The Health Care Authority requires completion of an opioid attestation form for Apple Health enrollees when the daily opioid dose exceeds 120 morphine milligram equivalents (MME), or an enrollee begins chronic use of opioids. Chronic use of opioids is defined as use of any opioid for more than 42 days within a 90-day period.
- Confirm the enrollee’s CHPW member ID and Provider One ID are listed on the form
- Ensure all opioids, including dose & frequency the enrollee is taking are listed on the form
- Calculate the total daily MME the enrollee will receive AND document on the form
- See link below for link to an MME calculator
- See link below for link to an MME calculator
- Follow the correct prompts on the form to complete all applicable sections (sections 2, 3, 4)
- If enrollee will receive > 200 MME, ensure chart notes that include medical documentation that justify the medical need to exceed 200 MME are included
- Ensure the prescriber has signed, noted their specialty, and dated the form before submission, and the prescriber has written an opioid prescription for the patient within the last 90 days
The form can be found here: https://www.chpw.org/wp-content/uploads/content/provider-center/CHPW_Opioid_Attestation_Form.pdf
The HCA Opioid Policy can be found here: https://www.hca.wa.gov/assets/billers-and-providers/opioid-policy.pdf
HCA information about opioids & a MME calculator for Apple Health Enrollees can be found here: https://www.hca.wa.gov/billers-providers-partners/program-information-providers/opioids
If you have any questions, please call CHPW customer service at 1-800-440-1561.
