The Michigan Workers' Compensation Agency enacted new Rules governing the use of Opioids involving workers' compensation claims. This presentation provides background information concerning the purpose of the new Rules and how to handle them as part of a given workers' compensation claim.

1. UNDERSTANDING THE NEW
OPIOID RULES
BY:
RENALDO P. DeFRANK, JR.
LEVASSEUR & DEFRANK, P.C.
November 18, 2015

2. WHAT ARE OPIOIDS?
• Opioids are medications
that are prescribed to
relieve acute/chronic
pain
• Most opioids come in pill
or tablet form and can be
taken by mouth, but they
can also be prescribed in
patch form
• Common opioids being
prescribed are
hydrocodone (e.g.
Vicodin), oxycodone (e.g.
Oxycontin, Percocet) and
morphine (e.g. Kadian)

4. INTRODUCTION OF OPIOIDS TO THE
INJURED WORKER
• Treatment is provided to an injured worker
after an injury
• Physician determines that the degree of pain
merits the use of opioids
• The injured worker begins taking the
prescribed medication
• The path of opioid use begins!

5. CHRONIC PAIN
• Chronic pain exists beyond an
expected time for healing. It is
a persistent pain state not
associated with malignancy or
acute pain caused by trauma,
surgery infection or other
factors. However, these and
other pain sources, such as
sprains or twists, may
symptomatically persist to
become chronic benign pain.
The intensity will vary from
mild to severe disabling pain
that may significantly reduce
quality of life

6. OPIOID CONCERNS
• Dependence
• Addiction
• Abuse
– Over medicating
– Overdosing
– Selling the opioids to make $$$
• High medical costs
• Legal exposure
• Medicare!!!

7. THE OPIOID MOVEMENT
• In October 2014, the FDA reclassified combination drugs with
hydrocodone as Schedule II drugs (HIGH POTENTIAL FOR ABUSE!!!)
• Methadone and Oxycodone are also Schedule II drugs
• This requires patients to see their doctors to obtain new
prescriptions, as opposed to obtaining refills without an office visit
• The reclassification limits somewhat the ease of access to opioids

8. AMENDMENTS TO THE WORKERS’
COMPENSATION RULES
• The Michigan Workers’ Compensation Agency (WCA) amended the
Workers’ Compensation Health Care Services rules and fee
schedule, effective December 26, 2014
• The amendments were put in place to address the problem of long-
term use of opioids by injured workers and help reduce medical
costs for the State’s job providers
• Limit potential addiction problems for injured workers, to keep
them healthy and get them back to work

9. • Rule 1008. (1) For purposes of these rules, chronic pain is
pain unrelated to cancer or is incident to surgery and
that persists beyond the period of expected healing after
an acute injury episode. It is pain that persists beyond 90
days following the onset of the pain. The payer shall
reimburse for opioids used in the treatment of chronic
pain resulting from work-related conditions.
• (2) This rule is applicable to opioid treatment of chronic
pain for the following: (a) Injury dates on or after June
26, 2015. (b) Beginning December 26, 2015, all other
injury dates.
R 418.101008 Reimbursement for opioid
treatment for chronic, non-cancer pain

10. R 418.101008a Required documentation for
reimbursement of treatment for chronic, non-cancer
pain with opioids.
• Rule 1008a. (1) In order to receive reimbursement for opioid
treatment beyond 90 days, the physician seeking reimbursement
shall submit a written report to the payer not later than 90 days
after the initial opioid prescription fill for chronic pain and every 90
days thereafter. The written report shall include all of the following:
• (a) A review and analysis of the relevant prior medical history,
including any consultations that have been obtained, and a review
of data received from an automated prescription drug monitoring
program in the treating jurisdiction, such as the Michigan
Automated Prescription System (MAPS), for identification of past
history of narcotic use and any concurrent prescriptions.
• (b) A summary of conservative care rendered to the worker that
focused on increased function and return to work.
• (c) A statement on why prior or alternative conservative measures
were ineffective or contraindicated.

11. • (d) A statement that the attending physician has considered the
results obtained from appropriate industry accepted screening tools
to detect factors that may significantly increase the risk of abuse or
adverse outcomes including a history of alcohol or other substance
abuse.
• (e) A treatment plan which includes all of the following: (i) Overall
treatment goals and functional progress. (ii) Periodic urine drug
screens. (iii) A conscientious effort to reduce pain through the use
of non-opioid medications, alternative non-pharmaceutical
strategies, or both. (iv) Consideration of weaning the injured worker
from opioid use.
• (f) An opioid treatment agreement that has been signed by the
worker and the attending physician. This agreement shall be
reviewed, updated, and renewed every 6 months. The opioid
treatment agreement shall outline the risks and benefits of opioid
use, the conditions under which opioids will be prescribed, and the
responsibilities of the prescribing physician and the worker.

12. • (2) The provider may bill the additional services required for
compliance with these rules utilizing CPT procedure code 99215 for
the initial 90 day report and all subsequent follow-up reports at 90-
day intervals.
• (3) Providers may bill $25.00 utilizing code MPS01 for accessing
MAPS or other automated prescription drug monitoring program in
the treating jurisdiction.

13. R 418.101008b Denial of reimbursement for
prescribing and dispensing opioid medications used to
treat chronic, non-cancer pain.
• Rule 1008b. Reimbursement for prescribing and dispensing opioid
medications may be denied, pursuant to the act. Denial of
reimbursement may occur if the physician reporting and treatment
plan requirements as stated in R 418.101008a are not met. Denial
of reimbursement shall occur only after a reasonable period of
time is provided for the weaning of the injured worker from the
opioid medications, and alternative means of pain management
have been offered.

14. WHAT DOES ALL OF THIS MEAN?
• Limits the ease to which
opioids are prescribed
• Extra hoops for physicians
to jump through in order
to get paid
• Detailed reports to
support the need for
opioid treatment
• Potential to curb the
prescription of opioids in
the first place

15. MAPS!

16. IMPACT ON WORK COMP CLAIMS
• Opioids are the most common
treatment for chronic pain
– A 2013 study found that 30%
of physician visits for back
and/or neck pain resulted in a
prescription for opioids
– As many as 90% of pain
management patients in the
U.S. receive opioids for
chronic pain
– 50% of patients who take
opioids daily for 90 days are
still taking them daily 5 years
later

17. LEADING PRESCRIBERS

18. WHAT DO THESE STATS MEAN?
• The stats show that family physicians, as opposed to pain
management specialists, are prescribing most of the opioids being
used today
• Once an injured worker goes down the opioid route, the odds of
long-term opioid use is significant
• Potential problems are on the horizon

19. WHY SHOULD YOU CARE ABOUT
OPIOID USE?
• Detrimental to the workforce
– Could prevent the injured worker from ever getting back to
work
• Cost of opioids is high
– Future medical treatment costs will be significant
– Need for periodic drug testing
– Potential need for a drug weaning program
– Increases the exposure of a given workers’ compensation claim
– Could lead to a large MSA amount and be an impediment to
settlement

20. HOW TO AVOID OPIOID PROBLEMS
• Be sure to direct medical care for the first 28 days after an injury
occurs
– Could prevent the opioid cycle from starting
• If/when opioids are being discussed as part of a treatment plan,
consider a second opinion (e.g. IME)
• Consider the use of a Nurse Case Manager (NCM) to oversee the
treatment plan, once opioids are prescribed
– Discuss alternatives to opioid treatment
– Monitor the reports from the physicians in support of the
continued use of opioids
– Once opioids are being used, determine the appropriate plan to
wean the injured worker off of the opioids
• Contact an attorney to discuss the claim

21. QUESTIONS?
Renaldo P. DeFrank, Jr.
LeVasseur & DeFrank, P.C.
24725 W. 12 Mile Rd., Ste 230
Southfield, MI 48034
Office: 248-356-8600
Cell: 248-207-6365
www.levasseurlaw.com
rdefrank@levasseurlaw.com