As you are probably aware, the Oregon Health Authority (OHA) has implemented an initiative to end long-term opioid use for non-malignant conditions of the back and spine.
On June 15, 2016, EOCCO notified its members of the first phase of changes to the treatment coverage that began on July 1, 2016. The EOCCO Clinical Advisory Panel has developed an implementation plan for the next phase of treatment changes, which began on Aug. 1, 2017. Providers with patients receiving long-term opioids for a condition of the back and spine also received a letter noting the patient’s name.
Phase 2 timeline
8/1/17: We started asking for additional information for patients requesting non-interventional treatment authorization(s) for conditions of the back or spine. (see additional information, below)
10/1/17: A treatment plan and opioid taper schedule was required for members receiving long-term opioid therapy for a condition of the back and spine. To ensure a safe transition, EOCCO will work with providers and their patients’ taper plans.
1/1/18: The OHA will end coverage for long-term use of opioids for conditions of the back and spine.
Additional information
As of Aug. 1, 2017, the following forms are required to be submitted for osteopathic and chiropractic manipulation therapy, physical and occupational therapy, and acupuncture starting on the fifth visit in a rolling 12-month period.
- History and physical
- Therapy progress notes
- Short Form McGill/SF-MPQ or a similar validated functional improvement tool
- KeeLe STarT Form or documentation of the total score for low-risk patients and sub score for medium and high-risk patients
- Opioid Taper Form, if applicable
However, between Aug. 1, 2017, and Sept. 30, 2017, authorization for services were not impacted for members on long-term opioid usage for chronic back and spine pain that did not have an Opioid Taper Form. This was to allow providers to establish a taper plan with their patients.
Effective Oct. 1, 2017, EOCCO adopted strict adherence to Guideline Note 56 and Guideline Note 60. Lack of an individual treatment plan and opioid taper schedule did result in a reduction of authorized services.
These requirements apply to new therapy requests for authorization, as well as extensions of existing authorizations for services after Oct. 1, 2017, for members receiving long-term opioids for conditions of the back and spine.
EOCCO has mailed letters to EOCCO members identified as receiving long-term opioids for conditions of the back or spine beginning July 2017. They were requested to take the letter to their healthcare provider to start working on a plan to taper their opioid use.
Resources and tools
EOCCO understands that you may have questions about these changes and need additional resources. We’ve updated our opioid tapering website with the following tools and resources to assist you through this transition:
- Guideline Notes 56 and 60
- Short form McGill
- KeeLe STarT form
- Sample Opioid Taper Form
- Documentation from the community forums for chronic non-cancer pain management held in four EOCCO counties in 2017
- OHA’s decision and guidelines for the treatment of back and spine pain
- OHA’s resources on tapering patients with chronic pain off prescription opioids
- Information about authorization requirements with EOCCO
Questions?
For additional questions, please email us at medical@modahealth.com.
