Press Release  Audit Recommends MassHealth Pursue Cost-Saving Improvements to Medication Administration

Boston — An audit released today by Auditor Suzanne M. Bump calls on MassHealth to explore cost-saving improvements to its medication administration process for group adult foster care (GAFC) members. The audit looked at the administration of the GAFC program by Community Connection Healthcare (CCH) in Quincy. The audit estimates that by improving its medication administration, MassHealth could have saved up to $2.1 million at CCH. A previous audit of Nizhoni Community Care in Somerville found similar savings opportunities.

“As state leaders look to control the growth of spending in MassHealth, our audits have shown a small change to the program’s medication administration guidelines could result in significant savings for the Commonwealth,” Bump said. “I encourage MassHealth to work with Community Connection Healthcare, and other providers to further-explore this and other cost-saving measures.”

Currently, when a GAFC member cannot manage his or her own medication, the GAFC provider is prohibited under MassHealth regulations from administering medication, and instead contracts with a registered nurse to provide these services. However, the audit notes that MassHealth regulation allows individuals who are trained in administering prescription medication to perform medication management, even if they are not registered nurses. If MassHealth adjusted its guidelines to allow and direct GAFC providers to use certified nursing assistants who are certified in medication management to provide these services to member who require them it could result in millions of dollars in savings in the program, the audit found.

CCH agreed with this recommendation, noting in its response, “We do agree that many of the medication functions do not need skilled nurses, they are merely just reminding and assisting the client with the taking of simple medications. It is evident that the state could achieve significant cost savings from utilizing the GAFC program if the staff was MAP (Medication Administration Program) trained.”

The audit found that CCH was properly administering its GAFC program.

However, the audit also found that MassHealth allowed CCH to bill approximately $1.8 million for unallowable group adult foster care services that were duplicative of services provided through other means. MassHealth enabled this improper practice in an email to providers informing them that they could bill for these duplicative services, despite regulations to the contrary. This problem was first identified in an audit released by Bump’s office last summer.

CCH was established in 2011 as a GAFC provider. During the audit period, from July 1, 2011 through June 30, 2016, it received approximately $11.8 million in GAFC payments from MassHealth for 311,970 claims for 848 members.

The Community Connection Healthcare audit is available here.

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