Member News Updates - Iowa Health Care Association

Iowa Medicaid and the Iowa Department of Health and Human Services (DHHS) recently released informational letter (IL) 2727 regarding the SUPPORT Act Section 5042(e)(1)(A) reporting requirements survey for federal fiscal year (FFY) 2025.

Section 5042 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, codified in 42 U.S.C. 1396w-3a, requires covered providers that are permitted to prescribe controlled substances and that participate in Medicaid to query qualified prescription drug monitoring programs (PDMPs) before prescribing controlled substances to most Medicaid beneficiaries. In Iowa, the PDMP is known as the Prescription Monitoring Program (PMP), or Iowa PMP AWARxE.

Documentation of the database query within the PMP must be made in the member’s file by the prescribing provider. Subject to the requirements under Iowa Code Chapter 124, subchapter VI, if the provider is unable to conduct a review of the PMP, the member’s file should include the reasons the provider was unable to complete the review. Upon request by the Iowa Medicaid program, the prescribing provider shall submit the documentation.

This does not apply to Medicaid members who are receiving inpatient hospice care or long-term residential facility care. Notification of provider requirements for prescribing controlled substances was provided in IL 2280.

Section 1927(g)(3)(D) of the Social Security Act requires each state to submit an annual report on the operation of its Medicaid Drug Utilization Review (DUR) program. CMS has included questions to reference metrics for compliance with provisions outlined in Section 5042 of the SUPPORT Act. Mandatory State reporting to CMS began with the FFY 2023 DUR survey and will continue annually.

Please complete the survey regarding your prescribing practices for FFY 2025, from October 2024 through September 2025. The survey is open effective immediately and will close on March 31, 2026, at 11:59 p.m. CST.

Click here to complete the survey

If you have questions, please contact Iowa Medicaid Provider Services, the appropriate managed care organization (MCO) or prepaid ambulatory health plan (PAHP).

Iowa Medicaid Provider Services