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Lawmaker: Behavioral health system close to collapse
Some providers not being paid; state levies $1.2 million fine

Kate Nash | The New Mexican
Posted: Friday, November 06, 2009
- 11/7/09
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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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Comments (7)
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Meowtain Lion   (posted on 11/8/2009)
Optum wrote a proposal that beat out VO's . Nuff said. Hopefully this can get fixed promptly so people who need the help can get it. Starting from the drawing board will be even more devestating for the clients.
Ms. Blah Blah   (posted on 11/8/2009)
The story tells us that "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." Further, the state has issued a corrective action plan to the highly compensated nonperforming consultant, OptumHealth. One year into this lucrative contract and the state needs a consultant to oversee its consultant, OptumHealth. Said oversight consultant will be paid by the nonperforming consultant, OptumHealth. Bad and bizarre move. Do I hear potential conflict of interest? The Secretary and the Collaborative need to do the jobs they are charged with doing and come down very hard on this company and its local representative. Client advocates need to start screaming loud and lighting a very hot fire under the Governor. When the contract comes up for renewal bid it out again with the understanding that OptumHealth gets very low marks for meeting performance goals and should not win the bid. I can assure you that if OptumHealth winds the bid again the Governor/Secretary/Collaborative will look like fools and will deserve all criticism aimed at them. These are the kinds of stories that obscure the day by day good work of government and its employees. It is demoralizing for a state worker to hear mostly undeserved constant condemnation of government and then this mess with a government contractor surfaces.
Fred Stokes   (posted on 11/7/2009)
It would be interesting to know who selected this company and how. There must companies that do this sort of thing in other states. They would have the software and experience to do this easily. This company must be inexperienced or they could do the job. So how did they get selected. Unhappily the New Mexican never asks the hard questions.
Ambro A   (posted on 11/7/2009)
Face it! You`re all forked up on one drug or another. Don`t give me any shiit about drugs. Most all you are nothing but two bit pill popping psychotic junkies. Yeah sure you get to deal killer drugs. I`d rather snort a rail, from my bros, than pop killer pills from soulless creatures in white coats..
Ambro A   (posted on 11/7/2009)
OptumHealth? Optum? Try OpiumHealth. Just a bunch of drug dealing psychotic mind numbed robots. How sad, we bust the "FREE" drug dealers , while rewarding the Pharma death drug dealers. This crap has got to end.
Robert Turner   (posted on 11/7/2009)
From what I've heard, the previous company (Value Options) was doing a stellar job. The switch was totally unnecessary. So why did the State "fix" something that didn't need fixing? Perhaps a good investigative reporter could find out!
Kenneth Kast   (posted on 11/7/2009)
I find it hard to believe that state government couldn't do a better job making these payments itself for less money than they are giving to private industry to f things up. Please remind us what was said to be the problem with the previous provider? Didn't they provide enough political donations?


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