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Audit Audit of the Office of Medicaid (MassHealth)—Review of Counseling Provided to MassHealth Members Receiving Medication-Assisted Treatment for Opioid Use Disorders

This audit focuses on patients who were prescribed buprenorphine as part of their medication-assisted treatment. The audit examined MassHealth claims data from January 1, 2011 through December 31, 2015 and included interviews with medical professionals during calendar year 2017.

Binder organization: Office of the State Auditor
Date published: March 21, 2019

Executive Summary

The Office of the State Auditor (OSA) receives an annual appropriation for the operation of a Medicaid Audit Unit to help prevent and identify fraud, waste, and abuse in the state’s Medicaid program, known as MassHealth. Medicaid is a joint federal-state program created by Congress in 1965 as Title XIX of the Social Security Act. At the federal level, the Centers for Medicare & Medicaid Services, within the federal Department of Health and Human Services, administer the Medicare program and work with state governments to administer state Medicaid programs.

Under Chapter 118E of the Massachusetts General Laws, the Executive Office of Health and Human Services, through the Division of Medical Assistance, administers MassHealth. MassHealth provides access to healthcare for approximately 1.8 million eligible low- and moderate-income children, families, seniors, and people with disabilities annually. In fiscal year 2017, MassHealth paid healthcare providers more than $15.3 billion, of which approximately 50% was funded by the Commonwealth. Medicaid expenditures represent approximately 39% of the Commonwealth’s total annual budget.

OSA has conducted an audit of opioid use disorder counseling provided to MassHealth members who received buprenorphine under any brand or generic name as part of their medication-assisted treatment (MAT) for opioid use disorders for the period January 1, 2011 through December 31, 2015. Our audit sample was based on buprenorphine prescriptions for calendar years 2011 through 2015. Our interviews with sampled members’ prescribers occurred between February 6, 2017 and August 16, 2017.

In August 2018, Governor Baker signed into law Chapter 208 of the Acts of 2018, An Act for Prevention and Access to Appropriate Care and Treatment of Addiction. This law established a commission on community behavioral health promotion, made up of 21 appointees, to “work to promote positive mental, emotional and behavioral health and early intervention for persons with a mental illness, and to prevent opioid use disorders among residents of the commonwealth.” The law also, among other things, expands access to naloxone1 and MAT, such as treatments using buprenorphine, and provides for additional services to help residents of the Commonwealth overcome opioid use disorders. Services include recovery coaching; support for families and children; and training and supervision for medical professionals to test for, detect, and treat early signs of opioid use disorders.

The purpose of this audit was to determine whether MassHealth members received and/or had access to appropriate and necessary counseling to aid in their recovery from opioid use disorders.

Finding 1

Some MassHealth members who were treated for opioid use disorders did not receive, and/or may not have had access to, recommended counseling.

Recommendations

  1. MassHealth should take additional measures to better ensure that prescribers effectively facilitate member participation in opioid use disorder counseling.
  2. MassHealth should further investigate the reasons that were provided to OSA during this audit for members’ not having access to counseling and take whatever measures it can to minimize these barriers to access.

Finding 2

Some MassHealth members are not receiving opioid use disorder counseling from healthcare professionals who either are certified or specialize in addiction treatment.

Recommendation

MassHealth should collaborate with the Department of Public Health to ensure that opioid use disorder counselors have the proper training, skills, and knowledge to provide effective opioid use disorder counseling.

Finding 3

Prescribers did not always maintain documentation supporting medical visits where prescriptions were given to MassHealth members.

Recommendation

MassHealth should conduct a review of these prescribers’ medical documentation and recover any payments for services that were not properly documented.

 

A PDF copy of the audit of the Office of Medicaid (MassHealth)—Review of Counseling Provided to MassHealth Members Receiving Medication-Assisted Treatment for Opioid Use Disorder is available here.

 

1.    Naloxone is the drug used to reverse the effects of opioid overdoses to save lives.

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Phone

Fax

(617) 727-3014

Address

Massachusetts State House
Room 230
Boston, MA 02133
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