SAMHSA's Oversight of Accreditation Bodies for Opioid Treatment Programs Did Not Comply With Some Federal Requirements

Why OIG Did This Audit

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that, in 2017, 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers. Medication-assisted treatment (MAT), provided by opioid treatment programs (OTPs), combines the use of medications with other therapies to treat opioid use disorders. Federal regulations established an oversight system for the treatment of substance use disorders with MAT. OTPs must be certified by SAMHSA and accredited by a SAMHSA-approved accreditation body. We reviewed SAMHSA's oversight of the accreditation bodies because the adequacy of that oversight affects the safety of patients and the public.

Our objective was to determine whether SAMHSA's oversight of accreditation bodies complied with Federal requirements.

How OIG Did This Audit

We reviewed SAMHSA's activities in overseeing accreditation bodies. Specifically, we reviewed the results of SAMHSA's inspections performed at selected OTPs from October 2016 through September 2018 (audit period) and a judgmental sample of 30 reports for accreditation surveys conducted by accreditation bodies during our audit period. We also requested documentation of SAMHSA's evaluations of accreditation elements.

What OIG Found

SAMHSA performed inspections at selected OTPs but did not (1) meet its goal for the number of OTPs it would inspect, (2) take actions to address accreditation bodies' noncompliance with survey requirements, or (3) determine whether OTPs complied with the Federal standards when patient charts were incomplete. In addition, SAMHSA reviewed accreditation bodies' survey reports, but the reports were inconsistent and did not contain sufficient information to determine whether the OTPs met the Federal standards. Finally, SAMHSA's evaluations of accreditation bodies' accreditation elements were not documented or retained. (An example of an accreditation element would be accredited OTPs' commitment to continually improving their organizations and service delivery to the people served.) Without improved oversight and proper documentation of its evaluations, SAMHSA may not be able to adequately evaluate the performance of accreditation bodies and ensure that OTPs are meeting the Federal opioid treatment standards.

What OIG Recommends and SAMHSA Comments

We recommend that SAMHSA (1) identify steps it can take and take action to ensure that it meets its goal for the number of OTPs it inspects each year and (2) review the results of its inspections and take action to address accreditation bodies' noncompliance with survey requirements. The report also lists three more procedural recommendations.

SAMHSA concurred with all of our recommendations and provided specific information on actions that it planned to take to address two of our recommendations.