30 day reminder: SUPPORT Act changes to PMP affect Apple Health (Medicaid) providers beginning October 1

Washington State Health Care Authority sent this bulletin at 08/30/2021 03:00 PM PDT

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30 day reminder: SUPPORT Act changes to PMP affect Apple Health (Medicaid) providers beginning October 1

The Health Care Authority (HCA) sends you this communication to inform you we are implementing new requirements to check the prescription monitoring program (PMP) in response to the SUPPORT Act.

Beginning October 1, 2021, all states will require Medicaid providers to check the prescription drug monitoring program (PMP) before prescribing and shortly after dispensing a controlled substance (Schedule II through Schedule V) to a Medicaid client.

This requirement falls under sections subtitle E of the SUPPORT Act, establishing the “Medicaid Providers Are Required to Note Experiences in Record Systems to Help In-need Patients Act” or the “Medicaid PARTNERSHIP Act”.

Implementation and next steps

HCA gathered feedback during the public hearing period between March and April 2021, and is now finalizing guidelines for determining appropriate reviews of the Washington PMP consistent with SUPPORT Act requirements. These will be reflected in the October 1 prescription drug program billing guide. The guidelines are designed to inform providers how HCA will measure appropriate reviews of the PMP for reporting to the Centers for Medicare and Medicaid Services (CMS).

Prior to writing and shortly after dispensing a prescription for a controlled substance to a Medicaid patient, providers will be expected to review the (most recent 12-month period) prescription drug history of a covered individual in the PMP for:

The number and type of controlled substances prescribed and filled
Who prescribed a controlled substance

Background

The Washington State Health Care Authority (HCA) is working to implement new rules from the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The SUPPORT Act is federal legislation that was signed into law in 2018. Sections 5041 and 5042 of the SUPPORT Act create new requirements for providers when prescribing controlled substances to Medicaid clients.

Questions

We understand this will have a significant impact on providers, and we want to work cooperatively to assist with your providers in this transition.

If you have any question or comments, please email HCA.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.