Evidence status: CURRENT MEDICAID HIGH-MME FRAMEWORK. Michigan Medicaid’s high-MME prior-authorization record contains both exceptions and detailed continuing requirements. Those distinctions matter when documenting who is actually subject to the Pain Medication Agreement condition.

Current threshold

Values above 90 MME per day trigger the high-MME prior-authorization criteria for opioids within the current Common Formulary framework.

Initial exceptions

The current criteria identify exceptions including documented current cancer-related pain, sickle cell disease pain, hospice or palliative care, and residence in certain long-term-care or other facilities exempt from MAPS reporting/checking. When an exception applies, the additional high-MME information is not required for that section.

When no exception applies

The provider must complete the additional high-MME record, including the signed Pain Medication Agreement, recent MAPS/NarxCare review, risk assessment, non-opioid interventions, toxicology screening, naloxone counseling, and clinical documentation supporting the need to exceed the threshold.

Continuation of therapy

Continuation requires the high-MME criteria to remain satisfied and documentation of a taper plan or the clinical rationale why tapering is not appropriate.

Why the exceptions belong in the public record

The agreement cannot be accurately described as a universal Michigan Medicaid requirement without preserving the threshold, exceptions, and program context that determine when the condition applies.

Primary source

Michigan Medicaid Health Plan Common Formulary Prior Authorization Criteria

Reviewed: October 5, 2026.