Objective

To determine the extent of implementation of the three recommendations included in our initial audit report, Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Report 2017-S-66).

About the Program

Opioid treatment programs (Treatment Programs) provide medication-assisted treatment, which includes certain opioid medications and counseling and behavioral therapies for people diagnosed with an opioid use disorder. The State maintains a database to monitor controlled substance prescription drug use, known as the Internet System for Tracking Over-Prescribing (I-STOP), which contains records of controlled substance prescriptions. I-STOP is a tool to assist prescribers in determining the most appropriate treatment for an individual and can be used by Treatment Programs to identify undisclosed opioid prescriptions or drug abuse. State law requires Treatment Programs to consult I-STOP when controlled substances are dispensed for off-premises use. Federal guidance encourages Treatment Programs to coordinate care with patients’ other prescribers of controlled substances.

We issued our initial audit report on November 20, 2018. The audit objective was to determine if the Department of Health (Department) had taken sufficient steps to safeguard Medicaid recipients who were receiving opioids while also in a Treatment Program for opioid use disorder. The audit covered the period October 1, 2013 through September 30, 2017. Auditors identified 18,786 recipients who received 208,198 opioid prescriptions through the Medicaid program while also receiving opioids as part of a Treatment Program for opioid use disorder. These recipients may have received inappropriate, unnecessary, and/or dangerous prescriptions if Treatment Programs did not check I-STOP and, where authorized, coordinate care with other prescribers – auditors noted 493 of the 18,786 recipients required medical care as a result of opioid or narcotic overdoses that occurred within a month of receiving a prescription opioid, and 12 of those individuals died during the time of their medical care involving the overdose. Based on a review of medical records for a sample of 25 recipients who received 1,065 opioid prescriptions while also in a Treatment Program for their opioid use disorder, auditors determined Treatment Programs were not consistently checking I-STOP in accordance with requirements, and also found that care coordination occurred for only 59 of the 1,065 prescriptions (6 percent). We recommended the Department take steps to ensure Treatment Programs appropriately check I-STOP and evaluate steps to improve scrutiny over opioid prescriptions for Medicaid recipients who are being treated for opioid use disorder.

Key Finding

Department officials made significant progress in addressing the problems identified in the initial audit report. Of the initial report’s three audit recommendations, two were implemented and one was partially implemented.

Key Recommendation

Officials are given 30 days after the issuance of the follow-up to provide information on any actions that are planned to address the unresolved issues discussed in this report.