Opioid prescribing reports
Minnesota law requires the Department of Human Services to provide individualized opioid prescribing reports to all health care providers who prescribed opioids for pain management and treat people enrolled in MinnesotaCare or Medicaid, also called Medical Assistance in Minnesota-. This includes health care providers who only care for Medicaid and MinnesotaCare members enrolled in a managed care organization.
The opioid prescribing reports compare a prescriber’s opioid prescribing rates to the average rates of their specialty group. The data provided in the reports is from Medicaid and MinnesotaCare administrative claims data — the reports do not use data from the Prescription Drug Monitoring Program. The goal of sharing this data with providers is to support quality improvement.
Access your report
Providers who prescribed at least one opioid analgesic in an outpatient setting to a Medicaid or MinnesotaCare member in the measurement year will receive a report. Specific opioid formulation exclusions apply.
DHS will send the first individual prescribing reports in the beginning of 2019 to your MN—ITS mailbox. To access your report, you must register for a MN—ITS mailbox. MN—ITS is the free, web-based HIPPA-compliant system DHS uses for electronic billing and communication with providers. This is not the same system that individuals use to purchase health insurance in the MNsure marketplace.
Enrolled providers receive a customized MN—ITS Registration Letter with an initial user ID and password. DHS will send MN—ITS Registration Letters to all opioid-prescribing providers who do not currently have a MN—ITS account, via U.S. Postal Service. Please watch for this letter and notify your administrative staff or billing office to watch for it and route it to you so you can register your account.
Training on how to access your report in the MN—ITS mailbox will become available prior to the release of the reports. DHS will provide a link to the training on this site and Provider news and updates.
The first set of reports will use 2018 prescribing data. The data in each report is from Medicaid and MinnesotaCare administrative claims data. This means that only data on your Medicaid and MinnesotaCare patients will be included in the reports.
Patients included in the reports
The opioid prescribing reports exclude individuals who received a cancer diagnosis or treatment in the measurement year, and individuals receiving hospice or palliative services. Patients receiving medication-assisted treatment for Opioid Use Disorder are also excluded from the prescribing reports.
All other Medicaid and MinnesotaCare members are included, including children, individuals with both Medicaid and Medicare coverage, and members for whom DHS receives a pharmacy claim.
The reports compare providers’ metrics to the average rates within their specialty group. DHS used the National Plan and Provider Enumeration System (NPPES) database to locate providers’ National Provider Identifier (NPI) primary taxonomy code. Providers are included in one of 30 specialty groups based on their NPI primary taxonomy code. DHS also reviewed provider enrollment data when a primary taxonomy code was missing.
Access the NPPES website to verify that your primary taxonomy code accurately reflects your current practice. Providers who disagree with their specialty group assignment are encouraged to change the primary taxonomy code associated with their NPI number. Alternatively, providers can update their enrollment information with DHS to change or add a specialty code associated with their provider type. DHS is also exploring options for physician assistants and advanced practice registered nurses to correctly identify their specialty practice.
DHS will not share the 2019 opioid prescribing reports with a prescriber’s practice, licensure boards or the public. In the future, DHS and the Opioid Prescribing Work Group will set parameters for disclosures to affiliated practices in accordance with Minn. Stat. 256B.0638. The statute permits the agency to notify a provider’s affiliated practice when the provider is required to participate in the quality improvement program. Public disclosure is only permitted at such time a provider is disenrolled from serving Medicaid and MinnesotaCare members.
The reports do not include any identifiable patient data or information about a specific prescription.
Quality improvement program participation
There are quality improvement thresholds for five of the seven opioid prescribing sentinel measures. Providers whose prescribing rate is above the threshold for any of the five measures will be required to participate, if they also prescribed above a certain volume of opioid analgesic prescriptions to public health care program enrollees in the measurement year.
The reports present the comparative rates in bar graphs, and the quality improvement threshold is clearly marked in each graph. If your prescribing rate is above the threshold, then you may be subject to participation (based on your prescribing volume). Prescribers will also receive additional information about participating in the quality improvement review.
Participation in the quality improvement program is based on the second set of reports which will be released in early spring 2020. The second set of reports will provide updated data and prescribing rates reflecting the time after receipt of this first report.
Expectations of providers who must participate in the quality improvement program
DHS, the work group, and partners in the medical community are currently developing the quality improvement program. It is our intent to identify a set of required activities — based on pain phase — that a provider would incorporate into their quality improvement plan. The activities will take into account different measures that are over set thresholds, provider practice types, system capacity, and existing quality improvement efforts within clinics or systems. Providers will submit their plan to DHS for review by an external body.