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N.D. Cent. Code § 65-05-40

Opioid therapy and benzodiazepine duration limits - Termination of coverage

Redline — December 1, 2021 → current.View current text →
Current — January 1, 2022
As of December 1, 2021
(1) The organization may not pay for opioid therapy that exceeds ninety morphine milligram equivalents of opioid medication per day, or more than a seven-day supply of an opioid medication within any single outpatient transaction during the initial thirty-day period of opioid therapy. The limitations do not apply to: Opioid therapy prescribed for active and aftercare cancer treatment;
(1) The organization may not pay for opioid therapy that exceeds ninety morphine milligram equivalents of opioid medication per day, or more than a seven-day supply of an opioid medication within any single outpatient transaction during the initial thirty-day period of opioid therapy. The limitations do not apply to: Opioid therapy prescribed for active and aftercare cancer treatment;
(2) End-of-life and hospice care;
(2) End-of-life and hospice care;
(3) Treatment for substance use disorder;
(3) Treatment for substance use disorder;
(4) An emergency room setting;
(4) An emergency room setting;
(5) An inpatient hospital setting;
(5) An inpatient hospital setting;
(6) A long-term care facility setting; or
(6) A long-term care facility setting; or
(7) An assisted living facility setting.
(7) An assisted living facility setting.
(8) Opioid therapy includes controlled substances listed in subsections 3 and 4 of section 19-03.1-07, subsection of section 19-03.1-09, subsection of section 19-03.1-11, subsections 3 and 4 of section 19-03.1-13, or any substance with similar properties or affects.
(8) Opioid therapy includes controlled substances listed in subsections 3 and 4 of section 19-03.1-07, subsection 6 of section 19-03.1-09, subsection 3 of section 19-03.1-11, subsections 3 and 4 of section 19-03.1-13, or any substance with similar properties or affects.
(9) The organization may not pay for benzodiazepine therapy beyond a cumulative duration of four weeks, except when approved by the organization for the treatment of an anxiety disorder. Benzodiazepine therapy includes controlled substances contained in subdivisions a, i, j, k, l, p, r, v, x, ee, mm, qq, xx, yy, aaa, and ccc of subsection 4 of section 19-03.1-11, or any substance with similar properties or affects.
(9) The organization may not pay for benzodiazepine therapy beyond a cumulative duration of four weeks, except when approved by the organization for the treatment of an anxiety disorder. Benzodiazepine therapy includes controlled substances contained in subdivisions a, i, j, k, l, p, r, v, x, ee, mm, qq, xx, yy, aaa, and ccc of subsection 4 of section 19-03.1-11, or any substance with similar properties or affects.
(10) The organization may not pay for any combination therapies that include controlled substances from subsections 1 and 2 concurrently.
(10) The organization may not pay for any combination therapies that include controlled substances from subsections 1 and 2 concurrently.
(11) A review of requests to depart from the established limits in subsections 1, 2, and 3, upon a showing of medical necessity, are dispute resolution decisions under section 65-02-20.
(11) A review of requests to depart from the established limits in subsections 1, 2, and 3, upon a showing of medical necessity, are dispute resolution decisions under section 65-02-20.

Official source: North Dakota Legislative Branch. Reproduced from public-domain North Dakota statutes; confirm against the official source for the current text. Not legal advice.