Florida Did Not Comply With Requirements for Documenting Psychotropic and Opioid Medications Prescribed for Children in Foster Care

Why OIG Did This Audit

The United States Food and Drug Administration issued a safety announcement stating that a review found the combined use of opioid and some psychotropic medications can result in serious side effects, including slowed or difficult breathing and death. In addition, ineffective oversight of psychotropic and opioid medications may increase the risk of inappropriate dosing or medication combinations. To receive Federal funding for child welfare services, States are required to have a plan for the oversight of prescription medications, including psychotropic and opioid medications prescribed for children in foster care. In recent audits, we found that psychotropic and opioid medications prescribed for children in foster care were not accurately documented in the States' child welfare information systems.

Our objective was to determine whether Florida complied with State requirements related to the psychotropic and opioid medications prescribed for children in foster care who were eligible for assistance under Title IV-E of the Social Security Act (the Act).

How OIG Did This Audit

We randomly selected a sample of 115 children who were prescribed psychotropic or opioid medications. We reviewed the Medicaid claim data, case files in Florida's Safe Families Network (FSFN), and health care records maintained outside of FSFN for the children in our sample.

What OIG Found

Florida did not always comply with State requirements related to the psychotropic and opioid medications prescribed for children in foster care who were eligible for assistance under the Act. Specifically, for the 85 sample children who were prescribed psychotropic drugs we found: (1) the psychotropic medications prescribed for 36 children were not recorded in FSFN, (2) the medication logs for 56 children were not maintained in FSFN, and (3) the authorization for prescription of psychotropic medications for 33 children were not contained in FSFN. In addition, we found the opioid medications prescribed for 57 of the 60 children in the sample were not recorded in FSFN.

What OIG Recommends and Florida Comments

We recommend that Florida: (1) provide training to child protective investigators and caseworkers on medication management and administration that addresses requirements for updating case records in FSFN for children who are prescribed psychotropic medications (including related medication logs and authorizations) and opioid medications and (2) coordinate with the Florida Agency for Health Care Administration to obtain access to Medicaid claim data for all children under its care and supervision. Florida elected not to provide comments on the draft report.