What is the new rule?

In 2018, in an effort to address opioid abuse in the United States, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (Support) Act was signed into law. Part of this new law, section 5042, mandates that all state Medicaid programs require Medicaid providers to check a prescription drug monitoring program (PMP) prior to prescribing any controlled medication, not just opioids, to a Medicaid patient.

Will this rule affect me?

This rule will impact all Apple Health (Medicaid) providers who prescribe.

How do I Comply?

To comply with the rule, prior to prescribing any controlled medication for an Apple Health patient, the provider must check the Washington State PMP no more than 10 days before writing the prescription. This task may be delegated to anyone who has authorization to access the PMP, as long as they inform the treating provider of all the patient’s current prescriptions before the provider prescribes a controlled medication. When checking the PMP, the patient history must be reviewed and the date and time of this review must be recorded in the patient’s record. If the PMP is inaccessible, or the provider is unable to access it, that effort must be documented in the patient’s record along with their intention to access the PMP once it is available.

Health Care Authority Compliance Checks

The Health Care Authority (HCA) will measure PMP checks by matching the date written on prescriptions in claims data with the PMP log data. A check inside of the 10-day appointment window will count as a qualified check and a check outside of that timeframe will count as an unqualified check. If there is no PMP review recorded for a prescription, the prescription will be documented as unchecked. The HCA may send educational letters to prescribers when less than 80% of a prescriber’s PMP checks are considered qualifying checks.

Please make sure to regularly check wsda.org/regulations for future updates regarding this rule.