844 IAC 2.2-3-8 - Drug monitoring testing
Authority: IC 25-22.5-2-7; IC 25-22.5-13-3
Affected: IC 25-1-9; IC 25-27.5
Sec. 8.
(a) At any
time the physician assistant determines that it is medically necessary, whether
at the outset of an opioid treatment plan, or any time thereafter, a physician
assistant prescribing opioids for a patient shall perform or order a drug
monitoring test, which must include a confirmatory test using a method
selective enough to differentiate individual drugs within a drug class, on the
patient.
(b) In determining whether
a drug monitoring test under subsection (a) is medically necessary, the
physician assistant shall consider, subject to the provisions of subsection
(c), each of the following factors where applicable and reasonably feasible:
(1) Whether there is reason to believe a
patient is not taking the prescribed opioids or is diverting the
opioids.
(2) Whether there has been
no appreciable impact on the patient's chronic pain despite being prescribed
opioids for a period of time that would generally have an impact.
(3) Whether there is reason to believe the
patient is taking or using controlled substances other than opioids or other
drugs or medications including illicit street drugs that might produce
significant polypharmacological effects or have other detrimental interaction
effects.
(4) Whether there is
reason to believe the patient is taking or using opioids in addition to the
opioids being prescribed by the physician assistant and any other treating
practitioner.
(5) Attempts by the
patient to obtain early refills of opioid containing prescriptions.
(6) The number of instances in which the
patient alleges that the patient's opioid containing prescription has been lost
or stolen.
(7) When the patient's
INSPECT report provides irregular or inconsistent information.
(8) When a previous drug monitoring test
conducted on the patient raised concerns about the patient's usage of
opioids.
(9) Necessity of verifying
that the patient no longer has substances in the patient's system that are not
appropriate under the patient's treatment plan.
(10) When the patient engages in apparent
aberrant behaviors or shows apparent intoxication.
(11) When the patient's opioid usage shows an
unauthorized dose escalation.
(12)
When the patient is reluctant to change medications or is demanding certain
medications.
(13) When the patient
refuses to participate in or cooperate with a full diagnostic workup or
examination.
(14) Whether a patient
has a history of substance abuse.
(15) When the patient has a health status
change (for example, pregnancy).
(16) Co-morbid psychiatric
diagnoses.
(17) Other evidence of
chronic opioid use, controlled substance abuse or misuse, illegal drug use or
addiction, or medication noncompliance.
(18) Any other factor the physician assistant
believes is relevant to making an informed professional judgment about the
medical necessity of a prescription.
(c) It shall not be considered a violation of
this section for a physician assistant to fail to conduct a review of all
eighteen (18) factors listed in subsection (b) if the physician assistant
reasonably determines following a review of less than all of the factors listed
in subsection (b) that a drug monitoring test is medically necessary.
(d) Nothing about subsection (b) shall be
construed to prohibit the physician assistant from performing or ordering a
drug monitoring test at any other time the physician assistant considers
appropriate.
(e) If a test
performed under subsection (a), or conducted under subsection (d), reveals
inconsistent medication use patterns or the presence of illicit substances, a
review of the current treatment plan shall be required. Documentation of the
revised treatment plan and discussion with the patient must be recorded in the
patient's chart.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.