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Pennsylvania Tightens Medication Rules to Help Combat Opioid Crisis

March 07, 2017

Yesterday, Governor Wolf announced increased regulatory oversight by Department of Human Services (DHS) to ensure appropriate utilization of medically assisted treatment (MAT) by Medicaid providers. MAT is an evidenced-based treatment option that combines drugs such as buprenorphine that help reduce withdrawal symptoms with traditional drug addiction therapy. Many individuals find MAT as a more viable option than therapy with drug abstinence.

These tightened rules are meant to close loopholes and identify prescribers that prey upon addicted individuals by circumventing the customary treatment and prescribing practices for Medicaid beneficiaries.

“Success in the fight against opioid crisis requires that we address the issue from all angles,” said Governor Wolf in a press release. “Not only must we make sure that quality treatment options are available from Pennsylvanians suffering from an opioid use disorder, we must also make sure that we are doing everything we can to make sure treatment is appropriate and that we keep unscrupulous individuals from taking advantage of those who are fighting the disease of addiction.” 

These new requirements for Medicaid beneficiaries will:

  • Disallow cash payments for MAT by mandating providers to be enrolled in the Medicaid program
  • Encourage office visits for MAT by auditing visit and prescription frequency
  • Establish quality metrics and pre-authorization guidelines for prescriptions
  • Identify poor performing and high-volume providers for negative action by DHS and Medicaid Managed Care Organizations (MCOs)

HAP will continue to update members on the rapidly evolving opioid regulations. Two regional workshops have been scheduled for May 4 and May 17. These interactive workshops will offer providers and stakeholders a chance to get regulatory updates and treatment best practices.

For more information about HAP’s work to combat the opioid crisis, contact Michael Consuelos, MD, HAP's senior vice president, clinical integration.

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