MedicaidAdministrativeMedium impact
20-511 Start with Primary Care to Manage High-Risk Opioid Use
Health Net·CA · Family Medicine, Internal Medicine, General Practice +1 more·Pharmacy
We identified it
Jun 20, 2026
Summary
Health Net California has updated policy 20-511 focusing on HEDIS quality measures for high-risk opioid use management. The policy provides guidance on tracking opioid prescribing patterns, concurrent benzodiazepine use, and substance abuse treatment initiation for primary care providers in specified California counties.
Action Required
Immediately: Primary care providers in applicable California counties should review opioid prescribing practices against HEDIS quality measures. Implement tracking for patients receiving >120 MME daily, multiple provider prescriptions, and concurrent opioid/benzodiazepine use. Contact Quality Improvement Department at cqi_dsm@healthnet.com for questions. Cancer and hospice patients are excluded from most measures.