Reminder: NYDOH Opioid Treatment Plan Requirements

The New York State Department of Health (NY DOH) notified providers via letter dated Feb. 13, 2019, of a new Public Health Law concerning the prescription of opioids.

The law, effective April 1, 2018, amends Public Health Law §3331 and requires that a written treatment plan be part of the patient’s medical record if a practitioner prescribes opioids for pain lasting more than 3 months or past normal tissue-healing time.

Exceptions include patients who are being treated for:

  • cancer that is not in remission;
  • hospice or another end-of-life care; and
  • palliative care.

The letter further states that the treatment plan must follow generally accepted national professional or governmental guidelines, and shall include (but is not limited to) the documentation and discussion of the following clinical criteria within the medical record:

  • goals for pain management and functional improvement based on diagnosis, and a discussion on how opioid therapy would be *tapered to lower dosages or tapered and discontinued if benefits do not outweigh risks;
  • a review with the patient of the risks of and alternatives to opioid treatment; and
  • an evaluation of risk factors for opioid-related harms1.

A resource which may assist you in developing interventions for the required Opioid Treatment Plan may be found on the Center for Disease Control (CDC) website and is called CDC Pocket Guide: Tapering Opioids for Chronic Pain.

As a follow-up to the Opioid Treatment Plan notification, in the May 2019 New York State Medicaid Update, practitioners were notified that effective on January 1, 2020, all Medicaid fee-for-service and Medicaid Managed Care providers who prescribe opioids for pain that has lasted for more than 3 months or past the time of normal tissue healing must have a written opioid treatment plan in accordance with the requirements above present in the patient’s medical record. Documentation and discussion of these plans should be reviewed at least annually. The NY DOH has also stated those practitioners who fail to comply with this requirement may be subject to audit.

1NY DOH Opioid Treatment Plan Letter, February 13, 2019 -
1New York State Medicaid Update – May 2019 Volume 35 – Number 6