Audit Highlights Need for Improved Access to Opioid Counseling and Expanded Prescriber Training

Report focuses on patients who were prescribed buprenorphine as part of their medication-assisted treatment

Boston, MA – Citing the Commonwealth’s ongoing opioid epidemic, State Auditor Suzanne M. Bump is calling on MassHealth, the state’s Medicaid program, to take steps to expand access to counseling for individuals receiving medication-assisted treatment (MAT) for Opioid Use Disorder (OUD) and establish training standards for medical professionals that provide this counseling. The call comes after an audit from Bump’s office that found many MassHealth members receiving medication to treat OUD did not receive or otherwise could not access counseling. The audit notes the importance of counseling for patients receiving MAT.

“The Commonwealth has made immense progress in addressing the opioid crisis facing our state and our nation, but the challenge continues,” said Bump. “By addressing access for those in recovery and by establishing training standards for medical professionals offering buprenorphine and other medication-assisted treatment, we can achieve even greater success.”

Auditors found approximately 27 percent of MassHealth members treated for OUD did not receive or may not have had access to recommended counseling. Interviews of providers conducted by Bump’s staff indicated a shortage of available counselors, a lack of bilingual and multilingual counselors, low reimbursement rates, and few counselors with proper OUD specialized training likely reduced patient access to counseling. Bump encourages MassHealth to take additional measures to ensure those who need OUD counseling have full access to care and treatment.

The audit also showed that some MassHealth members received OUD counseling from health care professionals who were not certified in addiction treatment. These medical professionals instead had expertise in internal medicine, family medicine, or psychiatry, rather than addiction medicine. While the audit does not assert that these medical professional were working outside the scope of their practice or licensure, it notes that because they had not received specialized training in addiction treatment counseling members may not have received comprehensive counseling when undergoing treatment for OUD. 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.

The audit examined MassHealth medical claims data from January 1, 2011 through December 31, 2015 and included interviews with medical professionals during calendar year 2017.

Finally, the audit found some MassHealth prescribers did not always maintain proper documentation of visits in which they provided buprenorphine prescriptions to patients.

According to the Chapter 55 Report released in August 2015, which included information from 29 Massachusetts public health and governmental agencies, approximately 4.4 percent of Massachusetts residents over the age of 11 use opioids. The Health Policy Commission reported in September 2016 that hospital inpatient stays related to opioid use increased by 84 percent from 2007 through 2014.

MassHealth is administered through the Executive Office of Health and Human Services, through the Division of Medical Assistance. The state’s Medicaid program annually provides access to health care for approximately 1.8 million eligible low- and moderate-income children, families, seniors, and people with disabilities. In FY17, MassHealth paid providers more than $15.3 billion, of which 50 percent was funded by the Commonwealth. Medicaid expenditures represent approximately 40 percent of the state’s total annual budget.

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