HHS-OIG: Washington Opioid Treatment Programs Not Fully Compliant with Federal and State Regulations
An audit conducted by the Department of Health and Human Services Office of Inspector General (HHS-OIG) of the opioid treatment programs (OTPs) in Washington state found that 96% of sampled OTPs failed to fully comply with federal and state requirements for providing and documenting opioid treatment services. Those failures potentially put Medicaid enrollees at risk of poor treatment outcomes, including relapses, overdoses, or deaths.
OTPs include medication and counseling services for people diagnosed with opioid use disorder. There are federal and state requirements for OTPs, and noncompliance with those requirements can lead to poor patient outcomes. HHS-OIG conducted the audit to assess Washington state’s efforts to combat the opioid crisis and assessed a random sample of 100 enrollee-months at 22 OTPs between January 1, 2019, and July 31, 2020. Out of the sample of 100 enrollee-hours, 96 failed to meet federal and state requirements. If the sample was representative of all OTPs over that period, HHS-OIG estimated that 132,002 enrollee-months did not comply with federal and state requirements.
The most commonly identified areas of noncompliance were documentation failures, such as the failure to adequately document enrollee admissions, treatment plans, opioid treatment services, the results of drug screens, checks of Washington’s prescription drug monitoring program (PDMP) prescription data, and enrollee assessments. HHS-OIG also found that OTPs did not provide take-home medications in accordance with federal and state requirements. The failures were attributed to a lack of state oversight of the OTPs.
HHS-OIG made several recommendations for improving oversight to ensure full compliance and the Washington State Health Care Authority (HCA) concurred with all the recommendations and has developed a plan to address the identified issues. Those measures include partnering with the Department of Health to update the Washington Administrative Code (WAC) to reflect changes to the federal code of regulations that impact OTPs that were enacted on April 2, 2024. By January 1, 2025, HCA will convene at least one meeting with all OTP provider stakeholders to ensure they are aware of the new federal and state regulations and the importance of compliance with those regulations. HCA will also develop procedures for reviewing OTP compliance with federal and state regulations.
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