22.5-2-7; IC 25-22.5-13-3
Affected: IC 16-21; IC 16-25; IC 16-28; IC 25-1-9; IC 25-27.5
Sec. 3.
(a) This
section and sections 4 through 9 of this rule establish requirements concerning
the use of opioids for chronic pain management for patients.
(b) Notwithstanding subsection (a), this
section and sections 4 through 9 of this rule shall not apply to the use of
opioids for chronic pain management for the following:
(1) Patients with a terminal
condition.
(2) Residents of a
health facility licensed under IC 16-28.
(3) Patients enrolled in a hospice program
licensed under IC 16-25.
(4)
Patients enrolled in an inpatient or outpatient palliative care program of a
hospital licensed under IC 16-21 or a hospice licensed under IC 16-25.
However, a period of time that a patient who was, but is no longer, a resident or patient as described in subdivisions (2) through (4) shall be included in the calculations under subsection (c).
(c) The requirements in the
sections identified in subsection (a) only apply if a patient has been
prescribed:
(1) more than sixty (60)
opioid-containing pills a month for more than three (3) consecutive
months;
(2) a morphine equivalent
dose of more than fifteen (15) milligrams per day for more than three (3)
consecutive months;
(3) a
transdermal opioid patch for more than three (3) consecutive months;
(4) tramadol, but only if the patient's
tramadol dose reaches a morphine equivalent dose of more than sixty (60)
milligrams per day for more than three (3) consecutive months; or
(5) an extended release opioid medication
that is not in an abuse deterrent form for which an FDA-approved abuse
deterrent form is available.
Subdivisions (1) and (2) do not apply to the controlled substances addressed by subdivisions (3) through (5).
(d) Because the requirements in
the sections identified in subsection (a) do not apply until the time stated in
subsection (c), the initial evaluation of the patient for the purposes of
sections 4, 7, and 8(a) of this rule shall not be required to take place until
that time.
(e) Notwithstanding
subsection (d), the physician assistant may undertake those actions earlier
than required if the physician assistant deems it medically appropriate and, if
those actions meet the requirements, a further initial evaluation is not
required. If the physician assistant conducts actions earlier than required
under this subsection, any subsequent requirements are determined by when the
initial evaluation would have been required and not at the earlier date it
actually was conducted.
Notes
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