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Some MassHealth Members Are Not Receiving Opioid Use Disorder Counseling From Healthcare Professionals Who Either Are Certified or Specialize in Addiction Treatment.

Bump encourages MassHealth to work with the state’s Department of Public Health to develop training standards for health care professionals that provide counseling to members recovering from OUD.

Table of Contents

Overview

When we interviewed 83 prescribers for 103 sampled members, 49 prescribers responded that they personally gave the sampled members opioid use disorder counseling. Of these 49 prescribers, 11 may not have the qualifications necessary to provide effective counseling for members being treated for opioid use disorders. Specifically, the physicians specialized in internal medicine, family medicine, or psychiatry, not addiction medicine. None of them had addiction medicine certifications from the American Board of Preventive Medicine, American Board of Psychiatry and Neurology, or American Board of Addiction Medicine. As a result, some members may not have received comprehensive counseling when undergoing treatment for opioid use disorders.

Best Practices

According to an ASAM article titled “How to Identify a Physician Recognized for Expertness in the Diagnosis and Treatment of Addiction and Related Health Conditions,” a qualified substance abuse counselor should possess expert knowledge, training, and education in the field of addiction medicine. ASAM recommends that healthcare professionals complete an accredited residency or fellowship in addiction medicine or addiction psychiatry or obtain a certification or subspecialty in addiction medicine from one of the following boards:

  • ASAM or the American Board of Addiction Medicine
  • the American Board of Preventive Medicine
  • the American Board of Psychiatry and Neurology
  • the American Osteopathic Association

Reasons for Issue

MassHealth does not specifically identify what type of education or certification counselors should obtain to provide counseling to members recovering from opioid use disorders. According to physicians we interviewed as part of this audit, there is a lack of training opportunities sponsored by DPH, and in the United States as a whole, for counseling in the field of addiction medicine.

Recommendation

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

Auditee’s Response

MassHealth agrees that practitioners providing counseling, and other services, to members with OUD should be qualified and well trained, but disagrees with this OSA finding. The OSA audit bases its finding on ASAM’s public policy statement “How to Identify a Physician Recognized for Expertness in the Diagnosis and Treatment of Addiction and Related Health Conditions.” The scope of this ASAM public policy statement is specific to recognizing whether a physician has expertise in addiction. . . . The OSA finding extrapolates from this publication that all counselors must have the qualifications outlined in the publication, including having completed a residency or fellowship in addiction medicine or addiction psychiatry or obtained a certification or subspecialty in addiction medicine from a medical board. There is no indication that any practitioners treating MassHealth members with OUD are operating outside of their scope of practice or licensure. In fact, many different practitioner types can appropriately provide treatment, including counseling, to members with OUD. The ASAM guidelines recommend a broad range of practitioners according to individual patient need. An overview of the ASAM guidelines published by the Medicaid Innovation Accelerator Program states that providers eligible to provide treatment in an outpatient setting may include “appropriately credentialed and/or licensed treatment professionals including counselors, social workers, psychologists, and physicians (whether addiction-credentialed or generalist).” . . .

Furthermore, best practices for the treatment of OUD must also include treatment for co-occurring disorders, as appropriate. MassHealth members with OUD have a high prevalence of co-occurring disorders and integrated treatment planning and delivery for co-occurring disorders involves a range of healthcare professionals. Such healthcare professionals must necessarily have a broader range of expertise than those recommended within this audit finding.

Auditor’s Reply

In its response, MassHealth points out that according to Medicaid Innovation Accelerator Program guidelines, a broad range of appropriately credentialed and/or licensed treatment professionals, including counselors, social workers, psychologists, and physicians, are eligible to provide opioid use disorder treatment in outpatient settings. We do not dispute this fact, but as noted above, MassHealth does not specifically identify what type of education or certification counselors should obtain to provide counseling to members recovering from opioid use disorders. OSA acknowledges that there are various appropriately trained and/or credentialed healthcare professionals who could effectively provide these services. However, during our audit, we looked at whether the physicians providing the counseling to the members in question had any specialized training in this area. As noted above, we found that 11 might not have the qualifications necessary to provide effective counseling for members they were treating for opioid use disorders. They specialized in internal medicine, family medicine, or psychiatry, not addiction medicine; none of them had addiction medicine certifications. OSA is not asserting that all counselors who provide services to members must have this specialized training, but that members may have better outcomes if they receive counseling from healthcare professionals who have had such training. In support of this, as noted above, ASAM has stated that a qualified substance abuse counselor should possess expert knowledge, training, and education in the field of addiction medicine.  

Further, OSA does not state or suggest that the MassHealth providers in question are working outside the scope of their practice or licensure. Rather, our concern is that MassHealth does not currently have any policies or regulations that specifically identify the standards, including the types of education and certification, its counselors should obtain to provide counseling to members recovering from opioid use disorders. We encourage MassHealth to work with DPH to develop and document such standards.

In its response, MassHealth states that appropriate treatment for opioid use disorders must also include treatment for co-occurring disorders, as appropriate. Although we do not dispute this assertion, OSA believes that in addition to receiving counseling for their co-occurring disorders, members might benefit from counseling by a healthcare professional with a certification or specialties in addiction medicine.

Date published: March 21, 2019
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