Medicaid, HealthChoice MCOs take steps to prevent opioid-related problems

Response follows treatment reimbursement boost in program’s renewed waiver

Baltimore, MD (February 8, 2017) – In keeping with the Hogan administration’s leadership in fighting the opioid crisis in Maryland, the Department of Health and Mental Hygiene is announcing policies reforming the opioid-prescribing process in the Medicaid program, to seek to block the prescription pathway to substance use disorders.
In partnership with all eight of its HealthChoice managed care organizations, the program Maryland Medicaid aims to reduce opioid misuse, dependence, overdose and death in both Medicaid fee-for-service and HealthChoice managed care programs.
“These policy changes will not only help those struggling with substance abuse, but also aid prevention efforts, treatment options, and increase our capacity to save lives,” said Maryland Gov. Larry Hogan. “Our administration strongly supported Medicaid’s waiver renewal, which will significantly expand treatment options by providing reimbursement where it has been absent – and we support this step as well.”
“More than 20 percent of Marylanders are enrolled in the HealthChoice program,” said Health and Mental Hygiene Secretary Dennis R. Schrader. “Six out of eight of our HealthChoice managed care organizations are integrated provider and payer networks, so they are natural partners in our efforts to combat the opioid epidemic. These changes support our strategic approach to enhance the reach of these policies through collaborative education, prevention and treatment action.”
The policy changes, which will be in place by July 1, 2017, aim to:
  • Prevent medical and non-medical opioid use, abuse, and substance use disorder from developing;
  • Identify and treat opioid dependence early in the course of the disease;
  • Prevent overdose deaths, medical complications, psychosocial deterioration, transition to injection drug use, and injection-related disease; and
  • Identify and outreach to providers who do not follow standard practice.
All high-dose and long-acting opioids, including fentanyl prescriptions issued to Maryland Medicaid members, are now subject to prior authorization. In addition to these new prior authorization requirements, Maryland Medicaid is also encouraging providers to:
  • Consider non-opioids as first-line treatment for chronic pain;
  • Offer naloxone to patients who meet certain risk factors;
  • Conduct thorough substance use disorder screening prior to prescribing opioids;
  • Refer patients to treatment that are identified as having a substance use disorder; and
  • Use the Department’s Prescription Drug Monitoring Program for all Controlled Dangerous Substance prescriptions.
“We are united in this effort,” said Public Health Services Deputy Secretary Dr. Howard Haft. “We applaud the efforts that our state’s Medicaid program and its managed care organizations are embarking upon to tackle this nationwide crisis. The opioid epidemic is a serious public health threat. By improving prescribing practices, providers stand to help make marked progress in combatting the effects of the opioid epidemic in Maryland.”