This rule governs the bureau's
reimbursement for services to aid injured workers in discontinuing medications
which may be necessary and appropriate in the treatment of work related
injuries, but which may increase the risk of dependency, misuse, and substance
use disorder in some injured workers if continued. Medically necessary and
appropriate services to aid injured workers in discontinuing these medications
may include services which provide functional restoration and pharmacologic and
non-pharmacologic treatment alternatives.
(A)
Assessment
services will be reimbursed when the medical documentation reflects:
(1)
The injured
worker is currently receiving a medication prescribed for and reimbursed in the
injured worker's claim;
(2)
The injured worker has expressed a desire to
discontinue the medication(s) and is willing to participate in a treatment
program; and
(3)
The physician of record determines, based on clinical
observation and other factors, that a dependency assessment may be
appropriate.
(B)
Ongoing services, subject to paragraph (C) of this
rule, will be reimbursed when the results of the dependency assessment indicate
treatment is medically necessary and appropriate to aid in the discontinuation
of the medication and a treatment plan and monthly documentation of the injured
worker's participation and progress in the treatment plan are
submitted.
(C)
The bureau will reimburse outpatient, inpatient, or any
combination of inpatient and outpatient treatment for the purpose of
discontinuing medication for:
(1)
Up to a total of forty-two days of inpatient care
during the life of the claim; and
(2)
Up to a total of
eighteen months of outpatient care during the life of the
claim.
(D)
The bureau will reimburse medically necessary and
appropriate medications prescribed for assisting the injured worker's
discontinuance of the targeted medication.
Notes
Ohio Admin. Code
4123-6-21.8
Effective:
9/1/2020
Five Year Review (FYR) Dates:
05/01/2025
Promulgated
Under: 119.03
Statutory
Authority: 4121.12,
4121.121,
4121.30,
4121.31,
4121.44,
4121.441,
4123.05
Rule
Amplifies: 4121.12,
4121.121,
4121.44,
4121.441
