The FDA has issued a Safety Communication that sudden discontinuation or rapid tapering of opioids is associated with great risks in patients physically dependent on opioids, including acute withdrawal symptoms, exacerbation of pain, serious psychological distress and thoughts of suicide. Patients may attempt to treat their pain or withdrawal with illicit opioids such as fentanyl or heroin or may require emergency department or inpatient care.
CCOs are encouraged to work collaboratively with their members and providers to authorize an appropriate tapering schedule and follow-up plan when indicated. No standard opioid tapering schedule is suitable for all patients. CCOs should not mandate discontinuation or tapers for members who have received long-term opioid therapy if the provider attests that it is currently unsafe to do so. Point-of-sale utilization controls are permitted when there is a transparent process to request exceptions to any implemented limits.
CCOs must ensure covered medications are furnished in an amount, duration and scope that is no less than the amount, duration and scope for the same service furnished to beneficiaries under the fee-for-service (FFS) OHP program. OAR 410-141-3835(6). Below are key aspects of FFS coverage for short-acting and long-acting opioids:
- Forced opioid taper plans are not required for any OHP FFS members already on long-term (greater than 6 weeks) opioid therapy. While the FFS program implemented dose and day-supply limits, exceptions are allowed based on individual circumstances through the PA process.
- Members may continue opioid therapy at their current dose if the provider documents that initiating a taper is currently unsafe.
Center for Disease Control and Prevention (CDC) clinical guidelines related to dosing are not intended to be used as strict standards of care; rather, they are intended to be guideposts to help inform clinician-patient decision-making. Risks of opioid use increases continuously with dosage, and there is no single dosage below which risks are eliminated.
What should you do?
Review coverage of long-term opioid treatment and make any changes that are necessary to ensure coverage is clinically sound, consistent with state standards and guidelines, and no more restrictive than FFS amount, duration, and scope.
Questions?
If you have any questions, please contact Deborah (“Dee”) Weston, Pharmacy Program Policy Advisor, at Deborah.G.Weston@oha.oregon.gov.
Please make sure your ACT programs sign up for a training date to ensure they are well prepared for new data indicators.We are pleased to announce that the task of updating data is completed! All necessary updates to the data dictionary are finalized and now aligns with the new Oregon ACT Database (OAD) indicators.
There will be a series of opportunities to receive the appropriate training for these new indicators. This OCEACT training is mandatory, and attendance with at least one staff member from each program will need to be completed prior to the resume of data collection on July 1, 2024. It will be important for program success in this transition to learn about these new indicators and review the new data dictionary.
Trainings
- May 22 at 1 p.m.
- May 28 at 2 p.m.
- June 5 at 4 p.m.
- June 14 at 9 a.m.
Please email Alyssa Kerlinger at akerlinger@optionsonline.org to register and get the link for the day you would like to attend. Please ensure the person attending the training is the one asking for link; this list is how attendance will be verified. More than one person per program can attend, but please register soon to reserve a spot.
If you have any questions about this memo please contact Angella James, EBPC/ACT Policy at angella.pulkownik2@oha.oregon.gov or at 503-367-6414
The Medicaid Advisory Commitee’s Advancing Consumer Experience subcommittee wants to hear from you. Speak up at a listening session with the Oregon Department of Human Services (ODHS) about the Agency with Choice program.
ODHS is puttng the program into place because of a new state law. ODHS staff will share how the new law affects long term services and supports (LTSS). They will also talk about early plans the agency has for making changes because of the new law.
We want to hear from you. How will these changes affect the services you or a loved one receive? What recommendations do you have for ODHS as they make changes to the program to comply with the new law?
We will provide Spanish and American Sign Language (ASL) interpretation.
For people who speak or use a language other than English, people with disabilities or people who need additional support, we can provide free help to participate in this meeting. Please call or email the meeting organizer, Sarah Wetherson, at 503-793-1920 or sarah.e.wetherson@oha.oregon.gov. We accept all relay calls.
Delivery System Network guidance:
Long Term Services & Supports guidance:
For previous guidance, please see the CCO Contract Forms page.
- 9 to 11 a.m., May 20, 2024
- 9 to 11 a.m., May 23, 2024
- 1 to 2 p.m., June 3, 2024
- 1 to 3 p.m., June 4, 2024
- 1 to 3 p.m., June 5, 2024
- 1 to 4 p.m., June 14, 2024
Learn more about these RACs and the rulemaking process.
May 21, 2024
Please visit the committee and workgroup links below for more information about meetings. You can also view the OHA Public Meeting calendar.
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