State officials plan an emergency meeting Tuesday to deal with what some say is quickly becoming a crisis for some behavioral health providers.
OptumHealth, which has a state contract that could be worth up to $1 billion over four years, is late in paying many service providers, leaving some in a financial bind, the state says.
"This is real close to a total systems collapse," state Sen. Dede Feldman, vice chairman of the Legislature's interim Health and Human Services Committee, said.
"Consumers are not receiving services because providers are not being paid," she said.
Those affected include the mentally ill and people with substance-abuse problems. About 80,000 people are served.
Already, the situation is to the point where the Behavioral Health Collaborative, a Cabinet-level group that represents 15 state agencies and the governor's office, has taken several steps to sanction the company, including levying a $1.2 million fine.
The collaborative is also working to find a monitor to oversee the company's dealings in the state. The monitor will be paid by OptumHealth, which manages the combined funds of publicly funded behavioral health services.
Gov. Bill Richardson has blasted the company, and lawmakers are not happy.
Feldman, D-Albuquerque, said she and other lawmakers have heard from service providers who are scraping by to keep providing services as they wait for payment.
"The providers and the consumers are between a rock and a hard place even more than they usually are," she said.
The state says the company's malfunctioning claims-management system is to blame, and says the company has had months to resolve the problem.
In a statement, officials from the Behavioral Health Collaborative said "thousands of provider claims, amounting to millions of dollars, have gone unpaid. Because of the malfunctioning system, OptumHealth has excessively denied, pended, lost and/or rejected provider claims." The letter also says "many providers have simply not been paid for services performed, placing them under financial strain and, in some cases, a financial crisis."
The state issued a corrective action plan for the company, with 14 steps for it to take. The company also will have to pay "all reasonable costs incurred by the collaborative for the actions taken to remedy OptumHealth's' non-compliance, including costs for independent contractors."
OptumHealth spokesman Chris Cervini provided a statement saying progress had been made in the situation, including getting payments to providers.
In October, the company paid $34.5 million to providers, compared to $25.6 million in September, he said.
"We have heard the concerns of the collaborative and the Legislative Health and Human Services Committee and continue to take aggressive action to increase payments to providers, including continuing our special expedited-payment program for providers experiencing difficulties with the system," the company's statement said.
The state selected OptumHealth in January and its contract started July 1. The deal is to be re-negotiated each year, and this year is worth about $378 million, paid each month as claims are sent.
State officials at the time praised the Golden Valley, Minn.-based group, saying it rated "far above the other bidders overall in all categories by the evaluation team."
It's unclear what could happen at the meeting Tuesday, which is scheduled from 8:30 a.m. to 11:30 a.m. in room 321 of the Capitol.
A spokeswoman for the collaborative described the meeting as "an opportunity to update the whole collaborative, get public input and discuss possible options if the (OptumHealth) contract is terminated."
Contact Kate Nash at 986-3036 or knash@sfnewmexican.com. Read her blog at www.greenchilechatter.com.
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