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OhioBWC - Basics: (Policy library) - File

Drug Testing PP SigAppr 09-23-2016

Policy and Procedure Name:

Drug Testing

Policy #:

MP-21-01

Code/Rule Reference:

R.C. 4121.441, 4123.66; O.A.C. 4123-6-08, 4123-6-16.2, 4123-6-25

Effective Date:

09/23/16

Approved:

Freddie L. Johnson, Chief of Medical Services (signature on file)

Origin:

Medical Policy

Supersedes:

All medical policies and procedures, directives and memos regarding urine drug testing that predate the effective date of this policy.

History:

Rev. 08/11/15, 05/09/14 and 12/11/13

Review date:

09/23/21

 

 

I. POLICY PURPOSE


The purpose of this policy is to ensure that BWC provides direction for the utilization of drug testing (DT) for injured workers (IW), especially those who are receiving or being considered for chronic opioid therapy in the management of chronic non-cancer pain.

 

II. APPLICABILITY

 

This policy applies to MCOs and providers of drug tests.

 

III. DEFINITIONS

Alternative drug testing (ADT): a chemical analysis of bodily specimens, with the exception of urine, that are obtained to identify presence or absence of parent drugs or their metabolites. For the purpose of this policy, it is inclusive of both the immunoassay and a confirmation test such as gas chromatography, mass spectrometry or high-performance liquid chromatography.

Chronic opioid therapy: the consistent use of opioids for more than ninety (90) days.

Chronic pain: discomfort (i.e., pain) that extends beyond the expected period of healing.

Point-of-care testing: done at or near the site of patient care using commercial devices (e.g., in-office urine drug testing).

Urine drug testing (UDT): a chemical analysis of the urine to identify presence or absence of parent drugs or their metabolites. For the purpose of this policy, it is inclusive of both the immunoassay and a confirmation test such as gas chromatography, mass spectrometry or high-performance liquid chromatography.

IV. POLICY

 

A.    It is the policy of BWC to:

1.    Ensure appropriate use of opioids in the treatment of chronic pain management by allowing DTs;

2.    Require provider submission of the IW’s level of risk to the MCO prior to determining the appropriate number of DTs to authorize for the IW;

3.    Allow up to four DTs yearly as determined by the injured worker’s (IW) individual risk assessment, which shall be submitted no less than once a year; and

4.    Allow up to two additional DTs yearly when a provider documents the demonstration of aberrant behavior by an IW.

 

B.    Drug testing methods:

1.    It is the policy of BWC that UDTs are the preferred method of drug testing.

2.    It is the policy of BWC to allow Alternative Drug Testing (ADT) (e.g., blood, saliva and hair follicle):

a.    Only when a urine specimen is unobtainable due to medically documented reasons; and

b.    Only when testing facilities/labs use FDA approved test kits/devices to obtain ADTs.

 

C.   It is the policy of BWC to reimburse for:

1.   DT performed in a laboratory that is CLIA (Clinical Laboratory Improvement Amendments) certified;

2.    DTs performed following the process outlined in the procedure section of this document;

3.   DT billed under codes reflected in this link (DT codes).

4.   Quantitative testing for an individual drug that the IW is prescribed which is not included in the standard drug panel listed in C.5; 

5.    A standard drug panel immunoassay test that includes the following drugs:

a.    Amphetamines;

b.    Opiates;

c.    Cocaine;

d.    Benzodiazepines;

e.    Barbiturates;

f.     Oxycodone;

g.    Methadone;

h.    Fentanyl;

i.      Marijuana; and

j.      Hydrocodone.

6.    DT that includes the standard drug panel listed above in Section IV.C.5. a-j, when the IW is taking a prescription drug that is not paid for by BWC.

7.    Additional tests for drugs not included in the standard drug panel listed above in Section IV.C.5. a-j when:

a.    The IW is prescribed the drug; and/or

b.    The physician deems the testing medically necessary.

8.    Point-of-care DTs when medical documentation identifies an immediate need.

9.    Drug confirmation by gas chromatography, mass spectrometry or high-performance liquid chromatography solely for the drug in question when the immunoassay results are positive or when:

a.    An unexpected drug or its metabolites are identified;

b.    The prescribed drug or its metabolites are not identified in the DT.

10.  DTs immediately prior to the initiation of opioid therapy for chronic non-cancer pain or for the extension of opioid therapy beyond the acute phase (e.g., a patient has been on opioids for the treatment of an acute injury for six weeks or more and the practitioner is considering opioids for chronic pain).

11.  DTs while a patient is on opioid therapy for chronic non-cancer pain to:

a.    Verify compliance with the treatment regimen; and/or

b.    Identify undisclosed drug use and/or abuse.

 

V. PROCEDURE FOR UDT AND ADT COLLECTION

A.   UDT

1.    Providers of urine drug tests shall ensure a collection protocol that protects the security and integrity of the urine collection by:

a.    Testing the IW as soon as possible after the physician order is given;

b.    Verifying the IW’s identification via a photo identification or other confirming ID;

c.    Collecting only one specimen at a time;

d.    Having the IW remove any garments which might conceal substances or items to adulterate the urine specimen;

e.    Instructing the IW to wash and dry his/her hands prior to urination;

f.     Securing all water sources;

g.    Ensuring the water in the toilet tank and bowl are blue;

h.    Inspecting the testing site to ensure no unauthorized substances are present;

i.      Removing all soaps, disinfectants, cleaning agents or other possible adulterants from the testing area;

j.      Providing individual privacy for the IW during specimen collection;

k.    Measuring the specimen temperature within four (4) minutes of its collection to ensure the temperature is between 90-100 Fahrenheit;

l.      Visually inspecting the urine for color and contaminants;

m.   Sealing and labeling the specimen with seals containing the date and specimen number in the presence of the IW;

n.    Having the IW initial the seals, certifying that it is his/her specimen.

2.    A chain of custody form (appendix A) or equivalent form containing a minimum of the following elements shall be used in the collection and  processing of the urine specimen:

a.    IW’s name, address, date of birth, signature, date of signature and claim number;

b.    Collection site’s name, address, phone and fax number;

c.    Reason for the test;

d.    Drugs to test for;

e.    Specimen temperature within four (4) minutes of collection;

f.     Additional comments;

g.    Collection time, date and printed name and signature of collector;

h.    Date and name of courier to whom the specimen was released;

i.      Printed name and signature of lab employee receiving the specimen and the date of specimen receipt;

j.      Documentation that the specimen bottle seals were intact upon the labs receipt of the specimen;

k.    Results and result date.

B.    ADT shall be collected pursuant to the FDA approved drug kit.

C.   Specimens failing to meet the above listed criteria shall be rejected for testing.


 

Chain of Custody Form
Appendix A

Injured worker (donor) demographics

Name:

Contact number:

 

Claim number:

 

Address, City, State and Zip Code:

 

Date of birth:

I certify that I provided my urine specimen to the collector; that I have not adulterated it in any manner; each specimen bottle used was sealed with a tamper-evident seal in my presence; and that the information provided on this form and on the label affixed to each specimen bottle is correct.

Injured worker’s signature:

 

Date (mm/dd/yy):

Collection site demographics

Name:

 

Address, City, State and Zip Code:

 

 

 

Phone number:

Fax number:

To be completed by the collector

Reason for testing:      

         Random         Reasonable Suspicion/cause        Follow-up        Other (specify) ___________________

Drug test to be preformed:

        Amphetamines        Opiates        Cocaine        Benzodiazepines       Barbiturates       Oxycodone

        Methadone              Fentanyl         Marijuana metabolite        Hydrocodone         Other (specify)_____________

Temperature within 90 and 100 F within 4 minutes of collection:         Yes          No   

 Specimen collection:        Split         Single         None provided (explain) _______________________

Additional observations:

 

Time of collection:

Date of collection (mm/dd/yy):

I certify that the specimen given to me by the donor was collected, labeled, sealed and released to the courier service noted in accordance with applicable Federal requirements.

Collector’s name (please print):

 

Signature of collector:

 

Time of specimen release:

Date of specimen release (mm/dd/yy):

Name of courier the specimen bottles were released to:  ______________________________________

To be completed by the lab upon receipt of the specimen

Accessioner’s name (please print):

 

Signature of accessioner:

 

Specimen receipt date:

Specimen bottle seal intact?          Yes       No 

Name of person specimen bottles released to:

       Negative        Positive        Dilute        

       Test cancelled       Refusal to test       Adultered        Substituted  

 Remarks: ___________________________________________________________________________

Positive for:

        Amphetamines        Opiates        Cocaine        Benzodiazepines       Barbiturates       Oxycodone

        Methadone          Fentanyl         Marijuana metabolite        Hydrocodone

Other (list):

 

Remarks:

 

Lab technician’s name (please print):

Signature of Lab technician:

 

Date (mm/dd/yy):

 

 

 


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