{"id":4737,"date":"2009-07-15T22:14:00","date_gmt":"2009-07-16T04:14:00","guid":{"rendered":"http:\/\/www.nmpolitics.net\/index\/2009\/07\/behavioral-health-transition-rocky-on-both-ends\/"},"modified":"2009-07-15T22:14:00","modified_gmt":"2009-07-16T04:14:00","slug":"behavioral-health-transition-rocky-on-both-ends","status":"publish","type":"post","link":"https:\/\/nmpolitics.net\/index\/2009\/07\/behavioral-health-transition-rocky-on-both-ends\/","title":{"rendered":"Behavioral health transition rocky on both ends"},"content":{"rendered":"

\"\"<\/a><\/p>\n

Lawmakers want a special audit of ValueOptions contract; providers\u2019 association says it fears \u2018slow, inaccurate, or untimely payments<\/span>\u2019<\/span> from OptumHealth during transition<\/span><\/p>\n

<\/span>If legislators and behavioral health providers are to be believed, the state\u2019s transition between behavioral health contracts has been rocky on both ends.<\/p>\n

A bipartisan group of 13 state legislators sent a letter<\/a> to State Auditor Hector Balderas<\/a> on Monday requesting a special audit of the contract with the outgoing provider, ValueOptions<\/a>, which expired June 30. The lawmakers, who were organized by Rep. Nate Cote<\/a>, 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.<\/p>\n

The legislators also stated in the letter that they are \u201cconcerned with the response of the responsible state agencies to complaints.\u201d<\/p>\n

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\u2019t been paid.<\/p>\n

\u201cWe\u2019ve 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,\u201d Cote said.<\/p>\n

Balderas will seek funds for special audit<\/span><\/span><\/p>\n

In response to the lawmakers\u2019 letter, a spokeswoman for Balderas, Caroline Buerkle, said the auditor will \u201csubmit a plan with associated costs (for a special audit) for the Legislature to consider.\u201d<\/p>\n

ValueOptions spokesman Lon Wagner was quoted by The Santa Fe New Mexican<\/a> as saying that the company was already audited this year by the state\u2019s Behavioral Health Collaborative.<\/p>\n

\u201cIt was resolved earlier this year through an audit by the collaborative, which examined dozens of our claims on a case-by-case basis,\u201d the newspaper quoted Wagner as saying. \u201cThe conclusion? ValueOptions did not deny services and that we did properly grant authorizations.\u201d<\/p>\n

The New Mexican quoted Betina Gonzales McCracken, spokeswoman for the collaborative, as saying that the company had been fined $1.5 million.<\/p>\n

\u201cThe 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,\u201d McCracken was quoted as saying. \u201cThe collaborative is determined to hold ValueOptions accountable for the sanctions.\u201d<\/p>\n

Providers make proposal to OptumHealth
<\/span><\/p>\n

Meanwhile, there are apparently also complaints about the transition to the company that took over for ValueOptions on July 1, OptumHealth<\/a>. A July 13 letter<\/a> from the Alamogordo-based Behavioral Health Providers Association to OptumHealth identifies a list of issues that the association says will result in \u201cslow, inaccurate, or untimely payments to providers\u201d during the transition.<\/p>\n

Those problems include, according to the letter, \u201clack of timely response to our inquiries\u201d and \u201cOptum not yet able to accept any type of electronic batch billing or paper claims.\u201d<\/p>\n

The association proposed that providers be given a payment by OptumHealth each month for the next six months based on last year\u2019s budget to ensure that providers can continue to serve clients.<\/p>\n

The association wrote in the letter that it recognizes that the proposal \u201ccarries with it the risk of other problems, such as a cumbersome reconciliation process,\u201d but wrote that such \u201cpotential risks\u201d are \u201cclearly 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.\u201d<\/p>\n

ValueOptions agreed to something similar when it came into the state several years ago, the letter states.<\/p>\n

The association asked that OptumHealth respond to the letter by Thursday. An OptumHealth spokesman did not respond to a request for comment earlier today.<\/p>\n","protected":false},"excerpt":{"rendered":"

Lawmakers want a special audit of ValueOptions contract; providers\u2019 association says it fears \u2018slow, inaccurate, or untimely payments\u2019 from OptumHealth during transition If legislators and behavioral health providers are to be believed, the state\u2019s transition between behavioral health contracts has been rocky on both ends. A bipartisan group of 13 state legislators sent a letter […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4737","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/4737","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/comments?post=4737"}],"version-history":[{"count":0,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/posts\/4737\/revisions"}],"wp:attachment":[{"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/media?parent=4737"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/categories?post=4737"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nmpolitics.net\/index\/wp-json\/wp\/v2\/tags?post=4737"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}