Notice of Agency Rule-making Proposal- Urine Drug Testing

This rule is being proposed in order to limit and align urine drug testing to current industry standards. The Department proposes the following: • Drug testing must be supported by documentation in the medical record. • The frequency and choice of assay used should be based on an assessment of the individual member’s risk potential. • Separate payment for testing of adulterants or specimen validity is not reimbursable. • Confirmation testing is covered only to confirm an unexpected result. • Urine drug testing is limited to two (2) specimens per rolling month. Additional test(s) may be requested with a Prior Authorization. • Substance abuse treatment is to be measured by random testing rather than scheduled testing. • Routine urine drug screening should focus on detecting specific drugs of concern. • A presumptive test may be followed by a definitive test to specifically identify drugs or metabolites. Confirmation tests must be performed by a second method. A presumptive test to confirm a presumptive test is not reimbursable. • Standing orders for presumptive testing must be signed and dated no more than sixty (60) days prior to the date of specimen collection. Standing orders for conformation and/or quantitative testing is prohibited. • The Department clarifies what is considered not medically necessary. The Department also proposes adding language for Prior Authorization to the Definitions.