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Behavioral health numbers wrong

SANTA FE – The federal agency that oversees Medicaid is now saying the number of New Mexicans receiving services increased, rather than declined, after last year’s shake-up in the behavioral health system.

The Centers for Medicare and Medicaid Services told the state Human Services Department last week it wanted to clarify that a 23 percent drop in the number of people getting services – which CMS cited in a December letter to the state agency – “was reflective of one geographical part of the state, and was not indicative of services within the state as a whole.”

“Statewide, the data indicates a 16 percent increase in consumers served,” CMS said in a letter to the state agency dated April 3.

There has been an ongoing debate over the extent to which services to the mentally ill and addicted were disrupted after Gov. Susana Martinez’s administration cut off Medicaid funding last year to 15 New Mexico nonprofits and brought in Arizona providers to replace 12 of them.

The HSD had disputed the 23 percent reduction in services from the start. In a March 28 letter to the federal agency it complained that the figure was not supported by data, and asked that it be corrected.

“While some regional variation in the client census may exist, the statewide analysis clearly indicates substantially higher client counts,” HSD Secretary Sidonie Squier wrote.

Squier said she froze the Medicaid funding after an audit by a Boston-based firm showed overbilling, mismanagement and possible fraud.

The figure of a 23 percent reduction in services was contained in a Dec. 24 cover letter from CMS that accompanied the final report on the federal agency’s site visit to New Mexico in September.

It was not clear at the time how CMS had arrived at the figure, and the federal agency has not responded to inquiries from the Journal for clarification.

The latest letter from CMS also raises questions that the federal agency did not immediately answer.

While the April 3 letter says the 23 percent drop referred to a geographical area, it didn’t specify what area, and it’s not clear from the data in the December report what area CMS is talking about.

HSD spokesman Matt Kennicott said it appears the reference may be to a 23 percent drop in the number of consumers seen by one of the Arizona providers, Agave Health Inc. The company serves nine communities in a wide swath of northern New Mexico – including Raton in the northeast, Los Lunas in the south, and Grants to the west.

CMS did not reply on Tuesday to a question from the Journal seeking clarification about the geographical area.

The data in the site-visit report was provided to CMS by HSD, and includes numbers of people served in November 2013 compared to May 2013, before the Arizona providers took over.

Overall, the HSD-supplied numbers show an increase in people served, from 10,318 in May to 12,004 in November, about 16 percent.

The subset of children getting school-based behavioral management services declined in the same period by nearly 35 percent, from 1,027 to 668, according to the data. Agave accounted for a big chunk of that decline.

According to HSD, the dip in behavioral management services may be due to children no longer needing the services, and to previous “overutilization” of BMS by the New Mexico providers who were replaced. Agave replaced Santa Fe-based TeamBuilders and two companies affiliated with it.

The number of children getting BMS services is now about 700, Kennicott said.

CMS in its April 3 letter said that although the clarification about the 23 percent is important, “CMS would reiterate its concern with the decrease in the number of individuals served in that geographic region” and wants HSD to submit a plan to correct it.

Sen. Gerald Ortiz y Pino, D-Albuquerque, an outspoken critic of the behavioral health shake-up, likened the latest development to “arguing over ancient history.”

“The issue really is now – what’s going on right now – and that’s what we ought to be focusing on,” he said, adding that CMS had been “less than helpful” in assessing what happened in New Mexico.

He also renewed his criticism of OptumHealth New Mexico, which was in charge of the Medicaid-funded behavioral health system until January.

“Optum was supposed to be overseeing the providers, HSD was supposed to be overseeing Optum, and CMS was supposed to be overseeing HSD – and none of us has the slightest idea of what is going on, because none of them were doing their jobs,” the lawmaker told the Journal.