SAMHSA's Oversight Generally Ensured That the Commission on Accreditation of Rehabilitation Facilities Verified That Opioid Treatment Programs Met Federal Opioid Treatment Standards

Why OIG Did This Audit

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that, in 2019, 1.6 million people in the United States suffered from opioid use disorders. Opioid treatment programs (OTPs) provide medication-assisted treatment (MAT), which 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. Because the Commission on Accreditation of Rehabilitation Facilities (CARF), a SAMHSA-approved accreditation body, accredited approximately 60 percent of OTPs in the United States, we conducted this audit of SAMHSA's oversight of CARF.

Our objective was to determine whether SAMHSA's oversight ensured that: (1) CARF verified that OTPs met Federal opioid treatment standards and (2) CARF's survey teams met Federal requirements.

How OIG Did This Audit

To determine whether SAMHSA's oversight ensured that CARF verified OTPs' compliance with Federal opioid treatment standards, we reviewed: (1) CARF's latest renewal application submitted to SAMHSA, which included CARF's policies and procedures and accreditation elements, and (2) a judgmental sample of 30 accreditations for OTPs that CARF surveyed from September 2019 through February 2020. We also reviewed CARF's processes for hiring surveyors and selecting them to conduct surveys.

What OIG Found

SAMHSA's oversight generally ensured that CARF verified that OTPs met Federal opioid treatment standards. As part of its oversight activities, SAMHSA: (1) reviewed CARF's renewal application, which included CARF's policies and procedures and accreditation elements; (2) inspected a selected sample of OTPs that CARF accredited and surveyed; and (3) reviewed accreditation reports submitted by CARF. In addition, SAMHSA's oversight ensured that CARF's survey teams met Federal requirements. Specifically, SAMHSA's review of CARF's renewal application included a review of CARF's policies and procedures for: (1) hiring surveyors with required education and experience, (2) training provided to surveyors, (3) selecting surveyors for each survey, and (4) avoiding conflicts of interest.

SAMHSA could improve its oversight to ensure that CARF's records contain sufficient detail to support each accreditation decision made by CARF. SAMHSA's policies and procedures did not require verification that accreditation bodies' (including CARF's) records contained sufficient detail supporting each accreditation decision. Not reviewing an accreditation body's records to determine whether they contain sufficient detail could make it difficult for SAMHSA to determine whether accreditation decisions are supported and to effectively evaluate the accreditation body's performance.

What OIG Recommends and SAMHSA Comments

We recommend that SAMHSA update its policies and procedures to require verification that accreditation bodies maintain records that contain sufficient detail to support each accreditation decision.

SAMHSA concurred with our recommendation and stated that it will update its current policies and procedures to ensure that records include sufficient detail to support accreditation bodies' decisions. SAMHSA stated that it anticipates the updated policies and procedures will be in place by January 2022.