Minnesota Statutes, 256B.0638 requires the Minnesota Department of Human Services (DHS) to develop individualized opioid prescribing reports for all health care providers who prescribe opioids for pain management to Minnesotans enrolled in MinnesotaCare or Medicaid.
In 2024, DHS will only issue opioid prescribing reports to a small portion of Medicaid or MinnesotaCare enrolled providers, specifically those who have been identified as exceeding the community standard. All other clinicians seeking a copy of their DHS opioid prescribing report can do so by submitting a request using the Opioid Prescribing Improvement Program (OPIP) Inquiry online form.
2023 prescribing reports will be available to providers in the April - May timeframe. Providers will receive reports in one of two ways:
Prescribing reports are issued annually. We compile prescribing data from the previous calendar year in March and issue prescribing reports by April or May of each year.
Prescribers may request digital copies of their reports by completing the Opioid Prescribing Improvement Program (OPIP) Inquiry online form or emailing OPIP staff at dhs.opioid@state.mn.us.
The data in each report are from Medicaid and MinnesotaCare administrative claims which means only data on Medicaid and MinnesotaCare patients are included in the DHS prescribing reports. All prescriptions written in an outpatient setting are included, including those for children and individuals with both Medicaid and Medicare coverage.
Yes. Patients with a cancer diagnosis or treatment in the measurement year and patients who received hospice services are excluded. All buprenorphine products, including those used to treat Opioid Use Disorder, are excluded. Procedural sedation or anesthesia and medications administered in an emergency room or from an inpatient pharmacy are also not included.
No. The exclusions are applied at either the patient or prescription level.
No. Under Minnesota Statutes, 256B.0638, the opioid prescriber reports are confidential to individual prescribers, their affiliated employers, clinics or organizations.
No. All data in the reports are presented in aggregate form and do not identify specific patients or their prescriptions.
DHS uses 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.
Yes. Please email dhs.opioid@state.mn.us to provide additional information about your specialty.
The only threshold difference applies to those in surgical specialties for acute prescribing (Measures 1 and 2). For Measure 1, there is no quality improvement threshold for surgical specialties. For Measure 2, the dose threshold for surgical specialties is 200 MME, which is higher than the recommended dose for nonsurgical specialties (100 MME). Providers whose specialty designation is not accurately reflected on their report can still obtain the comparative data for their correct specialty by visiting the Sentinel Measures: averages by specialty webpage.
The quality improvement thresholds will remain at their current level, unless DHS is advised to change the threshold by its clinical advisory body. The QI thresholds are static. They do not change as prescribing trends change within a specialty.
DHS uses administrative claims data within the reports. DHS is confident the data underlying the reports is accurate and also recognize that the primary purpose of the data is for billing purposes. Therefore, there are instances when a pharmacy or medical claim may be linked to an organization or consolidated NPI number, rather than an individual.
It is important to keep in mind that the data is only for Minnesota Health Care Programs members who received an outpatient opioid prescription. Therefore, it is likely that the data underrepresents the scope of your opioid prescribing. Providers who wish to review all of their prescribing data may do so in the Minnesota Prescription Monitoring Program (PMP).
You may request a more detailed description of DHS’ methodology may request one from DHS by emailing dhs.opioid@state.mn.us.
DHS will distribute the 2023 prescribing reports to providers in April and May of 2024. These reports will indicate whether a provider is considered an outlier in their opioid prescribing and should partake in a QI effort. If providers are unsure about their QI status, they can contact OPIP staff by completing an Opioid Prescribing Improvement Program (OPIP) Inquiry online form or emailing dhs.opioid@state.mn.us.
The QI program will begin in May 2024 when DHS distributes the 2023 opioid prescribing reports. Reports are available to any provider who prescribed at least one outpatient opioid prescription to a Minnesota Medicaid or MinnesotaCare member in 2023. DHS will provide guidance directly to participants about the quality improvement requirements after reports have been sent and providers are notified of their QI status.
QI liaisons are individuals within health systems and clinics who have been identified to be a contact person for DHS during the QI project. In general, QI liaisons support communication between DHS, QI providers and health care organizations. Liaisons are provided with the most up-to-date project information.
Liaisons may be in clinical or administrative roles, depending on the size of the organization, and any existing opioid stewardship infrastructure. Liaisons are not expected to oversee or manage providers’ quality improvement work unless it is determined to be appropriate by the organization.
Details about the quality improvement program are available on the Quality Improvement program webpage.
DHS staff, as well as their clinical contractors, are also available to support individuals and systems in their quality improvement efforts. Extensive quality improvement resources are available on the Provider education and the Opioid prescribing reports webpages.
DHS will work with providers and health systems with existing quality improvement programs to avoid duplicative efforts. Providers in this type of situation should contact OPIP staff by sending an email to dhs.opioid@state.mn.us.
No, the statute does not exempt any provider specialties from participation. However, there is an alternative to quality improvement for clinicians who treat chronic pain. Email dhs.opioid@state.mn.us to request more information about how to apply to be waived from quality improvement.
DHS will dismiss prescribers from participating in OPIP when the prescribers demonstrate that their practices are patient-centered and reflect current community standards of care. DHS’ expectation is that providers flagged for QI participation will take time to methodically understand why their prescribing behavior appears to be different from their peers, whether their practice follows current standards of care, and if not, why that is the case. In some cases, clinicians will treat patients whose conditions or circumstances warrant different dosing considerations.
No, as defined in Minnesota Statutes, 256B.0638, DHS does not have the authority to disenroll providers based upon their engagement in OPIP.
