Lawmakers want a special audit of ValueOptions contract; providers’ association says it fears ‘slow, inaccurate, or untimely payments’ from OptumHealth during transition
If legislators and behavioral health providers are to be believed, the state’s transition between behavioral health contracts has been rocky on both ends.
A bipartisan group of 13 state legislators sent a letter to State Auditor Hector Balderas on Monday requesting a special audit of the contract with the outgoing provider, ValueOptions, which expired June 30. The lawmakers, who were organized by Rep. Nate Cote, D-Las Cruces, lodged a host of complaints including that providers were not being reimbursed in a timely manner or at all for services they provided, that clients were being inappropriately denied service and that the company retaliated against providers who complained.
The legislators also stated in the letter that they are “concerned with the response of the responsible state agencies to complaints.”
In an interview, Cote said the problems are longstanding but appear to have gotten worse as ValueOptions was heading out the door. He said he has received several complaints from constituents, including a provider in Las Cruces whose clinic is on the verge of closing because of about $500,000 in claims that haven’t been paid.
“We’ve managed to lose providers in this state in the last few months because they were not being reimbursed. And the loss of these providers, more likely than not, is impacting low-income people in this state,” Cote said.
Balderas will seek funds for special audit
In response to the lawmakers’ letter, a spokeswoman for Balderas, Caroline Buerkle, said the auditor will “submit a plan with associated costs (for a special audit) for the Legislature to consider.”
ValueOptions spokesman Lon Wagner was quoted by The Santa Fe New Mexican as saying that the company was already audited this year by the state’s Behavioral Health Collaborative.
“It was resolved earlier this year through an audit by the collaborative, which examined dozens of our claims on a case-by-case basis,” the newspaper quoted Wagner as saying. “The conclusion? ValueOptions did not deny services and that we did properly grant authorizations.”
The New Mexican quoted Betina Gonzales McCracken, spokeswoman for the collaborative, as saying that the company had been fined $1.5 million.
“The collaborative quickly acted on complaints from behavioral-health providers and consumers about inadequate payments and inappropriate and untimely denials for services which led to several directed corrective action plans,” McCracken was quoted as saying. “The collaborative is determined to hold ValueOptions accountable for the sanctions.”
Providers make proposal to OptumHealth
Meanwhile, there are apparently also complaints about the transition to the company that took over for ValueOptions on July 1, OptumHealth. A July 13 letter from the Alamogordo-based Behavioral Health Providers Association to OptumHealth identifies a list of issues that the association says will result in “slow, inaccurate, or untimely payments to providers” during the transition.
Those problems include, according to the letter, “lack of timely response to our inquiries” and “Optum not yet able to accept any type of electronic batch billing or paper claims.”
The association proposed that providers be given a payment by OptumHealth each month for the next six months based on last year’s budget to ensure that providers can continue to serve clients.
The association wrote in the letter that it recognizes that the proposal “carries with it the risk of other problems, such as a cumbersome reconciliation process,” but wrote that such “potential risks” are “clearly overshadowed by the health and well-being of our customers, for whom the impact of the cessation of services would be wholly negative and potentially catastrophic.”
ValueOptions agreed to something similar when it came into the state several years ago, the letter states.
The association asked that OptumHealth respond to the letter by Thursday. An OptumHealth spokesman did not respond to a request for comment earlier today.