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Feds: Behavioral health service use down 23% in NM

Copyright © 2014 Albuquerque Journal

SANTA FE – Federal officials who visited New Mexico behavioral health provider sites after a shake-up in the system last year say the number of people receiving services had dropped 23 percent, a figure the state disputed on Wednesday.

The state Human Services Department contended there actually has been an increase in the number of consumers getting services since Arizona companies took over.

The Centers for Medicare & Medicaid Services, which oversees Medicaid and is part of the Department of Health & Human Services, cited the 23 percent figure and called it a concern in a Dec. 24 letter to state officials.

“Currently the number of consumers receiving BH services is 23% less than the number of consumers receiving this service pre-transition,” said the letter from CMS that accompanied the final report on a site visit to New Mexico in September.

It’s the first time federal officials have weighed in on the aftermath of the upheaval in the Medicaid-funded system that treats the mentally ill and addicted.

The report recommended more outreach and communication with behavioral health consumers, especially with the advent of Centennial Care, the state’s revamped Medicaid program under which behavioral health is being overseen by four managed care organizations.

It was not immediately clear how CMS arrived at the 23 percent decrease, what period of time it was referring to, or whether it applied only to the 10 provider sites that CMS visited. The actual report of the site visit didn’t include the 23 percent calculation, and CMS officials couldn’t be reached for comment on Wednesday.

HSD spokesman Matt Kennicott said it was “simply inaccurate.” The HSD supplied information to CMS that showed in May 2013 there were 10,318 people served by the 12 providers that were later replaced by Arizona companies, he said. In November 2013, those successor companies served 12,004 people, according to the HSD.

“It’s very clear that there was an increase,” the spokesman said.

Consumers and their advocates have insisted that the sweeping changes in the system last year resulted in interruptions in service, and CMS said it wanted to identify any problems with access to services or continuity of care.

The system was upended when the administration of Gov. Susana Martinez halted Medicaid funding to 15 nonprofits in June 2013, saying an audit had shown overbilling and possible fraud. Twelve of the 15 providers were replaced by Arizona companies brought in by HSD.

CMS said it identified several areas that were affecting care for new and continuing patients.

The availability of school-based behavioral management services for children was reduced because some required agreements between school districts and new behavioral health providers hadn’t been implemented, the report said.

“Currently the number of consumers receiving (school-based) BMS services is between 28% to 59% less than the number of consumers receiving this service pre-transition,” the Dec. 24 letter from CMS said.

The letter went on to say that “some of this decrease was related to over-prescription of these services to individuals that may not need the service or the amount of service provided.”

The HSD has told federal officials that some providers were flagged for overutilization of some services, including BMS. It said in a Feb. 17 letter to CMS that it “expected a decrease in BMS as it became managed in a more clinically appropriate manner by the incoming agencies.”

The HSD also has told federal officials that the necessary agreements between school districts and behavioral health agencies have since been completed and are in place.

The HSD referred the 15 providers to the Attorney General’s Office to investigate possible fraud. Thus far, one provider has been cleared of fraud and the other 14 reports are pending.

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