Providers who prescribed at least one opioid analgesic in an outpatient setting to a Medicaid or MinnesotaCare enrollee in 2018 will receive a report. Specific opioid formulation exclusions apply.
DHS will electronically send the reports to as many providers as possible. The reports will be sent to the provider’s MN–ITS mailbox.
A small number of providers will receive their reports via the U.S. Postal Service in June or July 2019. This includes providers who only care for Medicaid or MinnesotaCare members enrolled in managed care organizations. These providers do not have access to a MN—ITS mailbox for the first year of reports but will receive their reports electronically in the future.
Please submit a question using the online feedback form.
DHS does not plan on printing reports by request for providers at this time.
The reports rely on claims data for Minnesotans enrolled in Medicaid or MinnesotaCare (fee-for-service and managed care organization members). The first set of reports will use 2018 prescribing data.
Prescriptions for patients with a cancer diagnosis or treatment in the measurement year and patients who received hospice or palliative care services are excluded. Medications used to treat Opioid Use Disorder are not included in the analysis.
No. All providers who prescribed an opioid analgesic to a Medicaid or MinnesotaCare enrollee in an outpatient setting will receive a report.
Specialty information comes from the CMS National Plan and Provider Enumeration System. Each provider’s specialty group is based on their National Provider Identifier (NPI) primary taxonomy code. The taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct levels: provider grouping, classification and area of specialization (American Medical Association. Health Care Provider Taxonomy. Version 19.0 January 2019).
Taxonomy codes are self-selected by the provider. The taxonomy codes are organized based on education and training and are used to define specialty, not specific services that are rendered.
DHS used the Level III information to assign a provider to a specialty, unless that level of data was unavailable. In those instances, DHS relied on Level II information and internal DHS provider enrollment data.
Providers are encouraged to change the primary taxonomy code provided 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 for year two.
Not at this time. In the future, DHS and the work group will set parameters for disclosures to affiliated practices in 2020 or 2021 in accordance with Minn. Stat. 256B.0638.
You will receive additional information about participating in the quality improvement review.
Participation in the quality improvement program is based on the follow-up set of reports, which will be released in 2020. The follow-up set of reports will provide updated data and prescribing rates reflecting the time after receipt of the first report. There are quality improvement thresholds for five of the seven opioid prescribing sentinel measures. The reports present comparative prescribing rates in graphs, and the quality improvement threshold is clearly marked in each graph. Providers whose prescribing rate is above the threshold for any of the five measures must participate in the quality improvement program if they also prescribed above a certain number of opioid analgesic prescriptions to Medicaid and MinnesotaCare enrollees that year.
DHS, the work group and partners in the medical community are currently developing the quality improvement program. The intent is 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.
Yes, the state is aware that providers who care for patients receiving long-term opioid therapy face specific challenges related to managing their patients. The quality improvement efforts related to measures on chronic opioid analgesic therapy will focus on harm reduction, provider education, peer consultation and risk assessment.
The state is also aware that providers may inherit significant numbers of chronic pain patients, for example, when a pain specialist in their geographic area retires. This will be considered, and may be reason for a special cause exemption.
Providers who treat patients with very severe, acute pain of extended duration will be considered for a special cause variation. Additional information about how to request exemption will be provided closer to beginning the quality improvement program.
As a reminder, surgical specialties are exempt from quality improvement based on their prescribing rate for measure 1 (frequency of prescribing an index opioid prescription).