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CMS Introduces New Medicaid Opioid Management Guidelines

States must do more to monitor the prescription and use of opioids within their Medicaid programs, the Centers for Medicare & Medicaid Services told them this week.

In a formal guidance letter to state Medicaid programs issued as part of implementation of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018, CMS called on states to update their drug utilization programs, revise relevant portions of their state Medicaid plan, and introduce stronger practices for setting limits on the prescription of opioids and monitoring the use of opioids among patients for whom such drugs are prescribed.  These changes must include both prospective and retrospective drug utilization review.

The new requirements apply both to Medicaid fee for service and managed care programs and all of these steps must be completed by the end of calendar year 2019.

Learn more from the CMS guidance letter “State Guidance for Implementation of Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act.”

Filed in Federal Medicaid issues.

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2012 Safety-Net Association of Pennsylvania