February 19, 2016

Delegation wants federal investigation into behavioral health situation

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Democratic members of New Mexico congressional delegation announced they are calling on the federal government to investigate the behavioral health shakeup from two years ago.

The call came in the form of a letter from two U.S. Senators and two of the three members of Congress. All four are Democrats.

The letter to U.S. Department of Health and Human Services Secretary Sylvia Burwell cites Attorney General Hector Balderas’ investigation that cleared 13 of 15 providers; the investigation into the final two providers is still ongoing. Last week, Balderas announced ten more providers were cleared, in addition to the three who had been cleared the year before.

The state Human Services Department stripped 15 providers of funding over “credible allegations of fraud” from an audit by Public Consulting Group. Most of the providers when out of business.

The administration brought in providers out of Arizona to fill the gaps. Some of these Arizona health providers have already left the state and critics say there has been a shakeup in necessary services; HSD has pointed to numbers showing that more people are getting such services now than before the audit.

Now, however, the congressional delegation is weighing in and wants a federal investigation.

“Attorney General Balderas’s findings confirm our longstanding concern that the well-documented irregularities surrounding HSD’s decision to suspend payments, which was not required by federal law, has undermined the legitimacy of its entire audit process,” the letter states. “Furthermore, HSD denied providers’ due process of law by indefinitely withholding payments while taking deliberate steps to preclude providers from challenging the charges against them. This callously disrupted care for New Mexico’s most vulnerable.”

This echoes what U.S. Rep. Michelle Lujan Grisham told NM Political Report last week. At the time, Lujan Grisham said in addition to wanting federal oversight, she was working on federal legislation to provide that sort of oversight.

In addition to Lujan Grisham, U.S. Senators Tom Udall and Martin Heinrich and U.S. Rep. Ben Ray Lujan signed onto the letter.

“Medicaid is a federal-state partnership, and CMS should exercise any authority at its disposal to ensure that something like this will not happen again,” the letter states. “We ask that the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services thoroughly review the Attorney General’s report and provide us with a response detailing which oversight options are available and what actions the agency plans to take in response to this serious situation.”

Democrats in the state legislature also called for action last week.

The full text of the letter is available below.

Letter to Sec. Burwell from NM delegation

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