The MO HealthNet Opioid Prescription Intervention (OPI) Program has provided clinical advisory mailings to prescribers caring for MO HealthNet participants since 2010. The program involves selected evidence-based, best practice Quality Indicators™ (QI’s) applied to MO HealthNet pharmacy and medical claims data to generate a customized packet of information to providers regarding their prescribing activity. We know providers have used this information to update their prescribing practices and improve care to our MO HealthNet participants.

The Department of Social Services – MO HealthNet Division (MHD) is working collaboratively with the Department of Mental Health (DMH) and the Department of Health and Senior Services (DHSS) to enhance our interactions with providers and accelerate the goals of the OPI Program.

The following are important changes that will affect providers who prescribe opioids for MO HealthNet participants:

  1. Adherence to CDC Guideline for Prescribing Opioids for Chronic Pain
    MO HealthNet has developed clinical policy based on best practices, including the CDC 2016 Guideline for Prescribing Opioids for Chronic Pain. Clinical Edits in the Pharmacy Program currently reflect these recommendations and will be enforced in future updates. The CDC offers a fact sheet version of the CDC Guidelines.
  2. UPDATED and NEW OPI Quality Indicators™
    The OPI Program will continue to provide an individualized mailing packet for providers whose prescribing activity results in flagging one or more Quality Indicators™ (QI’s). The list of QI’s has been revised and prioritized by MO HealthNet; additional QI’s added at a future date. Providers will need to carefully review their OPI mailing packet for changes to the QI’s.
  3. Provider Response and Feedback
    MO HealthNet wants to work with providers to ensure common patients receive care according to best practice guidelines for opioid prescribing. To help meet this goal, MO HealthNet will ask providers to engage in dialogue regarding prescribing activity identified through the OPI mailing process. Providers should make use of the new Feedback Form provided with the OPI mailing packets to facilitate communication regarding patients on their OPI report.

    The Missouri Medicaid Audit and Compliance (MMAC) Unit will be the contact for provider communications and feedback. Particular QI’s may receive a higher priority for additional provider follow-up. Providers who do not provide responses to initial communication may receive a second letter. Providers should respond within 20 business days from date of the second letter with a satisfactory explanation of prescribing activity to avoid referral to their respective licensing board and the Bureau of Narcotics and Dangerous Drugs within DHSS.

    Missouri Medicaid Audit and Compliance (MMAC) Unit
    PO Box 6500
    Jefferson City, MO 65102-6500
    Phone: (573) 751-3399
    Fax: (573) 526-4375
    Email: (encrypted emails only)

  4. Implementation of Updated and New Opioid Clinical Edits
    Effective March 6, 2018, enhanced Opioid Clinical Edits will be implemented in the Pharmacy Program. The edits, based on CDC Opioid Guidelines, will deny pharmacy claims based on clinical criteria consistent with the QI’s identified in the OPI mailing program. A Morphine-Milligram-Equivalent (MME) Accumulation Edit is planned for a May 1, 2018 implementation and will more accurately identify total MME daily dosing and the risk of harm from overdose. For MO HealthNet participants requiring opioid therapy exceeding the criteria established in these Clinical Edits, providers will need to obtain prior authorization.

Contact Us

The State collaborative agencies are charged with protecting the health and safety of Missouri families and communities. We appreciate the service you provide to our MO HealthNet participants and the citizens of Missouri. We intend to work more closely with the provider community to provide the best care possible.

If you have questions or need additional assistance, you can contact us at (573) 751-3399.

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