W. Va. Code R. § 85-20-58

Current through Register Vol. XLI, No. 45, November 8, 2024

Section 85-20-58 - Required authorization for treatment of chronic, noncancer pain with opioids

58.1. No later than thirty days after the attending physician begins treating the worker with opioids for chronic, noncancer pain, the attending physician must submit a written report to the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, in order for the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, to pay for such treatment. The written report must include the following:

a. A treatment plan with time-limited goals, including a time schedule to wean the injured worker from opiod use;

b. A consideration of relevant prior medical history;

c. A summary of conservative care rendered to the worker that focused on reactivation and return to work;

d. A statement on why prior or alternative conservative measures may have failed or are not appropriate as sole treatment;

e. A summary of any consultations that have been obtained, particularly those that have addressed factors that may be barriers to recovery;

f. A statement that the attending physician has conducted appropriate screening for factors that may significantly increase the risk of abuse or adverse outcomes (e.g., a history of alcohol or other substance abuse); and g. An opioid treatment agreement that has been signed by the worker and the attending physician. This agreement must be renewed every six months. The treatment agreement must outline the risks and benefits of opioid use, the conditions under which opioids will be prescribed, the physician's need to document overall improvement in pain and function, and the worker's responsibilities.

W. Va. Code R. § 85-20-58